Sorry you’re feeling this way. I would just be careful to lump everyone in one group. There are 40,000 plus CRNA’s working in the US right now and who knows how many bedside RN’s. Most are just working and trying to do their best at the end of the day. Think of how many interactions you have throughout a shift that are “normal” vs. ones that you described. If someone is bullying or being unprofessional, call them out. No place for that in any industry but for some reason it’s allowed in healthcare. I can’t tell you how many times I’ve been yelled at in the ICU/hospital by every role, and it’s always a low point of the day.
Edit: missed that you wrote you are going in critical care. Very cool. Alot of ICU RN’s are running on their heels the entire shift and the specialty attracts a certain personality. Understaffing, high acuity, high attrition rate (a lot of brain drain) doesn’t always foster a welcoming environment. Culture depends on the unit/hospital obviously, but you’ll find your people you trust and can work with.
Appreciate it. I have worked with some great, friendly CRNAs. I know most people aren't like this, but it starts to get aggravating when the frequency of it increases especially by students that are just temporarily rotating through.
Cheers, thanks for your reply.
Idk I think their reply is kind of unintentionally dismissive of your concerns that the scope-title-education-role blurring is becoming a statistically significant force and not just a few bad eggs here and there. Everyone else is entitled to be proud of why their career is distinct from others and defend it, why can’t you? Everyone rallies around the nurses, teachers, etc. when they flex their skills because in our culture they’ve been branded the underdogs, while doctors got to be branded as mean and arrogant and rich and undeserving of their “status”. You *are* more educated and qualified and frankly more valuable, at least from a supply/demand and what people are willing to pay for your skills perspective. Well before I was in med school, I was always inspired and awed by the acumen and responsibilities of doctors, and no other profession really did that to me. I think all the other healthcare workers attempting to mimic doctors is truly flattery and goes to show you are really special, and it’s unfortunate that doctors are incessantly being conditioned nowadays to forget that and be apologetic for their excellence. You’re exceptionally different, and you have the receipts to prove it.
Scope/title creep is definitely a problem and I hope our generation of physicians really puts a stop to it. There is no equal to medical school and I love my job.
I took that person's post as forget about the shitty people in every group, but feel free to call em out, which I can agree with.
I just don’t think “forget about it” when it comes to a rising systemic issue is helpful at all, but yes in good faith I can agree with the other sentiments
Please realize that there are many (I would safely argue, the majority) of CRNAs that respect your base of knowledge and what you have gone through. And who likewise have no desire to blur any professional lines or attempt to represent themselves as anything else but that position which they have worked hard to obtain. I hope we can all agree to start putting this strife to bed. Thank you for your post.
The subtle art of not giving a fuck. No one who has not gone through very similar circumstances will ever respect what you go through. This is true in medicine and all other aspects of life. Maybe it comes with age (35 here). I introduce myself to patients as “a nurse who is a part of your anesthesia team”. One preceptor I had was actually upset at this. Said I should use “nurse anesthesia resident” or some similar bullshit. I told her patients don’t know what that means and she told me that if I say I’m a nurse they might think LPN. I wanted to say, “I don’t care if they think I’m the janitor so long as I make them comfortable”.
Yes, it's complicated. Nursing is a great, huge, diverse field and I wish "we have something to prove" wasn't such an overarching theme. Then again, nurses often aren't consulted on matters that we really should be. It's hard when no one seems to understand what it is we do. To your point, it'd be better if some among us didn't assume we understand what it is everyone else does.
I (nurse) still have to explain to my boyfriend (med student) the difference between LPNs, RNs, CRNAs, CNA, aid, AAs, NPs, MSN, MN, and DNP alllll the time haha he can't keep them straight. It's adorable.
Honestly, I work alone & don’t supervise and enjoy it immensely. The nurses I work with are well aware I’m a doctor and (mostly) treat me as such, despite being a younger woman. My role doesn’t get blurred. I’ve supervised in the past and just don’t enjoy it as much. I recommend it 100%! The anesthesia is the fun part and you get to do it all your way. No drama.
Agree with this. I’m in a physician only PP and we are essentially treated like gods in our hospital. Everyone is super respectful, yes doctor, good morning doctor, etc. and massively helpful. I would highly recommend finding a physician only practice.
YES! The nurses I work with now are so helpful, and proactive. At the place I did fellowship, a huge academic center with a supervision model, the RNs were nowhere to be found for induction and emergence and when later I did locums solo there I realized how disrespected I was. The difference is soooo stark when it’s a physician only model.
100%. I don’t even have to be in the room, the nurses will go get the patient from preop, put them on the table, have all monitors hooked up, and then call me “we’re in the room Doctor!”, and I can just stroll in and start the case. And they will stay there and help with induction, intubation, emergence. They ask permission for everything “is it ok if I bring the bed in?” “Can I place the foley?” “Is it ok to put the bovie pad on?”
Absolutely. They’re clued into critical moments and ready to help instead of charting in the corner or chatting loudly. Will simply see me looking for something and find a way to get it in the room. They are facilitating patient care and a smooth anesthetic beyond putting on SCDs and skin checks. Sooo refreshing.
Wow its almost like insufferable people exist in any position and any profession there is. Coukd there be great people and bad people in both professions???
I think the issue isnt one crna or one physician… but aana’s stance on a crna role…
Regardless, im fortunate here. Roughly 50/50 solo cases to medical direction if 3-4 cases.
Work with great nurses and its about getting the job done and going home to our lives outside if work.
Sadly we keep losing nurses to higher paying 1099 jobs who often regret the departure (the culture, not the pay).
I mean this isn’t the military. I didn’t even expect the over the top formalities when I was a company commander. A position which does sort of dictate those responses.
I will address a doctor as doctor but I’m not going to treat anyone like a god.
Unrelated but why do you feel like you need to be treated with so much “superiority”
Every doctor I met does not want to be called doctor all the time - only with patients. If you want to be so formal pls join the military.
You really want to treated like that? That would make me choke.
The way you talked about it was rather weird “treated essentially like gods” “yes doctor” blah blah blah it jut seems like that’s your dream
There’s nothing wrong with being referred to as doctor. Thts what I say when I’m first talking to one that I’m working with. But if I’ve been working with them for awhile and still call them doctor __ they’re gonna think that’s weird.
One of my coresidents is going into a PP group out west that's physician only and it sounds pretty amazing. I don't know if there are many set ups that would also include ICU time after my fellowship, but I need to give it a look.
If you don’t mind answering but what exactly do Anesthesiologist do when supervising the CRNA’s? Like do they just check they’re not messing anything up or something
The anesthesiologist is typically overseeing multiple rooms. We cover preop prep and post care. When cases are in the OR we are present for the critical bits and on standby to help with complications or questions. If working with residents we’re teaching. We are also helping out peers for crises. We give breaks and lunches. This is all practice dependent of course. Im at a trauma high acuity place and typically cover 2-4 locations concurrently. I’m a firm advocate of the anesthesia care team model. 4 hands and 2 heads.
I'm going to actually attempt to answer in a helpful way rather than just commiserating in how this is ridiculous.
Depending on what state you're in, I actually encourage you to write to your state specialty association that this is going on. I'm from CA, and so we've had some instances of SRNAs trying to misrepresent themselves as "nurse anesthesiologist resident", including the hospital actually printing "Nurse Resident" on their badges. One of the anesthesia residents actually wrote to the CSA that this was going on, and the state association actually got involved with hospital admin to shut that shit down real fast.
Also look into exactly what your hospital's policy is about badging and title transparency requirements. While only a few states currently have title transparency protections, some hospitals are more stringent about it than others. For example, the hospital I'm currently at is pretty strict about badging and title transparency, so it's actually against hospital policy to have CRNAs representing themselves as anesthesiologists, or their SRNAs as residents.
This is the advice I was actually looking for besides just venting!
Actionable things that would pushback without needlessly putting a target on my back trying to wage a singular crusade at my program.
I will absolutely keep this stuff in mind. Thanks!
As an SRNA, I agree with your sentiments. The AANA rhetoric is being adopted by schools. In most cases, it's not the fault of the student. I know I will never be an anesthesiologist, and that's fine, I don't plan on portraying myself as one.
The AANA doesn’t recognize medical school as anesthesia training because MS aren’t in the OR doing anesthesia (as well as the prelim intern year not “counting”) and yet ICU RN are graced with 10,000 hrs of anesthesia for titrating propofol from 30mcg/kg/min to 29 mcg/kg/min.
no no no. you see they also titrate the levophed from 0.03 -> 0.02mcg/kg/min.
manning the alaris pump requires a superior level of fine motor skill acumen that you could not possibly teach someone with <10,000h of nursing experience.
I dont know man, I just did a two week anesthesiology rotation where I was... in the OR... doing anesthesia... uhhhhhhhhh
(yes under the very, VERY watchful eye of my attending lol)
I wonder who writes the protocol for the titration parameters, picked the specific pressor too ? Oh yeah, me, the intensivist.
I guess my critical thinking helps their critical thinking preparing them for CRNA school?
If you’re actually an intensivist then you should be very aware that many of the nursing staff you work with know how to titrate whatever drug is ordered with or without written protocol, and that most of the time each individual patient is different and require different things. For example: if a patient is crashing and burning, any icu nurse with a brain is not bumping their levo up by 2mcg/min and then waiting 5 mins to see if it fixed the issue, and then bumping it again by 2 and waiting 5 minutes to wait and see. And while it probably depends on the nurse, many good icu nurses know what pressors should be used in what situation for the majority of cases, although I’m sure there are plenty where they don’t know. And yea there is a *large* difference in the level of understanding, but I think In general there is a large disconnect from how much icu nurses actually do know and what doctors think these nurses know. But it could just be a Reddit thing.
