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

[giantswing]

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.

That's the concern tho, there's movement to have crnas work with no anesthesiologist on site or with the surgeon acting as their "supervisor."

And it's already happening.

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[BorntobeDO?]

Yeah they teach all that in nursing school though

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

Hey man, I did great on verbal, and I dont think nursing school hurt that score at all.

That's the concern tho, there's movement to have crnas work with no anesthesiologist on site or with the surgeon acting as their "supervisor."

And it's already happening.

Thats dumb on the surgeons part, sure hes saving a good amount of money but what happens when his outpatient boob job turns into malignant hyperthermia, and hes only got a CRNA. He will be cannon fodder for the lawyers.

 

[giantswing]

Thats dumb on the surgeons part, sure hes saving a good amount of money but what happens when his outpatient boob job turns into malignant hyperthermia, and hes only got a CRNA. He will be cannon fodder for the lawyers.

Exactly!! Except depending on the hospital, the practice, and so on, the surgeon may not get a choice!

 

[BorntobeDO?]

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

Is it really tho? Their are hospitals that use local groups and you can choose to join them, the only issue is you might have to go somewhere you dont want. Thats a personal call, and maybe I was being alittle unfair in the post you quoted, but there are always options.

 

[Sirach38]

Yup. Unfortunately it will be years and many law suits/poor patient perioperative outcome later until they learn.

 

[Sirach38]

Is it really tho? Their are hospitals that use local groups and you can choose to join them, the only issue is you might have to go somewhere you dont want. Thats a personal call, and maybe I was being alittle unfair in the post you quoted, but there are always options.

There are still options but this is changing at a rapid pace. AMC companies are expanding and buying out all the hospital contracts. By the time current med students graduate, all of anesthesia may be dominated by these large companies as the small private groups can't compete.

 

[BorntobeDO?]

Exactly!! Except depending on the hospital, the practice, and so on, the surgeon may not get a choice!

Like I said, you always have a choice, it not be one you want to make but its there, I have already quit a job I didnt feel was safe, and I told my wife to do the same with a shady psych center that wanted her to pull meds for the psychologists to gve on the next shift (I am not even sure psychologist can give drugs, but I know for sure I wont be pulling their drugs out and getting blamed if something is done wrong cause supposedly "you pulled the wrong med" or whatever excuse they come up with.

When it comes to situations like that, its better to quit and walk away safe than to stay and have the place flush you down the toilet after they scapegoat you.

This is why you make sure you use a healthcare contract lawyer, that $500 bucks is probably the best you can spend. And the shady places will pull their offers if you reveiw it anyhow cause they have some nonsense in there. I fully intend to negotiate my first position when attending. If the place wont play, then I will go somewhere else. There are thousands of hosp, we all have options. Heck we can all ban together and make a medical cruiseship.

 

[BorntobeDO?]

There are still options but this is changing at a rapid pace. AMC companies are expanding and buying out all the hospital contracts. By the time current med students graduate, all of anesthesia may be dominated by these large companies as the small private groups can't compete.

Maybe, but walmart didnt kill off every local store. As corporations get bigger they develope inherent inefficiency, there will always be room for the guys who can do it better to steal some share. You could always run a non narcotic pain management clinic doing blocks if you had to. And if you really had to the Anesthesiologists could strike, its not like there are replacements all over the place.

But yeah, its definately an ever changing marketplace. All we can do is learn the game and play it.

 

[Rendar5]

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

say what?

 

[jl lin]

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.

What you don't realize is that I took it once--unlike a number of folks, especially back then, who had to take it more than once to get licensed. At that time it was NOT pass/fail. At that time, you received a score. Mine was very high. It got me jobs even after I already had a job promise. The reason is that they sent me my score before my license, and I needed that piece of paper during the interviews for other nursing positions--in order to prove to other employers I had passed. You need a license to work as an RN. One ivory league -based hospital saw my board scores, commented on my great score, and offered me a position immediately, which was in a high-acuity area in their medical center.

The CCRN exam for adults was 90% medicine, which included hard, factual, definitive medicine in terms of material. Have you taken it? It was challenging. I did well and I took it without cancelling on a very snowy WE day, sick as a dog. You couldn't walk in without knowledge and application-based experience and score high on that exam,, let alone get in the median for scoring.

Yes, you definitely can learn with increasingly complex patients as a highly interested and committed RN in critical care, especially in the units where you may have more time to hone in on intimate medical details of one or two patients at a time.

How ridiculous that you have stretched out everything I stated. Go back and re-read or please close it up. The latter is the best bet. I didn't say what you are saying I said.

Really, the stretched out commentary from whomever, without fully comprehending what I have shared, is just about arrogance, trolling, and drama. Apparently you are MS1. Does this mean you have a ton of time on your hands and that your med school experience thus far has been such a breeze? How many years of RN full-time in critical care at high acuity centers did you work prior to MS? I do not know, but I bet it wasn't near mine. Quality experience over time makes a big difference. It also matters where you work and what is allowed in your particular state and in your particular shop. You clearly didn't read/comprehend what I wrote, else you would not have replied as you have. Now why would you do that? Hmm?

 

[Sirach38]

What you don't realize is that I took it once, before it was pass/fail. At that time, you received a score. Mine was very high. It got me jobs even after I already had a job promise--the reason is that they sent your score before your license, and I needed to prove to other employers I had passed. You need a license to work as an RN.

The CCRN exam for adults was 90% medicine, which included hard, factual, definitive medicine in terms of material.
Yes, you do learn with increasingly complex patients--especially in critical care, where you have more time to hone in on intimate medical details.

How ridiculous that you have stretched out everything I stated. Go back and re-read or please close it up. The latter is the best bet.

