Talk:Certified Registered Nurse Anesthetist (CRNA)

Addition of References

May 23 - This page is undergoing an update with the inclusion of references. Please be patient as the process and research does take some time. Eclipse Anesthesia 15:18, 23 May 2007 (UTC)

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Again this article has been vandalised to reflect certain political view point found only in the US. It is immoral to disrupt the educational function of wikipedia to present a personal angry viewpoint. I appeal to the rest of the Wikipedia community to lock this page from further attacks. In addition, those of you who continue to edit this page anonymously to spread your own vitriol, are cowards.Aestiva 12:19, 26 March 2007 (UTC)

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The Wikipedia Nurse Anesthetist page is an important resource of information and education for the public worldwide. This english edition reflects mainly practice in the United States. Anesthesia practice in United States (and other countries) is provided by both nurse specialists and physicians. Therefore, practice models can be the source of debate among the specialty groups. This can lead to biased or Wiki vandalism on this web page. It is very important that this page remain factual and unbiased to respectfully represent the voice of the of American nurse anesthetists and nurse anesthetist worldwide. Therefore, this page is monitored and edited by representives of the Communications division of the American Association of Nurse Anesthetists. We hope to continue development and expand on the written and photo content, and encourage Wiki community input. Eclipse Anesthesia 21:28, 5 December 2006 (UTC)

It does indeed mainly reflect the US role and this needs to be fixed. It does not need to "represent the voice of the American Association of Nurse Anesthetists (AANA) and nurse anesthetist worldwide", it needs to present the facts, which may or may not be to the AANA's liking. Wikipedia is not a vessel with which to promote this particular professional role, it is a place of information. --John24601 22:50, 9 December 2006 (UTC)

Nurse anesthetist practice on over 100 countries, with very diverse roles and capabilities. It would take tremendous research and countless pages to present. So yes, this page now is focused on the US role, but does provide information on the IFNA. You imply that the AANA does not represent facts. I have studied anesthesia history for 15 years. If there is anything not factual on this page, please provide the details so it can be investigated and corrected. Eclipse Anesthesia 02:54, 14 December 2006 (UTC)

Would someone please provide a reference to CRNA’s being allowed to operate a pain clinic? In my experience I have not encountered this. Additionally the line “CRNAs can administer anesthesia in all types of surgical cases” is a bit misleading because while some states allow for unsupervised CRNA practice no state allows for unlimited practice.Kubed 08:53, 6 January 2007 (UTC) Kubed

Nurse anesthetists do practice in pain clinics, but this is very limited, and those that do practice are with other physicians or an anesthesiologist, or are also certified as a nurse practitioner. Since pain medicine involved diagnosis, invasive procedures and outpatient medical and drug management, this is more in line with the practice of medicine, not CRNA or nursing practice. In respect to the line “CRNAs can administer anesthesia in all types of surgical cases”, this is not misleading, but can be better defined. The limits of CRNA practice are dependent on the hospital's credentialling process and allowed privileges for allied health practitioners. And just like physicians, privileges are based on prior training, certifications and experience. State law does not define this aspect of practice, it defines the extent of collaboration (or supervision) with the surgeon or anesthesiologist (if present). Certainly there are some facilities that limit what a CRNA can and cannot do. However, a majority of rural practices only have CRNAs, and therefore they have previleges to administer anesthesia in all types of surgical cases. I have worked in both rural and in urban medical centers, and have been fully credentialled with no restrictions on the procedure list. Again, it depends on the facility, not with state laws. Eclipse Anesthesia 13:46, 23 January 2007 (UTC)

IN REFERENCE TO "ANESTHESIA CARE TEAM": "Frequently, CRNAs will provide care alongside an anesthesiologist, in what is termed the Anesthesia Care Team. This combines the expertise of both a physician and nurse anesthetist to provide excellent peri-operative care." This statement is misleading because it suggests that anesthesiologists and nurse anesthetists each bring to the "anesthesia care team" a unique form of expertise that works in tandem with the other, and in-turn that the anesthesia care provided by an anesthesiologist without the collaboration of a CRNA is of lesser quality than that provided with the collaboration of a CRNA. This is not the case. It is the anesthesiologist who possesses "expertise" in the science and practice of anesthesia. The CRNA is not, and has never been, considered to possess "expertise" in anesthesia. I recommend that the words "both" and "and a nurse anesthetist" be removed from the above quotation. —Preceding unsigned comment added by 66.109.35.58 (talk) 18:03, 10 November 2008 (UTC)

