CRNAs Should Not be Allowed to Practice Independently - One Anesthesiologist’s Opinion

[tnbutterfly - Mary]

Jonathan Slonin, an anesthesiologist and past president of the Florida Society of Anesthesiologists, believes that lawmakers should not allow the administration of anesthesia without a physician in the room. Although he works with and respects Certified Registered Nurse Anesthetists (CRNAs), they are not physicians.

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They have years of training, but they are not trained in medical diagnosis and treatment, and while they are highly skilled and a vital part of the medical care team, they should never be the lead of that team.

While the American Association of Nurse Anesthetists are advocating for a proposed bill that would allow CRNA’s to practice without the supervision of a physician, some see this as a dangerous and costly move.

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...safety should be the primary goal and that is why physician-led care must remain the standard. If CRNAs were given complete independence to practice complex medicine, costly mistakes will happen. And when they do, we all pay for those mistakes through increased healthcare costs.

What do you think???

For more on this story, see Anesthesia without a physician in the room? Lawmakers should not all that / Opinion

[subee, MSN, CRNA]

On 12/5/2019 at 7:46 PM, No Pain No Gain said:

Interesting. What is a clear license. I’ve heard of anesthesiologists and Anesthetists being drug addicts but then getting clear licenses after coming back from rehab. Another interesting philosophical point. If nurse practitioners where trained to do surgery how many CRNAs would be comfortable with a nurse taking out their appendix or amputating grandmas leg while the surgeon was at home watching tv or sleeping. Inviting discussion on this topic.

Illogical argument. Anesthesia was NURSING from the very beginning. The Medical students weren't adequate for the job at the time so a school for nurse anesthesia was created. The FIRST formal anesthesia education offered in the country. Surgery requires much vaster body of knowledge than anesthesia. We have separate (mostly 3 credits each) courses in cardiac physiology, repiratory physiology, neuroscience and pharmacology but with a slant towards how these systems are affected during an anesthetic. It's a small specialty with a limited armentarium. Surgery, on the otherhand, is definitely the practice of medicine. So the above argument is silly. I've never heard the term "clear license" after over 20 years of working with addicted CRNA's and RN's. Are you saying that nurses shouldn't be allowed to return to nursing after addiction? Well, that's just stupid, too. However, there are definitely more people in anesthesia (MD's and CRNA's alike) who can't and won't return to anesthesia because of the stress and access. But it doesn't mean that can't return to their respective fields in different capacities. I don't know where your information comes from but it's obviously not from any knowledge of the field. And whoever mentioned NA.org - yes, I remember.

But clinical situations come up on the members only AANA forum.

[ArmyRntoMD, BSN, RN]

I agree with some exceptions. I think nurses should be able to practice independently if there would not otherwise be a physician present.

[klone, MSN, RN]

2 hours ago, ArmyRntoMD said:

I agree with some exceptions. I think nurses should be able to practice independently if there would not otherwise be a physician present.

Why? Their outcomes are just as good, and they're less expensive.

[ArmyRntoMD, BSN, RN]

Can I see a link to the study? I’ve only seen one study on the topic and it was wrought with flaws as far as being a valid study. Much like many “nursing studies”. I wish more nursing informaticians had a heavier science background. In BSN school they kept having us read studies and they all had glaring errors that made them invalid.

Are you suggesting that CRNA and MD anesthesia education are equivalent?

[klone, MSN, RN]

I think you mean *fraught, rather than *wrought. And no, I'm not suggesting that their educations are equivalent. I say what I mean.

[klone, MSN, RN]

And here is a Cochrane review of 6 studies:

https://wana-crna.org/cochranerev.htm

[ArmyRntoMD, BSN, RN]

English isn’t my strength. I am a science person?.

Let me comb through these studies and I’ll get back to you.

[subee, MSN, CRNA]

On 12/7/2019 at 11:22 PM, ArmyRntoMD said:

English isn’t my strength. I am a science person?.

Let me comb through these studies and I’ll get back to you.

I think I'm starting to understandArmyRNtoMD. If you are from another country that does not have master's or doctorate trained nurse anesthestists, then you don't understand the rigors of our education here in the US. It's very tough to get accepted into a program and we do have science pre-reqs. I needed O-chem and physics pre-application. For two or three years you don't have much of a life...just like in med school. I had to wwork alone straight out of training (after 5 and on weekends). While it was harrowing for me and the patients didn't have the benefit of 35 years of experience, I was prepared adequately to at least be safe. And that's all a patient gets when they are assigned an inexperienced doc. And, don't confuse us with NP's who get to go to school online:)

[ArmyRntoMD, BSN, RN]

No I understand that CRNA school is quite difficult, I know several nurses that have gotten in.

Just follow my logic. Nurses here acknowledge that the educations of MDs and CRNAs aren’t equivalent. There are many factors that can skew studies. For instance, MDs tend to handle the more complex cases.

Is the nursing consensus that the extra 6+ years of schooling plus residency are pointless? I would think the MD would learn a lot in that timeframe.

I have a ton of respect for CRNAs as well as NPs. I just don’t believe in independent nursing practice when supervision is possible. Now in extreme circumstances yes by all means, let nurses practice independently.

[subee, MSN, CRNA]

2 minutes ago, ArmyRntoMD said:

No I understand that CRNA school is quite difficult, I know several nurses that have gotten in.

Just follow my logic. Nurses here acknowledge that the educations of MDs and CRNAs aren’t equivalent. There are many factors that can skew studies. For instance, MDs tend to handle the more complex cases.

Is the nursing consensus that the extra 6+ years of schooling plus residency are pointless? I would think the MD would learn a lot in that timeframe.

I have a ton of respect for CRNAs as well as NPs. I just don’t believe in independent nursing practice when supervision is possible. Now in extreme circumstances yes by all means, let nurses practice independently.

No, I would never say that the educations are equivalent. But my own experience, plus the historical experience and data extracted from our long history of being providers that MDA's do not need to be present for about 90% of the cases done on any particular day. Sometimes we need another set of experienced hands and sometimes we need to consult with an MDA , but they don't need to be involved in 100% of the cases. If it's a super big case with a super sick patient, that's a 2 person case anyway, usually a team of MDA and CRNA. Don't need 2 MDA, but need more than two CRNA's. Why is it that we are sole providers to soldiers in the field but need an MDA around for a D and C? That's a very inefficient system.

[ArmyRntoMD, BSN, RN]

I think a better question is what is wrong with physician oversight? If you want to be independent why not just be a physician?

[LibraSunCNM, BSN, MSN, CNM]

1 minute ago, ArmyRntoMD said:

I think a better question is what is wrong with physician oversight? If you want to be independent why not just be a physician?

But why is physician oversight necessary if the evidence shows that it isn't required, because CRNAs give safe, effective care?