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AAs vs NAs - Differences?

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JCole View Drop Down
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  Quote JCole Quote  Post ReplyReply Direct Link To This Post Topic: AAs vs NAs - Differences?
    Posted: 03 Jan 2009 at 6:36pm
Anesthesiologist Assistants vs. Nurse Anesthetists …

What are the differences between an AA and a CRNA?

Jeffrey S. Plagenhoef, M.D., Chair
Committee on Anesthesia Care Team

The question for decades: Do differences in the education and practice of anesthesiologist assistants (AA) and nurse anesthetists (NAs) indicate the superiority of one profession over the other in either ability or capability? Anesthesiologist assistants and nurse anesthetists are both longstanding members of the anesthesia care team (ACT). ASA and the Centers for Medicare & Medicaid Services (CMS) share the position that anesthesiologist assistants and nurse anesthetists have identical clinical capabilities and responsibilities. Nearly four decades of experience have proven the safety of the ACT with either an anesthesiologist assistant or nurse anesthetist as the nonphysician anesthetist. However, certain differences do exist between anesthesiologist assistants and nurse anesthetists. Since some of these differences are being mischaracterized in claims of superiority of one over the other, objective investigation and documentation was called for and was assigned to the Committee on the Anesthesia Care Team (CACT). This article summarizes the findings.

After thoroughly analyzing prerequisites for admission, curricula, graduation and certification requirements, and clinical practice and overall quality, the CACT drafted the recently approved “ASA Statement Comparing Anesthesiologist Assistant and Nurse Anesthetist Education and Practice”. The committee was greatly aided in its mission by the coincidental publication of an impartial study comparing the education and practice of Anesthesiologist Assistants and Nurse Anesthetists commissioned by the Kentucky Legislature. The Legislative Research Commission published its 59-page detailed report on February 2007 (see Of note, several other states (recently Florida and North Carolina) have reached the same conclusion.

Three differences between anesthesiologist assistants and nurse anesthetists can be summarized as follows:

    1. Prerequisites to training: Nurse Anesthetist schools require an RN degree and one year of critical care work experience. Anesthesiologist Assistant schools require an undergraduate degree emphasizing the requirements for medical school admission. ASA agrees with the impartial findings of the Kentucky Legislature that the requirement for clinical experience may constitute a temporary aid to those beginning their Nurse Anesthetist or Anesthesiologist Assistant education, but it makes no difference to the final outcome of that training.

    2. Performance of regional anesthesia and invasive catheters: More Nurse Anesthetist education programs provide instruction in the technical aspects of regional anesthesia. A higher percentage of Anesthesiologist Assistant programs provide instruction in the placement of invasive monitors. There is no evidence to suggest that the innate abilities of either student type impact their suitability for these anesthesia practices. The decision by some Anesthesiologist Assistant programs to limit the teaching of regional techniques was influenced by the opinion of some anesthesiologists that neither Anesthesiologist Assistants nor Nurse Anesthetists should perform these invasive procedures. That limitation is voluntary, consistent with ASA policy and was implemented to enhance patient safety.

    3. Supervision and independent practice: Anesthesiologist Assistants must be supervised by an anesthesiologist, and Nurse Anesthetists may be supervised by any physician. Political victories rather than changes in education have allowed Nurse Anesthetists in some states to practice without the CMS requirement for physician supervision. Requiring that anesthesiologists supervise Anesthesiologist Assistants in no way constitutes a mark of inferiority. To the contrary, and as concluded by the Kentucky study, Anesthesiologist Assistant work is directed only by anesthesiologists because Anesthesiologist Assistants want it that way. They agree that the safest ACT is one led by an anesthesiologist, so it is their desire to practice in a manner that supports what they agree is the highest quality and safety available.

History has everything to do with the differences above. The Anesthesiologist Assistant profession was founded in the early 1970s by anesthesiologists striving to design an improved educational program for anesthesia physician extenders that would also include a direct path to medical school if desired. Focused on that goal, those pioneers in education recognized the value added by strong premedical backgrounds. By requiring prerequisites for admission to medical school in order to qualify for admission to Anesthesiologist Assistant schools, Anesthesiologist Assistants may go from Anesthesiologist Assistant practice directly into medical school. Disadvantaged in this regard, Nurse Anesthetists who wish to advance their ability and knowledge in anesthesia by becoming anesthesiologists have to first go back to the undergraduate level to complete a premedical curriculum. Thus by history, tradition, philosophy of education and desire, the Anesthesiologist Assistant is trained to work within the ACT. The quality and scope of their education has nothing to do with this decision.

In distinction, the Nurse Anesthetist discipline developed much earlier, in the late 1800s and early 1900s, in response to surgeons’ requests for more anesthesia providers. As now, anesthesiologists alone could not accommodate all surgical demands. Necessity was truly the mother of invention for the evolution of Nurse Anesthetist practice — we needed more anesthesia providers. As early as 1916, Nurse Anesthetists began fighting legal battles claiming their right to provide anesthesia supervised only by surgeons. Nurse Anesthetist organizations have never formally supported or advocated for the idea that Nurse Anesthetist care is safer under the direction of an anesthesiologist or even supervision of a surgeon. Their legal right to practice without the supervision of an anesthesiologist is the result of their history, tradition, philosophy of education and tremendous political effort.

In summary, our analysis of prerequisites for admission, curricula, graduation and certification requirements, clinical practice, and overall quality and ability of both Anesthesiologist Assistants and  Nurse Anesthetist supports the findings of the comprehensive, unbiased study of the Kentucky Legislature and CMS policies recognizing the two professions as being equivalent. After a year of practice, the relative quality and skill of individual anesthesiologist assistants and nurse anesthetists likely has more to do with personal talents and abilities than the educational route taken. This observation is supported by the testimonies of many anesthesiologists who have gained valuable insights working within the ACT for decades with both anesthesiologist assistants and nurse anesthetists who find no significant differences between the two groups of professionals in their daily clinical practices.

ASA’s conclusion: Differences do exist between anesthesiologist assistants and nurse anesthetists in regard to the prerequisites, curriculum, instruction in regional anesthesia and invasive monitoring, and requirements for supervision in practice. However, these differences are not based on superiority of education or ability, but are rather a product of differences in historical development and the philosophies and motivations of those that practice within each profession.


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Edited by admin - 02 Jul 2012 at 7:07pm
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