To state that a CRNA with 2-3 years of advanced post graduate education and whatever years of experience does not have expertise in the very field they practice is ludicrous. —Preceding unsigned comment added by 137.242.1.60 (talk) 13:20, 27 January 2009 (UTC)

CRNAs have nursing degrees. Anesthesiologists have doctoral degrees in medicine. CRNAs spend 2-3 years in CRNA programs, about a year of which is spent taking abridged versions of some of the medical science courses that anesthesiologists took in great deal while in medical school. Similarly, CRNA programs do not provide them with the kind of extensive anesthesia training that anesthesiology residencies provide to medical graduates. This means that CRNAs are not maximally trained in anesthesia. Anesthesiologists are. By virtue of this fact, anesthesiologists have "expert" status. CRNAs do not. —Preceding unsigned comment added by 74.76.164.86 (talk) 08:07, 5 May 2010 (UTC)

reverts

I've just reverted a sequence of edits over the last few days, which have introduced a thread of vitriolic dissatisfaction with the role and made claims as to the safety & legality of nurse anaesthesia and its desirability compared to medical anaesthesia. These arguments are important and should, IMHO, be a central feature of this (and other advanced practice nursing) articles, however in the form they were presented they were not encyclopaedic: they read as anti-nursing rants based on nothing but the opinion of the editor. These are, however, widely held beliefs and it is important they're included, and I'd like to see them back, but preferably with reference to evidence, historical documents and expert opinion, and presented in a more balanced way. --John24601 10:05, 1 April 2007 (UTC)

Thank you. I welcome, and hope we all do as well, the inclusion of other views and opinions when presented properly. F. L. (talk) 01:46, 28 September 2019 (UTC)

This page needs to be better referenced

If we're going to stop the constant editing of this article to reflect certain particular views, then we need to reference this more thoroughly (and to unbiased, third party sources). I don't work in america, so I don't know, for example, whether CRNAs have to work "under" doctors in all states, some states, or no states, but the constant jostling for position between each of the different camps is doing the article no good. Unfortunately, as I don't live or work in america, I have little idea where to start looking for sources, but those editors who hold each of the different opinions on this and other issues might want to point me towards some, or insert some in the article yourselves. We could also do with some comparison in the article somewhere between success rates in nursing & medical anaesthesia, I am aware of a study in the USA by Silber et al published in "Anesthesiology", but ideally we could do with a meta-analysis, which I'll start looking for. This is an important article, and could be very good, but we need to put a stop to the constant bickering! --John24601 06:28, 26 April 2007 (UTC)

Silber has been widely discredited. In fact an editorial in the issue in which it originally appeared took the authors to task for passing off their political posturing as scientific research.

Why, if you don't work in America, should you be so interested in CRNAs or their Wiki article?

deepzCRNA

I have a research interest in advanced nursing practice in the UK, and like to have some wider awareness of what's going on, especially because I am involved with the move for nurse-led anaesthesia in the UK. I don't have detailed knowledge of the Silber paper, I'm merely aware of its existance. I will look into what you said, but that doesn't change the fact that some facts & figures are needed to give credibility to this article. As I've already stated, I don't work in the USA and I don't have a huge deal of knowledge of how the system works, which is why I may not be the best person to do this. --John24601 06:28, 3 May 2007 (UTC)

Have just had a quick look online at the Silber paper, and the contents of the entire edition, and can't see any editorial relating to it in that issue. Can you provide a reference, just to satisfy my curiosity? —The preceding unsigned comment was added by John24601 (talk • contribs) 06:37, 3 May 2007 (UTC).

My guess is that you must have a hard copy to view that editorial. Good luck

deepzCRNA 04:09, 10 May 2007 (UTC)

Re: Silber:

http://www.expertlaw.com/forums/showpost.php?p=77382&postcount=8

deepzCRNA 13:53, 7 May 2007 (UTC)

Well, whilst that's quite interesting, a post on a forum isn't exactly the same thing as an editorial in the journal edition the paper was published in, is it? --John24601 07:08, 8 May 2007 (UTC)

References

The majority of the content comes from two sources. The Communications office of the AANA from which I directly communicate with, and content from my personal resources. I am a history buff of anesthesia and have about 40 antique or collection quality text on anesthesia. I also have many old journals and documents. Included in my collection is Thatcher's History of Anesthesia, Roberson's Victory of Pain, Echenhoff's Anesthesia from Colonial Times, Key's History of Surgical Anesthesia, and the more recent Bankert's Watchful Care. All the information on the Wikipedia page come from these various sources that are considered credible and authoritative. Eclipse Anesthesia 15:41, 8 May 2007 (UTC)