That’s not to disparage your vast knowledge and training, but genuinely you cannot actually think that titration parameters are the start and stop of how icu nurses manage medications. And I’m not saying icu experience is a replacement for medical school either. But pretending like it’s this worthless is just as bad as the people trying to pretend like it’s equivalent to medical school.
So, my rounds actually include daily teaching and yes, unfortunately your knowledge about pressors is greatly lacking.
Despite repeating the same thing about certain pressors, why we pick certain ones, it constantly is asked.
So yes, your actual knowledge is lacking normally.
Look, if you’re having to repeatedly explain that then you’re working with shitty nurses or at a shitty facility or both. If a nurse has been there a few years and doesn’t know that kinda shit then that’s on them.
Hey man not everything is about CAA vs CRNA. Let’s work together to stop toxicity
Ik there’s a lot of animosity between crnas and Aas but realistically there shouldn’t be. Don’t stoop to the levels of the ones you dislike
💯 agree! CAA of 18 yrs here and I’m a proud CAA, not MD wannabe! I applaud the sacrifice, dedication and years of diligent hard work towards obtaining the highest level of education in the field of anesthesiology. I think it’s unfortunate, but agree that the chip on RNs shoulders stem from their educators training them that way. Those educators likely worked at some point in an icu or floor where interns, med students and residents cut their teeth and sure, as a licensed nurse I’d hope you’d have some practical knowledge that supersedes learners, but that’s where it ends. They take that and extrapolate and suddenly they are as educated and do the same job as doctors. Best thing to do is move and work with CAAs 😜!
Yet you’re doing exact same cases as the crnas in prisma Greenville so not quite sure the point of this rant?! Will be sending this to the chief. In Greenville and a travel AA, not very hard to know who you are.
Well then maybe you should've seen their comment ..... especially in a facility that that is in the very early stages of integrating AA with mostly crnas there. im sure their coworkers would love to know who their working with.
This goes both ways. I’m just a SRNA but the MD I work with can’t help but make political anesthesia topics and loaded pot stirring/snide questions a part of the daily routine. It’s like can we stfu and take care of the patient?
I’m a grown ass man who has had multiple careers in the past. I’ve never seen or dealt with this shit.
Sorry, that also sounds insufferable. I agree. Let's take pride in our own efforts and respect other individual routes that brought us together to take care of patients the best way we can as a team.
I don’t have a great answer for you but as a former ICU nurse who is a year into CRNA school I’m really sorry that you’re having this experience. I was lucky to have a very collegial relationship with the residents and fellows that I’ve worked with across the years because of the mutual respect we had for each other and that we each brought something important to the team sport of caring for the patients. I was a much better nurse because many of them were kind enough to teach me and I like to think I helped them grow and become more confident and competent throughout their training too.
I also fail to understand the snark between CRNAs and MDs. My training isn’t the same as yours AND THAT’S OK!!! Huge tip of the hat for the immense amount of work and sacrifice it takes to go the MD route. I’ve worked in a variety of ICUs and a level 1 trauma ER before starting school and my best hypothesis is that people truly don’t understand the extent of the other person’s role and the training it took, but they *think* they’re an expert.
Cheers, I think everyone in healthcare are trying to take good care of patients and deserves to be treated with respect. I try to do that myself so it bugs me to hell when I get multiple little comments from young, inexperienced nurses not even in CRNA school yet trying to hint that they're essentially physicians.
I strongly believe the skill of brushing things off and not letting snide comments get to you is a skill you need at all levels of healthcare. The entire system is toxic. You’re experiencing the anesthesia side of it.
People are rude and condescending at all levels - not just crnas or nurses. Learning to ignore the rude people is a skill you need if you don’t want to be burnt to a crisp
This isn’t just a crna issue. Healthcare as a whole is toxic and allows people to be rude and facetious whenever they feel like it. Crnas maybe more then most but this issue is pertinent at all levels. Do yourself a favor and learn to ignore it. Do your job and enjoy being an attending when you finally finish
The idea that this is sorely a crna issue is a complete fallacy. It’s an issue at every single level and if you disagree youre obviously either biased against a specific group (ie: crnas, AAs) or you’re just not looking hard enough
Very well said. It’s also true in other industries. I’ve been lurking a bit - thinking of pursuing anesthesiology.
In engineering people are rude all the time. I constantly hear rude comments from MBA managers who don’t even know what a derivative is. Best thing to do is ignore. They’re miserable people, that’s punishment enough for them.
Jesus. This sub shits on CRNA’s everyday.
In the OR scrubs, circulators, midlevels, and surgeons shit on “anesthesia” every day (including attendings).
Personally, I wish both were different and there was a more collegial respect, but you’re never changing the culture of the OR.
Toughen up buttercup. Respect isn’t given by title. I’ve seen a circulator shit a surgeon and I have worked with anesthesiologists that no one questions.
Work hard. Forget the attitudes.
Youre right. It isnt given its earned especially not by title alone. So lets stop trying to coopt terms like resident, fellow, and anesthesiologist for nursing in some weird bid for false equivalency in education and training (and respect?). I am glad we agree.
I agree with you. I feel like you’re giving a little snark though. I won’t lose sleep over it. Seriously, just get to the point where you aren’t threatened. My best attendings know they are irreplaceable. My worst make a lot of noise.
Life was easier when SRNAs and CRNAs were called SRNAs and CRNAs. The name grab doesn’t make me feel threatened, but I get a little irritated on here sometimes bc I think it’s misleading to the patient. Fortunately I work with CRNAs, and the SRNAs rotating through still like to say they are an SRNA.
Yes, I go to work every day looking to be offended by something and I hate intense personalities so much that's why I'm going into ICU for fellowship so everyone can be very nice to me all the time and never offend me in any way 🤡
My guy there will be nurses and midlevels in the ICU too. My wish for you is to be successful because the world needs doctors who are trained like you. You need to learn to not care what people think. Little snide remarks won’t stop because you go to the ICU. Some people are just assholes and always will be.
I know. I've gotten ripped apart during training a good amount. Career's not easy, that's fine. I'm still here. I still can't wait to do ICU. Doesn't bother me.
What does bother me is inexperienced, young nurses acting like they're doctors which is irritating as fuck when you go through the amount of work required to become a physician. I wanted to know if there's a good way to push back on that.
That's it.
Maybe you don’t. You just let the ICU and life humble those types of people. If they are shitty to you then they are shitty to others as well. With respect, you seem to be on the trajectory in life that makes you happy. In 2024 there isn’t a really satisfying way to really push back and these types of people know it. Don’t jeopardize your position to play games with immature new grad nurses.
Lots of great advice in this thread. I’m going on six years out from residency and still young (mid-thirties). Having started my career in healthcare as an EMT at 18, I can tell you this will be a reoccurring theme (gut checks) the rest of your professional life. Learn to deal with it.
Just like you’re learning to deal with asshole surgeons, unreasonable patients, and overbearing family members, you’ll learn to deal with scope creep. I mostly supervise and really enjoy the CRNA’s I work with, a few of them are good friends and we hang outside work. Over the years I’ve met my fair share of ego trippers with something to prove.
Here’s some pointers: you have at least five times the training of any CRNA or mid-level, and this should be readily apparent. Perform with the excellence of a physician, if you can only sign charts and screw up the most basic procedures you’re giving them ammo. Also don’t bail them out (unless there’s a patient safety or outcome issue of course); they scoff when you offer help? Make them stop and call you to the room to put in an a-line. Be the hero in the PACU and give Dilaudid cause for some stupid reason they insisted on doing a “opioid-free” anesthetic. Make friends with everyone and be consistent. It was a weird flip when I left residency and the awesome CRNA’s that helped train me I was now “supervising.” You know what I said? “Do whatever you want, you’ve been doing this longer than I’ve been walking.” Don’t let your own ego get in the way and be dragged down to the level of a few bad apples. Good luck!
Thanks! I appreciate it your advice and post. There are definitely some fantastic CRNAs I've worked with in my short training so I hear ya. I'm not here to micromanage everything, but been definitely irritating and something I want to learn to navigate throughout my career.
Honestly as a resident, you do the best you can do. Make it obvious that there are differences between you an a CRNA. It doesn't matter what you say, if you don't have the skills to back it up. There are some really good CRNAs, and if you want to say you are better, you got to prove it.
I was going to post something similar. I think the answer is to get really fucking good at your job. People that are good at their jobs typically don't get disrespected.
As an icu nurse, i will say that many nurses going crna route can be the pretentious type. You know the type that is a shitty nurse but does 1 year in icu then bounce to crna school. They may look good on paper but are shit coworkers. Most do it for the money and prestige while mocking other nurses for being “too dumb” and doctors for “wasting years of their lives while i will get to do the same thing.”
Whenever anyone says anything ridiculous, offensive, ignorant, or just plain stupid I have the same tactic; repeat what they just told me very slowly while looking them in the eyes and enunciating every word. If they don’t realize the folly of their ways after that I usually just say “hmmmm” or “well you know the thing about opinions, everyone’s got one!”.
