6 thoughts on “The DNAP Debate Continues”

1. At last a real time frame for when this will happen. I am one one of the last of the grandfathered diploma prepared CRNA’s. I am one of those day to day people who encouraged students to keep on with there education and be the best CRNA that they can. But I am appalled at the cost in time and money for these kids. What will the cost be by then? How many years will the CRNA of 2055 have to work to pay off the debt? Traditionally nursing and specialty salaries have not returned much if anything on the dollar. Salaries now are stagnant- look at Gas works. The ACA is going to force more cut backs in health care at a time when we are asking our new generation to invest thousands more dollars and 8 or more years to become a CRNA. Is it going to be possible? I should be including all advanced nurse practitioners in this statement because all are affected. Also where will the money come from for all these loans. Hospitals and anesthesia groups are probably not going to take on this debt. If they do will new CRNA’s become like indentured servants, paying back years in their careers for loan forgiveness?

   I want nurse anesthesia at the forefront of any change in our practice, not being dragged along behind nursing academia and caught up in their schemes.

2. Bonnie— I appreciate your comments. Education has indeed skyrocketed since I started my CRNA program in ’83.In ’87 I went back at night to SJU to finish my MS in nurse anesthesia so that I wouldn’t get caught in the predicament of not being able to move to a different state or job. The world has changed,standards and demands have changed and we are being dragged into the new century like it or not. I recently got my DNAP at VCU and am very glad that I did because it helped me to refresh my writing skills and teaching with power point and also my research skills. If we want to keep up with what the world demands of us then we have to do it. Likewise I think that the coming trend of having us write new boards is a little ridiculous especially if you have been in the field for more than 30 years. But the new board is now independent and they want to stretch their wings and create new standards.

   The AANA board will have some say in this to keep it realistic. But yes this is getting very expensive and will cut down on the number of new graduate CRNA’s and will in fact be difficult to pay off. However we will probably be regarded in a new and better light when being compared with new graduate residents in an age where new socialized medicine brings millions of new patients to be seen and handled. Can the MD’s really justify their control when they can’t prove better outcomes, when many crna’s have handled cases alone in the back country and in the military?

3. I have only a few years to work so most of this discussion is moot for me. Many other CRNA’s will no doubt retire before most of the new stuff is in place.Hospitals now are trying to force staff nurses to all have MSN degrees now so what the ANA could not do the workplace is attempting. I believe in education. It is the only way to be independent but also to force a system that has been working to change for change itself usually backfires or costs too much to sustain itself in the long term it implodes. Those millions of people coming into the health system will not have ARNP’s or PA’s to care for them because I believe that the pool of young men and women that would have entered nursing and PA programs will turn to other careers that offer more return for the cost. It has already been seen in staff nursing. The top students that used to enter nursing are gone. Now its the third or fourth tier of HS grads. Also many nursing grad leave the profession completely within the first years.
   It’s no fluke that nursing is a graying profession. Look in most ORs outside of large cities. I am the oldest in my hospital’s OR but most of the nurses I work with are over 45-50 +

   You hope that we will be regarded in a new and better light. I hope so too because right now there are a slew of legal actions, bills to limit ARNP practice and smear campaigns out there too confuse the public, discredit our education and abilities, and take control of boards of nursing. Membership, voting and donations are down in nursing organizations not in the least because of the economy, but also because nurses feel that their organizations are out of touch with the reality of every dday practice. I have heard several nurse say, “you hafta be rich or have a rich hubby to run for office,” or, ” they don’t care about us just their______.”

   I keep saying more and more that I am glad that I am nearing the end of my career. I dearly have loved being an anesthetist. Seen lots of change. We adapt to change and we have always made the most of what has been thrown our way but in a continually more restrictive practice arena can we continue to do this?

4. Bonnie– In some ways you may be right however; the world has gotten more complex. where a Bachelors degree was once a sign of sophistication or success, it is now just a modest bump along the way. You may have way more experience than many of your young colleagues and may be better at administering anesthesia but you yourself said that you’re ready to retire and enjoy what you have built up and set aside. Maybe I am hyperactive in terms of my love of coupling education and experience, but that is my road and I enjoy the teaching aspect as well.

   Yes it is and always will be a fight with the other provider group(s) but we are making headway. In 1896 the MD’s had only about 6months of college and the rest was experiential training. some of the residents coming out of their residency want to be anointed by all. It is changing. To make it change you need credentials and you need qualified teachers to teach the new SRNA’s. There is new knowledge and lots of technology and yes we can do a lot more than when we started out in the day.

   Unfortunately; see the writing on the wall. Change with it, be ahead of the curve or get crushed by the wheels of progress. It is a whole lot more difficult to get into anesthesia school than ever before and yes there will still be candidates busting down the doors. You are still ahead of millions who would like to be in your shoes and it won’t get any easier. Yes other groups will still try and eat your lunch. The world is demanding more credentials etc etc.

5. Edward, I agree with all you say about the world, technology, and education. We need to be educated in our field but not at the expense of losing site of the capabilities and subversiveness of some of the other players.

   You may have missed my point.

   Until the public perceives us as the skilled, competent, educated practitioners that we are, all the education in the world means nothing. It means all the world to us, but in the public’s eye we are nurses and “there to help the doctor.” It is demeaning to explain over and over who and what we are and what we can do.

   Until we achieve parity we will continue to strive as individuals and as an association to meet the changes that the world throws at us. We as practitioners and as an association play catch up more often than not (bills to restrict practice come up more often than bills to widen our scope of practice, or the creation of the AA). I wanted to teach but theI n realized that I did not have the patience for academia. I stayed in the OR and have been happy for over 3 decades. It is just time for the older generation to become mentors and pass on our skills and lessons learned in the field rather than a book.

6. Bonnie– I agree with you! You are a valuable resource and I hope that you are around working and teaching in the OR to the young students for a long time so that they wil benefit from your knowledge and expertise. Sometimes you just can’t learn the process and the decision making, and the techniques from a book. Us old timers are valuable to the younger folks in many ways. I also agree that it is a struggle against the other provider groups who tend to denigrate our value and ability and flood the market with nonsense by shortchanging our abilities but using us while they sit back and watch TV while we work. The public needs to become acquainted with the value of CRNA’s who have worked for years in both the private and public sector and the military and the back underserved areas of America where CRNA’s have worked long and hard hours to bring anesthesia care and labor and delivery services to the poor and underserved. We need people like you to keep up the fight and raise your voice so that the public will learn of the value of the CRNA as a practitioner!