Really, the stretched out commentary from whomever, without fully comprehending what I have shared, is just about arrogance, trolling, and drama. Apparently you are MS1. Does this mean you have a ton of time on your hands and your med school experience thus far has been such a breeze? How many years of RN full-time in critical care at high acuity centers did you work prior to MS? Quality experience over time makes a big difference. It also matters where you work and what is allowed by whom at your particular state and shop. You clearly didn't read/comprehend what I wrote, else you would not have replied as you have. Now why would you do that?

Please come back when you take the MCAT, Step1, etc and brag to us about those scores. Nobody cares about your nursing scores on this forum. I'm sure there are nursing forums somewhere on the internet where you can go brag. Just use google.

 

[jl lin]

Please come back when you take the MCAT, Step1, etc and brag to us aboit those scores. Nobody cares about your nursing scores on this forum. I'm sure there are nursing forums somwhere on the jnternet where you can go brag. Just use google.

I know they don't. And, lol, I don't care if they don't care. Just like I could give two craps about yours. The person directly insulted me and my verbal abilities. It's there on the record. He's acting like a b-wipe and doesn't know what he is talking about. So I addressed that with him, put him on ignore, and addressed the stupid comment that followed, which moved along the same idiotic lines.

You just work on your exams and worry about you and that delightful attitude. I'm betting you are one that is not too warm and fuzzy with people skills either. What are you? 24, 26? Really? Go back to studying now.

And now you have been awarded with the ignore feature as well. God, it's annoying getting (How did that one doc here put it in such a cool way?). . .oh yea, "bat-signaled" with stupid alerts based on stupid comments from people that either have poor reading skills or just want to have pizzing contests to prove how wonderfully childish they are. I realize that 25 may be the new 15, but really, no thanks. And it's great b/c you don't have to be bothered by the "bat signals" from childishness once you employ the ignore feature!!!

 

[giantswing]

For all the pre meds and not yet third years reading this thread, this is a shining example of how not to conduct yourself in medical school and for sure not the floors.
And if you do act like is know your classmates will have an awesome time watching you crash and burn on rounds, and residents will talk about you. You don't want to be the student the residents talk about.

 

[Rendar5]

Acting smug about others doesn't always win you points among attendings though. Though I am genuinely amused by the reach-arounds going on here. With all the pairs constantly liking each other's posts.

 

[Psai]

I've always said that the like system was stupid

 

[fancymylotus]

What you don't realize is that I took it once--unlike a number of folks, especially back then, who had to take it more than once to get licensed. At that time it was NOT pass/fail. At that time, you received a score. Mine was very high. It got me jobs even after I already had a job promise. The reason is that they sent me my score before my license, and I needed that piece of paper during the interviews for other nursing positions--in order to prove to other employers I had passed. You need a license to work as an RN. One ivory league -based hospital saw my board scores, commented on my great score, and offered me a position immediately, which was in a high-acuity area in their medical center.

The CCRN exam for adults was 90% medicine, which included hard, factual, definitive medicine in terms of material. Have you taken it? It was challenging. I did well and I took it without cancelling on a very snowy WE day, sick as a dog. You couldn't walk in without knowledge and application-based experience and score high on that exam,, let alone get in the median for scoring.

Yes, you definitely can learn with increasingly complex patients as a highly interested and committed RN in critical care, especially in the units where you may have more time to hone in on intimate medical details of one or two patients at a time.

How ridiculous that you have stretched out everything I stated. Go back and re-read or please close it up. The latter is the best bet. I didn't say what you are saying I said.

Really, the stretched out commentary from whomever, without fully comprehending what I have shared, is just about arrogance, trolling, and drama. Apparently you are MS1. Does this mean you have a ton of time on your hands and that your med school experience thus far has been such a breeze? How many years of RN full-time in critical care at high acuity centers did you work prior to MS? I do not know, but I bet it wasn't near mine. Quality experience over time makes a big difference. It also matters where you work and what is allowed in your particular state and in your particular shop. You clearly didn't read/comprehend what I wrote, else you would not have replied as you have. Now why would you do that? Hmm?

The real question is.....
Can you rip out a tooth faster than I can?? Probably not.

Seriously though, what on earth did you expect when you started posting this stuff with that attitude? Zero backlash??

 

[Obnoxious Dad]

CRNAs make $150,000 per year because the actions of Anesthesiologists and the policies of the American Association of Nurses Anesthetists (AANA) have created an artificial shortage of CRNAs.

In the early 1980s studies published at Stanford and the University of North Carolina looked at the anesthetic outcomes of surgeries to see if there was a difference among cases involving CRNAs alone, CRNAs in a care team model and anesthesiologists working alone. These studies found no difference in outcomes. The Stanford study looked at 17 different hospitals and the investigators controlled for the health of the patients and the inherent risk of the procedures.

As a result of these studies urban hospitals in many cases went with an anesthesia care team model to cut costs and in many rural hospitals CRNAs practiced without the supervision of an anesthesiologist. This killed the job market for anesthesiologists and residency classes started shrinking.

This precipitated the closure of some CRNA programs at ASA strongholds like the University of Michigan. In addition some CRNA programs that were entirely hospital based closed because the AANA began requiring all programs to offer a Masters degree. This closed the program in Wausau, WI. Furthermore some hospitals with CRNA programs closed for financial reasons. Milwaukee County is an example.

With the greater use of CRNAs and the closure of CRNA training programs hospitals started to bid up the wages of CRNAs. This should have precipitated the opening of more CRNA training programs and some have opened. However, a CRNA training program needs the cooperation of attending anesthesiologists and anesthesiologists have in many cases resisted.

That's why CRNAs make $150K.

 

[fancymylotus]

Wait, nurses make 150k a year? How did I miss this?!?! I should have been a nurse.

 

[oldanddone]

The real question is.....
Can you rip out a tooth faster than I can?? Probably not.

Seriously though, what on earth did you expect when you started posting this stuff with that attitude? Zero backlash??