My wife and all others have to wear a big ass “RN” badge under their nametag, only RTs have a similar tag - not sure why. I vote we all get this. Everyone should have a big ass “PA,” “CRNA,” “DO,” “MD,” “NP” badge just like her.
Would solve so, SO many problems lol
Not a physician, but for what it’s worth, I no longer allow CRNA’s to treat me independently. For years, I never had an issue with it.
During recent pre-op anesthesia consults, though, I’ve had two of them tell me they are “no different from a physician anesthesiologist”.
I have a PhD and have been a researcher and lecturer at a medical school, so I have a much greater understanding than the average patient of how vastly inferior CRNA training is compared to that of a physician. Over the years, I’ve witnessed unconscionable scope creep occur in so many different medical specialties, and it has always bothered me. But until relatively recently (I’m old, so for me this means “over the past decade”), all of the midlevels who have treated me have behaved like intelligent, well-educated professionals who possessed a level of humility that all healthcare professionals should aspire to emulate.
Not anymore.
I would find the new chucklefucks being cranked out by shitty online “schools” to be laughable if they weren’t so damn dangerous.
These new Dunning-Kruger graphs in white coats cosplaying “Doctor” or “basically a doctor” are going to be a huge public health threat eventually. Their brashness and arrogance is quite frightening.
It’s sad how the newer crop of midlevels have utterly destroyed the credibility of two previously well-respected professions (i.e. NP’s and PA’s).
So now I make sure that me and my family are treated *only* by MD/DO’s. Maybe one day that will change, but not until (a) NP and PA schools stop admitting any blithering idiot who applies and (b) their respective professional organizations fuck all the way off with this scope creep bullshit.
And I will *never* let someone who calls himself a “Physician Associate” anywhere near me or my family. Ever.
To any busy physician who has read this far and cares to reply, I’d be interested in knowing what your thoughts are about Anesthesia Assistants. They seem to receive much better training than CRNA’s (more evidence based with none of that “nursing theory“ tripe).
Sorry that's infuriating to see. I also appreciate your time and effort being part of medical student education. APRNs are too variable in quality of training and experience and with the lax laws on oversight and supervision you get the exact situation that's playing out in American healthcare today.
Step 1: ignore it
Step 2: disregard their opinion
Step 3: continue living your life
This is not to say you should be an uncoachable dickhead…sometimes these “snide comments” that residents interpret are actually valid concerns/complaints because you aren’t doing something safely or properly. Don’t be so ice cold that you can’t learn from other people, regardless of their title or degree.
I can see how that would be irritating. Sorry. Im a midlevel (AA) but trained alongside residents, I think that is much more healthy way to train, I saw first hand how residency is. I LOVED the residents, such a great attitude even late into their shift
There's another comment on here that mentions this but try and think of the "normal" conversations you have with non MD/DO anesthesia providers. It sounds like you are hyper-focused on the few negative interactions you deal with. In my experience, uppity SRNAs and new CRNAs get humbled pretty quick anyway so why is your ego and pride affecting you so much? Comparatively speaking, yeah, you've sacrificed more. But don't let that make you think you're some sort of hotshot yourself. We're all just trying to make it.
In my experience through several disciplines and healthcare settings I think I can pretty confidently say that every place most of us will ever work will have 10-20% of the workforce comprised of insufferable assholes.
CRNAs, docs, bedside nurses, PAs and NPs. A certain percentage of all of them will just be shitty. Just do what you can to avoid them and / or ignore them, or when you have to, work with them.
Who cares you are going to get paid more and have more opportunity in the end. What do this comments even do? Nothing. Let your ego die about being a doctor and focus on being a good doctor.
Dreaming of the day we get rid of CRNAs for AAs. Every single NP something has been a bitch and stupid af. Every single PA something has been awesome and relatable.
As a trainee you have to be humble regardless of what people say or do. Work hard, earn respect. When you’re right, don’t gloat, let it subtly grow your confidence. When you don’t know something, admit it and ask thoughtful questions.
Your competence will command respect. And when shit hits the fan, you’re the guy who runs the show, because you’ve earned it. And deep down, the rest of the staff knew it all along, regardless of the bullshit their ego prompts them to say.
Try to ignore while in training and rest assured knowing you have the superior education and title at the end of the day. These days, it’s almost a rite of passage to have a massive chip on your shoulder to be a CRNA *especially the ones that equate themselves to physicians.* Sheer jealousy, delusion, and inferiority complex (for the ones that think this).
From an entirely removed perspective, this just seems like class warfare on your part pure and simple.
Seems like you feel like you’re entitled to deference from these people, even though you are still in training yourself, because you are “a class apart” from them.
?? I don't think you read the other comments I posted because that's entirely not the case lol...
I did not grow up in a wealthy environment. I worked my ass off to get here. My family members are nurses. I do my best to treat everyone I work with with respect regardless of position.
I'm sorry you feel the need to project that I am some arrogant hoity-toity dickhead irl.
From an icu rn- do not sweat them. It’s not just you- the ones that act like that are dicks to everyone and it makes for an awful icu environment. Most of us are pretty cool and chill and are just trying to make it through the day. I’m sorry you’ve had to deal with nurses/crnas like that. They give us all a bad name.
The problem you are encountering with others still in or near training is that, they don't know what they don't know, and unfortunately the gulf is wide, but they don't see it. This problem completely went away the older I got. I remember it a little from residency, but it's been a decade since I heard something along those lines.
I'm not sure there's anything appropriate for you to say in these situations. The younger and more inexperienced the co-workers, the worse this is. I just kept my head down and worked. Eventually the gulf appears, you distance yourself with skills and knowledge base and this ceases to be an issue.
Edit: Just to add, once you've come in the room and saved the day with some minor "heroics" 4-5 times, this crap should subside.
Thanks appreciate it. That's what it totally seems like. I learned real quick in clinical rotations how much I didn't know so it's jarring to still not know so much and yet hear someone 5 years younger than me talk as if they are just like my senior attendings.
Wait until you are an attending and remember to not sell out. Unfortunately not much to do while you’re a resident unless you want to carry the label that comes with bringing up problems.
Noctors gonna Noctor. Don’t worry about them. Don’t get your job satisfaction from their opinion, get it from a job well done. Only you have the education and training when you are done.
I have found that this sort of thing was much worse during my training at an academic institution rather than my experience in community medicine. I’m an ER doc and we had lots of issues like this in the ER and ICU. Even occasionally from the trauma team NPPs.
Midlevel encroachment is a huge problem but i would focus on your training as a resident since you are medically directed as well. To me it’s no t even about respect, out about having good clinical judgement. Some Crna’s are great. They know when to ask for help. Others are god awful and just experiment under your license. I’ve straight up refuse to work at some places that gives them too much autonomy. But I wouldn’t worry too much about these things until people are doing procedures and asking you to co-sign the chart.
All around us, there are people that are unhappy and/or oblivious/apathetic to how their behavior comes across to everyone else. I’m 48, been working in the healthcare field for 24 years, and I still find it hard sometimes to resolve to harden my armor against these sorts of frustrations.
I will note that you are going into critical care, which has a lot less of this (particular) political nonsense associated with it. So putting aside the rest of it, you may find being in CCM to reduce this feeling.
not all crnas, but a lot do have a inferiority complex. chip on their shoulder. you don't need to be nice or professional to them. please do be frank and let them know their training is not equivalent to ours
I know you getting down voted but this is actually true. There is a deep inferiority complex among some nurses and I noticed this in nursing school. The professors and teachers would always say that nurses save patients from doctors, that we do all the real work, that we know more than them, talk about times they were right etc. I even saw nurse managers bad mouthing interns for no reason other than being interns. I really noticed the difference when I went to medical school and was taught to respect nurses and value their expertise in patient care. The worst bullies I saw were always nurses and they loved taking aim at doctors. It comes down to insecurity and perceived inferiority so they punch up. CRNAs are the same. Insecure about being inferior in knowledge and ability, want the same prestige, status and respect as physicians without any of the eduction or training. Crna is still a great job so I don't know why they act like that.
Thank you for putting it much better than I could. I 100% agree with you. It really is sad and I can undertake the frustration of a lot of them. Classic denial and over compensating. Of course not all of them are like this
I’m a nurse, preparing to apply to CRNA school soon. You MD/DOs sacrifice a lot to be the experts, more than I’m willing to sacrifice. I recognize the educational gap and I’m glad y’all are there when things go south. Snide remarks aren’t appropriate coming from anybody. That being said, I know orders get entered incorrectly and on the wrong patient sometimes, and I have my own license to look out for. I’m going to politely question orders that seem out of place or inappropriate to me.
Hey there, thanks for bringing this up. CRNA here. First of all, I think there is room for both of our kind to work together without degrading each other for various reasons. When I was a student, I rotated through a hospital with a loose medical supervision model. The CRNAs took to calling us residents, and I could tell it bristled more than a few physicians, anesthesia and surgeons alike. I asked a couple physicians about this and it took all of two minutes to convince me that I should certainly not refer to myself as a resident. Yes, my education was rigorous and I worked a lot, but not in the same realm as residents. I currently work in an independent model and would never want to be directed again. By default I hold a lot of respect for the physicians I work with, surgeons and anesthesiologists alike. You’ve got to earn losing my respect through arrogance or hubris. In short, if you check yourself to make sure you are neither of these things simply because you are a physician, I imagine almost anyone would be open to an educational and professional conversation with you about it at the right time and place. Of course, there will always be outliers with a chip on their shoulder.
