CRNAs under Bush's administration

[kstiefel]

My name is Katherine Stiefel and I am a junior nursing student at the University at Buffalo. My long term career goal is to become a CRNA and I have been following this LISTSERV closely.

I am interested in your opinions regarding the federal requirement for hospital physician supervision of CRNAs re-enacted under the Bush administration. According to Inglis (2003), this re-enactment of supervision may be potentially received by CRNAs as demoralizing and infringing upon the autonomy of their role. Inglis (2003) also notes that this re-enactment creates a "phony hierarchy" where physicians gain greater status and economic rewards. In contrast, Inglis (2003) says how in everyday practice this re-enactment of supervision by physicians of CRNAs has had no real effect.

My questions are: Has this re-enactment requirement changed your practice in any ways, and if so, how?

Thanks in advance for your replies.

Katherine M. Stiefel

Junior Nursing Student

University at Buffalo

Reference:

Inglis, T. (2003). Nurse anesthetists:One step forward, one step back: physician supervision requirements for CRNAs jeopardizes access to care. American Journal of Nursing, 103(1), 91-94.

[CRNA, DNSc]

My name is Katherine Stiefel and I am a junior nursing student at the University at Buffalo. My long term career goal is to become a CRNA and I have been following this LISTSERV closely.

I am interested in your opinions regarding the federal requirement for hospital physician supervision of CRNAs re-enacted under the Bush administration. According to Inglis (2003), this re-enactment of supervision may be potentially received by CRNAs as demoralizing and infringing upon the autonomy of their role. Inglis (2003) also notes that this re-enactment creates a "phony hierarchy" where physicians gain greater status and economic rewards. In contrast, Inglis (2003) says how in everyday practice this re-enactment of supervision by physicians of CRNAs has had no real effect.

My questions are: Has this re-enactment requirement changed your practice in any ways, and if so, how?

Thanks in advance for your replies.

Katherine M. Stiefel

Junior Nursing Student

University at Buffalo

Reference:

Inglis, T. (2003). Nurse anesthetists:One step forward, one step back: physician supervision requirements for CRNAs jeopardizes access to care. American Journal of Nursing, 103(1), 91-94.

No change and by the way 12 states have now opted out of the supervision regulations!!!!!

[kmchugh]

I am interested in your opinions regarding the federal requirement for hospital physician supervision of CRNAs re-enacted under the Bush administration. According to Inglis (2003), this re-enactment of supervision may be potentially received by CRNAs as demoralizing and infringing upon the autonomy of their role. Inglis (2003) also notes that this re-enactment creates a "phony hierarchy" where physicians gain greater status and economic rewards. In contrast, Inglis (2003) says how in everyday practice this re-enactment of supervision by physicians of CRNAs has had no real effect.

My questions are: Has this re-enactment requirement changed your practice in any ways, and if so, how?

Agree with the above poster. No real change. I practice rurally. We have two CRNA's, no MDA's, and practice independently. I make the decisions regarding my anesthetics.

KM

[Tony35NYC]

I see Bush eventually going back to the same type of preventative healthcare at the community clinic level as they do it in many rural areas and in most developing countries, and the faith-based community health programs are just one step in this direction. The majority of these community clinics are run by advance practice nurses, and the politicians know this route is a much cheaper approach to healthcare than expensive medical interventions later down the road. As the cost of healthcare continues to rise, the politicians will soon find themselves under serious pressure to placate the big insurance companies with some type of 'hedge', and fiscal deficits will also force them to look for more ways to cut back on the amount of money being paid out of medicaid and medicare for expensive medical therapy.

I wouldn't be surprised to see more legislation being introduced to further widen the scope of practice of advance practice nurses like NPs, Clinical Nurse Specialists, and CRNAs. The physicians may not approve but even they know they can't take on the HMOs and win.

[sproutsfriend]

Slowing the escalating health care costs (reduction is not realistic) will be the driving force expanding the advanced practice nurse role. Physicians will whine and claim that quality will suffer but that's a weak argument. Access to timely, less expensive, quality care can only be accomplished by a health care model that includes mid level practitioners and advanced nursing providers.

[yoga crna]

The key economic issues impacting healthcare are affordibility and access. CRNAs have a history of being leaders in delivery of anesthesia with these two principles in mind. How this will play out in the new Bush administration is going to be interesting. As much as the Republicans have traditionally favored less government, it it likely we will see some kind of government based or supported universal health care. Look for more HMO and managed care models of health care delivery.

The AANA is a very strong professional organization with a very productive Washington DC office and good leadership from the home organization in Chicago. Also, CRNAs are excellent at lobbying for patient safety in anesthesia and for value based reimbursement. I hope all of you students and new graduates get involved in the process. It is your future.

Getting back to the original question, nothing has changed with the supervision issue. In the Opt-Out states, patients haven't been dying because of non-supervised anesthesia by CRNAs. Go figure.

Yoga.

"When Wayne Gretzy was asked about his sucess as a hockey player, he said because he always went to where the puck was going, not where it had been."