Hey, jl ln is trying to give a straightforward point that was given by another poster whose wife was a nurse, training and evaluated on the job ie while getting paid, while they were a resident. the squad didn't come out after that poster....hmmm.....why not is a question to ask.

I can see jl ln get frustrated with the attitude getting directed towards them. of course, there is no reasoning with a mob mentality. and showing frustration is to the basest elements of medical community what showing blood is to sharks.

this mob has not pulled any sources to learn and then be able to compare residency training vs on the job training of nurses, and won't listen to those who can tell them about the kinds of training. this mob also comes from the era of 'out of pocket' certificate training and maybe does not realize that the standard used to be that the employer took on the role of training in the first few years of *being paid*. for whatever reasons, this mob is speaking from a very uninformed position.

what's more, this mob is not reading the prior threads carefully enough, and just starting to blow-hard for the sake of blowing hard. and is barely even on topic or contributing to the advancement of the discussion anymore.

i respectfully ask to Knock It Off.

 

[fancymylotus]

Hey, jl ln is trying to give a straightforward point that was given by another poster whose wife was a nurse, training and evaluated on the job ie while getting paid, while they were a resident. the squad didn't come out after that poster....hmmm.....why not is a question to ask.

I can see jl ln get frustrated with the attitude getting directed towards them. of course, there is no reasoning with a mob mentality. and showing frustration is to the basest elements of medical community what showing blood is to sharks.

this mob has not pulled any sources to learn and then be able to compare residency training vs on the job training of nurses, and won't listen to those who can tell them about the kinds of training. this mob also comes from the era of 'out of pocket' certificate training and maybe does not realize that the standard used to be that the employer took on the role of training in the first few years of *being paid*. for whatever reasons, this mob is speaking from a very uninformed position.

what's more, this mob is not reading the prior threads carefully enough, and just starting to blow-hard for the sake of blowing hard. and is barely even on topic or contributing to the advancement of the discussion anymore.

i respectfully ask to Knock It Off.

Um, when you parade onto a forum full of medical students and compare your training as a nurse to their training, how well do you think that's going to go over? Also, there's no mob mentality here, lose the victim card.

 

[oldanddone]

CRNAs make $150,000 per year because the actions of Anesthesiologists and the policies of the American Association of Nurses Anesthetists (AANA) have created an artificial shortage of CRNAs.

In the early 1980s studies published at Stanford and the University of North Carolina looked at the anesthetic outcomes of surgeries to see if there was a difference among cases involving CRNAs alone, CRNAs in a care team model and anesthesiologists working alone. These studies found no difference in outcomes. The Stanford study looked at 17 different hospitals and the investigators controlled for the health of the patients and the inherent risk of the procedures.

As a result of these studies urban hospitals in many cases went with an anesthesia care team model to cut costs and in many rural hospitals CRNAs practiced without the supervision of an anesthesiologist. This killed the job market for anesthesiologists and residency classes started shrinking.

This precipitated the closure of some CRNA programs at ASA strongholds like the University of Michigan. In addition some CRNA programs that were entirely hospital based closed because the AANA began requiring all programs to offer a Masters degree. This closed the program in Wausau, WI. Furthermore some hospitals with CRNA programs closed for financial reasons. Milwaukee County is an example.

With the greater use of CRNAs and the closure of CRNA training programs hospitals started to bid up the wages of CRNAs. This should have precipitated the opening of more CRNA training programs and some have opened. However, a CRNA training program needs the cooperation of attending anesthesiologists and anesthesiologists have in many cases resisted.

That's why CRNAs make $150K.

So CRNA wages went up when training requirements went up, but training programmes could not match, and so closed, thereby creating a market shortage, which drives up the value of those present.

Combined with the prior poster who described CRNAs flooding the market with cheaper rates for same services, which will drive down rates for services, at which point, market will get to choose the more valued service (anesthesia) at the new and cheaper rate.

if anesthesia agree to training more crnas, does that not then just drive the cost of the service down for everyone in the long run even further?

having an economic view of the politics of all this is important, and i hope that possibly there will be room for crna and anesthesia to even work together to combat that overall mechanism of cheapening labour for everyone.

the current model of battling for access to scope of practice at a cheaper remuneration is not good. for anyone, in the long run, except for institutional financial administrators, particularly in for-profit models.

 

[oldanddone]

Um, when you parade onto a forum full of medical students and compare your training as a nurse to their training, how well do you think that's going to go over? Also, there's no mob mentality here, lose the victim card.

how do you think that *should* go over? because how it is going over is not how i think that *should* go over.

using terms like 'parade onto' it's as if that person may not actually have something or two to teach about the actual clinical practice of doctors and nurses. in fact, when they talk about nursing training and the practicalities of how that happens on the job, people *should* go *silent* because it is *nothing* they will learn about in med school, unless in a random interprofessional lecture, maybe. yet, no respectful silence followed by reasonable interactions.

just because there's a mob, doesn't make the other person a victim. however, the mob will try... 'lose the victim card'? that is such a flippant way to try and dismiss a person. very disrespectful in my books.


edited to add: when a conversation has to derail to talk about being civil to each other, then the fact is, there is an issue. get back on topic or get going. that's the last derailed post i will make. will start reporting and letting others figure it out backchannel.

 

[fancymylotus]

how do you think that *should* go over? because how it is going over is not how i think that *should* go over.

using terms like 'parade onto' it's as if that person may not actually have something or two to teach about the actual clinical practice of doctors and nurses. in fact, when they talk about nursing training and the practicalities of how that happens on the job, people *should* go *silent* because it is *nothing* they will learn about in med school, unless in a random interprofessional lecture, maybe. yet, no respectful silence followed by reasonable interactions.

just because there's a mob, doesn't make the other person a victim. however, the mob will try... 'lose the victim card'? that is such a flippant way to try and dismiss a person. very disrespectful in my books.


edited to add: when a conversation has to derail to talk about being civil to each other, then the fact is, there is an issue. get back on topic or get going. that's the last derailed post i will make. will start reporting and letting others figure it out backchannel.

