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Post by katevaughn on Nov 30, 2016 12:07:29 GMT -5
This month's article is presented by Augustine. He has picked a great article concerning CRNA scope of practice laws and whether or not anesthesia complications arise from a certain team delivery model. I think you all will really enjoy this one and look forward to the discussion afterwards! Here is the link to the article. Questions to be encompassed within your response: There is a lot of chatter about the models of anesthesia care and it's efficacy. 1. In your personal opinion do you think that the anesthesia care team model (ACT) is safer than a solo anesthetist practice? Why or why not? 2. There is often practice restrictions during the the student nurse anesthetist residency (Ex: practice restrictions or limitations in training for SRNAs at certain facilities) . In your opinion is a new graduate nurse anesthetist equipped to practice independently right out of school? Why or why not?
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Post by mscotth2 on Dec 1, 2016 11:52:16 GMT -5
Thanks Augustine, great article! This is something we all should be familiar with, especially on the state level as AA legislation is again on the horizon. It is of interest that the only article cited that found an increase in complications with non-medical directed anesthesia was the Silber article written in 2000--and it included far fewer cases (just PA). Interestingly enough, there were no disclosures or conflict of interest statements by the authors. Of course, this article, though stated to have no conflict of interest may be negated by the opponents of the results.
1. In my personal opinion, having an experienced, back up provider is safer. Be it an anesthesiologist or another CRNA, 2 heads/2 sets of hands are better than one. Again, my opinion. 2. As for SRNAs being independent out of school, it depends on their program and their preparation. We have had new graduates that have never placed an arterial or central line on a real, live patient. Other new graduates staffed their own rooms as SRNAs. I think this answer truly depends on SRNA preparation and there is not a universal standard among the 120 some nurse anesthesia programs. That being said, I understand that many residents are told they need to apply to fellowship following residency in order to be prepared to practice.
Happy holidays everyone, Mary
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Post by katevaughn on Dec 6, 2016 12:48:54 GMT -5
Scope20of20Practice20Laws20and20Anesthesia2....pdf (130.85 KB) A couple of people have had trouble downloading the article from the link provided so I have included the link in another form above. If you still have trouble, write me an email and I can forward the article that way. I apologize for the inconvenience!
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Post by krechti1 on Dec 6, 2016 14:33:41 GMT -5
1. I personally prefer to work with an anesthesia care team model. Having worked in many different models, I feel more comfortable having somebody available, if needed, for back up. Especially in the scenario of an unanticipated difficult airway, or unanticipated event (PE, unexpected massive blood loss), I definitely like knowing there are other anesthesia professionals I can call in to help if needed. I agree with Mary that the other provider can be an anesthesiologist or another CRNA.
2. I agree that the education is so variable for SRNA's, depending on their program, that it is hard to give a definitive answer to this question. I think the best programs give their students a chance to experience both environments of working with other CRNA's/ attendings and working solo, with a CRNA/ attending close by, but not in the room at all times. There are some things that you have to learn by working alone, and with somebody always there, you may never learn where you are deficient. I think the programs that allow SRNA's to be on their own for a portion of their training have graduates who are more ready to practice independently right out of school.
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Post by faresha on Dec 11, 2016 18:23:35 GMT -5
1. I prefer ACT because more is better on most days. There are times when I have asked the room staff to assist me with acute unexpected events and this furthers my support that having more anesthesia hands is important.
2. In general, I would say no that a new graduate SRNA should not practice independently. From personal experience, I went to a great CRNA program but that does not mean that I was familiar with every anesthesia situation. I think a solid high-quality education program is better than a skill-oriented training program. It's great when a program is both but most tasks can be learned yet it is much harder to remedy knowledge deficits. I do think some SRNAs are prepared and capable of practicing solo out of school. I think if most CRNAS practiced solo in facilities then CRNA educational programs would shift their focus of teaching to ensure that the majority of new graduates are comfortable with entry to practice as solo providers. However, solo CRNA practice is not the cultural norm.
Faresha Sims
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Post by jhadley on Dec 22, 2016 12:42:29 GMT -5
Interesting article!
1. I also prefer to work as a part of an ACT. I have definitely had a couple scenarios where I've needed an extra set of hands unexpectedly and I'm not sure I would have been able to manage solo.
2. Due to the wide variability in SRNA training, I believe new graduate CRNA's should not be able to practice independently right out of school. I recall vividly the anxiety I felt as a new grad since the majority of my training I had a CRNA in the room readily available to consult with and can not imagine all of a sudden being in a practice where I had no backup. Also, there are skills which I feel can only be developed over time (managing challenging airways, regional, alines, etc.) I also think working as a part of a team out of school allows for learning to continue since you are constantly being exposed to people with different training and abilities.
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Post by faraclarke on Dec 28, 2016 17:45:47 GMT -5
1. I prefer to work in an ACT model because in the case of an emergency there is another anesthesia provider who can assist quickly and efficiently. It can be difficult to delegate tasks to non-anesthesia providers because they are not familiar with anesthesia terms (such as the "APL valve"), the location of anesthesia-specific equipment, and the sequence of airway management. I have found that they do not always identify the urgency of an emergent situation; thus execution may be delayed, interrupted, or slow. In addition, working closely with other providers has the potential to broaden your expertise, particularly in a setting where different providers have differing experiences having been trained in a variety of other facilities and sub-specialties.
2. I believe that there is great benefit to getting solid experience in a setting with an ACT model where a new grad is able to gain confidence, solidify skills, and acquire the experience necessary to be able to confidently handle emergent, rare, or not-previously-experienced situations that may arise while working in independent setting. I believe that patient safety is the most important consideration, and not only is provider with novice experience at more of a disadvantage in an independent setting, so is the entire multi-disciplinary team, and most importantly, the patient.
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