Talk:Certified registered nurse anesthetist

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There is a move discussion in progress on Talk:Crna which affects this page. Please participate on that page and not in this talk page section. Thank you. —RMCD bot 17:31, 1 August 2019 (UTC)

Page Introduction Edits

Addressing the edits that have been made to the introduction:

• Most CRNA education programs currently issue master's degrees in nursing.[1] Beginning in 2025, all CRNA schools will transition to issuing doctoral degrees in nursing."

There's no link providing what percentage of CRNA programs are currently doctorate or masters. In addition the link provided doesn't even give information on the requirements for education. I reverted the sentence and placed a reference from the council on accreditation, which clearly states, "All U.S. nurse anesthesia educational programs are at the Master’s or Doctoral degree level and therefore require a Baccalaureate Degree for entry."

• At the time, mortality was so high that over 1 in 4 patients died.[2] In 1938, the development of anesthesiology as a medical specialty paved the way for safe oversight of nurse anesthetists, allowing for the CRNA credential to come into existence in 1956.[3]"

This sentence is written in such a way that it insinuates CRNAs were either the cause of high mortality for surgery or that mortality was so high no one cared who gave anesthesia. Also, placing mortality figures then writing a sentence saying that the founding of anesthesiology as a medical specialty 70 years led to the CRNA title coming into existence makes it seem like CRNAs were dangerous and needed oversight. The first citation given actually states that there were only 43 related anesthesia deaths in the 80,000 surgery cases during the US Civil War, in direct contradiction to the statement of the author. The second citation, is from the AANA and lists nothing about MD anesthesiologists, the safety of anesthesia providers prior to 1956, or anything about the anesthesiology medical qualification "allowing" for the CRNA credential to exist.

• "Complete autonomy in this case means that liability is simply shifted from the anesthesiologist to the surgeon, due to the captain of the ship doctrine. In other words, oversight of anesthesia shifts from a physician specialized in administering anesthesia to a physician with no training in administering anesthesia. The American Academy of Nurse Anesthetists states that this is completely safe. "

This entire paragraph is misleading and false. Not only is none of this information cited, but it stands in direct contrast to the researched information in the original paragraph, which has information from the AANA, JCHAO and two lengthy legal briefings from the legal council of the AANA about liability in the operating room that directly contradicts the information being put forth in this paragraph.

Introductory Paragraph

I think the information about the size of the profession and the SOP summary should stay at the head of the page because it's a piece of information that delineates the profession from anesthesiologists (ie, it's limitations in the law and its prevalence). The SOP is usually something that is very blurry and a concise summary helps define the profession better.

Demographics

If we're introducing CRNAs in general, it doesn't make sense to say that CRNAs are 40% male in my opinion. Makes a lot more sense to say what the most common demographics are (60% female). KhanzotChinev (talk) 15:20, 18 April 2021 (UTC)

Or we can just take it out since (1) we can't agree on its composition and (2) no other healthcare worker page on wikipedia has sex or race demographics in its introductory paragraph. - ???

Agreed, I don't know why it was there in the first place. KhanzotChinev (talk) 15:48, 18 April 2021 (UTC)

Use of mid-level provider

Mid-level provider is literally the phrase used by CMS. It' snot derogatory to use specific language, and in fact it supports patient autonomy. Non-physician practitioner is another one used in CMS. I think I'll add it as well. KhanzotChinev (talk) 19:42, 17 April 2021 (UTC)

Liability

KhanzotChinev a surgeon being held responsible for an adverse outcome in the OR is not the same as the legal liability of the profession. That being said a single case does not mean that (1) it's a legal precedent or (2) that it delineates liability for CRNAs (or any profession) in the OR versus the surgeon. Here are a few of the MANY cases where an adverse outcome at the hand of an anesthesiologist lead to lawsuits against the surgeon:

• – Chism v. Campbell, 250 Neb. 921
• - Herrington v. Hiller, 883 F.2d 411
• - Dunn v. Maras, 182 Ariz. 412, 897 P.2d 714
• - Adams v Childrens Mercy Hospital, 848 SW 2d535
• - Costell v Toledo Hospital, 98 Ohio App.3d586
• - Ruby Jones v Neuroscience Associates, Inc., 250Kan. 477, 827 P.2d 51 (1992)
• - Seneris v Haas, 45 Cal. 2d 811, 291 P.2d 915(California, 1955)
• - Szabo v Bryn Mawr Hospital, 432 Pa. Super.409, 638 A. 2d 1004, (1994)
• - Tiburzio-Kelly v Montgomery, 452 Pa. Super.158, 681 A. 2d 757 (1996)
• - Robertson v Hospital Corporation of America,653 So. 2d 1265 (Court of Appeal of Louisiana,1995)
• - Kerber v Sarles, 542 NYS 2d 94, 151 Ad.2d1031, (New York, 1989)
• - Brown v Bozorgi, 234 Ill. App. 3d 972, 602NE 2d 48, (1992)

That last case (Brown v Bozorgi) is almost an exact mirror of the source you provided, except it was an anesthesiologist who botched the intubation and the surgeon was sued.

