'Here's Why Nurse Anesthetists Earn Over $150,000 A Year'

[giantswing]

Not for me. I like the oatmeal ones best. It's probably the number one feature of my residency program: a high ratio of oatmeal raisin to chocolate chip on the complementary cookie platter.

To each their own. My rank list will be determined by the quality of pens they give out and the presence of chocolate chip cookies.

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[sntpmdmaybe]

Learn to diagnose and treat disease on their own without supervision. Learn what tests to run and when, and more importantly what to not order and when to not operate.
Nurses do not diagnose. Neither do nurse anesthetists. Nps get a crash course in it with a very limited education base which limits their differential. After years of working on the floor they may know how to "diagnose" via pattern recognition, but not the h and p, the differential dx, and the clinical medicine aspect. They may rhink they do, but they don't.

Thank you for your response. The parrallel I'm trying to draw here is that you are learning while working and you shouldn't scoff at the article counting work experience in the years of training. I'm sure the ICU nurse turned CRNA did not know everything they needed to know when they began their career but their years as an ICU nurse provided them with knowledge that can't be learned from school alone. Residents don't know everything after med school or there would be no need for residencies.
What you are not getting from my previous post is that I am not saying that a four year residency is equal to 4years nurse ICU experience. Physician and nurse training are mutually exclusive but the path you take has some simularities.
To be a physician you need 4year ug-4 years med school- 4 years residency maybe throw in a fellowship too
To be CRNA 3-4 years ug- work experience as a BSN in this case 4 or 3years (can't remember)-however many years it takes to be a CRNA
Do you understand what I'm trying convey now?
I never said CRNAs are the same as Anesthesiologists, or that they should be treated the same. I was simply drawing a parrellel between the training of the CRNA in this case and that of a physcian. I don't think 4years of work experience should be scoffed at. We count 12+ years when saying how long it takes to become a doctor.

 

[giantswing]

Thank you for your response. The parrallel I'm trying to draw here is that you are learning while working and you shouldn't scoff at the article counting work experience in the years of training. I'm sure the ICU nurse turned CRNA did not know everything they needed to know when they began their career but their years as an ICU nurse provided them with knowledge that can't be learned from school alone. Residents don't know everything after med school or there would be no need for residencies.
What you are not getting from my previous post is that I am not saying that a four year residency is equal to 4years nurse ICU experience. Physician and nurse training are mutually exclusive but the path you take has some simularities.
To be a physician you need 4year ug-4 years med school- 4 years residency maybe throw in a fellowship too
To be CRNA 3-4 years ug- work experience as a BSN in this case 4 or 3years (can't remember)-however many years it takes to be a CRNA
Do you understand what I'm trying convey now?
I never said CRNAs are the same as Anesthesiologists, or that they should be treated the same. I was simply drawing a parrellel between the training of the CRNA in this case and that of a physcian. I don't think 4years of work experience should be scoffed at. We count 12+ years when saying how long it takes to become a doctor.

Work experience is not training. Peroid. You're out of your leauge here.

 

[Baller MD]

Thank you for your response. The parrallel I'm trying to draw here is that you are learning while working and you shouldn't scoff at the article counting work experience in the years of training. I'm sure the ICU nurse turned CRNA did not know everything they needed to know when they began their career but their years as an ICU nurse provided them with knowledge that can't be learned from school alone. Residents don't know everything after med school or there would be no need for residencies.
What you are not getting from my previous post is that I am not saying that a four year residency is equal to 4years nurse ICU experience. Physician and nurse training are mutually exclusive but the path you take has some simularities.
To be a physician you need 4year ug-4 years med school- 4 years residency maybe throw in a fellowship too
To be CRNA 3-4 years ug- work experience as a BSN in this case 4 or 3years (can't remember)-however many years it takes to be a CRNA
Do you understand what I'm trying convey now?
I never said CRNAs are the same as Anesthesiologists, or that they should be treated the same. I was simply drawing a parrellel between the training of the CRNA in this case and that of a physcian. I don't think 4years of work experience should be scoffed at. We count 12+ years when saying how long it takes to become a doctor.

Except when they are in the ICU, they don't make medical decisions. They just do whatever the ICU docs tell them to do like puppets.

 

[Beargryllz]

Except when they are in the ICU, they don't make medical decisions. They just do whatever the ICU docs tell them to do like puppets.

ICU docs are puppets to evidence and policy

But you're still right

 

[Baller MD]

ICU docs are puppets to evidence and policy

But you're still right

Yeah because interpreting data and making a decision based on those data doesn't require critical thinking, right? /sarcasm

 

[Beargryllz]

Yeah because interpreting data and making a decision based on those data doesn't require critical thinking, right? /sarcasm

Yeah they teach all that in nursing school though

It made for some easy points this last semester though since it was all review

 

[sntpmdmaybe]

Work experience is not training. Peroid. You're out of your leauge here.

No I'm not you just obviously have an over inflated since of self if you believe that.