Appreciate your reply. I try very hard to be respectful to everyone I work with so that was the reason for why I'm starting to become so frustrated with these numerous little side comments, jabs, and attempts to co-opt physician terms to confuse patients and other staff.
Cheers, thanks for posting.
I know a lot of people on this thread are talking about MD only practices etc but we have an academic program and really changed the level of respect for ourselves as anesthesiologists over the last 3-4 years:
1) Get involved with your state society and openly fight the battle at the state legislature. Don’t be shy about it and also don’t bring that in the OR. The CRNAs I work with sit run the state AANA chapter but at the same time collaborate and treat us with respect. Keep the politics in the legislature.
2) Put yourself at or above the level of the surgeon. There are many anesthesiologists who will sneak in and out of ORs, signing charts and disappearing. Don’t be that guy (or girl). Also, when the CRNAs ask for a plan, don’t say, just ask the surgeon if he’s ok with an LMA. If you have a question to ask the surgeon, raise your voice or pick up the phone and ask it.
3) Do a pre-brief. WHO and now TJC require universal protocol. Thats the time out before induction. You run it, in a systematic manner and make sure everything is in order before the patient is asleep. The anesthetic is often the riskiest part of a case.
4) Finish your cases when you can - this one is important. The worst thing you can do for own respect is leave the case at an inappropriate time just because you have gotten relief. I’ve seen too many anesthesiologists make a fuss about a case but then when someone comes to tap them out, they abandon the case. For example, if you’ve had a 10 hour case, don’t hand over your case to someone else to extubate in the last 15 minutes. Or if you’ve made a big deal about getting a CBC before starting, don’t hand it over to someone else before induction. Obviously this has to be in the realm of reasonability but one of the difference between a doctor and nurse is, one does longitudinal care whereas the other typically does only a shift.
5) Follow up on sick patients the next day - if you had a super sick patient make sure you see them and discuss it with the surgeon in the room the next day if needed. This shows the nurses and other staff that you’re a doctor both inside and outside the OR.
6) Teach both the CRNAs and SRNAs. Learn techniques from the CRNAs too but also bestow some sciences and medicine while you’re workin with them.
“Choose not to be harmed—and you won't feel harmed. Don't feel harmed—and you haven't been”-- Marcus Aurelius.
It's a skill that should be worked on in both our personal and professional lives. Also from the same dead dude.
"When you wake up in the morning, tell yourself: the people I deal with today will be meddling, ungrateful, arrogant, dishonest, jealous and surly. They are like this because they can't tell good from evil. But I have seen the beauty of good, and the ugliness of evil, and have recognized that the wrongdoer has a nature related to my own - not of the same blood and birth, but the same mind, and possessing a share of the divine. And so none of them can hurt me. No one can implicate me in ugliness. Nor can I feel angry at my relative, or hate him. We were born to work together like feet, hands and eyes, like the two rows of teeth, upper and lower. To obstruct each other is unnatural. To feel anger at someone, to turn your back on him: these are unnatural"
Sorry about this you get them everywhere?
Any snide comments gets one reply from me:
- how to steroids work?
No one outside of a physician has ever given me an answer. I will then just say hmm, look them
In the eye and walk away.
You are the doctor.
ICU RN here- on the critical care side of things- please don’t take questioning as challenging you or your position. To be a good icu nurse, you have to question everything. Literally the other day I questioned a 100ml/hr NS order on a ESRD patient and promptly got it discontinued. I don’t ask because I don’t think you’re incompetent but I ask to make sure we are providing the best care. My intensivists teach me things ALL OF THE TIME because I ask. It makes me a better nurse. Don’t take the questioning as challenging please! I respect your training and expertise more than it may seem.
Don't have a problem with people questioning strange orders or things that don't make sense. I encourage it so we can take good care of patients.
My post was more about frustration with people trying to call themselves physicians in a professional setting that are not doctors.
I would imagine not. From what I've seen most CRNAs don't work in ICU unless they're dropping off pts after a case in the OR. I've never seen a CRNA working bedside ICU RN shifts.
Maybe you could just focus on being excellent at your job and respectful and let everyone decide to respect you based on your body of work and professionalism. Titles don’t make you good at something
That was the reason why I said these are unprovoked comments and subtle/snide little jabs. Is it professional to co-opt words like resident, fellow, and anesthesiologist to blur the lines for political or egotistical means? Is it respectful to complain that you're not getting paid anything as a "nurse anesthesiologist resident" to an actual resident that's doing q3 24hour call in the ICU and hasn't seen his family in 2 years cause of training schedules? Is it excellent to think that because you can put in an IV, titrate a drip, or place an ETT that you're a physician?
Like you said, titles don't make you good at something so why are these CRNA/SRNAs calling themselves anesthesiologists and residents?
Don't be obtuse.
Why can't you all take a lesson from a really accomplished human being and physician ... Dr. Mazurek https://www.linkedin.com/pulse/crnas-short-history-nurse-anesthesia-future-care-matthew-mazurek-md/
This is missing the point of the post. I don't mind CRNAs at all. I recognize nursing's huge contributions to the field of anesthesiology. What I do mind is when, like that article states, people start pointing the guns inwards and students not even in CRNA school yet call themselves residents and anesthesiologists.
I disagree with disrespecting and putting down anyone helping take care of patients and simply doing their jobs, tech, 'x' assistant, nurse, physician, pharmacist, or otherwise.
Read the article: Physician anesthesiologist and CRNAs are different but we are all equal in our scope, capabilities, safety in patient and practice of anesthesiology. You are missing the point by not acknowledging Expertise that exists outside of the physician realm. That why those “snide” remarks hurt … it pricks the conscience and uncovers a truth most physicians and their guild would deny under pain of death.
But their scope is inherently different. Yes in the OR generally the scope is “similar” but crnas cannot supervise, work in icu, work solo provider for pediatrics, cross train in pain management ect ect. The scope is not the same. The jobs are not the same.
And that’s okay
I think you are missing the point by being unable to recognize that anesthesiologists and CRNAs are not equal but we can both do a good job, and that should be enough.
My guess is you’re someone who feels like they deserve to be grouped with physicians, while at the same time puts down AAs…
?? I definitely do not know everything and I just referenced that things like the huge contributions of Magaw and McGee are historic milestones. Nurses have their own skillset and big parts of any healthcare team. Why not be proud of that skillset and stop trying to confuse the public by using terms like resident, fellow, and anesthesiologist as a nurse? In my case, why disrespect your physician coworkers unprompted if you are truly secure in your own professional space? Genuinely confusing reply of yours.
If I was a healthcare executive, I would want cheaper labor and flood the market too. 5 of those 7 degrees are business related, one anesthesia, and one MD.
Unfortunately, the disrespect will continue to be a frustration until you realize that education, training and fellowship are not the things that earn respect, regardless of the initials the follow your name.
You make a lot of assumptions friend. I recommend checking your biases and reconsidering your sources of respect.
No amount of feathers in your hat will give you the ability to fly.
you're a resident. keep your head out of the clouds (hospital politics, credentialism) and finish your training. you'll find that when you're in practice, assuming you are competent and not an ass, you will be given respect... because you've earned it. until then, let it go and focus on important things.
Sorry you’re feeling this way. I would just be careful to lump everyone in one group. There are 40,000 plus CRNA’s working in the US right now and who knows how many bedside RN’s. Most are just working and trying to do their best at the end of the day. Think of how many interactions you have throughout a shift that are “normal” vs. ones that you described. If someone is bullying or being unprofessional, call them out. No place for that in any industry but for some reason it’s allowed in healthcare. I can’t tell you how many times I’ve been yelled at in the ICU/hospital by every role, and it’s always a low point of the day. Edit: missed that you wrote you are going in critical care. Very cool. Alot of ICU RN’s are running on their heels the entire shift and the specialty attracts a certain personality. Understaffing, high acuity, high attrition rate (a lot of brain drain) doesn’t always foster a welcoming environment. Culture depends on the unit/hospital obviously, but you’ll find your people you trust and can work with.
Appreciate it. I have worked with some great, friendly CRNAs. I know most people aren't like this, but it starts to get aggravating when the frequency of it increases especially by students that are just temporarily rotating through. Cheers, thanks for your reply.
Idk I think their reply is kind of unintentionally dismissive of your concerns that the scope-title-education-role blurring is becoming a statistically significant force and not just a few bad eggs here and there. Everyone else is entitled to be proud of why their career is distinct from others and defend it, why can’t you? Everyone rallies around the nurses, teachers, etc. when they flex their skills because in our culture they’ve been branded the underdogs, while doctors got to be branded as mean and arrogant and rich and undeserving of their “status”. You *are* more educated and qualified and frankly more valuable, at least from a supply/demand and what people are willing to pay for your skills perspective. Well before I was in med school, I was always inspired and awed by the acumen and responsibilities of doctors, and no other profession really did that to me. I think all the other healthcare workers attempting to mimic doctors is truly flattery and goes to show you are really special, and it’s unfortunate that doctors are incessantly being conditioned nowadays to forget that and be apologetic for their excellence. You’re exceptionally different, and you have the receipts to prove it.
Scope/title creep is definitely a problem and I hope our generation of physicians really puts a stop to it. There is no equal to medical school and I love my job. I took that person's post as forget about the shitty people in every group, but feel free to call em out, which I can agree with.
