any CRNAs as mid-level providers in the ICU?

Specialties CRNA

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coming from an academic institution, PA's and NP's are an integral part of our CCM team. are there any CRNA's here that work in the ICU's in such a capacity in addition to working in the OR?

i am about to graduate with my BSN and am looking forward to a career in anesthesia, however i am also interested in the role of the mid-level provider in the ICU setting. is there any way i could do both?

are you saying that crnas should not intubate on the floors and not start lines??

if the state they are working in defines a narrow scope of practice to be only involved in peri-anesthesia only then legally probably they should not intubate on floors, respond to codes outside of the or or place lines... even though these are skills they use on a daily basis and are well versed in, but if it is outside of the scope of practice it opens up liability for the crna and health care facility.

now if the state does not place restrictions to include only peri-anesthesia care then the crna is a perfect provider for lines, intubations ect.

part of the problem with advanced practice nursing is varied scopes of practice that do not reflect the training and competency of the nurses.

jeremy

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Specializes in CRNA, Finally retired.
if the state they are working in defines a narrow scope of practice to be only involved in peri-anesthesia only then legally probably they should not intubate on floors, respond to codes outside of the or or place lines... even though these are skills they use on a daily basis and are well versed in, but if it is outside of the scope of practice it opens up liability for the crna and health care facility.

now if the state does not place restrictions to include only peri-anesthesia care then the crna is a perfect provider for lines, intubations ect.

part of the problem with advanced practice nursing is varied scopes of practice that do not reflect the training and competency of the nurses.

jeremy

i've been a crna for 25 years and never heard of a state that placed limitations on what we do outside of the or. i've always covered intubations, a-line placements and difficult iv's when called. anyone else out there heard of this?

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if the state they are working in defines a narrow scope of practice to be only involved in peri-anesthesia only then legally probably they should not intubate on floors, respond to codes outside of the or or place lines... even though these are skills they use on a daily basis and are well versed in, but if it is outside of the scope of practice it opens up liability for the crna and health care facility.

now if the state does not place restrictions to include only peri-anesthesia care then the crna is a perfect provider for lines, intubations ect.

part of the problem with advanced practice nursing is varied scopes of practice that do not reflect the training and competency of the nurses.

jeremy

i agree, thanks for explaining..

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I have never seen a CRNA performing this role in the ICU. First of all, they would probably take a huge paycut. Secondly, many hopsitals that do not have residents have nurse practicioners in the ICU. As a CRNA in PA, I won't even have prescriptive authority. I know some CRNA's in other states do, but it is really not necessary for the job we perform in the OR. I have seen CRNAs intubate and occasionally place a-lines in the unit, but that is it!

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I've been a CRNA for 25 years and never heard of a state that placed limitations on what we do outside of the OR. I've always covered intubations, a-line placements and difficult IV's when called. Anyone else out there heard of this?

I looked to Oregon board of nursing, the scope appears to be restricted to anesthesia related care only:

http://www.oregon.gov/OSBN/pdfs/npa/Div52.pdf

If does not make sense but I don't see anythign that would allow a CRNA to intubate unless it is related to the anesthesia plan.

Jeremy

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Specializes in SRNA.

According to the Oregon scope of practice thing

"Except as provided to the contrary by the rules and regulations or bylaws governing medical procedures in a hospital or ambulatory surgical center, a CRNA shall collaborate with a physician or dentist, or with other health care professionals whose scope of practice includes the authority to provide anesthesia care to a patient."

So all you have to do is have a hospital rule that says CRNAs can tube in the ICU and you're good to go.

-S

I looked to Oregon board of nursing, the scope appears to be restricted to anesthesia related care only:

http://www.oregon.gov/OSBN/pdfs/npa/Div52.pdf

If does not make sense but I don't see anythign that would allow a CRNA to intubate unless it is related to the anesthesia plan.

Jeremy

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Specializes in Nurse Practitioner/CRNA Pain Mgmt.

At the hospital I currently work at, the ICU calls upon us CRNAs to respond to difficult intubations that the attending and residents can't get. Also, as a level I trauma center, whenever a trauma patient comes in the ER, the CRNA on duty for trauma is FIRST to attempt to intubate even before the ER resident or attending physician.

I guess it all depends on how a hospital's anesthesia service is set up. I know for a fact, that CRNAs in my hospital can intubate outside the surgical arena when asked to do so by other medical services within the organization.

Vince.

CRNP/CRNA

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According to the Oregon scope of practice thing

"Except as provided to the contrary by the rules and regulations or bylaws governing medical procedures in a hospital or ambulatory surgical center, a CRNA shall collaborate with a physician or dentist, or with other health care professionals whose scope of practice includes the authority to provide anesthesia care to a patient."

So all you have to do is have a hospital rule that says CRNAs can tube in the ICU and you're good to go.

-S

But if you read further it limits scope of practice of the CRNA is as follows:

Assessment of the health status of the patient as that status relates to the relative risks associated with anesthetic management of the patient

Determination and administration of an appropriate anesthesia plan, including but not limited to selection, ordering and administration of anesthetic agents, airway management and monitoring and recording of vital signs, life support functions, mechanical support use, fluid management and electrolyte and blood component balance

Action necessary to counteract problems that may develop during implementation of the anesthesia plan

Necessary or routine post anesthesia care

The CRNA may only provide anesthesia services within the scope of practice for which he or she is educationally prepared and for which competency has been established and maintained. Educational preparation includes academic course work, workshops or seminars, provided both theory and clinical experience are included.

So if a CRNA goes to ICU to intubate, place a line or other task that is not related to anesthesia care how is that included? Mind you I don't agree with this but when I read the document it looks to be a narrow scope of practice that only includes anesthesia related tasks/responsibilities.

Jeremy

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Jeremy, are you a CRNA? No? Then please don't try to tell us what our scope of practice is. It is not outside a CRNA's scope of practice to respond to a code and intubate someone.

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Specializes in SRNA.

It's all covered by the exception. All this document says is that a CRNA's practice is limited to anesthesia related stuff except when we don't want it to be. According to this policy all they (meaning any hospital or surgical center) need is another policy that allows the CRNA to tube in the ICU.

-S

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Jeremy, are you a CRNA? No? Then please don't try to tell us what our scope of practice is. It is not outside a CRNA's scope of practice to respond to a code and intubate someone.

Nope I am not a CRNA... just a NP, and I was participating an the discussion. I was only mentioning that a proffesional should know the limits of their state when practicing since all 50 states are different. I listed the Oregon regulations since it looked restricted in scope of practice to see if I was not reading it correctly or if someone could add further to the discussion. If that offended you I am sorry but I felt that was approperiate content for this thread.

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Specializes in CRNA, Finally retired.
Nope I am not a CRNA... just a NP, and I was participating an the discussion. I was only mentioning that a proffesional should know the limits of their state when practicing since all 50 states are different. I listed the Oregon regulations since it looked restricted in scope of practice to see if I was not reading it correctly or if someone could add further to the discussion. If that offended you I am sorry but I felt that was approperiate content for this thread.

First of all: please don't say you're JUST an NP. I cringe when I hear someone say "just a nurse." Your work is no more less complicated than ours - its just a different arena. Secondly, airway management is the CRNA's forte. Not only is it in our scope of practice, for most of us its our JOB to intubate anywhere in the hospital. Sometimes the ER docs are even congnizant to call anesthesia first when they see a difficult intubation in from of them, so we don't have do deal with a bleeding pharynx after someone else's failed attempt.

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