 

[link2swim06]

Thank you for your response. The parrallel I'm trying to draw here is that you are learning while working and you shouldn't scoff at the article counting work experience in the years of training. I'm sure the ICU nurse turned CRNA did not know everything they needed to know when they began their career but their years as an ICU nurse provided them with knowledge that can't be learned from school alone. Residents don't know everything after med school or there would be no need for residencies.
What you are not getting from my previous post is that I am not saying that a four year residency is equal to 4years nurse ICU experience. Physician and nurse training are mutually exclusive but the path you take has some simularities.
To be a physician you need 4year ug-4 years med school- 4 years residency maybe throw in a fellowship too
To be CRNA 3-4 years ug- work experience as a BSN in this case 4 or 3years (can't remember)-however many years it takes to be a CRNA
Do you understand what I'm trying convey now?
I never said CRNAs are the same as Anesthesiologists, or that they should be treated the same. I was simply drawing a parrellel between the training of the CRNA in this case and that of a physcian. I don't think 4years of work experience should be scoffed at. We count 12+ years when saying how long it takes to become a doctor.

The problem is the flip in roles. Carrying out orders can make people learn associations but doesn't teach a whole lot about the decision making process. Actually making decisions and choosing when to order things is an entire new ballgame. All that clinical experience isn't interchangeable with the clinical experience of med school or residency. It's not that it isn't valuable whatsoever...it's just not valid to compare years of 'clinical experience.' Especially when you factor in how few hours ICU nurses work compared to residents. I worked 319 hours last month, I highly doubt any nurse in your entire hospital worked that many hours.

 

[giantswing]

No I'm not you just obviously have an over inflated since of self if you believe that.

Report back after at least third year of medical school. You'll have changed your mind.

 

[Frazier]

The worst part about residency is when you think it's a chocolate chip cookie but it's really an oatmeal raisin cookie.

I can't speak for the metaphor, but I freaking love oatmeal raisin cookies.

 

[67552931811]

I would think yes. I would go on to say it is almost like a residency.

What kind of things do residents do during their residencies?

Expected.

 

[Sirach38]

Thank you for your response. The parrallel I'm trying to draw here is that you are learning while working and you shouldn't scoff at the article counting work experience in the years of training. I'm sure the ICU nurse turned CRNA did not know everything they needed to know when they began their career but their years as an ICU nurse provided them with knowledge that can't be learned from school alone. Residents don't know everything after med school or there would be no need for residencies.
What you are not getting from my previous post is that I am not saying that a four year residency is equal to 4years nurse ICU experience. Physician and nurse training are mutually exclusive but the path you take has some simularities.
To be a physician you need 4year ug-4 years med school- 4 years residency maybe throw in a fellowship too
To be CRNA 3-4 years ug- work experience as a BSN in this case 4 or 3years (can't remember)-however many years it takes to be a CRNA
Do you understand what I'm trying convey now?
I never said CRNAs are the same as Anesthesiologists, or that they should be treated the same. I was simply drawing a parrellel between the training of the CRNA in this case and that of a physcian. I don't think 4years of work experience should be scoffed at. We count 12+ years when saying how long it takes to become a doctor.

You're post are absolutely bananas. Are you in high school? Middle school? You certainly have absolutely no clue what the roles of physicians and nurses are. It's hard to even answer your questions because you are coming from a completely clueless perspective. You're on a different planet.

 

[Ashley_Green1988]

Can somebody hand these guys some kind of penis-measuring contraption so that they can settle things once and for all.

 

[giantswing]

Can somebody hand these guys some kind of penis-measuring contraption so that they can settle things once and for all.

It'd be over too fast. Mines biggest.

 

[Rendar5]

I hate to tell you guys this, but he's not wrong that nurses receive training during working time. It's different type of training than residencies, but it is on the job training. My wife was once an RN and she became a critical care RN while I was a resident, and critical care training was on the jo and continuous over a couple of years with the bulk being in the first year.

As clueless as he may be about residency training, you guys are just as clueless when it comes to nursing training. Like with PA training. It's all work environment training in the first couple years. They don't come out of school with enough knowledge or understanding for anything except the very basics.

 

[Rendar5]

just so you don't make any assumptions, my wife does not work as a nurse anymore, and was never a midlevel provider .

 

[Sirach38]

Nobody is denying that nurses get training...but, to equate nurse training with a residency is asinine.

 

[W19]

Why would any anesthesiologist want to be bothered with a trivial case easily managed by a nurse?

Delegating tasks to other professionals is ubiquitous in medicine. It is inevitable from even the most basic utilitarian model.

These trivial cases are the ones that make them so arrogant to the point now that they are saying there is no difference between them and the MD/DO... because what they do is just-- trivial...