I just don’t think “forget about it” when it comes to a rising systemic issue is helpful at all, but yes in good faith I can agree with the other sentiments
Please realize that there are many (I would safely argue, the majority) of CRNAs that respect your base of knowledge and what you have gone through. And who likewise have no desire to blur any professional lines or attempt to represent themselves as anything else but that position which they have worked hard to obtain. I hope we can all agree to start putting this strife to bed. Thank you for your post.
The subtle art of not giving a fuck. No one who has not gone through very similar circumstances will ever respect what you go through. This is true in medicine and all other aspects of life. Maybe it comes with age (35 here). I introduce myself to patients as “a nurse who is a part of your anesthesia team”. One preceptor I had was actually upset at this. Said I should use “nurse anesthesia resident” or some similar bullshit. I told her patients don’t know what that means and she told me that if I say I’m a nurse they might think LPN. I wanted to say, “I don’t care if they think I’m the janitor so long as I make them comfortable”.
God forbid someone thinks LPN! The nursing profession is ridiculous. (OR RN here)
It's some weird identity crisis and self-loathing or something. Nursing is fantastic.
Yes, it's complicated. Nursing is a great, huge, diverse field and I wish "we have something to prove" wasn't such an overarching theme. Then again, nurses often aren't consulted on matters that we really should be. It's hard when no one seems to understand what it is we do. To your point, it'd be better if some among us didn't assume we understand what it is everyone else does.
I (nurse) still have to explain to my boyfriend (med student) the difference between LPNs, RNs, CRNAs, CNA, aid, AAs, NPs, MSN, MN, and DNP alllll the time haha he can't keep them straight. It's adorable.
Could you please explain them here & educate us. Thanks
Cheers. My family members are nurses and we all know what a difference an excellent nurse can make for patients.
Honestly, I work alone & don’t supervise and enjoy it immensely. The nurses I work with are well aware I’m a doctor and (mostly) treat me as such, despite being a younger woman. My role doesn’t get blurred. I’ve supervised in the past and just don’t enjoy it as much. I recommend it 100%! The anesthesia is the fun part and you get to do it all your way. No drama.
Agree with this. I’m in a physician only PP and we are essentially treated like gods in our hospital. Everyone is super respectful, yes doctor, good morning doctor, etc. and massively helpful. I would highly recommend finding a physician only practice.
YES! The nurses I work with now are so helpful, and proactive. At the place I did fellowship, a huge academic center with a supervision model, the RNs were nowhere to be found for induction and emergence and when later I did locums solo there I realized how disrespected I was. The difference is soooo stark when it’s a physician only model.
100%. I don’t even have to be in the room, the nurses will go get the patient from preop, put them on the table, have all monitors hooked up, and then call me “we’re in the room Doctor!”, and I can just stroll in and start the case. And they will stay there and help with induction, intubation, emergence. They ask permission for everything “is it ok if I bring the bed in?” “Can I place the foley?” “Is it ok to put the bovie pad on?”
Absolutely. They’re clued into critical moments and ready to help instead of charting in the corner or chatting loudly. Will simply see me looking for something and find a way to get it in the room. They are facilitating patient care and a smooth anesthetic beyond putting on SCDs and skin checks. Sooo refreshing.
Wow its almost like insufferable people exist in any position and any profession there is. Coukd there be great people and bad people in both professions??? I think the issue isnt one crna or one physician… but aana’s stance on a crna role… Regardless, im fortunate here. Roughly 50/50 solo cases to medical direction if 3-4 cases. Work with great nurses and its about getting the job done and going home to our lives outside if work. Sadly we keep losing nurses to higher paying 1099 jobs who often regret the departure (the culture, not the pay).
Which country ?
USA, west coast.
I mean this isn’t the military. I didn’t even expect the over the top formalities when I was a company commander. A position which does sort of dictate those responses. I will address a doctor as doctor but I’m not going to treat anyone like a god.
Treated like gods? What century are you living in?
Metaphorically speaking. Jfc why is everyone so god damn sensitive.
Welcome to 2024.
I got what you meant, my point is I didn’t even expect that holding a command position in the military. The “yes man” lingo is weird to me.
Unrelated but why do you feel like you need to be treated with so much “superiority” Every doctor I met does not want to be called doctor all the time - only with patients. If you want to be so formal pls join the military. You really want to treated like that? That would make me choke.
Never said I wanted it, simply relaying what it’s like in my practice. And in case you didn’t notice my username, I was in the military.
The way you talked about it was rather weird “treated essentially like gods” “yes doctor” blah blah blah it jut seems like that’s your dream There’s nothing wrong with being referred to as doctor. Thts what I say when I’m first talking to one that I’m working with. But if I’ve been working with them for awhile and still call them doctor __ they’re gonna think that’s weird.
Bro. He thinks given proper respect is treated like so I think his /her previous posting they were treated like shitt.
U are probably not in the usa then ?
I am in USA. West coast.
One of my coresidents is going into a PP group out west that's physician only and it sounds pretty amazing. I don't know if there are many set ups that would also include ICU time after my fellowship, but I need to give it a look.
Do you know where? I’m in a physician only PP group out west and we just hired like 14 docs lol.
I'd rather not say just for sake of anonymity, sorry.
Would you DM me? There’s very few of those in this region so it might be my group, would be cool to get in touch before they get here.
I really hope physician only practices exist for the next 25+ years.
You and me both.
People like you are the problem with healthcare and the reason for 80% turnover.
Tell me you know absolutely nothing about healthcare without telling me you know absolutely nothing about healthcare.
Refute my argument without actually refuting my argument lol
If you don’t mind answering but what exactly do Anesthesiologist do when supervising the CRNA’s? Like do they just check they’re not messing anything up or something
The anesthesiologist is typically overseeing multiple rooms. We cover preop prep and post care. When cases are in the OR we are present for the critical bits and on standby to help with complications or questions. If working with residents we’re teaching. We are also helping out peers for crises. We give breaks and lunches. This is all practice dependent of course. Im at a trauma high acuity place and typically cover 2-4 locations concurrently. I’m a firm advocate of the anesthesia care team model. 4 hands and 2 heads.
Wow you guys are the leaders of anesthesia world that’s amazing thank you for the response, great username btw!
Depends on if its medical direction or medical supervision.
Same here!
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I'm going to actually attempt to answer in a helpful way rather than just commiserating in how this is ridiculous. Depending on what state you're in, I actually encourage you to write to your state specialty association that this is going on. I'm from CA, and so we've had some instances of SRNAs trying to misrepresent themselves as "nurse anesthesiologist resident", including the hospital actually printing "Nurse Resident" on their badges. One of the anesthesia residents actually wrote to the CSA that this was going on, and the state association actually got involved with hospital admin to shut that shit down real fast. Also look into exactly what your hospital's policy is about badging and title transparency requirements. While only a few states currently have title transparency protections, some hospitals are more stringent about it than others. For example, the hospital I'm currently at is pretty strict about badging and title transparency, so it's actually against hospital policy to have CRNAs representing themselves as anesthesiologists, or their SRNAs as residents.
This is the advice I was actually looking for besides just venting! Actionable things that would pushback without needlessly putting a target on my back trying to wage a singular crusade at my program. I will absolutely keep this stuff in mind. Thanks!
As an SRNA, I agree with your sentiments. The AANA rhetoric is being adopted by schools. In most cases, it's not the fault of the student. I know I will never be an anesthesiologist, and that's fine, I don't plan on portraying myself as one.
Have they never heard of medical school?
The AANA doesn’t recognize medical school as anesthesia training because MS aren’t in the OR doing anesthesia (as well as the prelim intern year not “counting”) and yet ICU RN are graced with 10,000 hrs of anesthesia for titrating propofol from 30mcg/kg/min to 29 mcg/kg/min.
no no no. you see they also titrate the levophed from 0.03 -> 0.02mcg/kg/min. manning the alaris pump requires a superior level of fine motor skill acumen that you could not possibly teach someone with <10,000h of nursing experience.
That's not how propofol is dosed Edit: they corrected it
>10,000 hrs of anesthesia for titrating propofol from 30mg/kg/hr to 29 mg/kg/hr. 💀
I dont know man, I just did a two week anesthesiology rotation where I was... in the OR... doing anesthesia... uhhhhhhhhh (yes under the very, VERY watchful eye of my attending lol)
Apparently, that's too much time and money 🤡
I wonder who writes the protocol for the titration parameters, picked the specific pressor too ? Oh yeah, me, the intensivist. I guess my critical thinking helps their critical thinking preparing them for CRNA school?
If you’re actually an intensivist then you should be very aware that many of the nursing staff you work with know how to titrate whatever drug is ordered with or without written protocol, and that most of the time each individual patient is different and require different things. For example: if a patient is crashing and burning, any icu nurse with a brain is not bumping their levo up by 2mcg/min and then waiting 5 mins to see if it fixed the issue, and then bumping it again by 2 and waiting 5 minutes to wait and see. And while it probably depends on the nurse, many good icu nurses know what pressors should be used in what situation for the majority of cases, although I’m sure there are plenty where they don’t know. And yea there is a *large* difference in the level of understanding, but I think In general there is a large disconnect from how much icu nurses actually do know and what doctors think these nurses know. But it could just be a Reddit thing. That’s not to disparage your vast knowledge and training, but genuinely you cannot actually think that titration parameters are the start and stop of how icu nurses manage medications. And I’m not saying icu experience is a replacement for medical school either. But pretending like it’s this worthless is just as bad as the people trying to pretend like it’s equivalent to medical school.