That's great, but I think they each need to be individually referenced so that other users may go and read them themselves if they wish, to verify the claims. --John24601 15:50, 8 May 2007 (UTC)

This is something I want to start working on. However, most of these books are rare and out of print, making it difficult for someone to verify. I really don't know why anyone would go through all the effort to verify the claims. The word "claims" implies the possiblity of misleading text. I find this rather insulting. As I maintain and edit this page, I present the facts according to current practice and facts on history directly obtained from these authoritative sources. Eclipse Anesthesia 20:23, 12 May 2007 (UTC)

I'm sure you're quite right in what you're saying, but the fact remains that it is wikipedia policy to cite claims in articles (see WP:V. And if you are synthesising things from a number of primary sources, then are you maybe not doing original research? Wikipedia needs not only to be transparent and unbiased, but needs to be seen to be so, and the best way to do this is to be as open as we can about where information came from :) --John24601 18:16, 13 May 2007 (UTC)

External links providing consumer information need not conform to everyone's chosen political viewpoint.

deepzCRNA 12:11, 1 September 2007 (UTC)

This article has a large number of references from a few sources, sources whose purpose it to promote crnas. Quotes used in the article include weasel words and the article reads in places like a addvertising brochure. I would like to see that cleaned up, I'm going to go through and add some other sources, and remove some of the weasel words. My first impression is that there is an ownership issue here, too, but I hope that is not the case. Fuzbaby (talk) 19:11, 14 June 2009 (UTC)

Apparently there is an ownership issue here; this article needs to be more balanced. After checking references several sentences have statements that are not in the source, or are synthesis. Other sections are slanted to infer factual errors (for instance, leaving out basic history of anesthesia by refusing to include any history not specific to nurses to infer that there was no other history). Some info in unencyclopedic (like the burial place of some early nurses). Info that is not glamorous, like the fact that early anesthesia was considered technician work, is left out. The article has numerous weasil words and needs some style work (for instance, there is no point in saying something was excellent, or authorative...use the article to tell people that if its true instead, if its not...then...). I'm not an expert in anesthesia, but I know enough to know that some of this article is well done, and hidden within it is a lot of pov and unbalanced writing, which makes it worse than a simply poorly done article. Fuzbaby (talk) 01:37, 15 June 2009 (UTC)

I have since cleaned up your edits as an expert in Nurse Anesthesia, its history and its legal challenges. Mmackinnon (talk) 03:06, 16 June 2009 (UTC)

As mentioned on your talk page, I'll be fixing your obvious pov in the article. I admit that you are an "expert" voicepiece for the AANA, but perhaps if you read the references you use you will understand that they don't support the text and in some cases directly contradict your opinions as you've written them in the article. I'm going to make some changes and list each one in the talk page as to why it needs to be changed. Fuzbaby (talk) 18:39, 20 June 2009 (UTC)

Cleanup

I've cleaned up the external links in this article and moved links from the body to the external links section where they should be. Also added some tags for areas that needed fixes. I reworded one sentence so that it could be included without a reference. I've also created a page for the AANA, and it looks like some of the content from this article could be ported to their and removed from this page so to remove the worldview tag; also the numerous references to the AANA should be decreased to 1 or 2, or perhaps moved to a section called nurse anesthesia in the United States. Fuzbaby (talk) 04:24, 3 July 2009 (UTC)

I'm having a hard time finding the referenced legal challenges; the two I have found don't seem to support the text, at least not as written. Anyone find the text from the earliest case? I might have to see if my lexusnexus subscription still works...Fuzbaby (talk) 03:34, 21 July 2009 (UTC)

I don't understand your conclusions. The cases mentioned in the legal paragraph are described in detail by Bankert and Garde. In addition, Blumenreich specifically explains the overlap of nursing/medical functions. --Eclipse Anesthesia (talk) 00:36, 24 July 2009 (UTC)

Well, my conclusions come from reading the actual cases. Try that, and you will see what the problem is. My only problem is I can't find the text of the earliest case, the other two are available online.Fuzbaby (talk) 03:13, 24 July 2009 (UTC)

So you are saying that the many articles, book chapters, etc., that I have read over the years concerning these cases misreported the outcome (actually found CRNA practice illegal)? To be honest, I have not read the actual court proceedings. Perhaps you could elaborate on the actual findings and put all these authors to shame. BTY, the Hodgins and Crile case is well documented in Thatcher and Bankert, but it was a dispute with the state medical board. So I don't believe you will find original documents. However, I'm sure you have many good resources through the Mayo system. Additionally, Thatcher and Bankert are well referenced, and you could data mine to find original sources.--Eclipse Anesthesia (talk) 13:56, 24 July 2009 (UTC)