 

[W19]

Thank you for your response. The parrallel I'm trying to draw here is that you are learning while working and you shouldn't scoff at the article counting work experience in the years of training. I'm sure the ICU nurse turned CRNA did not know everything they needed to know when they began their career but their years as an ICU nurse provided them with knowledge that can't be learned from school alone. Residents don't know everything after med school or there would be no need for residencies.
What you are not getting from my previous post is that I am not saying that a four year residency is equal to 4years nurse ICU experience. Physician and nurse training are mutually exclusive but the path you take has some simularities.
To be a physician you need 4year ug-4 years med school- 4 years residency maybe throw in a fellowship too
To be CRNA 3-4 years ug- work experience as a BSN in this case 4 or 3years (can't remember)-however many years it takes to be a CRNA
Do you understand what I'm trying convey now?
I never said CRNAs are the same as Anesthesiologists, or that they should be treated the same. I was simply drawing a parrellel between the training of the CRNA in this case and that of a physcian. I don't think 4years of work experience should be scoffed at. We count 12+ years when saying how long it takes to become a doctor.

This is like saying that a CNA that works for ten years on a hospital floor, then went to school to become a RN and you can count the 10 years they worked on the floor as part of their RN training...

 

[jl lin]

I would think yes. I would go on to say it is almost like a residency.

The problem with this is there IS SO MUCH VARIATION. Three years in university, urban, high acute and turnout surgical ICUs is different from Podunk Community Hospital ICU. I mean, is it a teaching facility? Has the person worked those years FT and plus? Who is supervising and evaluating the clinical progress--this is often a sorry state for RNs, b/c of lack of well-established in-house education and strong and objective systems of evaluation. Heck, IMHO, they aren't as rigorous with advanced practice nurses with clinical hours and evaluation. Until the revamp and standardize theses process, more as medicine does, it's not really accurate to say this.

What I am saying is, depending upon the individual, clinically speaking (ignore the MS's comments b/c they are not yet working closely with ICU nurses like residents and fellows are), IT CAN BE, B/C IT VERY MUCH DEPENDS. So, many a CRNA-school candidate today or NP school candidate today can have maybe a year of clinical experience and get into these programs. We don't know what that year means, but regardless of how rigorous, dollars to donuts, NO way it's enough. But they get through their little BSN programs and keep moving through grad school with very little clinical experience--the quality and caliber of which is anyone's guess. Then they get a lot less supervised clinical practice exposure. Yea. It's problematic. Now if you have someone with 5 or > full-time years-- very, strong, clinical experiences, the proper certs and both nurses and doctors that can vouch for it, that may be different. But that is often not the typical student for advanced nursing practice programs anymore. Schools want the students, b/c they are businesses. Somehow they think going through to adding a doctoral degree will increase the caliber--clinically speaking--this is completely FALSE.

Physician's residency programs are rigorous, long, pain in arse processes for a reason. Doing what it required for board certification is in place for a reason.

But I also am of the belief that more objective systems of examination and evaluation need to be in place for either medicine or nursing. Though still very imperfect IMHO (too much subjective crap on evals), the former discipline, hands down, in general, is far superior with striving to implement that than the latter--nursing.


Bottom line. I know what you mean, b/c of individual experiences and insight, but in general, we can't make that statement, b/c in general, nursing still sucks at providing consistent, standardized clinical programs and evaluation systems--and b/c any chippy with a BSN and a mere 1 year in some ICU can score sufficiently on GRE, kiss up to some docs and others and get some decent references, and get into CRNA school. If I ran these programs, I wouldn't accept half of these applicants, b/c of their gross lack of fulltime clinical experience and decent scores on the critical care cert exam (AACN's CCRN). But hey, that would lose money for the programs.

 

[IlDestriero]

You have no idea how variable the CRNA training is. It's shocking. And someone's signing off on these programs saying that they're ok when some of the grads can't do anything.

 

[jl lin]

These trivial cases are the ones that make them so arrogant to the point now that they are saying there is no difference between them and the MD/DO... because what they do is just-- trivial...

Yup. I've seen this. There are exceptions--but these people are more intelligent and experienced, by far, than the average CRNA today. Same thing with NPs. Without the same education and rigorous clinical exposure, no they don't get the many complexities that can and do develop. It is what it is.

 

[jl lin]

Work experience is not training. Peroid. You're out of your leauge here.

Work experience indeed can indeed be training. In this you are incorrect. The trouble, as I have noted is in the variation of exposures and lack of standardized, rigorous clinical exposures with sound, objective systems of evaluation. I went into this already, so I won't repeat. There is too much variation, such that counting it can be hairy in a number of situations. If you think critical care RNs that work is some busy, teaching, university urban setting don't get exposure to medicine and medical thinking, you are ignorant of what goes on. Now, for some it will be better than others, b/c some of us give more of a damn about what the labs and hemodynamics we are recording, evaluating and call for mean. Many of have been required to review CXR, etc. Again, however, it varies too much, such that it is not something that can be readily or easily evaluated without having worked with the individual nurses for a good while. Since standardization processes are off for nurses IMHO, it's about knowing the individual RN and having worked WITH THEM for a while. And so, we can't make a blanket statement of equivalency to a rigorous residency program. But make no mistake. The great ICU RNs that work in great centers, hell yea. They learn a lot--and residents, fellows, and attendings would be screwed without them being there keeping an close on eye on their vary unstable patients.

Let's not get too ridiculous one way or another. It smacks of idiotic arrogance. Hell no. CRNA DOES NOT = ANESTHESIOLOGISTS. But on an individual basis, some folks will really surprise you either way. And it's only when you get out there and work in it that you will see what I mean.