Are you seriously threatening me? I didn't even respond to your post originally. Who jumped into what argument? Just stop.

 

[Mad Jack]

Maybe, but walmart didnt kill off every local store. As corporations get bigger they develope inherent inefficiency, there will always be room for the guys who can do it better to steal some share. You could always run a non narcotic pain management clinic doing blocks if you had to. And if you really had to the Anesthesiologists could strike, its not like there are replacements all over the place.

But yeah, its definately an ever changing marketplace. All we can do is learn the game and play it.

That sounds great in theory, but the simple fact is AMCs work well because they cut out all of the inherent inefficiencies in the system and work for prices that no independent group could manage to. Anesthesia is viewed largely as a cost by hospitals, so they don't care about quality so long as they can skip out on liability and reduce costs as much as possible. Having an AMC allows them both of those avenues, as the AMC and the anesthesiologists shoulder the responsibility while their costs for anesthesia are markedly reduced. As ACOs become a bigger player in the market and FFS is reduced, I expect this trend to intensify and independent practice to become even more inviable.

 

[Mad Jack]

What you don't realize is that I took it once--unlike a number of folks, especially back then, who had to take it more than once to get licensed. At that time it was NOT pass/fail. At that time, you received a score. Mine was very high. It got me jobs even after I already had a job promise. The reason is that they sent me my score before my license, and I needed that piece of paper during the interviews for other nursing positions--in order to prove to other employers I had passed. You need a license to work as an RN. One ivory league -based hospital saw my board scores, commented on my great score, and offered me a position immediately, which was in a high-acuity area in their medical center.

The CCRN exam for adults was 90% medicine, which included hard, factual, definitive medicine in terms of material. Have you taken it? It was challenging. I did well and I took it without cancelling on a very snowy WE day, sick as a dog. You couldn't walk in without knowledge and application-based experience and score high on that exam,, let alone get in the median for scoring.

Yes, you definitely can learn with increasingly complex patients as a highly interested and committed RN in critical care, especially in the units where you may have more time to hone in on intimate medical details of one or two patients at a time.

How ridiculous that you have stretched out everything I stated. Go back and re-read or please close it up. The latter is the best bet. I didn't say what you are saying I said.

Really, the stretched out commentary from whomever, without fully comprehending what I have shared, is just about arrogance, trolling, and drama. Apparently you are MS1. Does this mean you have a ton of time on your hands and that your med school experience thus far has been such a breeze? How many years of RN full-time in critical care at high acuity centers did you work prior to MS? I do not know, but I bet it wasn't near mine. Quality experience over time makes a big difference. It also matters where you work and what is allowed in your particular state and in your particular shop. You clearly didn't read/comprehend what I wrote, else you would not have replied as you have. Now why would you do that? Hmm?

That's cute that you could pass some entry level exams for a field that doesn't even operate at the midlevel. And passed a critical care exam that basically any MS-1 could pass (it's actually pretty laughable, check out the sample questions guise: http://www.aacn.org/wd/certifications/content/ccrnexamquestions.pcms?menu= ). Those don't mean a whole hell of a lot, as they gauge basic nursing skills that in no way qualify someone to be an independent practitioner. Your skills may not be worthless, but they certainly aren't comparable to that of a physician. I clocked over 10,000 hours as a respiratory therapist in one of those "ivory league," as you called them, hospitals, and going into med school I was blown away by how much I didn't even know about my own area of practice. Sure, I know a bit more about a few things here and there than a lot of the physicians out there (because really, not many people need to get into the nitty gritty of HFOV or specialized PFTs or any of the many esoteric modes of ventilation out there nowadays) but ultimately my training was lacking in so many respects that I wasn't even aware of. A skilled nurse does not a doctor make, no matter what their DNP degrees might declare.

 

[IlDestriero]

The CRNA programs are currently over producing CRNAs and the AANA couldn't care less. They want to flood the market, and it is already keeping their salaries down, and will certainly get worse. We have a constant stream of applicants for unadvertised jobs and we can pay less than average. If they were smart, they would clean house, raise the bar and close a lot of weak programs. That would insure a better product, improve their employment opportunities, and increase their pay.
That is not their focus. They want independence in all 50 states and ignore the fact that probably 90% of their members don't want to practice independently. If they did what was in the best interest of their members, things wouldn't be the way they are now. Of course the ASA isn't, in my opinion, making the best choices now either.

 

[IlDestriero]

I met some of the Ivory League folks when I went on safari. They are an interesting bunch.

 

[jl lin]

Acting smug about others doesn't always win you points among attendings though. Though I am genuinely amused by the reach-arounds going on here. With all the pairs constantly liking each other's posts.

Thanks Rendar5. No one said acting smug is going to get you anywhere--as a physician OR AS A RN. In fact, physicians may actually be a bit more tolerant of this than nurses, especially ICU RNs. They can be a tough bunch.
It's really sad that those attacking me so vehemently have not even looked at the particulars of what I am saying. They don't even realize that I agree that CRNAs should ALWAYS BE under anesthesiologist supervision. They realize I have advocated for direct presence of anesthesiologists on cases with families. My message was quite clear, and it was respected.

All this hubbub is extreme however. There are some radical CRNA types that want to function fully autonomously and there are many that do not. And if for no other reason, it's sad, but there is someone else to try and share the responsibility of outcomes. Why, b/c AS STRONG CLINICAL EXPERIENCE WILL DEFINITELY TEACH YOU (and has as of yet taught some of these students mouthing off about things they really don't know)----CRAP HAPPENS. It happens more than people know. If you work in a critical care area as a clinician you definitely will see and learn this.