As the (self declared) expert in the field I'm sure you did your homework before you added the information to the article. And certainly, even if you did read the primary sources you wouldn't put your own personal bias into how you decided to represent them here. I'm sure thats not the case. But to be specific with some inconsistencies, Frank v. South states "the mere giving of medicines which are prescribed by a physician in charge who has made a diagnosis and determined the disease and determined the remedy and directs the manner and the time and the character of the medicines to be administered, has never been considered engaging in the practice of medicine" and then later "to determine when the medicine should be given requires the exercise of some degree of judgment by a nurse" in general supports the idea that a nurse giving anesthesia while working with a surgeon is not the practice of medicine, but of nursing, and is acting by the direction of the surgeon who is overseeing the operation. Others, like Magi v. Board of Medical Examiners, state: "licensed registered nurse should not be restrained from administering general anesthetics in connection with operations under the immediate direction and supervision of the operating surgeon and his assistants". Chalmers v. Francis: "nurses in the surgery during the preparation for and progress of an operation are not diagnosing or prescribing within the meaning of the Medical Practice Act". "The case law further demonstrates that the nurse anesthetist at all times operates under the supervision and direction of a physician". What I take from this is that the law has in general favored anesthesia as both a nursing and a medicine function, and when it is a nursing function it is as an extension of the physician who schedules the surgery/anesthesia or the physician in the room (surgeon) while it is being given. The article as is tries very hard to leave out the full story and in describing the legal challenges of the past only tells 1/2 of the reasoning given by the courts. I don't, however, think that its necessarily a major issue with the article, perhaps a few minor wording changes will make it to faithfully represent the sources listed. Fuzbaby (talk) 00:29, 27 July 2009 (UTC)

I don't believe I ever called myself the expert. More of a hobbiest with a large library. The definition of an expert is one who comes from out of town and brings his own slides. I look forward to your "wording changes."--Eclipse Anesthesia (talk) 19:38, 27 July 2009 (UTC)

I've added a few lines about independent practice of CRNAs to the "scope of practice" session. This focuses on indepdent practice, because it is the most interesting fact about CRNAs that is not well-known to the public. --JadamR15 (talk) 00:55, 24 August 2010 (UTC)

I've fixed a few of your erroneous assertions about independent practice under the scope of practice section. As a physician, it's sad for me to see that the only way to truly solve this otherwise self-evident debate about the inappropriateness of independent practice is for CRNAs to kill a few patients without MD intervention that otherwise would not have died. Hubris has such a price. —Preceding unsigned comment added by 67.117.89.242 (talk) 03:55, 4 February 2011 (UTC)

Please refrain from adding unsourced material as you have REPEATEDLY done. jsfouche ☽☾Talk 20:41, 5 February 2011 (UTC)

protection request

Not done: {{edit semi-protected}} is not required for edits to semi-protected, unprotected pages, or pending changes protected pages. Also, no edit request details were provided.

• Please note that, if you were, instead, attempting to request page protection, you need to do that at this noticeboard: WP:RFPP. Thanks Begoon ^talk 01:26, 5 March 2012 (UTC)

Something ought to be done, this article gets vandalized pretty frequently and I would expect the vandalism to only get worse over the next few months and years. | pulmonological ^{talk • contribs} 12:33, 12 February 2013 (UTC)

I can see the theoretical concern given the state of anesthesia politics. I am a nurse anesthetist and will try and check this page more often for incidents of vandalism. F. L. (talk) 01:41, 28 September 2019 (UTC)

I can see the theoretical concern given the state of anesthesia politics. I am a nurse anesthetist and will try and check this page more often for incidents of vandalism. F. L. (talk) 01:41, 28 September 2019 (UTC)

International Scope

There's been some complaints that this article mainly deals with the position of CRNA inside the US. CRNA is a designation that only exists inside of the United States, with nurse anesthetists having education, certification, and designations specific to the US. I think it would be appropriate to spin off this information into its own article out of "Nurse Anesthetists" into "Certified Registered Nurse Anesthetist". This article can still house the general term and link to CRNA as its own specific designation (which it is). — Preceding unsigned comment added by Nowhereman86 (talk • contribs) 01:23, September 14, 2018 (UTC)

New Page

Due to the unique nature of this profession in the United States, we're moving all of the information specific to CRNA to it's own dedicated page. This page will now focus on the blanket term of "Nurse Anesthetist" with summaries about the international variances between the profession