And if you think that a 4th year resident or a fellow knows as much as a more experienced attending--working in the field for a while, you are really missing the boat. Don't miss my point here please. And I will not engage in pissing contests b/c they are the height of arrogance and stupidity.

 

[jl lin]

Report back after at least third year of medical school. You'll have changed your mind.

People should report back after having worked with some strong critical care RNs in residency, fellowship, or as attendings. You will change your mind about what some of them know and how they can save the patients' ass when you are inundated with a zillion other damn things. I have found residents, fellows, attendings (mostly) to be WAY more understanding and respectful than medical students--M3 or M4.
See, it's totally different when more of the bulk of responsibility is on you--residents, fellows, attendings. Then you will see the importance of strong teamwork--and the arrogance will take a holiday--hopefully for good.

 

[giantswing]

People should report back after having worked with some strong critical care RNs in residency, fellowship, or as attendings. You will change your mind about what some of them know and how they can save the patients' ass when you are inundated with a zillion other damn things. I have found residents, fellows, attendings (mostly) to be WAY more understanding and respectful than medical students--M3 or M4.
See, it's totally different when more of the bulk of responsibility is on you--residents, fellows, attendings. Then you will see the importance of strong teamwork--and the arrogance will take a holiday--hopefully for good.

Jeebus chill out.
I have nothing but respect for good nurses who are nice and do great work ect. A good nurse is worth their weight in gold. But roles and traing are separate, with overlap, but separate.

 

[JubalHarshaw]

Can somebody hand these guys some kind of penis-measuring contraption so that they can settle things once and for all.

It'd be over too fast. Mines biggest.

Which is why they call him Giant Swing.

 

[Kahreek]

i once slapped a nurse

she liked it.

If i had to choose another profession I would be a nurse. WHy? Because they are cool with their hats and stuff.

 

[fancymylotus]

i once slapped a nurse

she liked it.

If i had to choose another profession I would be a nurse. WHy? Because they are cool with their hats and stuff.

Do you enjoy being bright blue?!

 

[Kahreek]

Do you enjoy being bright blue?!

i am lost in the idiom.
What doest that mean?

 

[Kahreek]

Bright blue = on probation

ok
Idk, it feels the same

 

[RJGOP]

i once slapped a nurse

she liked it.

If i had to choose another profession I would be a nurse. WHy? Because they are cool with their hats and stuff.

Would you say that is the typical reaction from a nurse, or was your experience more anecdotal?

Just in case I ever need to slap a nurse.

 

[jl lin]

Work experience is not training. Peroid. You're out of your leauge here.

1. Work experience = clinical experience. Residency is core medical clinical experience, for which the resident is given a "salary," which is more like a stipend. The difference is the way in which medicine does this, which even for all it's warts and needed improvements is, in general, FAR superior than how nursing does it. Again, a committed attending will continue to grow in multiple ways--each year after residency/fellowship will only increase his/her knowledge, insight, adeptness, etc. If attendings stop learning and growing after residency and/or fellowship, these attendings are in BIG trouble. Yes, years and time invested in the work will increase expertise. In the healthcare fields, anyone that stops learning is going to hit a wall and be stifled and less effective, if not dangerous and subpar in general. These are the scariest and saddest people IMHO--those that feel that they have arrived. You never arrive. You only continue to improve and hopefully get better and wiser.

Jeebus chill out.
I have nothing but respect for good nurses who are nice and do great work ect. A good nurse is worth their weight in gold. But roles and traing are separate, with overlap, but separate.

I agree with this, but don't totally agree with your former statement for the previously stated and above stated reasons. *shrug*
Again, nothing against MSs (med students) but a number of them don't really get what I am trying to say until sometime in PGY I and onward. And the reason is that they aren't truly soldiers in action with the same level of accountability and load as residents, fellows, and attendings. It's easier to be a bit more c*cky when the heavier weight really isn't on you yet. You might be worried about an eval and LORs for residency, but that's really more about you as the student. It's different when you have to feel the weight of constant evaluation, hirer ups constant and particular demands while navigating the crazy hospital system, and the real heavy weight--the safety and effects of what you do or don't do on a much greater load of patients for whom you are more responsible.

 

[giantswing]

You've been missing the point. The point here is that clinical nursing experience and learning on the job as a nurse is not equal to a residency nor is it adquate training to make medical decisions as an attending or even a resident.

You can call me a stupid arrogant medical student all you want, but it's been the nurses and only the nurses i've ever seen getting their undies in a bunch like this.

do you just want to argue to argue?

 

[Patassa]

Work experience indeed can indeed be training.

In order for the work experience to be "training" wouldn't the work experience have to relate very closely to the job they will eventually perform?

You don't train a welder by having him sand wood.
You don't train an engineer by having him read literature.
You don't train CRNAs by having them....? Work in any other capacity than as a CRNA?

Just spit balling here.

 

[Rendar5]

or training a radiologist with a transitional year lol

In order for the work experience to be "training" wouldn't the work experience have to relate very closely to the job they will eventually perform?

