How exactly does a surgeon "supervise" a CRNA?

Specialties CRNA

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I dont get it. A surgeon knows NOTHING about gas at all.

So I'm confused when I hear some CRNAs say that their "supervising physician" (in states that require a supervising physician) are the surgeons running the case.

Explain to me exactly how a surgeon can "supervise" or "collaborate" wtih a CRNA.

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Good question...I always thought that a CRNA was supervised by the Anesthesiologist, much like NP's and PA's are supervised by physicians.

I would disagree that they don't know anything about gas. Anesthesia is a drug and I can't imagine a surgeon being completely untrained on this aspect...he would HAVE to know exactly how they worked in case he has to order meds during the surgery and how it's going to affect the patient.

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I've worked in an OR for many years, our CRNA's always had to have a Anesthesiologist as their Staffing MD. They didn't have to be in the room for the whole case, but had to be available if needed, and in my years in the OR, I was glad to have them for those unexpected emergencies! Mind you I've worked with some AMAZING CRNA's, but even the best could always use help in an emergency. While the physician in the room may have some knowledge of anesthetics and such that is NOT his specialty or his focus. Sounds fishy to me!

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I have never heard of a surgeon supervising a CRNA, only anesthesiologists. And in my experience, the CRNA really doesn't need "supervising" & works independently. Believe me, most surgeons don't know much about the gases, they just don't want their patients moving during surgery. The anesthetics used are determined by the anesthesia provider, and have little bearing on pain meds ordered by the surgeon; in fact, in the immediate post-op period, the analgesics & antimetics, fluids, etc. are ordered by the anesthesia provider. If a patient is having pain/nausea in PACU we call the anesthesia provider, not the surgeon.

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I have never heard of a surgeon supervising a CRNA, only anesthesiologists. And in my experience, the CRNA really doesn't need "supervising" & works independently. Believe me, most surgeons don't know much about the gases, they just don't want their patients moving during surgery. The anesthetics used are determined by the anesthesia provider, and have little bearing on pain meds ordered by the surgeon; in fact, in the immediate post-op period, the analgesics & antimetics, fluids, etc. are ordered by the anesthesia provider. If a patient is having pain/nausea in PACU we call the anesthesia provider, not the surgeon.

In many hospitals, especially in the rural areas, CRNAs are the only anesthesia provider working in that hospital. Therefore, if required by state laws or other regulations, CRNAs can be "supervised" by the surgeon or other physician who is requesting that an anesthetic be given. The CRNA is still legally responsible for the administration of the anesthetic and held to standards of care.

Medicare conditions of participation (for hospitals) require that a CRNA is "supervised" by a physician (note: no regulations require that the physician is an Anesthesiologist) unless the Governor of the State "OPTS OUT" from the requirement. Currently 14 states have "opted out" of the supervision rule.:lol2:

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If you had to place your bets, how much longer before the number of states that pass AA legislation eclipses the number of states that have opted out? The current score is 11 vs. 14.

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In many hospitals, especially in the rural areas, CRNAs are the only anesthesia provider working in that hospital. Therefore, if required by state laws or other regulations, CRNAs can be "supervised" by the surgeon or other physician who is requesting that an anesthetic be given. The CRNA is still legally responsible for the administration of the anesthetic and held to standards of care.

Medicare conditions of participation (for hospitals) require that a CRNA is "supervised" by a physician (note: no regulations require that the physician is an Anesthesiologist) unless the Governor of the State "OPTS OUT" from the requirement. Currently 14 states have "opted out" of the supervision rule.:lol2:

Thats what I'm talking about though. If there are no MDAs on staff and its just hte CRNA and surgeon, how does this work? Does the CRNA go up to the surgeon and ask "will you collaborate with me or supervise me on this case?" Or does the law state that the surgeon AUTOMATICALLY is supervising/collaborating with the CRNA?

For the states that require some kind of collaboration/supervision, how could this possibly work with a surgeon?

BTW, surgeons dont know anything about gas. If you asked them what the method of action of propofol was, they wouldnt have a clue.

Thats why I dont understand how a surgeon could possibly "supervise" or "collaborate" with a CRNA. Its the same thing as asking a family practice doctor to "collaborate" with a neurosurgeon.

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Anyone have a link that would show the states who have opted out?

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Thats what I'm talking about though. If there are no MDAs on staff and its just hte CRNA and surgeon, how does this work? Does the CRNA go up to the surgeon and ask "will you collaborate with me or supervise me on this case?" Or does the law state that the surgeon AUTOMATICALLY is supervising/collaborating with the CRNA?

For the states that require some kind of collaboration/supervision, how could this possibly work with a surgeon?

BTW, surgeons dont know anything about gas. If you asked them what the method of action of propofol was, they wouldnt have a clue.

