90% of CRNAs belong to the American Association of Nurse Anesthetists (AANA)

The article below is copied and pasted from www.nurse-recruiter.com.  I received the newsletter via email. See also http://www.nurse-recruiter.com/articles/article1_20080924.php.

This is a nice article about CRNAs. I didn't know that 90% of CRNAs join the professional association for nurse anesthetists, the American Association of Nurse Anesthetists.

Wow! Nurses don't typically join and support professional associations, so I was blown away by this stat. There are several national, state, and specialty nursing associations (I won't mention names) that need to review the AANA goverance, business, and marketing model to figure out what the AANA is doing "right" to attract such as high number of CRNAs to join.

Some (but certainly not all) national, state, and specialty nursing associations are struggling with finances and down right desperate for dues paying members.

Keep up the good work, AANA!!!

September 2008      

Nurse Anesthetists: the Often-Overlooked CRNA

By Norma Walsh

Most people outside the medical field - and a good deal of those within it - are not sure exactly what a nurse anesthetist does; some may have never even heard of it, or think of them as "assistants" to anesthesiologists. Nurse anesthetists have a long and storied history spanning over 150 years, and today perform an important and increasing role in patient care.

The first nurse to provide anesthesia was Catherine S. Lawrence, who administered anesthesia for Civil War surgeons circa 1861 to 1865. However, anesthesia was used infrequently, because it was considered too dangerous.The first "official" nurse recognized as a nurse anesthetist was Sister Mary Bernard, a Catholic nun who practiced in the 1870s at St. Vincent's Hospital in Erie, Pennsylvania. The first school of nurse anesthesia formed in 1909 at St. Vincent Hospital, Portland, Oregon. The course of study was 6 months long, and included classes on anatomy and physiology, pharmacology, and administration of common anesthetic agents. Soon, many schools offering similar programs were formed. Between 1912 and 1920, approximately 19 schools opened in the United States. All consisted of post-graduate anesthesia training for nurses, and were about 6 months in length. These included programs at Mayo Clinic, Johns Hopkins Hospital, Barnes Hospital, New York Post-Graduate Hospital and Presbyterian Hospital in Chicago.

At the time, physician residences in anesthesia did not exist, so doctors attended these programs to learn anesthesia. The nurse anesthesia specialty was formally organized on June 17, 1931, when the American Association of Nurse Anesthetists (AANA) held its first meeting. The new organization had two main objectives: establish a national qualifying exam, and establish an accreditation program for nurse anesthesia schools. The first national certification exam was held on June 4, 1945, with 92 candidates sitting for the exam.

Prior to World War II, anesthesia was considered more a nursing specialty. In 1942, there were 17 nurse anesthetists for every one anesthesiologist. Even as late as 1971, 48.5% of anesthesia was given by certified registered nurse anesthetists (CRNAs), while 38.34% was provided by American Society of Anesthesiology members. The numbers of physicians in this specialty did not greatly expand until the late 1960s and 1970s, which parallels a time in surgical history when operations became much more complex.

After many years of preparation, on January 19, 1952, a program for the accreditation of nurse anesthesia schools went into effect. The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer approximately 30 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists' (AANA) 2007 Practice Profile Survey.

Nurse anesthetist programs are offered by 109 educational institutions in the United States today. The programs are between 24 to 36 months in length (average 28) and provided on a Masters degree level. All programs include clinical training in university-based or large community hospitals. In addition, there are Doctorate programs (Nursing Doctorate or Doctor of Nursing Practice) at several universities in the United States. All programs require you to be a registered nurse, and have a four year college degree in science or nursing (BSN), and at least one year of acute care nursing experience before entry. Acute care is usually defined as intensive care, coronary care, emergency/trauma, etc. In addition, applicants must meet the qualifications of the graduate school (GRE, GPA, required course work). Because most programs have far more qualified applicants than available spaces, successful candidates usually have several years of experience in nursing in addition to specialized education in nursing or other health disciplines. Graduate college requirements may include a minimum score on GRE exams (e.g. 1000+), and possibly a 400 or graduate level statistics course. Anesthesia school requirements usually include recent college level math, physics, chemistry and anatomy.

There is a varied scope of practice for nurse anesthetists. They can work for a hospital, outpatient surgery center (surgery, dental, podiatrist), in a group practice or they can practice independently. CRNAs will work in collaboration with surgeons, dentists or podiatrists, or on an anesthesia team with an anesthesiologist, to provide anesthesia care. Laws governing the degree of physician collaboration or supervision will vary state to state. Most often, the patient can expect to receive their anesthetic from an anesthesia care team, with the CRNA and anesthesiologist working together. CRNAs can administer anesthesia in all types of surgical cases, applying all the accepted anesthetic techniques - general, regional, local, or sedation. The exception is "pain medicine," which is usually practiced by anesthesiologists. Others become clinical instructors, school directors, or department supervisors. Working hours vary according to practice, but in many cases, exceed 40 hours per week. Salaries exceed most nursing specialties, depending on location and experience.