You don't train a welder by having him sand wood.
You don't train an engineer by having him read literature.
You don't train CRNAs by having them....? Work in any other capacity than as a CRNA?

Just spit balling here.

 

[jl lin]

You've been missing the point. The point here is that clinical nursing experience and learning on the job as a nurse is not equal to a residency nor is it adquate training to make medical decisions as an attending or even a resident.

You can call me a stupid arrogant medical student all you want, but it's been the nurses and only the nurses i've ever seen getting their undies in a bunch like this.

do you just want to argue to argue?

You didn't read carefully what I have written, thus it seems the points are being missed by you and some others. No one said it is the same. I certainly didn't. But there is clinical knowledge that highly experienced critical care RNs possess that IS superior to those of med students or the like, who just haven't had the time to apply what they may have learned didactically. This is not an unreasonable expectation. The need to lord "OH hell no!" over those nurses that have worked and developed such knowledge comes down to something that is quite troubling, but hopefully will be overcome when there is a need to respect the knowledge and experience of others and work as a team. I never made my perspective about the equivalence or superiority in any type of mid-level practice--and I have demonstrated that clearly here and many times over elsewhere on SDN.

If you put the latter nurse-hate and advanced-nurse-practice-hate aside, and read carefully what I have said--and if you have the ability to be humble and consider the importance of being able to learn even from the smallest of creatures, you won't have a problem with what I have said.

And make no mistake. I am not one of the nurses seeking medicine in order to be "superior" to my former nurse-colleagues. Wow, that would be not only pathetic but quite stupid, b/c I have worked with some awesome nurses, whose critical insight far exceeds that of medical students in terms of sheer application. That's just a reality. I have worked it, seen it,lived it. It takes time to put the big and small pictures together in terms of application with patients. It NEVER comes overnight. . .EVER.

It's about what I want to focus on with patients and in terms of practice--and it is about the ability to apply sound medicine. But in terms of roles or titles or other such nonsense, I am SO far past that crap in my life, it is not funny. Yes, I will deal with the stupid politics, as I have always done, but hopefully at some point I will be able to practice with autonomy WITH the more detailed and comprehensive knowledge, insight, and clinical education (practicum) of a physician, rather than struggling to perform at some minimal level, even as a highly experienced critical care RN who would be NP or CRNA. I want the education and training (as painful as it can be) of medicine in order to feel confident in caring for a wide-array of patients, as individuals.

So, I really think you aren't seeing my perspective here. Note above where I wrote CRNA is not = to anesthesiologist.. This is completely indisputable. Same thing with other forms of advanced practice as compared with medicine. At the end of the day, however, no ONE will ever get around the need to apply knowledge directly to patients effectively without the clinical experience. Deal with the fact that you may be sitting in MS classes with PAs, NPs, and yes, RNs that have a boatload more of insight into what is going on with patients on the wards/units and how to treat them. No, they don't know it all. News Flash! No one does. But don't underestimate the importance of the clinical exposure/experience. This is where the rubber meets the road in becoming a practitioner. And this is in fact why some residents complain about the residency hours restrictions. They start working enough with patients in the hospital setting, and they FEAR they will not learn to apply enough or be adept enough to safely practice on their own after PGE. When one gets out there and starts working with these patients, it gets scary, and really, it should be. Frankly, I feel sorry for those with such experiences, who are in MS or residency, as they have to sit on their knowledge or try to be as invisible as possible at times, b/c of the sheer arrogance that has pretty much always been a part of the field of medicine.

Don't get me wrong. I am not against medicine--quite the contrary; but you better believe there is still this sort of ego-junk that can be associated with it. I don't think it is as bad as it used to be, but it is still there. In light of all the illness and stress, it makes a challenging field even more unnecessarily challenging. I know darn well there are some with such strong clinical experience that could speak up re: various medical issues with patients, but they won't in MS or even play it down in residency. Know why? The gunner types (wrought with silly insecurity--and who exist on multiple levels) will make the med school/residency experience harder for them. So, they do their best to keep a low profile. That's pretty darn sad. And who really gives a damn about being RIGHT all the time, but sad, insecure people?!! It's not about that, at all. The person that shows off all the time, whether with hoards of didactic knowledge or clinical knowledge isn't caring about sharing and understanding. They are making the learning about them--but these are not every person. So it's this kind of extreme, polarized thinking that takes over with people--that squelches those that could really share valuable questions, thoughts, perspectives that limits the whole experience for everyone. See, but honest intellectual inquiry, well that will get slapped down in many settings--so unfortunately, the person with a lot of clinical experience will have to learn more from their point of knowledge and experience on the down-low or with select physician-mentors. Human nature. It's a real bitch!

I have clarified my points. I am done here. If I'm alerted b/c you quoted me in order to continue with some stupid p!ssing contest, I will have to put you on ignore for a while. There is nothing more I can say that isn't sufficiently stated in my previous posts in this thread.