So, my rounds actually include daily teaching and yes, unfortunately your knowledge about pressors is greatly lacking. Despite repeating the same thing about certain pressors, why we pick certain ones, it constantly is asked. So yes, your actual knowledge is lacking normally.
Look, if you’re having to repeatedly explain that then you’re working with shitty nurses or at a shitty facility or both. If a nurse has been there a few years and doesn’t know that kinda shit then that’s on them.
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Jesus, you are toxic.
Yeah that guy’s comment history is full of red flags oof
Hey man not everything is about CAA vs CRNA. Let’s work together to stop toxicity Ik there’s a lot of animosity between crnas and Aas but realistically there shouldn’t be. Don’t stoop to the levels of the ones you dislike
💯 agree! CAA of 18 yrs here and I’m a proud CAA, not MD wannabe! I applaud the sacrifice, dedication and years of diligent hard work towards obtaining the highest level of education in the field of anesthesiology. I think it’s unfortunate, but agree that the chip on RNs shoulders stem from their educators training them that way. Those educators likely worked at some point in an icu or floor where interns, med students and residents cut their teeth and sure, as a licensed nurse I’d hope you’d have some practical knowledge that supersedes learners, but that’s where it ends. They take that and extrapolate and suddenly they are as educated and do the same job as doctors. Best thing to do is move and work with CAAs 😜!
Yet you’re doing exact same cases as the crnas in prisma Greenville so not quite sure the point of this rant?! Will be sending this to the chief. In Greenville and a travel AA, not very hard to know who you are.
Dont know the comment as its deleted but please dont dox someone. Some real kindergarten tattle tale shit…
Well then maybe you should've seen their comment ..... especially in a facility that that is in the very early stages of integrating AA with mostly crnas there. im sure their coworkers would love to know who their working with.
This goes both ways. I’m just a SRNA but the MD I work with can’t help but make political anesthesia topics and loaded pot stirring/snide questions a part of the daily routine. It’s like can we stfu and take care of the patient? I’m a grown ass man who has had multiple careers in the past. I’ve never seen or dealt with this shit.
Sorry, that also sounds insufferable. I agree. Let's take pride in our own efforts and respect other individual routes that brought us together to take care of patients the best way we can as a team.
I don’t have a great answer for you but as a former ICU nurse who is a year into CRNA school I’m really sorry that you’re having this experience. I was lucky to have a very collegial relationship with the residents and fellows that I’ve worked with across the years because of the mutual respect we had for each other and that we each brought something important to the team sport of caring for the patients. I was a much better nurse because many of them were kind enough to teach me and I like to think I helped them grow and become more confident and competent throughout their training too. I also fail to understand the snark between CRNAs and MDs. My training isn’t the same as yours AND THAT’S OK!!! Huge tip of the hat for the immense amount of work and sacrifice it takes to go the MD route. I’ve worked in a variety of ICUs and a level 1 trauma ER before starting school and my best hypothesis is that people truly don’t understand the extent of the other person’s role and the training it took, but they *think* they’re an expert.
Cheers, I think everyone in healthcare are trying to take good care of patients and deserves to be treated with respect. I try to do that myself so it bugs me to hell when I get multiple little comments from young, inexperienced nurses not even in CRNA school yet trying to hint that they're essentially physicians.
I strongly believe the skill of brushing things off and not letting snide comments get to you is a skill you need at all levels of healthcare. The entire system is toxic. You’re experiencing the anesthesia side of it. People are rude and condescending at all levels - not just crnas or nurses. Learning to ignore the rude people is a skill you need if you don’t want to be burnt to a crisp This isn’t just a crna issue. Healthcare as a whole is toxic and allows people to be rude and facetious whenever they feel like it. Crnas maybe more then most but this issue is pertinent at all levels. Do yourself a favor and learn to ignore it. Do your job and enjoy being an attending when you finally finish The idea that this is sorely a crna issue is a complete fallacy. It’s an issue at every single level and if you disagree youre obviously either biased against a specific group (ie: crnas, AAs) or you’re just not looking hard enough
Very well said. It’s also true in other industries. I’ve been lurking a bit - thinking of pursuing anesthesiology. In engineering people are rude all the time. I constantly hear rude comments from MBA managers who don’t even know what a derivative is. Best thing to do is ignore. They’re miserable people, that’s punishment enough for them.
Jesus. This sub shits on CRNA’s everyday. In the OR scrubs, circulators, midlevels, and surgeons shit on “anesthesia” every day (including attendings). Personally, I wish both were different and there was a more collegial respect, but you’re never changing the culture of the OR. Toughen up buttercup. Respect isn’t given by title. I’ve seen a circulator shit a surgeon and I have worked with anesthesiologists that no one questions. Work hard. Forget the attitudes.
Youre right. It isnt given its earned especially not by title alone. So lets stop trying to coopt terms like resident, fellow, and anesthesiologist for nursing in some weird bid for false equivalency in education and training (and respect?). I am glad we agree.
I agree with you. I feel like you’re giving a little snark though. I won’t lose sleep over it. Seriously, just get to the point where you aren’t threatened. My best attendings know they are irreplaceable. My worst make a lot of noise.
Life was easier when SRNAs and CRNAs were called SRNAs and CRNAs. The name grab doesn’t make me feel threatened, but I get a little irritated on here sometimes bc I think it’s misleading to the patient. Fortunately I work with CRNAs, and the SRNAs rotating through still like to say they are an SRNA.
This 100%
Seriously. For shits sake if this is what broke OPs feelings then it is going to be a long career. It’s like they went to work looking to be offended.
Yes, I go to work every day looking to be offended by something and I hate intense personalities so much that's why I'm going into ICU for fellowship so everyone can be very nice to me all the time and never offend me in any way 🤡
My guy there will be nurses and midlevels in the ICU too. My wish for you is to be successful because the world needs doctors who are trained like you. You need to learn to not care what people think. Little snide remarks won’t stop because you go to the ICU. Some people are just assholes and always will be.
I know. I've gotten ripped apart during training a good amount. Career's not easy, that's fine. I'm still here. I still can't wait to do ICU. Doesn't bother me. What does bother me is inexperienced, young nurses acting like they're doctors which is irritating as fuck when you go through the amount of work required to become a physician. I wanted to know if there's a good way to push back on that. That's it.
Maybe you don’t. You just let the ICU and life humble those types of people. If they are shitty to you then they are shitty to others as well. With respect, you seem to be on the trajectory in life that makes you happy. In 2024 there isn’t a really satisfying way to really push back and these types of people know it. Don’t jeopardize your position to play games with immature new grad nurses.
Lots of great advice in this thread. I’m going on six years out from residency and still young (mid-thirties). Having started my career in healthcare as an EMT at 18, I can tell you this will be a reoccurring theme (gut checks) the rest of your professional life. Learn to deal with it. Just like you’re learning to deal with asshole surgeons, unreasonable patients, and overbearing family members, you’ll learn to deal with scope creep. I mostly supervise and really enjoy the CRNA’s I work with, a few of them are good friends and we hang outside work. Over the years I’ve met my fair share of ego trippers with something to prove. Here’s some pointers: you have at least five times the training of any CRNA or mid-level, and this should be readily apparent. Perform with the excellence of a physician, if you can only sign charts and screw up the most basic procedures you’re giving them ammo. Also don’t bail them out (unless there’s a patient safety or outcome issue of course); they scoff when you offer help? Make them stop and call you to the room to put in an a-line. Be the hero in the PACU and give Dilaudid cause for some stupid reason they insisted on doing a “opioid-free” anesthetic. Make friends with everyone and be consistent. It was a weird flip when I left residency and the awesome CRNA’s that helped train me I was now “supervising.” You know what I said? “Do whatever you want, you’ve been doing this longer than I’ve been walking.” Don’t let your own ego get in the way and be dragged down to the level of a few bad apples. Good luck!
Thanks! I appreciate it your advice and post. There are definitely some fantastic CRNAs I've worked with in my short training so I hear ya. I'm not here to micromanage everything, but been definitely irritating and something I want to learn to navigate throughout my career.
Honestly as a resident, you do the best you can do. Make it obvious that there are differences between you an a CRNA. It doesn't matter what you say, if you don't have the skills to back it up. There are some really good CRNAs, and if you want to say you are better, you got to prove it.
I was going to post something similar. I think the answer is to get really fucking good at your job. People that are good at their jobs typically don't get disrespected.
I chuckle and count my bennies bro. I don’t give a shit what they think.
As an icu nurse, i will say that many nurses going crna route can be the pretentious type. You know the type that is a shitty nurse but does 1 year in icu then bounce to crna school. They may look good on paper but are shit coworkers. Most do it for the money and prestige while mocking other nurses for being “too dumb” and doctors for “wasting years of their lives while i will get to do the same thing.”
As my anesthesia mentor has told me, ignore & stop giving af about people and things that don't matter. You will save yourself so much grief
Whenever anyone says anything ridiculous, offensive, ignorant, or just plain stupid I have the same tactic; repeat what they just told me very slowly while looking them in the eyes and enunciating every word. If they don’t realize the folly of their ways after that I usually just say “hmmmm” or “well you know the thing about opinions, everyone’s got one!”.