CRNAs are the primary anesthesia providers in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals. Nurse anesthetists have been the main providers of anesthesia care to U.S. military men and women on the front lines since WWI, including the current conflicts in Iraq and Afghanistan.

Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. Approximately 44 percent of the nation's 39,000 nurse anesthetists and student nurse anesthetists are men, compared with less than 10 percent in the nursing profession as a whole. More than 90 percent of U.S. nurse anesthetists are members of the AANA. (the bold emphasis does not appear in the original article).

As advanced practice nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly. There is also a stringent recertification/continuing education requirement, as CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

Comments

[Greg Stocks CRNA EJD]

AANA dues are NOT expensive. Not considering the continuous need for representation of the profession in the face of complex regulatory and industry changes and challenges, many of which directly affect the amount of money a CRNA will be paid.
Assuming an annual salary of $150,000, dues of $645 amount to .04%. Not a bad return on investment. Arguments that AANA dues are too high utterly baffle me. And they are always void of detail as to where money is being wasted. Remove 'nurse' from nurse anesthetist? THAT is the proposed option which fixes everything and avoids having to pay dues to an association? Oh boy...

AANA Active Members Dues $645.00

From that:
Allocated to State Associations $232.50
Organizational Health Allocation & Strategic Reserve Fund$62.50

Now, consider membership in the American Medical Association Annual regular membership $420
No state medical association dues come from this. If you want to join, say, the Ohio State Medical Association that will cost you an additional $560 per year. So that's $980 per year for both. Now, what if you want to have membership in your medical specialty society? And/or the state chapter of that society? All extra. Hundreds extra.

"The AANA charges an enormous amount of money, and then charges us an additional amount of money to attend one of their meetings. Even at the supposed discounts that the AANA claims to give us, what they charge is ridiculous."

The statement is simply false. An 'enormous amount of money'...judge for yourself from the info above. Of course you have to pay to attend a national convention, over 5 days, in a top convention center. Who could possibly think $645 could cover that alone?!!

It costs a little bit of money to maintain yourself as a professional, and your profession as a respected entity. About as much as a big screen TV. Pony up.

Greg Stocks CRNA EJD

[Jack Stem]

Most CRNAs who criticize their state or national association generally have no idea of all the services the association provide to members. Since I have become deeply involved with the Ohio State Association of Nurse Anesthetists (OSANA) in 2005 as the chair of the Peer Advocacy for Practitioner Wellness Committee and one of two state peer advisors, I have come to respect those who spend a great deal of their time dealing with issues that have the potential to significantly decrease the ability of CRNAs to practice their profession to the full extent of their training.

Having become involved with the OSANA dealing with the number one health risk associated with the practice of anesthesia (substance misuse and chemical dependency), I have discovered the AANA has become the leading professional organization in facing this deadly disease. They have developed recommendations for the appropriate treatment of impaired anesthesia providers. They have developed a national organization, Anesthetists in Recovery (AIR) to provide a 24 hour hotline for their membership. They provide training workshops for over 70 state peer advisors, at no cost to the advisors, to ensure an impaired colleague receives immediate, appropriate assistance. We assist in interventions. We establish and develop contacts and relationships with treatment facilities with programs geared to treat anesthesia professionals. The state peer advisors provide continuing education regarding impairment, it's prevention and recognition for all training programs and any department of anesthesia requesting our services...all at no additional cost.

Another example is the battle building over the Scope of Practice Partnership led by the American Medical Association (AMA). This partnership is designed to provide the AMA and other physician groups and associations with the power to determine the scope of practice for ALL health care providers. This means the licensing board for the specific health care group would lose the legal right to determine the scope of practice for their profession. Doctors would determine what nurses, physical therapists, and any other health care provider are permitted to do in their practice. And because physicians make significantly more money than most of the other health care providers, they have the means to “outlast” any group choosing to challenge them. Like it or not, it takes $$ to fight the fight and stay up to date on the issues concerning our ability to practice according to our training. Without the association representing and uniting our members, we wouldn't be where we are today. All one need do is look at the chaos and lack of unity throughout the remainder of the nursing profession to see that the AANA is the leader in representing and advocating for their members. The AANA has advocated for their membership and won every major attempt by the ASA and other physician organizations to limit the scope of practice of CRNAs over the past 100+ years.