 

[giantswing]

You didn't read carefully what I have written, thus it seems the points are being missed by you and some others. No one said it is the same. I certainly didn't. But there is clinical knowledge that highly experienced critical care RNs possess that IS superior to those of med students or the like, who just haven't had the time to apply what they may have learned didactically. This is not an unreasonable expectation. The need to lord "OH hell no!" over those nurses that have worked and developed such knowledge comes down to something that is quite troubling, but hopefully will be overcome when there is a need to respect the knowledge and experience of others and work as a team. I never made my perspective about the equivalence or superiority in any type of mid-level practice--and I have demonstrated that clearly here and many times over elsewhere on SDN.

If you put the latter nurse-hate and advanced-nurse-practice-hate aside, and read carefully what I have said--and if you have the ability to be humble and consider the importance of being able to learn even from the smallest of creatures, you won't have a problem with what I have said.

And make no mistake. I am not one of the nurses seeking medicine in order to be "superior" to my former nurse-colleagues. Wow, that would be not only pathetic but quite stupid, b/c I have worked with some awesome nurses, whose critical insight far exceeds that of medical students in terms of sheer application. That's just a reality. I have worked it, seen it,lived it. It takes time to put the big and small pictures together in terms of application with patients. It NEVER comes overnight. . .EVER.

It's about what I want to focus on with patients and in terms of practice--and it is about the ability to apply sound medicine. But in terms of roles or titles or other such nonsense, I am SO far past that crap in my life, it is not funny. Yes, I will deal with the stupid politics, as I have always done, but hopefully at some point I will be able to practice with autonomy WITH the more detailed and comprehensive knowledge, insight, and clinical education (practicum) of a physician, rather than struggling to perform at some minimal level, even as a highly experienced critical care RN who would be NP or CRNA. I want the education and training (as painful as it can be) of medicine in order to feel confident in caring for a wide-array of patients, as individuals.

So, I really think you aren't seeing my perspective here. Note above where I wrong CRNA is not = to anesthesiologist.. This is completely indisputable. Same thing with other forms of advanced practice as compared with medicine. At the end of the day, however, no ONE will ever get around the need to apply knowledge directly to patients effectively without the clinical experience. Deal with the fact that you may be sitting in MS classes with PAs, NPs, and yes, RNs that have a boatload more of insight into what is going on with patients on the wards/units and how treat them. No, they don't know it all. News Flash! No one does. But don't underestimate the importance of the clinical exposure/experience. This is where the rubber meets the road in becoming a practitioner. And this is in fact why some residents complain about the residency hours restrictions. They start working enough with patients in the hospital setting, and they FEAR they will no learn to apply enough or be adept enough to safely practice on their own after PGE. When one gets out there and starts working with these patients, it gets scary, and really, it should be.

I have clarified my points. I am done here. If I'm alerted b/c you quoted me in order to continue with some stupid p!ssing contest, I will have to put you on ignore for a while. There is nothing more I can say that isn't sufficiently stated in my previous posts in this thread.

OMG what did you just write?

If you are taking the MCAT anytime soon, best of luck with the verbal section, because I question your reading comprehension!

Also, if you ever go to medical school, this type of attitude is going to get you MURDERED during third year! Dead serious.

 

[jl lin]

OMG what did you just write?

If you are taking the MCAT anytime soon, best of luck with the verbal section, because I question your reading comprehension!

Also, if you ever go to medical school, this type of attitude is going to get you MURDERED during third year! Dead serious.

Re-read. I have always scored very highly on verbal SAT, ACT, NCLEX, CCRN, and any other certifications related to my profession or as a classroom or clinical educator.

The murdered part, you have mentioned, that is addressed in the very end of my treatise above. The arrogance, well, it goes to a person's motivation for me. So, let's see how much you will really love patients and caring for them and their illnesses in the real world. If you are motivated from the perspective of arrogance, it's going to be a real big butt-kicking for you--or you will be one of those people that is so self-focused, and we will all just have to get passed you in one way or another in order to get what patients needs.

OK, I stated that I'm not doing p!ssing contests with you. Thank you SDN for the IGNORE feature. Sad it has to come to this, simply b/c of silly insecurity and arrogance. This is exactly why I won't be saying too much in MS or residency--especially if my Spidey-sense indicates this mentality is present. I will quietly question and f/u with things on my own. Learning should be shared--but it requires humility. Until we can learn from the tiniest of creatures and have an openness toward that, our learning will continue to be stunted. Continue with your "stream."

 

[Kahreek]

I hate to tell you guys this, but he's not wrong that nurses receive training during working time. It's different type of training than residencies, but it is on the job training. My wife was once an RN and she became a critical care RN while I was a resident, and critical care training was on the jo and continuous over a couple of years with the bulk being in the first year.

As clueless as he may be about residency training, you guys are just as clueless when it comes to nursing training. Like with PA training. It's all work environment training in the first couple years. They don't come out of school with enough knowledge or understanding for anything except the very basics.

if they are training get them training previleges and obligations. because life is a training.

 

[BorntobeDO?]

Until they try to strike out on their own.

Smart ones wont do this. And the dumb ones will ruin their independance opprotunity when they take on a case that is too much.