I only read the case you highlighted - Brown v Bozorgi. The surgeon was sued but not held liable. The judge and jury ruled in favor of the surgeon. If you could highlight any cases where the surgeon was actually held liable, I would be willing to investigate. Also, if you could sign your posts with four tildes (~) it would be helpful. KhanzotChinev (talk) 23:29, 18 April 2021 (UTC)

KhanzotChinev here are some cases where the surgeon is held liable for the actions of an anesthesiologist:

* Schneider v. A. EINSTEIN MED. CTR., ETC. 257 Pa. Superior Ct. 348 (1978) - Anesthesiologist unable to secure an airway on a patient in a timely manner. Surgeon and anesthesiologist both held liable for patients cardiovascular collapse.

* Rockwell v. Kaplan, 404 Pa. 574 (1961) - Anesthesiologist injects Sodium Thiopental intra-arterially. Surgeon and anesthesiologist both held liable for patients arm amputation.

* Menzie v. Windham Community Memorial Hosp., 774 F. Supp. 91 (D. Conn. 1991) - Anesthesiologist administers a spinal anesthetic and doesn't treat the profound hypotension. Both the surgeon and anesthesiologist are held liable for patients anoxic brain injury.

* Adams v Childrens Mercy Hospital, 848 SW 2d535 - Anesthesiologist and resident extubate patient that was in fluid overload and patient codes. Surgeon held partially liable.

There's many more. There's also instances where other physicians who aren't anesthesiologists make mistakes and the surgeon is vicariously held liable. In contrast here are some cases where the CRNA made a mistake and supervising practitioner was not held liable:

* Baird v Sickler, 69 Ohio St.2d 652 (1982)

* Foster v Englewood Hospital, 19 III.App3d 1055 (1974)

* McCullough v Bethany Medical Center, 235 Kan. 732 (1984)

* Elizondo v Tavarex, 596 S. w2d 667 (Texas, 1980)

There are many of these cases as well. The point is that the principles governing the liability of a surgeon working with a CRNA are the same as those governing an anesthesiologist. Courts do not look at the status of the anesthesia administrator but the degree of control the surgeon exercises over the manner in which the administrator - MD or CRNA - provides anesthesia.Nowhereman86 (talk) 16:20, 19 April 2021 (UTC)

Thank you for signing. I will be sure to read through at least some of these and tell you what I think. KhanzotChinev (talk) 21:23, 19 April 2021 (UTC)

List of lawsuits

KhanzotChinev I'm curious as to why you think a list of lawsuits brought against individual providers is an appropriate edit for this page. I just find it interesting that no other healthcare professional page (NPs, PAs, AAs, Midwifes, Dentists, Physicians, Anesthesiologists for that matter) provides anything like this on their page...yet you feel the need to add it here. Do you think there are not malpractice lawsuits brought against these professions? Is there a specific reason you believe they need to be listed on this page and no other healthcare profession? If so, what are your reasons?Nowhereman86 (talk) 22:56, 11 June 2021 (UTC)

Wiki Education assignment: Technical and Scientific Communication

This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 August 2022 and 9 December 2022. Further details are available on the course page. Student editor(s): Nneiman1 (article contribs).

— Assignment last updated by Khinsonycp (talk) 15:23, 21 September 2022 (UTC)

Some other things that I would contribute to this article would be areas on safety of anesthesia and specific things that can contribute to the safety of treatments provided by CRNA's as well as how proper education can contribute to a CRNA providing a patient with safe treatments. — Preceding unsigned comment added by Nneiman1 (talk • contribs) 15:43, 3 October 2022 (UTC)

Cost Effectiveness Section

Section seems overly important when considering that it is entire citation is a single study with methedologic issues. The paper didn't even vaguely guesture at issues such as complexity of cases, subspecialty anesthesia, safety comparisons, or conflicts of interests of it's authors. Is it wise to devote an entire section to this one citation? Or should it be condensed into a sentence or two in a different section, assuming anyone believes this one paper alone warrants such a bold claim? Are there other studies or prospectives that further back this claim? 45.47.122.48 (talk) 03:48, 5 December 2022 (UTC)

Move discussion in progress

There is a move discussion in progress on Talk:Certified Anesthesia Technician which affects this page. Please participate on that page and not in this talk page section. Thank you. —RMCD bot 03:03, 15 May 2023 (UTC)