New Air Force Policy Recognizes Full Scope of Nurse Anesthetist Practice
For Immediate Release
January 30, 2012
New Air Force Policy Recognizes Full Scope
of Nurse Anesthetist Practice
AANA Commends USAF for Ensuring Access to Safe, Cost-Effective Anesthesia Care for Men and Women Serving Our Country and Their Dependents
Park Ridge, Ill.--A new U.S. Air Force (USAF) policy governing anesthesia delivery in USAF facilities worldwide recognizes the full scope of Certified Registered Nurse Anesthetists (CRNAs) practice, thereby ensuring military personnel and their dependents access to the safest, most cost-effective anesthesia care. The policy promotes patient safety by approving anesthesia delivery models common to other American military service branches with which the Air Force often operates jointly, and that are also widely used in civilian healthcare.
"Our military personnel and their dependents deserve the best anesthesia care, and CRNAs are privileged to provide it to them," said Debra Malina, CRNA, MBA, DNSc, president of the American Association of Nurse Anesthetists (AANA). "We commend the Air Force for making these policy improvements, which were developed collaboratively within the Air Force by CRNAs, nurses and physicians. Formal recognition of the outstanding care our military CRNAs provide, through an unencumbered scope of practice policy, is based on existing scientific evidence and current best practices."
CRNAs provide the majority of anesthesia services to the U.S. armed forces at home and abroad, including the USAF. They are often the only anesthesia professionals deployed in front-line military facilities. In 2011, 142 active duty CRNAs served in the Air Force.
The updated policy, Air Force Instruction 44-102, was publicly issued on January 20 by the Secretary of the Air Force and replaces regulations dating to 2006. A collaborative process involving USAF physicians, nurse anesthetists, and other healthcare professionals led to the following important changes:
- The USAF's new Anesthesia Policy, Practice and Services demonstrates a commitment to professional collaboration among CRNAs and physician anesthesiologists in the interest of patient safety and access to care. Significantly, the policy states "Traditionally, ACT [anesthesia care team] referred to a CRNA working in a medical directed environment with an Anesthesiologist. However, in the [new policy], ACT refers to any combination of Anesthesiologist or CRNA working as a team.... The ACT concept is thus collaboration among anesthesia providers in the delivery of anesthesia and its related services."
- The new policy authorizes directors of USAF treatment facilities to name either a CRNA or anesthesiologist as chief of anesthesia.
- The new policy closely mirrors similar policies in place in the U.S. Navy, promoting consistent patient care by advancing joint, common healthcare delivery and practice rules across military healthcare facilities worldwide.
Among the scientific evidence considered by the USAF was the landmark 2010 Institute of Medicine report titled "The Future of Nursing: Leading Change, Advancing Health," and a 2010 research study published in the preeminent health policy journal Health Affairs
titled "No Harm Found when Nurse Anesthetists Work Without Supervision by Physicians." The publications underscored the patient safety, access to care, and cost-effectiveness benefits associated with policies promoting the use of CRNAs and other advanced practice registered nurses (APRNs) to their full scope of practice.
Jan 31, '12
AFI 44-119: USAF CRNA Scope of Practice
7.5.3. Scope of Practice:
188.8.131.52. May act independently in areas of demonstrated competency within theirdesignated scope of practice as indicted by ―Fully Competent‖ or code ―1‖ on theprivileges list for all American Society of Anesthesiologists (ASA) Classifications: 1, 2,3, 4 or 5 including ―E‖ for urgent/emergent obstetric care.
184.108.40.206. CRNAs will consult with an anesthesiologist or any other medical specialty forpatients who require such medical consultation based on acuity of the health condition orcomplexity of the surgical procedure. Consultation will be based on the judgment of theCRNA in coordination with the attending surgeon. The CRNA remains responsible andaccountable for determining when consultation with a physician specialist (e.g.,anesthesiologist, cardiologist, internist) is needed during any patient encounter. Theseprovider-to-provider consultations may be verbal, written, or electronic; will bedocumented in the patient’s medical record; should include the name of the specialistconsulted; and include a brief outline of the anesthetic plan developed or therecommended course of action. A collaborative relationship is a key component for safe,quality healthcare.
220.127.116.11. Provide anesthesia ―on-call‖ within their scope of practice and expertise,utilizing consultation and/or shared responsibility for patient care.
18.104.22.168. CRNAs are accountable for the preoperative assessment of all patients for whomthey are the primary anesthesia provider and will ensure the patients are appropriatelyprepared for anesthesia. This holds for patients of all ASA classifications. It also appliesfor anesthesia services in which the patient may have had the pre-anesthesia assessmentperformed by another provider in an anesthesia preoperative clinic. Specialists, includingbut not limited to surgeons and/or anesthesiologists, are not required to countersign apreoperative assessment or the anesthesia record.
22.214.171.124. CRNAs granted MTF privileges must have physician consultation (privileged tothe same scope of practice) available either in person or by phone when they areperforming direct patient care activities.
Last edit by Joe V on Jan 31, '12
: Reason: formatting for easier reading
May 8, '12
Quote from inforesource
As an Air Force O-6 (currently active duty as a PIC C141), I do not appreciate that a nurse (CRNA) may or may not be designated to provide my anesthesia care......anesthesia is the practice of medicine not nursing. CRNA are fine under the direction of anesthesiologists but totally unsafe as "solo" practitioners............yes, I was an advance practice nurse...so. please. nurses (CRNA) pleae spare me the "wannabee anesthesiologist drivel....you are not as safe as anesthesiologists"...suce substitution of midleval nurses as "anesthesia providers" is an insult to the USAF.......................
It is fortunate that the research and the Surgeon General of the USAF do not share your opinion. It is unfortunate that as a self described nurse and APN ( I notice you did not say CRNA) that you do not follow evidenced based practice or fail to acknowledge that military CRNAs have already been functioning independently for several decades and just as safely as our MDA counterparts. Anesthesia was determined, almost 100 years ago, by the courts to be a practice of nursing not medicine when a nurse is providing the anesthesia. This is the same as any other profession i.e. if a podiatrist is doing the surgery it is a practice of podiatry not medicine.
CRNAs are not midlevel anything. CRNAs have been providing anesthesia for nearly 150 years. The AANA was around a long time before the ASA, and nurse anesthetists were by far the largest group of anesthesia providers until the mid-twentith century when billing changed and suddenly anesthesia became a very lucrative speciality for physicians. Up until that time there were relatively few anesthesiologists in the US at all. CRNAs are and will for the foreseeable future continue to be the predominant provider of anesthesia services in the United States.
There are 1/3 of the states that have agreed that there is no need for any kind of supervision (real or imagined) of CRNAs to independently bill for CMS services. In order to "opt-out" of the supervision requirement the Governor of the state has to consult with the state board of medicine and nursing. In all most all of the 17 states this has happened in the medical board has agreed that CRNAs practicing independently does not pose a threat or lower the quality of anesthesia care to the public. When in fact CRNAs provide a service that most anesthesiologists are unwilling to do, and that is work in rural/underserved areas.
Last edit by wtbcrna on May 8, '12