People, however, shouldn't generalize and compare what they have seen, think they have seen or known with other nurse professionals. I stated this at the OUTSET of my responses in this thread. There is just too much variation and not enough standardization IMHO. You have to work with the individual RN directly--and in time--that's where you will see the qualitative differences in understanding pathophysiology, variations in responses to treatment, any number of things, that, however you want to slice it, yes, in fact are medical in nature. The overlap cannot be avoided, however, b/c there is not enough time for residents and fellows and attendings to stand over and monitor and evaluate critically ill patients progress continuously, 24/7. That is why they have these units. Unless docs can learn to become omnipresent or quickly clone and educate their clones, this is what needs to be in place.

I really think the some here do not understand a number of things. I was just reading the anesthesiologists thread on Joan Rivers. They will address some of the issues with putting sicker patients out on a non-unit floor and it has to do with the knowledge and experience and close monitoring abilities of the critical care RNs staffed in these units. Another wise anesthesiologist commented on the quintessential value of clinical experience. What isn't understood here is how closely critical care RNs work with residents, fellows, and attendings. Yes, this is in the field learning. Some nurses are better at going deeper into the medical science of what is going in with the patients and others may have only a baseline knowledge of critical problems and various nuance of changes physiologically speaking. But you must learn a certain amount of medicine for that patient to thrive or even survive. I mean it is what it is. But that does not mean I have stated that PGM programs are not superior in how they function, teach, and evaluate. Again, if you read one of my initial posts, you would see that I in fact stated that. More than once for God's sake. So the insane attacks are not based in anything but foolishness, lack of understanding, and IMHO arrogance that hopefully will be smacked out of some when they are in their PGE experiences.

For the anti-advanced practice arguments, I suggest delineating specifically on the lack of quality and quantity of hours AND the severe lack of standardized evaluation processes for them in contrast with the required standardized structure of PGME programs. The whole critical care and advanced practice nurses don't know squat argument will not work. There are those that know very little, and there are those that know a lot. And how things are applied by mere didactic understanding without understanding real life application of medicine, clinically speak--well it can be huge--even with or without evidence based practice. And you aren't gonna get this until you are working long hours in the midst of the action until residency and onward. If you have PA, NP, and strong critical care RN experience, residency will still be eye-opening and indeed have many robust experiences, but you may find that their is a stronger comfort and familiarity with approaches. Don't disregard and be hating on those people that have had the benefit of years of strong clinical experience. In due time, everyone more or less has to get onto the same page. Again, some of the now ignored commentators to my replies have misconstrued what I have state, and in general, just don't care to want to understand. I can't help that lines of close-minded thinking. I also hope they change their attitudes before residency, b/c they will need the support of strong critical care nurses caring for the patients for whom they will be given responsibility.

Last time: This SDN member never said CRNA is + anesthesiologists. I have worked extensively in these areas. I would NEVER SAY THAT based on experience alone. Why are people so quick to launch into attack rather than to try to understand? Could I be b/c they really don't want to do so? Now, that is truly a problem for them and for those with whom they work.

 

[jl lin]

The CRNA programs are currently over producing CRNAs and the AANA couldn't care less. They want to flood the market, and it is already keeping their salaries down, and will certainly get worse. We have a constant stream of applicants for unadvertised jobs and we can pay less than average. If they were smart, they would clean house, raise the bar and close a lot of weak programs. That would insure a better product, improve their employment opportunities, and increase their pay.
That is not their focus. They want independence in all 50 states and ignore the fact that probably 90% of their members don't want to practice independently. If they did what was in the best interest of their members, things wouldn't be the way they are now. Of course the ASA isn't, in my opinion, making the best choices now either.

I agree COMPLETELY with what you have stated. Yes, hell yes. Raise the bar. And stop plugging in ICU nurses with minimal clinical experience into these programs. Also, make them score high on the adult CCRN.

 

[Baller MD]

CRNAs make $150,000 per year because the actions of Anesthesiologists and the policies of the American Association of Nurses Anesthetists (AANA) have created an artificial shortage of CRNAs.

In the early 1980s studies published at Stanford and the University of North Carolina looked at the anesthetic outcomes of surgeries to see if there was a difference among cases involving CRNAs alone, CRNAs in a care team model and anesthesiologists working alone. These studies found no difference in outcomes. The Stanford study looked at 17 different hospitals and the investigators controlled for the health of the patients and the inherent risk of the procedures.

As a result of these studies urban hospitals in many cases went with an anesthesia care team model to cut costs and in many rural hospitals CRNAs practiced without the supervision of an anesthesiologist. This killed the job market for anesthesiologists and residency classes started shrinking.

This precipitated the closure of some CRNA programs at ASA strongholds like the University of Michigan. In addition some CRNA programs that were entirely hospital based closed because the AANA began requiring all programs to offer a Masters degree. This closed the program in Wausau, WI. Furthermore some hospitals with CRNA programs closed for financial reasons. Milwaukee County is an example.

With the greater use of CRNAs and the closure of CRNA training programs hospitals started to bid up the wages of CRNAs. This should have precipitated the opening of more CRNA training programs and some have opened. However, a CRNA training program needs the cooperation of attending anesthesiologists and anesthesiologists have in many cases resisted.

That's why CRNAs make $150K.

Wow did not know this. Thanks.

 

[giantswing]

It's not as if anyone is saying nurses don't get trained on the job, are good at their job, or even have something to teach medical students. This is all true.

People got up in arms when a poster said x number of years of nursing experience was like a residency, then asked what aresidency was. While Ji Lin makes ecxellent points that, for themost part i agree with, they are buried in a mountain of text, written while foaming at the mouth and frankly, a snotty tone, which greatly undermines her points.

(And acting like this when you get frusterated will get you killed on floors as a med student!)

