New Jersey Supreme Court Unanimously Upholds Office-Based Surgery Regulations
The New Jersey Supreme Court affirmed the Appellate Division's decision and held that the office-based surgery regulations challenged by the New Jersey Association of Nurse Anesthetists were within the Board of Medical Examiners' delegated authority. The Court agreed with the Appellate Division's holding that the administration of anesthesia is the practice of medicine and that the regulations fall squarely within the Board's core jurisdiction, the licensing and qualifications of physicians, and how they perform their professional services. It also agreed that while the regulations have an indirect impact on the CRNAs' profession, the BME is not regulating the nursing profession, but rather the physicians who offer anesthesia in an office setting.
Recognizing the unique nature of the office setting, the Court held that the "wealth of testimony adduced at the public hearings on the regulations supported the need for enhanced education and oversight." This decision upheld the requirement that a qualified physician must supervise a nurse anesthetist who administers and monitors general or regional anesthesia. The regulations specify how many hours of continuing medical education in anesthesia the supervising physician must have completed. Lastly, the Court recognized the value of having an anesthesiologist involved in the delivery of anesthesia care. It is "fundamentally reasonable that additional education and training would enable anesthesiologists administering or overseeing anesthesia to better protect patients and to respond when complications occur."
I guess we were not as powerful as we thought we were and this shows doctors will always be above us.
the administration of anesthesia is a proper function of a registered nurse and is a function regulated by this section; this function may not be performed unless:
(1) the registered nurse has successfully completed the educational program of a school for nurse anesthetists accredited by the council on accreditation of education programs of nurse anesthesia of the american association of nurse anesthetists.
(2) the registered nurse is certified as a registered nurse anesthetist by the council on certification or on recertification of nurse anesthetists of the american association of nurse anesthetists.
(3) the certified nurse anesthetist is authorized to administer anesthesia in cooperation with a surgeon or dentist. the nurse anesthetist's performance shall be under the overall direction of the chief or director of anesthesia services. in situations or health care delivery facilities where these services are not mandatory, the nurse anesthetist's performance shall be under the overall direction of the surgeon or dentist responsible for the patient's care.
(5) a noncertified registered nurse who has completed an approved anesthesia program may administer anesthesia under the direction of and in the presence of the chief or director anesthesia services or a board certified anesthesiologist until the announcement of results of the first examination given for certification for which she is eligible. if a person fails to take or fails to pass the examination, the person shall immediately cease practicing as a nurse anesthetist. if the applicant, due to extenuating circumstances, cannot take the first scheduled examination following completion of the program, the applicant shall appeal to the board for authority to continue practicing.
(b) for purposes of this section, ''cooperation'' means a process in which the nurse anesthetist and the surgeon work together with each contributing an area of expertise, at their individual and respective levels of education and training.http://www.pacode.com/secure/data/049/chapter21/s21.17.html
unable to locate similar language in nj regs...this is root of problem imho.
PArt of the reason I think NJ CRSN's lost the case is the way nurse practice act is written re CRNA's
Compare that to PA's where is explicitly states:
21.17. Anesthesia.
The administration of anesthesia is a proper function of a registered nurse and is a function regulated by this section; this function may not be performed unless: (lists education to perform anesthesia)
Not to get hung up on semantics, but the statement that "The administration of anesthesia is a proper function of a registered nurse" is misleading because it implies that the administration of anesthesia is a functional by-product of licensure as an RN, rather than a functional by-product of licensure as a CRNA.
Also, this statement, in meaning, is implied summarily throughout NJ chapter 13. At least to me it is. So, I don't see the relative impact of this statement.
Specializes in Vents, Telemetry, Home Care, Home infusion.
I edited threasd to include entire section. I clearly see a difference in the PA board stating administering anesthesia is a nursing function with proper education, therefore the SBON has the right to regulate anesthesia practice.
NJ regs do not expressly state that in chapter 13. Therefore, NJ physicians won their round to regulate who administers anesthesia in physicians office practice.
... is misleading because it implies that the administration of anesthesia is a functional by-product of licensure as an RN, rather than a functional by-product of licensure as a CRNA.
Don't get hung up on the RN vs. CRNA distinction here. The ability to practice nurse anesthesia IS a by product of RN licensure. It is not the only requisite, and obviously other things are required as well (graduation from an accredited program, certification, etc.) I don't think any states have a specific CRNA license although many have a separate APN license.
The reason the language is important, is it determines which professional board has jurisdiction over CRNA practice. It is important that CRNAs are authorized to practice under their nursing license, which means they are accountable to the board of nursing. In some states the language is not so clear. This leaves the opening that the board of medicine may make the case that they have the authority over CRNA practice. Not the best situation for CRNAs.
Don't get hung up on the RN vs. CRNA distinction here. The ability to practice nurse anesthesia IS a by product of RN licensure. It is not the only requisite, and obviously other things are required as well (graduation from an accredited program, certification, etc.) I don't think any states have a specific CRNA license although many have a separate APN license.
