Question about nurses and prescriptions?

Nurses General Nursing

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Why can nurse practitioners write prescriptions, but nurse anesthetists cannot? I know practitioners can't write them in Georgia, but anesthetists can't anywhere.

Nurse anesthetists are at the top of their field, yet they don't have the power to write prescriptions?

Why is this? Can CRNAs write prescriptions in any state?

Specializes in Spinal Cord injuries, Emergency+EMS.
That's true. I guess I should have said that CRNA's in the OR setting have no need to write scripts, at least in large academic hospitals. Rural hospitals may be different.

you still need prescriptive authority to generate the direction to administer the drugs given in practicing Anaesthesia, - who else is going to generate those directions to administer ... ?

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Specializes in Education, OR,CVT Stepdown,Psych..
you still need prescriptive authority to generate the direction to administer the drugs given in practicing Anaesthesia, - who else is going to generate those directions to administer ... ?

Not sure I follow you. In the US (at least in Illinois), CRNA's do not need prescriptive authority to anesthetize a patient for surgery. They work under an anesthesiologist. According to the AANA website:

"There must be medical participation in the determination to provide anesthesia to patients."

http://www.aana.com/Resources.aspx?id=2504

So, their "authority" comes from the physician.

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Specializes in Spinal Cord injuries, Emergency+EMS.
Not sure I follow you. In the US (at least in Illinois), CRNA's do not need prescriptive authority to anesthetize a patient for surgery. They work under an anesthesiologist. According to the AANA website:

"There must be medical participation in the determination to provide anesthesia to patients."

http://www.aana.com/Resources.aspx?id=2504

So, their "authority" comes from the physician.

how does the Nurse Anaesthetist obtain, possess and administer the medication without the presence of a physician anaesthetist? there must be some mechanism in place to generate a direction to administer ....

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Specializes in FNP.

In my last hospital, CRNA's worked independently. We didn't even have an anesthesiologist on staff. There was no "supervision" of any kind. The CRNAs also handled post op pain control.

Everyone once in a while we would get a patient who would try to refuse a CRNA and insist upon a physician provider. We would cheerfully tell them, "oh, OK, no problem. Let me just let the OR know to cancel your procedure, and then we will get started on your transfer. Would you prefer Hospital A approx 75 miles away, or Hospital B approx 60 miles away in the other direction? Oh, and do let your family know they do not provide accomodations so they can make hotel arrangements...."

I never had anyone take me up on that offer, lol.

I never saw a CRNA write any Rx for tx after d/c, the PCP did that. There was a "pain clinic" in the next town staffed by two MDAs. They didn't have hospital privileges at our place or the sister hospital in that town. AFAIK, it was just the two of them, and there wre not any CRNAs in that clinic.

And I agree that CRNAs and NPs are parallel and equal careers. I have never met anyone IRL who thought otherwise.

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Specializes in Anesthesia.

There is no state or federal regulation that requires that CRNAs work with/under an anesthesiologist in any state.

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Specializes in Education, OR,CVT Stepdown,Psych..
how does the Nurse Anaesthetist obtain, possess and administer the medication without the presence of a physician anaesthetist? there must be some mechanism in place to generate a direction to administer ....

The same way I, as an RN, do for conscious sedation cases. I get the meds from our pharmacy and administer them to our patients. The doctor ordered the meds and is not there when I administer them. At some point they are there for the surgery. I don't have prescriptive authority; which leads me to believe we are talking about different things. In the US, prescriptive authority means you possess a DEA number and are allowed to prescribe medications that a pharmacy can fill for a patient. Delivering medications in surgery (or on the floor for that matter) doesn't require prescriptive authority, only a doctor's order.

Our CRNA's obtain the meds, deliver the meds, and monitor the meds during surgery. When they intubate, however, an attending anesthesiologist is present. I'm not sure if it is an Illinois law, or just our hospital policy. Our CRNA's do not give scripts to patients after the surgery and none of them I spoke with have prescriptive authority.

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Specializes in Anesthesia.
When they intubate, however, an attending anesthesiologist is present. I'm not sure if it is an Illinois law, or just our hospital policy.

That is hospital policy.

FYI: You don't need a DEA number to have prescriptive authority. You have to have DEA number to prescribe certain controlled substances though.

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CRNAs do not have training program in chronic pain management. Even with most of the pain management physician learned chronic pain management through one year of fellowship because the complexity not simply procedure oriented subspecialty. Writing prescription requires the knowledge of internal medicine. It may seem that pain management physician only prescript narcotics. But having a license to dispense script, one has to be sure to understand the medical and legal consequence of having that responsibility. For those who really wants to practice medicine should seek advance training so to serve the public for their best interest. Good luck to yall.

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Specializes in Anesthesia.
CRNAs do not have training program in chronic pain management. Even with most of the pain management physician learned chronic pain management through one year of fellowship because the complexity not simply procedure oriented subspecialty. Writing prescription requires the knowledge of internal medicine. It may seem that pain management physician only prescript narcotics. But having a license to dispense script, one has to be sure to understand the medical and legal consequence of having that responsibility. For those who really wants to practice medicine should seek advance training so to serve the public for their best interest. Good luck to yall.

I would disagree that most pain physicians go through a formal fellowship training program. Most "pain management physicians" did little to no formal training in chronic pain management outside of residency other than maybe a short weekend/week long course in pain management.

There are a few CRNAs that do chronic pain management. Those few that do chronic pain management almost always do it in places where there are not physicians practicing chronic pain management. Depending on the program CRNAs do learn to deal with chronic pain. CRNAs spend a good portion of their program learning to deal with pain and how to administer interventional/regional techniques to deal with pain. In my mind that is much better than the FP that did a weekend course learning how to do chronic pain management, and is now doing epidural steroid injections to make more money.

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