 

[acceptmeplease]

It's not as if anyone is saying nurses don't get trained on the job, are good at their job, or even have something to teach medical students. This is all true.

People got up in arms when a poster said x number of years of nursing experience was like a residency, then asked what aresidency was. While Ji Lin makes ecxellent points that, for themost part i agree with, they are buried in a mountain of text, written while foaming at the mouth and frankly, a snotty tone, which greatly undermines her points.

(And acting like this when you get frusterated will get you killed on floors as a med student!)

Careful, you might get ignored, too.

 

[giantswing]

Careful, you might get ignored, too.

Already have been. But its easily missable as its at the end of the novel.

 

[jl lin]

That's cute that you could pass some entry level exams for a field that doesn't even operate at the midlevel. And passed a critical care exam that basically any MS-1 could pass (it's actually pretty laughable, check out the sample questions guise: http://www.aacn.org/wd/certifications/content/ccrnexamquestions.pcms?menu= ). Those don't mean a whole hell of a lot, as they gauge basic nursing skills that in no way qualify someone to be an independent practitioner. Your skills may not be worthless, but they certainly aren't comparable to that of a physician. I clocked over 10,000 hours as a respiratory therapist in one of those "ivory league," as you called them, hospitals, and going into med school I was blown away by how much I didn't even know about my own area of practice. Sure, I know a bit more about a few things here and there than a lot of the physicians out there (because really, not many people need to get into the nitty gritty of HFOV or specialized PFTs or any of the many esoteric modes of ventilation out there nowadays) but ultimately my training was lacking in so many respects that I wasn't even aware of. A skilled nurse does not a doctor make, no matter what their DNP degrees might declare.

Sigh. CCRN is not entry level. You have to work a certain amount of hours directly in the area--intensive care adults, neonates, pediatrics. Take it and THEN tell me what you think. Actually MS students would not in most cases score high on it.--especially MS-1's. The NCLEX, well, that is just a very strange kind of exam, which includes foundational knowledge of diseases, assessment, interventions/txs, and evaluation, etc. Pretty much the choices were suboptimal for the given patient scenarios--meaning, usually the least crappy of all the suboptimal choices was your best bet for an answer. It was, in my view, an odd kind of exam, and it was not CB'd like it is today, and it took two days to write the exam. It wasn't a piece of cake, b/c it was tricky, and you had to read well and understand what they were looking for. Again, I took NCLEX near the end of my program, scored well, never had to take it again. It was very application-based. The CCRN is more medical science and medical application based. You can't sit for it w/o X amt of hours of experience in critical care of adults or peds or neonates. Each is a separate exam. The adult exam is very much medical knowledge specific to typical, critically ill states, and at least when I sat, the scoring was broken down by CV, Neuro, Metabolics, etc. If you didn't know various dysrhythmias and tx's and expected responses, lab values, hemodynamics, vasoactive titrations and responses, blood gases for art, venous, and cap, you name it, you would not do well on it. But it was more than that as well. It's been a long time since I have taken it, but it was challenging and though stressful, a cool exam. I'd take it again. The peds and neonate CCRN exams are specific to those areas, and do not have as much foundation critical care knowledge as the adult exam. So most that take the others and the adults say the adult CCRN is the most challenging. Of course there are different opinions on that. Whatever.

About the other part, I never contradicted this position. NEVER. Please read carefully, seek proper clarification, or just don't respond. It's the lack of reading that has only led to the equivalent of pizzing contests here. As a non-trad, especially as an RRT that has had to work as part of the healthcare team, I'd think you would understand the importance of being beyond this IMHO. One thing has nothing to do with the other.

The position is not about the individual quality of a specific, critical care nurse's knowledge and application base. It was about the growing problem of advanced practice overstep. With regard to overstep, I have Always agreed to the problems with overstep--not simply on behalf of physician but b/c of advocacy for the patients! This is why some of the responses here are just outlandish.

Mad, re: med school, etc, as I already stated, my plan is to keep my lips closed as much as possible--even when I have developing questions Like I said, one has to us Spidey-sense.

 

[Mad Jack]

Sigh. CCRN is not entry level. You have to work a certain amount of hours directly in the area--intensive care adults, neonates, pediatrics. Take it and THEN tell me what you think. Actually MS students would not in most cases score high on it.--especially MS-1's. The NCLEX, well, that is just a very strange kind of exam. Again, I took NCLEX near the end of my program, . It was two days of testing on paper and was just an odd exam. It was very application-based. The CCRN is more medical science and medical application based.

About the other paert, I never contradicted this position. NEVER. Please read carefully, seek proper clarification, or jst don't responds. It's the The lack of reading has only led to the equivleent of pizzing contests. As a dnon-trad, yoit's key to be beyond this IMHO. One thing has nothing to do with the other.

The position is not about the individual quality of a specific, critical care nurse's knowledge and application base. It was about the growing problem of advanced practice overstep. With regard to overstep, I have Always agreed to the problems with overstep--not simply on behalf of physician but b/c of advocacy for the patients!!! This why some of the responses here are just outlandish.

Mad, re: med school, etc, as I already stated, my plan is to keep my lips closed as much as possible--even when I have developing questions Like I said, one has to us Spidey-sense.

Just because you have to work a lot before you take an exam doesn't mean that it is covering advanced information. All of the CCRN practice questions I've found online are the sorts of basic things that physicians should know before ever touching patients. It's easy material all around.

 

[jl lin]

Just because you have to work a lot before you take an exam doesn't mean that it is covering advanced information. All of the CCRN practice questions I've found online are the sorts of basic things that physicians should know before ever touching patients. It's easy material all around.