Thats why I dont understand how a surgeon could possibly "supervise" or "collaborate" with a CRNA. Its the same thing as asking a family practice doctor to "collaborate" with a neurosurgeon.

You are totally and absolutely correct here.

By the way, how does propofol work?

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Specializes in Anesthesia.
......Its the same thing as asking a family practice doctor to "collaborate" with a neurosurgeon.

Completely wrong. The CRNA is an independent specialist.

Apparently you have a viewpoint to push.

What you are not understanding is in DNSc's post: the surgeon orders the anesthetic, the CRNA delivers it. Each is a specialist in their own right. The surgeon does the mechanical cutting, CRNAs do the physiological manipulation. The CRNA is not liable for the surgeon's acts or omissions, nor is the surgeon liable for the CRNA's.

http://www.aana.com/uploadedFiles/Resources/Legal_Briefs/2007/legalbriefsp89-93.pdf

In all 50 States, CRNAs are legal independent providers.

d

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Specializes in Vents, Telemetry, Home Care, Home infusion.

fla nurse assoc: nurse practitioner scope newsletter june 2005

physician supervision, delegation and competence

cynthia a. mikos, esq.

anesthesia and sedation risks and precautions -

under federal law, it is a condition

of participation in the medicare

and medicaid programs for ascs

that a non-physician anesthetist be

under the supervision of the operating

physician. the requirement for

hospitals varies slightly in that a

crna must be under the supervision

of the operating practitioner or an

anesthesiologist who is immediately

available if needed.

states may request that their ascs

and hospitals be exempted from this

supervision requirement. according

to the american association of

nurse anesthetists' web site, however,

the only states that had opted

out of the federal supervision

requirement as of november 2004

were alaska, idaho, iowa, kansas,

minnesota, montana, nebraska,

new hampshire, new mexico,

north dakota, oregon, and washington.

proving supervision has occurred

the centers for medicare & medicaid

services (cms) do not define or

specify how to prove supervision.

nevertheless, having the supervising

physician sign certain anesthesia

orders, evaluations, or records may

be the simplest way for the asc or

hospital to confirm that supervision

has occurred.

it is omic's understanding that

the role of the treating physician, in

relation to the provision of anesthesia

services, is to (1) determine whether

a patient requires the surgery or

diagnostic procedure, (2) request

that anesthesia be administered, and

(3) determine that the patient is an

appropriate candidate for the procedure

and anesthesia. therefore, it is

not uncommon for the treating

physician to be asked to sign perioperative

orders for anesthesia, sedation,

and anxiolytic drugs and to co-sign

the pre-anesthesia evaluation conducted

by the nurse anesthetist in

addition to signing the record of

the operation prepared by the circulating

nurse as well as the dictated

operative report. it is less common,

however, for the surgeon to sign the

anesthesia record. if asked to do so,

the ophthalmic surgeon may wish

to clarify with the asc or hospital

the reason for this requirement,

since proof of the surgeon's presence

and/or supervision during the

procedure should be ample from

the aforementioned signed orders,

co-signed pre-op evaluation, and/or

operative records.

http://www.omic.com/new/digest/digest_summerfall_04_v9.pdf

texas: whether the board of nurse examiners may regulate the selection and administration of anesthesia and the care of an anesthetized patient by a certified registered nurse anesthetist, and related question

the legislature's choice of the word "delegate" as opposed to, and without reference to, "supervise" in section 157.058 of the occupations code indicates that a physician may less directly oversee a crna's performance than a physician who has delegated tasks under other subdivisions of the medical practice act. while the term "supervise" indicates "general oversight over, to superintend or to inspect," black's law dictionary 1299 (5th ed. 1979); accord xvii oxford english dictionary 245 (2d ed. 1989) (defining "supervise"), the term "delegate" denotes a deputization of one person, e.g., a crna, to act as the agent of the other, e.g., the physician, see black's law dictionary 383 (5th ed. 1979) (defining "delegate" and "delegation"); accord iv oxford english dictionary 411 (2d ed. 1989) (defining "delegate"). moreover, section 157.058(b) specifies that the physician's order need not "specify a drug, dose, or administrationtechnique," and section 157.058(d) directs us liberally to construe the section to utilize the skills and services of crnas. tex. occ. code ann. 157.058. all of these factors favor our reading that a physician who properly delegates anesthesia-related tasks to a crna is not required, as a matter of law, by the medical practice act to supervise the crna's performance of those tasks.

http://www.oag.state.tx.us/opinions/op49cornyn/jc-0117.htm

aana - legal briefs, june 1997 -- the nature of supervision

liability of a surgeon when working

with a nurse anesthetist

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If you had to place your bets, how much longer before the number of states that pass AA legislation eclipses the number of states that have opted out? The current score is 11 vs. 14.

Oh, no! :rolleyes:

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