I don't think most of you understand that part of the appeal of being a CRNA is NOT being the final authority. You are well paid but still protected if your working under someone else who has ultimate responsibily. Nurses do CRNA largely cause of the pay and lifestyle upgrade, not to try and steal anesthesiologist role. Most nurses do not want to be "the man (or woman)." They just want to do the job and go home.

Its painfully obvious some of you have never worked anywhere near a surgery environment based on the nonsense in here. Just cause a couple CRNAs say they want full practce rights doesnt mean that all (Or even 5%) really want that. They dont, and it is shameless fearmongering to claim they do.

 

[BorntobeDO?]

@HandsomeRob why anesthesiologists would be glad having CRNA?

Because you can bill them out at a 4 of them to 1 of you ratio. You may pay them well, but trust me, they make you money, and I guarentee their pay would go down if they didn't.

Its simple really, even if a CrNA only gets reembursed at a 80% rate, when you have 4 of them running you are making almost double your own rate without doing anything. Plus the fact that they get paid something like 1/3rd of an Anesthesiologist rate is definately a plus for you.

 

[Sirach38]

Because you can bill them out at a 4 of them to 1 of you ratio. You may pay them well, but trust me, they make you money, and I guarentee their pay would go down if they didn't.

Its simple really, even if a CrNA only gets reembursed at a 80% rate, when you have 4 of them running you are making almost double your own rate without doing anything. Plus the fact that they get paid something like 1/3rd of an Anesthesiologist rate is definately a plus for you.

Unfortunately this was the past. This is why CRNAs started to be used by anesthesiologist but the present and future is different. More and more, private practice anesthesiology is going away and being replaced by large AMCs. Anesthesiologist are now becoming employees and all that extra money is not going to them, it is going go the big management companies while anesthesiologists are paid peanuts for the same work and responsibility that they had in private practice.

 

[BorntobeDO?]

The problem with this is there IS SO MUCH VARIATION. Three years in university, urban, high acute and turnout surgical ICUs is different from Podunk Community Hospital ICU. I mean, is it a teaching facility? Has the person worked those years FT and plus? Who is supervising and evaluating the clinical progress--this is often a sorry state for RNs, b/c of lack of well-established in-house education and strong and objective systems of evaluation. Heck, IMHO, they aren't as rigorous with advanced practice nurses with clinical hours and evaluation. Until the revamp and standardize theses process, more as medicine does, it's not really accurate to say this.

What I am saying is, depending upon the individual, clinically speaking (ignore the MS's comments b/c they are not yet working closely with ICU nurses like residents and fellows are), IT CAN BE, B/C IT VERY MUCH DEPENDS. So, many a CRNA-school candidate today or NP school candidate today can have maybe a year of clinical experience and get into these programs. We don't know what that year means, but regardless of how rigorous, dollars to donuts, NO way it's enough. But they get through their little BSN programs and keep moving through grad school with very little clinical experience--the quality and caliber of which is anyone's guess. Then they get a lot less supervised clinical practice exposure. Yea. It's problematic. Now if you have someone with 5 or > full-time years-- very, strong, clinical experiences, the proper certs and both nurses and doctors that can vouch for it, that may be different. But that is often not the typical student for advanced nursing practice programs anymore. Schools want the students, b/c they are businesses. Somehow they think going through to adding a doctoral degree will increase the caliber--clinically speaking--this is completely FALSE.

Physician's residency programs are rigorous, long, pain in arse processes for a reason. Doing what it required for board certification is in place for a reason.

But I also am of the belief that more objective systems of examination and evaluation need to be in place for either medicine or nursing. Though still very imperfect IMHO (too much subjective crap on evals), the former discipline, hands down, in general, is far superior with striving to implement that than the latter--nursing.


Bottom line. I know what you mean, b/c of individual experiences and insight, but in general, we can't make that statement, b/c in general, nursing still sucks at providing consistent, standardized clinical programs and evaluation systems--and b/c any chippy with a BSN and a mere 1 year in some ICU can score sufficiently on GRE, kiss up to some docs and others and get some decent references, and get into CRNA school. If I ran these programs, I wouldn't accept half of these applicants, b/c of their gross lack of fulltime clinical experience and decent scores on the critical care cert exam (AACN's CCRN). But hey, that would lose money for the programs.

You are making an assumption that CRNA school is automatic acceptance when its anything but, sure there are butt-kissers that get good grades and get in easy. No its not med school but it aint easy, most nurses have trouble with the requirments, plus the culture of ICU nurses is usually biased against new grads (unless their so and sos kid), but for most people getting into the ICU is not easy, much less CRNA school.

This is just a general sentiment and not particularlly projected towards anyone specific:
No one is claiming that an ICU nurses training is equivelent to a residents, but to say its no training at all is flat out lie. And to try and imply because a lot of it is OTJ and therefore doesnt count is BS. Last time I checked residents get paid dont they? Well then it must be a job and not training, right?

The answer is no, and its the same for nurses.

 

[BorntobeDO?]

Unfortunately this was the past. This is why CRNAs started to be used by anesthesiologist but the present and future is different. More and more, private practice anesthesiology is going away and being replaced by large AMCs. Anesthesiologist are now becoming employees and all that extra money is not going to them, it is going go the big management companies while anesthesiologists are paid peanuts for the same work and responsibility that they had in private practice.