The reason the language is important, is it determines which professional board has jurisdiction over CRNA practice. It is important that CRNAs are authorized to practice under their nursing license, which means they are accountable to the board of nursing. In some states the language is not so clear. This leaves the opening that the board of medicine may make the case that they have the authority over CRNA practice. Not the best situation for CRNAs.
loisane crna
Yes, maybe it is a functional by-product, as opposed to a direct by-product. Though, I think I see NRSKarenRN's point now, with reagard to the explicit wording contained within PA's code. As you had stated, this could indeed peclude BME interference in policy where CRNAs are concerned.
Politically, this is an important decision for the A$A in NJ, but, financially, I don't think things will play out very well for NJ MDAs in the long run---at least, not as good as they had it before now. According to the law, all in-office procedures will now be performed by MDAs. This means the MDAs must now be physically present during the entirety of each procedure---and also be fully responsible for all the work. The more time they may have to spend doing one procedure the less time they'll have available to make more $$$ from doing others in the same day. No more 'supervision' of CRNAs from the golf course...therefore, no more $600,000+ salaries off the backs of CRNAs who work for them.
New Jersey residents should also not be surprised to see higher anesthesia fees for these procedures since MDAs cost more than CRNAs. However, the HMOs will staunchly resist any big increases in anesthesia fees, and I don't see medicare paying any big increases to the MDAs either. So, their success at chasing the CRNAs away also means they're going to have to work harder for their money. I wouldn't call this a 'win'. I have the feeling that it will prove to be a bitter-sweet 'victory' for the MDAs.
The entire thing smells fishy to me...or perhaps a win based on a technicality or unclear language.
So basically what we are saying is that NJ CRNAs can function independently in the hospital caring for the sickest patients but not in the office caring for plastic surgery patients. Not to say that plastic surgery patients cannot have significant comorbidities, but the decision just does not make sense.
The entire thing smells fishy to me...or perhaps a win based on a technicality or unclear language.
So basically what we are saying is that NJ CRNAs can function independently in the hospital caring for the sickest patients but not in the office caring for plastic surgery patients. Not to say that plastic surgery patients cannot have significant comorbidities, but the decision just does not make sense.
From a purely legal point of view, the ruling makes sense. I'm sure the justices made their decision partly based on the badly worded NJ Nurse Practice Act. One of my CRNA friends works with a group owned by a couple of MDAs and she tells me that herself and the other CRNAs have to work a LOT of overtime (and be on call) to make the approximately $160,000 they make each year. She said its like being pimped out, because they do all the work while the MDAs sit back and collect the money. She said her bosses each make over $500,000 a year in salary for themselves even though they hardly, if ever, show up at any of the procedures. They have 6 CRNAs working for them simultaneously while they fish, hunt, beach, yacht, and play golf.
Gosh, it must be good to be an MDA! Most people think you are a god, you make a ton of money, and for the most part you don't have to do anything as long as you have a couple CRNAs working under your "supervision" ---unless, of course, you now happen to be an MDA who lives in the state of NJ.
NRSKarenRN, BSN, RN
10 Articles; 19,196 Posts
part of the reason i think nj crna's lost the case is the way nurse practice act is written re crna's
nj (see chapter 13): http://www.state.nj.us/lps/ca/nursing/nurselaws.pdf
compare that to pa's where is explicitly states:
21.17. anesthesia.
the administration of anesthesia is a proper function of a registered nurse and is a function regulated by this section; this function may not be performed unless:
(1) the registered nurse has successfully completed the educational program of a school for nurse anesthetists accredited by the council on accreditation of education programs of nurse anesthesia of the american association of nurse anesthetists.
(2) the registered nurse is certified as a registered nurse anesthetist by the council on certification or on recertification of nurse anesthetists of the american association of nurse anesthetists.
(3) the certified nurse anesthetist is authorized to administer anesthesia in cooperation with a surgeon or dentist. the nurse anesthetist's performance shall be under the overall direction of the chief or director of anesthesia services. in situations or health care delivery facilities where these services are not mandatory, the nurse anesthetist's performance shall be under the overall direction of the surgeon or dentist responsible for the patient's care.
(4) except as otherwise provided in 28 pa. code 123.7© (relating to dental anesthetist and nurse anesthetist qualifications), when the operating/anesthesia team consists entirely of nonphysicians, such as a dentist and a certified registered nurse anesthetist, the registered nurse anesthetist shall have available to her by physical presence or electronic communication an anesthesiologist or consulting physician of her choice.
(5) a noncertified registered nurse who has completed an approved anesthesia program may administer anesthesia under the direction of and in the presence of the chief or director anesthesia services or a board certified anesthesiologist until the announcement of results of the first examination given for certification for which she is eligible. if a person fails to take or fails to pass the examination, the person shall immediately cease practicing as a nurse anesthetist. if the applicant, due to extenuating circumstances, cannot take the first scheduled examination following completion of the program, the applicant shall appeal to the board for authority to continue practicing.
(b) for purposes of this section, ''cooperation'' means a process in which the nurse anesthetist and the surgeon work together with each contributing an area of expertise, at their individual and respective levels of education and training.http://www.pacode.com/secure/data/049/chapter21/s21.17.html
unable to locate similar language in nj regs...this is root of problem imho.