i believe this may clarify the physician supervision question, this article i found on the calif. assoc of nurse anesthe site.
pay close attention to the last paragraph.
New Edition of the CRNA Scope of Practice Compendium Now Available
One of the hallmark activities of professional associations is the ability to clearly articulate the scope of practice of its constituent members. For more than 65 years, CANA has been the champion of nurse anesthesia practice not only in California, but has served as a model of excellence for CRNA associations across the country. An important component of CANA's many activities is the dissemination of accurate information about CRNA scope of practice to its members, other health professionals, health care institutions, payer groups, representatives of governmental agencies, state and federal legislators, and the public. CRNA practice in California is governed by statutes, regulations, and rules enacted by the state legislature in the Nurse Practice Act and the Nurse Anesthetist Act.
In 1996, with the advice and consent of CANA's Board of Directors, a compendium was produced and published that succinctly outlines the legal scope of practice of CRNAs and provides the documents that discuss the specific rules, regulations, and opinions which govern California nurse anesthesia practice. This document, titled "Certified Registered Nurse Anesthetists' Scope of Practice in California: A Compendium" or simply, the "Compendium."
The second edition of "CRNA Scope of Practice in California: A Compendium" is now available.
The book compiles the legal documents a hospital or surgery center might need in order to answer questions about CRNA scope of practice. CRNA scope of practice is often challenged by groups and individuals that seek to narrow CRNA practice rights. It is therefore helpful for hospitals and surgery centers to have a ready source of reliable information about what CRNAs may legally do in California.
Section headings, and the points made in each section are:
Legal Basis of Nurse Anesthesia Practice in California.
- The Board of Registered Nursing is the authority on CRNA scope of practice.
- CRNAs do not require physician supervision or physician signature of documents.
- CRNAs select and administer the full range of drugs and techniques.
- CRNAs practice in all settings: large institutions, ambulatory surgery centers, and office settings delivering monitored anesthesia care, regional & general anesthesia, and pain management services"
Attorneys General Opinions.
- CRNAs may administer regional as well as general anesthesia.
- Ordering an anesthetic is not equivalent to supervising an anesthetic.
Quality of Care and Professional Liability.
- No studies have found a significant difference in outcomes between CRNAs and other anesthesia providers.
- Surgeons do not bear increased liability for working with unsupervised CRNAs.
Nurse Anesthesia Practice in California Facilities Accredited by the JCAHO.
- JCAHO views CRNAs in California as Licensed Independent Practitioners.
- Institutional surveys by DHS, Medicare, and the California Medical Association where CRNAs work unsupervised have been uneventful.
Nurse Anesthesia Practice and the Medicare Conditions of Participation for Hospitals.
- Medicare rules do not intend physician supervision to mean responsibility for the anesthetic; rather the rule only requires that the surgeon be available to assist in the event of a medical emergency.