At my hospital the Anesthesia group contracts out to the hospital, they are still their own group, and thats probably why they have 150 CRNA's for like 20 Anesthesiologists. (The CRNAs work less hours in general, there is never more than 4 to 1)

 

[acceptmeplease]

Re-read. I have always scored very highly on verbal SAT, ACT, NCLEX, CCRN, and any other certifications related to my profession or as a classroom or clinical educator.

The murdered part, you have mentioned, that is addressed in the very end of my treatise above. The arrogance, well, it goes to a person's motivation for me. So, let's see how much you will really love patients and caring for them and their illnesses in the real world. If you are motivated from the perspective of arrogance, it's going to be a real big butt-kicking for you--or you will be one of those people that is so self-focused, and we will all just have to get passed you in one way or another in order to get what patients needs.

OK, I stated that I'm not doing p!ssing contests with you. Thank you SDN for the IGNORE feature. Sad it has to come to this, simply b/c of silly insecurity and arrogance. This is exactly why I won't be saying too much in MS or residency--especially if my Spidey-sense indicates this mentality is present. I will quietly question and f/u with things on my own. Learning should be shared--but it requires humility. Until we can learn from the tiniest of creatures and have an openness toward that, our learning will continue to be stunted. Continue with your "stream."

Nclex is a pass/fail test and it's a joke and there is no verbal section.

Also, I've been reading your posts and I'm going to tell you why nurses working in critical care settings before CRNA school is not the same as residency.

it's not formal training. Nursing hierarchy basically consists of a nursing manager being excited that everyone shows up because they don't have to worry about staffing. Patients may survive in spite of nursing incompetence. In medical training, crap rolls downhill; you have people of different levels of training ahead of you consistently teaching you and reminding you of what you don't know.

There are good critical care nurses out there, but usually those are the ones who want to be good critical care nurses and not CRNAs. But even then, what determines a "good" critical care nurse? It's extremely subjective, and a good nurse in one facility may not be so great in a different facility. I'm not saying physicians know everything about every situation, but medical boards require a consistent level of education and competence.

Medical school is much more difficult than nursing school, and until you've experienced it, it's very difficult to appreciate the vast difference in the amount of material you learn.

 

[giantswing]

Smart ones wont do this. And the dumb ones will ruin their independance opprotunity when they take on a case that is too much.

I don't think most of you understand that part of the appeal of being a CRNA is NOT being the final authority. You are well paid but still protected if your working under someone else who has ultimate responsibily. Nurses do CRNA largely cause of the pay and lifestyle upgrade, not to try and steal anesthesiologist role. Most nurses do not want to be "the man (or woman)." They just want to do the job and go home.

Its painfully obvious some of you have never worked anywhere near a surgery environment based on the nonsense in here. Just cause a couple CRNAs say they want full practce rights doesnt mean that all (Or even 5%) really want that. They dont, and it is shameless fearmongering to claim they do.

I sure hope you're right.
I've seen alot that do want independance and think they're ready for it. And as the surgeon being the supervisor for the crna, that is something I do not want, nor something I feel I'd be qualified for. I'd much much much rather work with an anesthesiologist who works with the crna, for liability reasons.
(FOR LIABILITY REASONS ONLY, BEFORE YOU ALL GET YOUR PANTIES IN A TWIST. Juries go after the surgeon if there is no ansthesiologist, not the crna.)
Time will tell.

 

[BorntobeDO?]

Unfortunately this was the past. This is why CRNAs started to be used by anesthesiologist but the present and future is different. More and more, private practice anesthesiology is going away and being replaced by large AMCs. Anesthesiologist are now becoming employees and all that extra money is not going to them, it is going go the big management companies while anesthesiologists are paid peanuts for the same work and responsibility that they had in private practice.

It is a sad reality that many physicians are becoming like nurses and just want all the risk removed and end up giving up most of the reward. I personally would want a local group and not a huge one. But that does mean more responsibility, so everyone has to do whats right for them.

 

[BorntobeDO?]

I sure hope you're right.
I've seen alot that do want independance and think they're ready for it. And as the surgeon being the supervisor for the crna, that is something I do not want, nor something I feel I'd be qualified for. I'd much much much rather work with an anesthesiologist who works with the crna, for liability reasons.
Time will tell.

I would too, I wouldnt want a CRNA without backup for just about anything. Even as a easy patient, that being said I have no problem with having an experienced CRNA for surgery as long as Anesthesia is onsite and physically close by. And any good Anesthesiologist will not let a CRNA take on more than they can handle. Even if I dont know their abilities the physicians who supervise them should. And really its hard to know how good or bad anybody (doctor or nurse) is without working with them a lot or knowing someone who has.

 

[Sirach38]

It is a sad reality that many physicians are becoming like nurses and just want all the risk removed and end up giving up most of the reward. I personally would want a local group and not a huge one. But that does mean more responsibility, so everyone has to do whats right for them.

This is not a choice. Anesthesiologists aren't choosing to become employees.