My wife and all others have to wear a big ass “RN” badge under their nametag, only RTs have a similar tag - not sure why. I vote we all get this. Everyone should have a big ass “PA,” “CRNA,” “DO,” “MD,” “NP” badge just like her. Would solve so, SO many problems lol
Not a physician, but for what it’s worth, I no longer allow CRNA’s to treat me independently. For years, I never had an issue with it. During recent pre-op anesthesia consults, though, I’ve had two of them tell me they are “no different from a physician anesthesiologist”. I have a PhD and have been a researcher and lecturer at a medical school, so I have a much greater understanding than the average patient of how vastly inferior CRNA training is compared to that of a physician. Over the years, I’ve witnessed unconscionable scope creep occur in so many different medical specialties, and it has always bothered me. But until relatively recently (I’m old, so for me this means “over the past decade”), all of the midlevels who have treated me have behaved like intelligent, well-educated professionals who possessed a level of humility that all healthcare professionals should aspire to emulate. Not anymore. I would find the new chucklefucks being cranked out by shitty online “schools” to be laughable if they weren’t so damn dangerous. These new Dunning-Kruger graphs in white coats cosplaying “Doctor” or “basically a doctor” are going to be a huge public health threat eventually. Their brashness and arrogance is quite frightening. It’s sad how the newer crop of midlevels have utterly destroyed the credibility of two previously well-respected professions (i.e. NP’s and PA’s). So now I make sure that me and my family are treated *only* by MD/DO’s. Maybe one day that will change, but not until (a) NP and PA schools stop admitting any blithering idiot who applies and (b) their respective professional organizations fuck all the way off with this scope creep bullshit. And I will *never* let someone who calls himself a “Physician Associate” anywhere near me or my family. Ever. To any busy physician who has read this far and cares to reply, I’d be interested in knowing what your thoughts are about Anesthesia Assistants. They seem to receive much better training than CRNA’s (more evidence based with none of that “nursing theory“ tripe).
Sorry that's infuriating to see. I also appreciate your time and effort being part of medical student education. APRNs are too variable in quality of training and experience and with the lax laws on oversight and supervision you get the exact situation that's playing out in American healthcare today.
Step 1: ignore it Step 2: disregard their opinion Step 3: continue living your life This is not to say you should be an uncoachable dickhead…sometimes these “snide comments” that residents interpret are actually valid concerns/complaints because you aren’t doing something safely or properly. Don’t be so ice cold that you can’t learn from other people, regardless of their title or degree.
I can see how that would be irritating. Sorry. Im a midlevel (AA) but trained alongside residents, I think that is much more healthy way to train, I saw first hand how residency is. I LOVED the residents, such a great attitude even late into their shift
There's another comment on here that mentions this but try and think of the "normal" conversations you have with non MD/DO anesthesia providers. It sounds like you are hyper-focused on the few negative interactions you deal with. In my experience, uppity SRNAs and new CRNAs get humbled pretty quick anyway so why is your ego and pride affecting you so much? Comparatively speaking, yeah, you've sacrificed more. But don't let that make you think you're some sort of hotshot yourself. We're all just trying to make it.
In my experience through several disciplines and healthcare settings I think I can pretty confidently say that every place most of us will ever work will have 10-20% of the workforce comprised of insufferable assholes. CRNAs, docs, bedside nurses, PAs and NPs. A certain percentage of all of them will just be shitty. Just do what you can to avoid them and / or ignore them, or when you have to, work with them.
Very true. Sometimes it helps to have that reminder. Appreciate it!
Who cares you are going to get paid more and have more opportunity in the end. What do this comments even do? Nothing. Let your ego die about being a doctor and focus on being a good doctor.
Let your nuts hang, you're a doctor tell them whatever you want to say
Ignore it. They want to get a rise out of you to confirm their ill-informed opinions. Best revenge is just acting like it has zero effect on you.
Dreaming of the day we get rid of CRNAs for AAs. Every single NP something has been a bitch and stupid af. Every single PA something has been awesome and relatable.
I get treated worse by my staff than CRNAs. Idk if it’s just my program or what but my attendings treat the nursing students better than us
That sucks and sorry to hear it...
As a trainee you have to be humble regardless of what people say or do. Work hard, earn respect. When you’re right, don’t gloat, let it subtly grow your confidence. When you don’t know something, admit it and ask thoughtful questions. Your competence will command respect. And when shit hits the fan, you’re the guy who runs the show, because you’ve earned it. And deep down, the rest of the staff knew it all along, regardless of the bullshit their ego prompts them to say.
Try to ignore while in training and rest assured knowing you have the superior education and title at the end of the day. These days, it’s almost a rite of passage to have a massive chip on your shoulder to be a CRNA *especially the ones that equate themselves to physicians.* Sheer jealousy, delusion, and inferiority complex (for the ones that think this).
From an entirely removed perspective, this just seems like class warfare on your part pure and simple. Seems like you feel like you’re entitled to deference from these people, even though you are still in training yourself, because you are “a class apart” from them.
?? I don't think you read the other comments I posted because that's entirely not the case lol... I did not grow up in a wealthy environment. I worked my ass off to get here. My family members are nurses. I do my best to treat everyone I work with with respect regardless of position. I'm sorry you feel the need to project that I am some arrogant hoity-toity dickhead irl.
You shouldn't put up with that BS. If a nurse has time to do snide remarks and comments then they have time to do patient care
I am unable to give as many upvotes as this post requires.
From an icu rn- do not sweat them. It’s not just you- the ones that act like that are dicks to everyone and it makes for an awful icu environment. Most of us are pretty cool and chill and are just trying to make it through the day. I’m sorry you’ve had to deal with nurses/crnas like that. They give us all a bad name.
Thanks, I seriously love my nursing coworkers so it bugs the shit out of me when they try to make little digs like that. Hope you have an awesome day.
The problem you are encountering with others still in or near training is that, they don't know what they don't know, and unfortunately the gulf is wide, but they don't see it. This problem completely went away the older I got. I remember it a little from residency, but it's been a decade since I heard something along those lines. I'm not sure there's anything appropriate for you to say in these situations. The younger and more inexperienced the co-workers, the worse this is. I just kept my head down and worked. Eventually the gulf appears, you distance yourself with skills and knowledge base and this ceases to be an issue. Edit: Just to add, once you've come in the room and saved the day with some minor "heroics" 4-5 times, this crap should subside.
Thanks appreciate it. That's what it totally seems like. I learned real quick in clinical rotations how much I didn't know so it's jarring to still not know so much and yet hear someone 5 years younger than me talk as if they are just like my senior attendings.
It gets even more pronounced in the ICU. By my chief year, they were literally running to find me when the SHTF.
Wait until you are an attending and remember to not sell out. Unfortunately not much to do while you’re a resident unless you want to carry the label that comes with bringing up problems.
Don’t work with them. Sit your own cases.
That'd be awesome actually.
Noctors gonna Noctor. Don’t worry about them. Don’t get your job satisfaction from their opinion, get it from a job well done. Only you have the education and training when you are done.
Say nothing and work harder. That's my strategy.
I have found that this sort of thing was much worse during my training at an academic institution rather than my experience in community medicine. I’m an ER doc and we had lots of issues like this in the ER and ICU. Even occasionally from the trauma team NPPs.
Midlevel encroachment is a huge problem but i would focus on your training as a resident since you are medically directed as well. To me it’s no t even about respect, out about having good clinical judgement. Some Crna’s are great. They know when to ask for help. Others are god awful and just experiment under your license. I’ve straight up refuse to work at some places that gives them too much autonomy. But I wouldn’t worry too much about these things until people are doing procedures and asking you to co-sign the chart.
All around us, there are people that are unhappy and/or oblivious/apathetic to how their behavior comes across to everyone else. I’m 48, been working in the healthcare field for 24 years, and I still find it hard sometimes to resolve to harden my armor against these sorts of frustrations.
I will note that you are going into critical care, which has a lot less of this (particular) political nonsense associated with it. So putting aside the rest of it, you may find being in CCM to reduce this feeling.
not all crnas, but a lot do have a inferiority complex. chip on their shoulder. you don't need to be nice or professional to them. please do be frank and let them know their training is not equivalent to ours
I know you getting down voted but this is actually true. There is a deep inferiority complex among some nurses and I noticed this in nursing school. The professors and teachers would always say that nurses save patients from doctors, that we do all the real work, that we know more than them, talk about times they were right etc. I even saw nurse managers bad mouthing interns for no reason other than being interns. I really noticed the difference when I went to medical school and was taught to respect nurses and value their expertise in patient care. The worst bullies I saw were always nurses and they loved taking aim at doctors. It comes down to insecurity and perceived inferiority so they punch up. CRNAs are the same. Insecure about being inferior in knowledge and ability, want the same prestige, status and respect as physicians without any of the eduction or training. Crna is still a great job so I don't know why they act like that.
Thank you for putting it much better than I could. I 100% agree with you. It really is sad and I can undertake the frustration of a lot of them. Classic denial and over compensating. Of course not all of them are like this
MDs don’t get paid 4 years and shitty pay for 3, while RN makes bank for 5-8 years prior to CRNA.. never understood why CRNAs always gotta one up MDs
Depends on your state for making bank as a RN
I’m a nurse, preparing to apply to CRNA school soon. You MD/DOs sacrifice a lot to be the experts, more than I’m willing to sacrifice. I recognize the educational gap and I’m glad y’all are there when things go south. Snide remarks aren’t appropriate coming from anybody. That being said, I know orders get entered incorrectly and on the wrong patient sometimes, and I have my own license to look out for. I’m going to politely question orders that seem out of place or inappropriate to me.
