AA's

  1. hello everyone,
    I have been a lurker on this board for about 6 months now, and I have to say that it has been very informative. I am an SICU RN in a level 1 trauma center, and hope to become a srna/crna someday(suprise, suprise!). I have a question about the recent talk of anesthesia assistants. I have read on this board as well as the ASA's website that 8 states have opted out of MDA supervision, and that in these states CRNA's are considered independent practitioners and need no MDA supervision. My question is that if in these 8 states the CRNA does not need any supervision; and has the right to practice on his/her own then who is to say that a CRNA could not oversee an AA in these 8 states? As I said before, I have no idea what the politics are behind this scenario; but I would like to try and understand!
    Thanks in advance for any responses, and for all of the great info posted to date!
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  2. 7 Comments

  3. by   meandragonbrett
    Nick@nite,
    You do realize that CRNAs can practice in all 50 states without MDA supervision, right? The opt out is concerning medicare patients. Regarding your question about supervision of AAs by CRNAs...What a great question! I never even thought of it! I cannot wait to read the replies!

    Brett
  4. by   gaspassah
    in todays litigeous (sp) society, would you want to supervise AA's when the very reason or basis of CRNA bias against them is their lack of education and experience dealing with patients. it would seem that this avenue of supervision would open the CRNA supervisor to lawsuits in the advent that poor decisions could be made by the AA resulting in poor patient outcomes. this would give power to the MDA's supporting restrictions against CRNA's and credence to the statements that anesthesiologist need to supervise all anesthesia providers. IMHO
  5. by   keermie
    I believe that this would be a political no-no. I agree with gaspassah regarding litigation. Also, AA's would proliferate in great #'s thus displacing CRNA's clout. Currently there are many attempts in state legislatures by the AANA to limit AA's practice. By taking on a supervisore role, the AANA would indirectly support their practice by creating a new avenue for employers of anesthesia practice to hire less expensive labor. Lastly as alluded by gaspassah, the AANA's main basis against AA's is their lack of education and experience dealing with patients; thus, facilitating poor patient outcomes which is another 180 from current AANA politics.
  6. by   fence
    AA's I believe can only practice under the direct supervison of an anesthesiologist (MDA). And I will have to agree that any push towards CRNA's supervising AA's would defeat the arguement that AA's lack the education and experience to provide Anesthesia care to pt.
  7. by   SCHMEGGA
    Originally posted by fence
    AA's I believe can only practice under the direct supervison of an anesthesiologist (MDA). And I will have to agree that any push towards CRNA's supervising AA's would defeat the arguement that AA's lack the education and experience to provide Anesthesia care to pt.
    Agreed! If CRNAs were to push for the ability to supervise AAs then that would just be defeating the point that we don't want AAs practicing in the first place.
  8. by   JasonGreen
    Originally posted by meandragonbrett
    Nick@nite,
    You do realize that CRNAs can practice in all 50 states without MDA supervision, right? The opt out is concerning medicare patients. Regarding your question about supervision of AAs by CRNAs...What a great question! I never even thought of it! I cannot wait to read the replies!

    Brett
    Yes, I believe that's true to an extent. No state says that CRNAs have to be medically supervised by an MDA, but some states say that CRNAs have to medically supervised by a physician. And I'm sure that the ENT doc the CRNA is giving gas for doesn't fully have the grasp of anesthetic concepts that a CRNA does (this doesn't make sense why the supervision then).
  9. by   gaspassah
    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.

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