Membership also provides the following benefits:
- Support Regarding Business and Clinical Practice Issues
- Publications That Inform and Educate
- Government Affairs Activities
- Informative Meetings and Networking Opportunities
- Support for Nurse Anesthesia Education, continuing the excellence in anesthesia that CRNAs provide and assuring the continuation of the profession
- Quality Anesthesia Practices and Patient Safety
- Continuing Education Activities
- Support for Research
- AANA Professional Liability Insurance Program
- AANA Health Insurance Benefits Program
- AANA Home & Auto Insurance Program
- AANA Life and Disability Income Programs

If a member feels the association isn't representing their interests, they have several options.

First, run for office and change the association into one that meets their vision of what the association should be and provide the membership.

Another option? Don't renew their membership. Membership in the association is not required to practice anesthesia as a CRNA.

Or, start another association and run it the way they see fit.

No organization is perfect. However, any organization that has over 90% of eligible candidates actually join must be doing MANY things right.

Oh, I forgot to mention that over 35% of membership dues to the AANA are returned to the state associations.

Spend some time at the open board meetings in your state or at the AANA offices. Actually watch what they do on a daily basis. It might change the way you see the Association.

Jack Stem
Chair and Peer Advisor
Peer Advocacy for Practitioner Wellness Committee
Ohio State association of Nurse anesthetists

[latonia]

James, thank you for the comment. I can't speak for others however I don't believe the cost of membership in a nursing professional association which consists of primarily of individual members should be based on the income or salary of members. I can see the rationale for this with a trade association which is industry based membership but not with a professional association.

I am not familiar with the dues charged by AANA but I know that my ANA dues are over $300 a year and my American Bar Association dues run $400-$550 a year, depending upon the number of sections I join. I am more than happy to write a check to the American Bar Association, the Ohio State Bar Association ($300) and The American Association of Nurse Attorneys ($140.00) however I cannot say the same for the American Nurses Association.

[James B. Lunsford]

What I don't understand is that just because I make a substantial
amount of money, that someone has their hand out for it. The AANA is no different.
Someone on this site was explaining that the money that we paid
was very little, seeing that we made so much. If I was making a
million dollars per year, it doesn't entitle the AANA or anyone else
to it. They use our money to buy buildings without our input or
permission, and they ask for additional money for scholarships.
This may be a good thing, but when I was paying my money, I was
paying this money to benefit me and my profession, not for scholarships. Like the government, they forget that they are supposed to be working for US and not the other way around.

So, exactly what is the AANA doing for us? I think, "Very little."
The profession could have been changed many years ago to
where we could have been "competing" with anesthesiologist instead
of being subservient to them. The word "NURSE" could have been
removed from our title. Being a nurse could still be the requirement
though. The word "NURSE," in itself means subservience. We have
been subservient to anesthesiologist for years, and will continue to be
so, until they completely eliminate us from the profession.

Just as Dentists are doctors and not Medical Doctors, and Podiatrists
are doctors and NOT medical doctors, our title could have very easily
been changed to something like "Doctor of Anesthesia Science." We could have been competing with them by now, on equal ground.

The AANA charges an enormous amount of money, and then charges us an additional amount of money to attend one of their meetings. Even at the supposed discounts that the AANA claims to give us, what they charge is ridiculous.

They tell us that there is no relationship with the licensing board,
however, the licensing board charges non AANA members $300.00 to "evaluate" our continuing education. I smell fraud.

Since Nurse Anesthetists are a national entity that is federally recognized, I believe that it is time for our congressmen to investigate
them to see if some of their practices are unethical. I believe that
something is very wrong with our association. Maybe it's time for
some of us to create another association so that we can have options. James B. Lunsford

[Jack Stem]

Latonia,

As a former CRNA I'd like to thank you for your kind words about the profession of nurse anesthesia. There are many reasons CRNAs join the AANA, here are a few that are at the top of the list:

- High level of autonomy (they perform all phases of anesthesia including preoperative physical assessment and postoperative assessment for discharge from PACU)
- Determining the type of anesthesia in collaboration with the patient and their physician colleague (anesthesiologist, surgeon, podiatrist, oral surgeon/dentist)
- Choosing the specific technique, medications to be administered before, during and after anesthesia
- There is a strong sense of collegiality and professionalism with other members of the association
- CRNAs have had to face numerous challenges (legal and legislative) to their scope of practice from anesthesiologists who wish to limit that scope of practice

As a result, CRNAs have discovered they MUST work together to maintain their ability to continue practicing their profession to the fullest extent of their scope of practice. Unity, being active in politics at the local, state and federal levels to safeguard their ability to practice, understanding they practice on equal standing with all members of the health care team, and the ability to determine their practice at all levels. None of this would be possible if not for an association that is proactive (not reactive) and willing to do what it takes to keep their profession alive and well.

Jack Stem
Chair
Peer Assistance and Practitioner Wellness Committee
State Peer Advisor
OSANA