The practice exams are NOT like the actual exam. You are VERY wrong. Let's not do the whole pissing thing. It's ridiculous. Can't you of all people see that? It is not easy material. If you can find a way past the hours requirements and licensure requirements, I'd encourage you to sit for it. But let's think about this reasonably, OK? I believe you are beyond M1 AND YOU HAVE CLINICAL EXPERIENCE AS AN RRT. Heck, for all I know, you may be M3-4 and doing some rotations as well. Great. Advantage--YOU--specifically b/c of these things!!!! So, no. You are not the typical MS student to which I was referring.

Actually you are helping to make my point. But see if you can slide in on the exam. After that, then tell me you think any MS1 or even 2 w/o clinical experience could do well on it!!! There is a threshold, but it is not pass/fail. You get scored on each area. How are you on your rhythms, beyond the very basic ones--and their various txs and risks? What about hemodynamics and the full panel of indices and what they indicate with and without various pharmacological and volume based titrations? How are you in your critical aspects in assessing and treating neuro pts--all the ICPs, meds, volume related and other metabolic variables? Take it. You may do OK, but that is b/c you had hopefully some strong RRT experience, and you are a stellar student past MS1.

Regardless, why is this something you want to compare male body parts over? Seriously mad. This is disappointing coming from you of all people. You are beyond this dude.

 

[jl lin]

Hey, jl ln is trying to give a straightforward point that was given by another poster whose wife was a nurse, training and evaluated on the job ie while getting paid, while they were a resident. the squad didn't come out after that poster....hmmm.....why not is a question to ask.

I can see jl ln get frustrated with the attitude getting directed towards them. of course, there is no reasoning with a mob mentality. and showing frustration is to the basest elements of medical community what showing blood is to sharks.

this mob has not pulled any sources to learn and then be able to compare residency training vs on the job training of nurses, and won't listen to those who can tell them about the kinds of training. this mob also comes from the era of 'out of pocket' certificate training and maybe does not realize that the standard used to be that the employer took on the role of training in the first few years of *being paid*. for whatever reasons, this mob is speaking from a very uninformed position.

what's more, this mob is not reading the prior threads carefully enough, and just starting to blow-hard for the sake of blowing hard. and is barely even on topic or contributing to the advancement of the discussion anymore.

i respectfully ask to Knock It Off.

OMG. Thank you. Exactly. From an attending no less! Much appreciated. For the record, I have said ad nauseum on SDN that I DO NOT and will NOT support full, independent practice of CRNAs without anesthesiologists supervision. I said I wouldn't have that for my family members that had to undergo surgery. I have said it until I am blue in the face. But yes. There does seem to be an issue of current processes differing from past processes. I mean, since 2008, really so much has changed in that regard as well as many others. It's very sad. And sadly, all of healthcare is not what it used to be. I am not saying it was perfect before--no. But I am saying it was run more by people that actually understood medicine, nursing, healthcare and true patient advocacy. That's NOT the biggest name of the game anymore. It is quite disheartening.

 

[giantswing]

As medical students, i guess we have no concept of healthcare, patient advocacy, or medicine. But i do abree that admins and politicians, which i assume is whom theyre referring to, have way too much say in the practice of medicine.

But still. The more this person goes on the crazier they seem.

 

[jl lin]

Proof of someone having real issues here is in the ad hominem and insults and the sycophantic gang-banging from other members with their support of nasty comments ("Look how I can "like" adversarial and trollish comments of my pals,") and other irrelevant nonsense. Classy.

Oldanddone summed it up quite well. The rest is just trollish behavior. Another thread that may end up closing. This is feeling like the pre-alllo forum.

 

[Mad Jack]

Proof of someone having real issues here is in the ad hominem and insults and the sycophantic gang-banging from other members with their support of nasty comments ("Look how I can "like" adversarial and trollish comments of my pals,") and other irrelevant nonsense. Classy.

Oldanddone summed it up quite well. The rest is just trollish behavior. Another thread that may end up closing. This is feeling like the pre-alllo forum.

You really don't deserve the flak you're getting, in all fairness. You seem like a skilled caregiver and clinician and I apologize for my earlier comments, I just tend to let a little misdirected rage fly in any thread regarding CRNAs, because they ruined what was to be my field of choice.

 

[jl lin]

You really don't deserve the flak you're getting, in all fairness. You seem like a skilled caregiver and clinician and I apologize for my earlier comments, I just tend to let a little misdirected rage fly in any thread regarding CRNAs, because they ruined what was to be my field of choice.

Thanks Mad. I'm pissed about it too. Everything anymore is about bottom line. It makes it very frustrating for everyone, especially those that have given up a good 12 years of their lives or more to become expert practitioners in a given field. Thank God when my family members had to have anesthesia, they were so cool about listening to me and my concerns re: monitoring and supervision from the anesthesiologist attendings--especially with my kids or elderly family members. When you see what can go wrong firsthand, well, you get cagey about who is caring for your loved ones.

I have had great experiences working with anesthesiologists. And if they weren't too busy, they were usually cool about discussing various medical considerations re: patients and such--many of them I have worked with are great teachers. Thing is, surgery and anesthesiology move--I mean least where I have worked. There are not many slow days--whether the patients flew through or crashed. Pretty much everyone went home tired.

I would love to pursue this avenue, but I'd want to go on to be a critical care intensivist in peds, and that's a longer and more competitive road. Also, given the bottom line issues, you've gotta wonder what will happen to anesthesia salaries. So how much will you be able to come out ahead after the extra time? Who is to say? It's a serious issue. I read the anesthesia forum with great interest. You can always learn something over there.

