*******SUPERVISION REQUIRED or NO for CRNAs?*******

  1. I am confused. Do CRNAs work ONLY under supervision of anesthesiologist or any physician? I was thinking they can work even independently all over USA with no supervision. Correct me if I am wrong. Do the rule change from state to state if so please describe more on that. What about NORTH CAROLINA state issue ??? Any changes are expected in terms of supervision on CRNAs?
    Can this also be implemented all over USA so that NO CRNA can work by them self with no supervision?? R they going to make supervision on CRNAs mandatory soon or what?
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    About rtinkam

    Joined: Jan '05; Posts: 8

    35 Comments

  3. by   yoga crna
    NO, NO, NO, THERE ARE NO STATES THAT REQUIRE CRNA SUPERVISION BY ANESTHESIOLOGISTS.

    Also, in my opinion, it is never going to happen. Each state licenses and regulates practice for that state, so there is no national licensure. There is a lot of action in a few individual states on this issue, but what was proposed was shot down by the courts (most recently Florida and NJ).

    That is why we must get and stay involved in our profession. Money, energy, letters, being politically active on all levels is the most important thing we can do (except for giving the same excellent anesthesia that we have for 100 years, without required "supervision".

    YOGA
  4. by   jubowen
    If I could continue this.....we have CRNA staff in our small hospital. They are given medical direction by the surgeon providing the surgery. My question is, for those of you in the same situation, how do you document that a discussion of the plan for anesthesia occurred?
    Thanks
  5. by   kitty=^..^=cat
    We added a field on our anesthesia form that says "MD/Surgeon concurs with planned anesthesia" and a little check-box. JCAHO has surveyed this form and it meets their standard.
  6. by   Brenna's Dad
    I'm really not sure why this checkbox you mention is required. The only requirement by the surgeon is to request anesthesia services. Since the surgeon knows next to nothing about anesthesia, I'm not sure how they can provide "medical direction." In fact, it is in the surgeon's best interest to minimize their liablity by staying out of the anesthetic all together. CRNAs continue to be independent practitioners.

    Yoga, please correct me if I am wrong.
  7. by   yoga crna
    I agree with Brenna' Dad. Any notation on the medical record that may be construed that the surgeon has anything to do with anesthesia, other than recommend that the patient gets one, can be used to imply liability in a malpractice action.

    Anesthesia and surgery are collaborative practices and should function as such in the clinical setting. I don't tell a surgeon what suture to use any more than he tells me what anesthetic to use. I refuse to use the word SUPERVISE in my practice. The surgeon needs to sign off on the history and physical and to note any abnormal labs, but other than that should not have anything to do with the anesthesia records.

    We really need to see this for what it is. It is an effort to demean our education and practice and make us second-level practitioners, because someone who is not an anesthetist needs to validiate our practice. THIS HAS NOTHING TO DO WITH MEDICARE REIMBURSEMENT, it is a practice issue.

    All contrary arguments encouraged

    Yoga.
  8. by   LPNer
    I do not mean to be a trouble maker here, I am truly confused as to why an advanced practice nurse should think s/he is above direction in the workplace?
    Why would a CRNA be concerned if they are required to work at the direction of an MD (anesthesiologist)?
    LPNs work at the direction of an MD, RN, etc. What's the difference? I think the RN should be dropped from our scope of practice since I see no need for it. Keep the MD, podiatrist, etc as we are nurses and our job is to carry out, look after, and evaluate (make suggestions as needed) and build on the care provided by the doc.
    CRNA's are also nurses and as such the job is to carry out, look after and evaluate (make suggestions as needed) and build on the care provided by the doc.
  9. by   Maxs
    Quote from LPNer
    I do not mean to be a trouble maker here, I am truly confused as to why an advanced practice nurse should think s/he is above direction in the workplace?
    Why would a CRNA be concerned if they are required to work at the direction of an MD (anesthesiologist)?
    LPNs work at the direction of an MD, RN, etc. What's the difference? I think the RN should be dropped from our scope of practice since I see no need for it. Keep the MD, podiatrist, etc as we are nurses and our job is to carry out, look after, and evaluate (make suggestions as needed) and build on the care provided by the doc.
    CRNA's are also nurses and as such the job is to carry out, look after and evaluate (make suggestions as needed) and build on the care provided by the doc.
    I don't mean to rain on your parade, but here is the difference: A CRNA knows more about anesthetics than the surgeon does. The MDA performs pretty much the same job as the CRNA. So the RN, and the LPN, the LPN is the first two semesters of RN school. Basically an LPN is 50% of an RN, and CRNA's are not 50% of MDA's that's the different. In my opinion CRNA (experience & performance) = MDA (experience & performance) and vice versa.