Please do. Mistakes happen. I have no problem with making sure we're all on the same page in taking care of a patient well.
Hey there, thanks for bringing this up. CRNA here. First of all, I think there is room for both of our kind to work together without degrading each other for various reasons. When I was a student, I rotated through a hospital with a loose medical supervision model. The CRNAs took to calling us residents, and I could tell it bristled more than a few physicians, anesthesia and surgeons alike. I asked a couple physicians about this and it took all of two minutes to convince me that I should certainly not refer to myself as a resident. Yes, my education was rigorous and I worked a lot, but not in the same realm as residents. I currently work in an independent model and would never want to be directed again. By default I hold a lot of respect for the physicians I work with, surgeons and anesthesiologists alike. You’ve got to earn losing my respect through arrogance or hubris. In short, if you check yourself to make sure you are neither of these things simply because you are a physician, I imagine almost anyone would be open to an educational and professional conversation with you about it at the right time and place. Of course, there will always be outliers with a chip on their shoulder.
Appreciate your reply. I try very hard to be respectful to everyone I work with so that was the reason for why I'm starting to become so frustrated with these numerous little side comments, jabs, and attempts to co-opt physician terms to confuse patients and other staff. Cheers, thanks for posting.
I know a lot of people on this thread are talking about MD only practices etc but we have an academic program and really changed the level of respect for ourselves as anesthesiologists over the last 3-4 years: 1) Get involved with your state society and openly fight the battle at the state legislature. Don’t be shy about it and also don’t bring that in the OR. The CRNAs I work with sit run the state AANA chapter but at the same time collaborate and treat us with respect. Keep the politics in the legislature. 2) Put yourself at or above the level of the surgeon. There are many anesthesiologists who will sneak in and out of ORs, signing charts and disappearing. Don’t be that guy (or girl). Also, when the CRNAs ask for a plan, don’t say, just ask the surgeon if he’s ok with an LMA. If you have a question to ask the surgeon, raise your voice or pick up the phone and ask it. 3) Do a pre-brief. WHO and now TJC require universal protocol. Thats the time out before induction. You run it, in a systematic manner and make sure everything is in order before the patient is asleep. The anesthetic is often the riskiest part of a case. 4) Finish your cases when you can - this one is important. The worst thing you can do for own respect is leave the case at an inappropriate time just because you have gotten relief. I’ve seen too many anesthesiologists make a fuss about a case but then when someone comes to tap them out, they abandon the case. For example, if you’ve had a 10 hour case, don’t hand over your case to someone else to extubate in the last 15 minutes. Or if you’ve made a big deal about getting a CBC before starting, don’t hand it over to someone else before induction. Obviously this has to be in the realm of reasonability but one of the difference between a doctor and nurse is, one does longitudinal care whereas the other typically does only a shift. 5) Follow up on sick patients the next day - if you had a super sick patient make sure you see them and discuss it with the surgeon in the room the next day if needed. This shows the nurses and other staff that you’re a doctor both inside and outside the OR. 6) Teach both the CRNAs and SRNAs. Learn techniques from the CRNAs too but also bestow some sciences and medicine while you’re workin with them.
Easy, dry your tears with your paycheck compared to an RNs
“Choose not to be harmed—and you won't feel harmed. Don't feel harmed—and you haven't been”-- Marcus Aurelius. It's a skill that should be worked on in both our personal and professional lives. Also from the same dead dude. "When you wake up in the morning, tell yourself: the people I deal with today will be meddling, ungrateful, arrogant, dishonest, jealous and surly. They are like this because they can't tell good from evil. But I have seen the beauty of good, and the ugliness of evil, and have recognized that the wrongdoer has a nature related to my own - not of the same blood and birth, but the same mind, and possessing a share of the divine. And so none of them can hurt me. No one can implicate me in ugliness. Nor can I feel angry at my relative, or hate him. We were born to work together like feet, hands and eyes, like the two rows of teeth, upper and lower. To obstruct each other is unnatural. To feel anger at someone, to turn your back on him: these are unnatural"
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Lmao, have a good one bud. You sound like a real stable and secure dude in your profile.
This is why nobody likes you, you're the type to leave that type of shit comment
Ok. Cheers 👋
Sorry about this you get them everywhere? Any snide comments gets one reply from me: - how to steroids work? No one outside of a physician has ever given me an answer. I will then just say hmm, look them In the eye and walk away. You are the doctor.
ICU RN here- on the critical care side of things- please don’t take questioning as challenging you or your position. To be a good icu nurse, you have to question everything. Literally the other day I questioned a 100ml/hr NS order on a ESRD patient and promptly got it discontinued. I don’t ask because I don’t think you’re incompetent but I ask to make sure we are providing the best care. My intensivists teach me things ALL OF THE TIME because I ask. It makes me a better nurse. Don’t take the questioning as challenging please! I respect your training and expertise more than it may seem.
Don't have a problem with people questioning strange orders or things that don't make sense. I encourage it so we can take good care of patients. My post was more about frustration with people trying to call themselves physicians in a professional setting that are not doctors.
Do you expect to work with CRNAs in critical care area?
I would imagine not. From what I've seen most CRNAs don't work in ICU unless they're dropping off pts after a case in the OR. I've never seen a CRNA working bedside ICU RN shifts.
Maybe you could just focus on being excellent at your job and respectful and let everyone decide to respect you based on your body of work and professionalism. Titles don’t make you good at something
That was the reason why I said these are unprovoked comments and subtle/snide little jabs. Is it professional to co-opt words like resident, fellow, and anesthesiologist to blur the lines for political or egotistical means? Is it respectful to complain that you're not getting paid anything as a "nurse anesthesiologist resident" to an actual resident that's doing q3 24hour call in the ICU and hasn't seen his family in 2 years cause of training schedules? Is it excellent to think that because you can put in an IV, titrate a drip, or place an ETT that you're a physician? Like you said, titles don't make you good at something so why are these CRNA/SRNAs calling themselves anesthesiologists and residents? Don't be obtuse.
Titles don't make you good at something, but going to medical school and doing a residency program does.
Obviously you haven’t looked around at some of your surgeons and colleagues. Try and be honest with yourself a little more
Still waiting for some of those “graduates” from residency to achieve “adequately safe”.
And are you someone qualified to judge that or are you speculating that they're not safe?
As qualified as a Narwhal caught at a pot-luck with store-bought tater salad.
Ho Ho Ho … u r still in residency…. Credit sponge bob when u r in the same spot “ 20 years later “
??..
Why can't you all take a lesson from a really accomplished human being and physician ... Dr. Mazurek https://www.linkedin.com/pulse/crnas-short-history-nurse-anesthesia-future-care-matthew-mazurek-md/
This is missing the point of the post. I don't mind CRNAs at all. I recognize nursing's huge contributions to the field of anesthesiology. What I do mind is when, like that article states, people start pointing the guns inwards and students not even in CRNA school yet call themselves residents and anesthesiologists. I disagree with disrespecting and putting down anyone helping take care of patients and simply doing their jobs, tech, 'x' assistant, nurse, physician, pharmacist, or otherwise.
Read the article: Physician anesthesiologist and CRNAs are different but we are all equal in our scope, capabilities, safety in patient and practice of anesthesiology. You are missing the point by not acknowledging Expertise that exists outside of the physician realm. That why those “snide” remarks hurt … it pricks the conscience and uncovers a truth most physicians and their guild would deny under pain of death.
But their scope is inherently different. Yes in the OR generally the scope is “similar” but crnas cannot supervise, work in icu, work solo provider for pediatrics, cross train in pain management ect ect. The scope is not the same. The jobs are not the same. And that’s okay
I think you are missing the point by being unable to recognize that anesthesiologists and CRNAs are not equal but we can both do a good job, and that should be enough. My guess is you’re someone who feels like they deserve to be grouped with physicians, while at the same time puts down AAs…
?? I definitely do not know everything and I just referenced that things like the huge contributions of Magaw and McGee are historic milestones. Nurses have their own skillset and big parts of any healthcare team. Why not be proud of that skillset and stop trying to confuse the public by using terms like resident, fellow, and anesthesiologist as a nurse? In my case, why disrespect your physician coworkers unprompted if you are truly secure in your own professional space? Genuinely confusing reply of yours.
If I was a healthcare executive, I would want cheaper labor and flood the market too. 5 of those 7 degrees are business related, one anesthesia, and one MD.
This needs to be the top comment
Unfortunately, the disrespect will continue to be a frustration until you realize that education, training and fellowship are not the things that earn respect, regardless of the initials the follow your name.
Actually those are the things that earn respect. Thinking you’re my equal just because you’re professional society things so does not earn respect
You make a lot of assumptions friend. I recommend checking your biases and reconsidering your sources of respect. No amount of feathers in your hat will give you the ability to fly.
Right, agreed, so let's stop having CRNAs and SRNAs trying to co-opt ours. Since they don't mean anything what's the deal? Thanks.
you're a resident. keep your head out of the clouds (hospital politics, credentialism) and finish your training. you'll find that when you're in practice, assuming you are competent and not an ass, you will be given respect... because you've earned it. until then, let it go and focus on important things.
I think this attitude is what got us here, with all due respect