 

[Mad Jack]

Thanks Mad. I'm pissed about it too. Everything anymore is about bottom line. It makes it very frustrating for everyone, especially those that have given up a good 12 years of their lives or more to become expert practitioners in a given field. Thank God when my family members had to have anesthesia, they were so cool about listening to me and my concerns re: monitoring and supervision from the anesthesiologist attendings--especially with my kids or elderly family members. When you see what can go wrong firsthand, well, you get cagey about who is caring for your loved ones. I have had great experiences working with anesthesiologists. And if they weren't too busy, they were usually cool about discussing various medical considerations re: patients and such. Thing is, surgery and anesthesiology moves--I mean least where I have worked, not many slow days--whether the patients flew through or crashed. Pretty much everyone went home tired. I would love to pursue this avenue, but I'd want to go on to be a critical care intensivist in peds, and that's a longer and more competitive road. Also, given the bottom line issues, you've gotta wonder what will happen to anesthesia salaries. So will you be able to come out ahead after the extra time? Who is to say? It's a serious issue. I read the anesthesia forum with great interest. You can always learn something over there.

No need to thank me for realizing I was being a dick. I do that sometimes and it's entirely unfair to the people I lay the haterade on.

Anesthesia is a rapidly sinking ship all around. The middlemen (AMCs) are going to skim everything they can, and due to the massive expansion of CRNA schools and the impending CRNA surplus, they'll be able to drive wages through the floor. Quality will probably follow the downward trend, but that remains to be seen. I wouldn't let a CRNA administer my anesthesia without an anesthesiologist present, nor would I let a family member been seen by an independent CRNA. APRNs have a place in our health care system, but that place is in collaboration with a physician. Midlevels need to have someone to fall back on when they hit the edge of their knowledge. It's not an insult, it's just reality- we've got different training that gives us different limits, and it upsets me that some people disregard these inherent limits and choose to sacrifice the safety of their patients for a bit of autonomy and cash.

 

[67552931811]

Thanks Mad. I'm pissed about it too. Everything anymore is about bottom line. It makes it very frustrating for everyone, especially those that have given up a good 12 years of their lives or more to become expert practitioners in a given field. Thank God when my family members had to have anesthesia, they were so cool about listening to me and my concerns re: monitoring and supervision from the anesthesiologist attendings--especially with my kids or elderly family members. When you see what can go wrong firsthand, well, you get cagey about who is caring for your loved ones.

I have had great experiences working with anesthesiologists. And if they weren't too busy, they were usually cool about discussing various medical considerations re: patients and such--many of them I have worked with are great teachers. Thing is, surgery and anesthesiology move--I mean least where I have worked. There are not many slow days--whether the patients flew through or crashed. Pretty much everyone went home tired.

I would love to pursue this avenue, but I'd want to go on to be a critical care intensivist in peds, and that's a longer and more competitive road. Also, given the bottom line issues, you've gotta wonder what will happen to anesthesia salaries. So how much will you be able to come out ahead after the extra time? Who is to say? It's a serious issue. I read the anesthesia forum with great interest. You can always learn something over there.

Or, you could just do: peds-->peds cc fellowship (nixing the gas part).

Peds-cc, while one of the more competitive peds subspec. is actually not that competitive overall (i.e. last year there were more positions offered than applications).

 

[jl lin]

I wouldn't let a CRNA administer my anesthesia without an anesthesiologist present, nor would I let a family member been seen by an independent CRNA. APRNs have a place in our health care system, but that place is in collaboration with a physician. Midlevels need to have someone to fall back on when they hit the edge of their knowledge. It's not an insult, it's just reality- we've got different training that gives us different limits, and it upsets me that some people disregard these inherent limits and choose to sacrifice the safety of their patients for a bit of autonomy and cash.

100% agree.

 

[jl lin]

Or, you could just do: peds-->peds cc fellowship (nixing the gas part).

Peds-cc, while one of the more competitive peds subspec. is actually not that competitive overall (i.e. last year there were more positions offered than applications).

I guess I look at some of the top shops around, and they seem pretty competitive.

About anesthesia medicine, and really, medicine in general, where is the unity I had hoped to see more of to stop all this overstep or at least limit it?

And I agree with IlDestriero, stop making it so darn easy for any BSN with a year of ICU (and now they allow ED, which is good but different--not as intensely looking at the disease processes for a number of reasons) get into these programs. I am pretty disheartened by education in general, b/c it's so much about money and greed as well. With the changes in Congress, is this not a good time to bring these concerns forward?

 

[Mad Jack]

I guess I look at some of the top shops around, and they seem pretty competitive.

About anesthesia medicine, and really, medicine in general, where is the unity I had hoped to see more of to stop all this overstep or at least limit it?

And I agree with IlDestriero, stop making it so darn easy for any BSN with a year of ICU (and now they allow ED, which is good but different for a number of reasons) get into these programs. I am pretty disheartened by education in general, b/c it's so much about money and greed as well. With the changes in Congress, is this not a good time to bring these concerns forward?

Peds-CC doesn't pay near enough to be worth the time invested. It's really not all that competitive at all.

 

[jl lin]

Peds-CC doesn't pay near enough to be worth the time invested. It's really not all that competitive at all.

They seem quite selective at certain hospitals I have worked. And some of those in fellowship have moved on to nice positions elsewhere. But yea. I think you really have to love it. I know I have loved working in it as an RN--after giving up a lot of autonomy doing CC with adults, comparatively speaking.

 

[IlDestriero]

Do tell. How much is enough for 6 years of training.
How many weeks a year are they working in the PICU for that money?
I'm not sure you know what you're talking about here.
Or you have extremely high income expectations.

 

[fancymylotus]

Do tell. How much is enough for 6 years of training.
How many weeks a year are they working in the PICU for that money?
I'm not sure you know what you're talking about here.
Or you have extremely high income expectations.

It's nowhere near etherman monies, I can tell you that. Or the winged scapula shooz monies. Jealous.

 

[jl lin]

Then I saw this:

Average Salary of Jobs with Related Titles
In USD as of Jan 7, 2015 100k 200k 300k
Physician Critical Care Intensivist in Baltimore, MD
$286,000