    Maxs
  10. by   LPNer
    Quote from Maxs
    I don't mean to rain on your parade, but here is the difference: A CRNA knows more about anesthetics than the surgeon does. The MDA performs pretty much the same job as the CRNA. So the RN, and the LPN, the LPN is the first two semesters of RN school. Basically an LPN is 50% of an RN, and CRNA's are not 50% of MDA's that's the different. In my opinion CRNA (experience & performance) = MDA (experience & performance) and vice versa.

    Maxs
    Yes yes, I understand what you are saying.

    What I don't understand is... if an LPN is performing pretty much the same job as an RN (in my state/hospital staff nurse is staff nurse, with few differences)
    OK, so it is the same thing as a CRNA : MDA? Right? You are doing the same job, with very few differences.

    What's the harm in being at the direction of the MDA, like LPNs : RNs, it will amount to nothing more than the MDA making the assignment (so to speak.)

    See what I mean? I am trying to understand where you, as an advanced practice nurse, are coming from, not arguing your position.
  11. by   spidermonkey
    .
    Last edit by spidermonkey on Mar 15, '06
  12. by   Maxs
    Quote from LPNer
    Yes yes, I understand what you are saying.

    What I don't understand is... if an LPN is performing pretty much the same job as an RN (in my state/hospital staff nurse is staff nurse, with few differences)
    OK, so it is the same thing as a CRNA : MDA? Right? You are doing the same job, with very few differences.

    What's the harm in being at the direction of the MDA, like LPNs : RNs, it will amount to nothing more than the MDA making the assignment (so to speak.)

    See what I mean? I am trying to understand where you, as an advanced practice nurse, are coming from, not arguing your position.
    I know what you are saying and I don't disagree with you, but most states do require an RN because simply an RN is allowed to perform more duties than an LPN. The problem is LPN's are restricted by the state to do many things that an RN can. Simply because the RN is trained at school to do more than the LPN is. For instance, say your a small private hospital, can you afford to hire an MDA and a CRNA because the MDA will supervise the CRNA if both of them can simply do the same job? NO!
    But LPN needs an RN because LPN's are not allowed to do more than what they have learned in school. As matter fact in most states they can't even work at a hospital. So let me ask you this, what do LPN's at long term facilities do? paper works, cathethers, pass med, and injections and do the lap reports by the doctors right. Why do they need to supervise the cna's when the cna's can simply be trained to do that? A cna is one portion of the four portions of nursing school, lpn is two portions of the four and the RN is four portions out of the four portions of nursing school. You see the difference. If we follow what you are saying, your saying that CNA's shouldn't need a supervision from LPN's as well.

    Maxs
    Last edit by Maxs on Mar 19, '05
  13. by   kirbykd
    Currently, in NC, the law and Nurse Practice Act states that CRNAs must work in "collaboration" with a physician (which can be a surgeon, dentist, podiatrist, anesthesiologist). The bill currently in committee in the state legislature will change the law to say that CRNAs should be "supervised" by a physician, if it passes. The biggest difference in practical terms is that if the physician is "supervising" the CRNA, then the physician will be held as liable, if not more so, legaly for the anesthetics provided. In NC, the bill could have a truly negative effect on rural health care. NC has 35 counties without any access to MDAs. All anesthetics in those areas are provided by CRNAs. Surgeons (or other physician) will have to claim "supervision" thus liability, for CRNAs to continue practice in those areas.
  14. by   jewelcutt
    I didn't realize LPNs are performing the same job as RNs. I know in our state they have limitations on the type of care they provide like giving IV meds for example. I have never seen an LPN in an ER or an ICU (correct me if I'm wrong, I'm not trying to insult) or one with ACLS,TNCC,IABP,CCRN etc. As far as the CRNA/MDA issue, one thing that people who aren't familiar with anesthesia is they don't have a knowledge of the history of anesthesia. CRNAs never needed to be supervised before, our profession was created for the safety of the patient, when surgery really got rolling and there was a need for attentive individuals to focus just on the patient and keep them alive. MDAs came around later. So you see, it has never been an issue of CRNAs breaking the physician led model, but rather protecting the responsibility they have always had.

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