Pain Management CRNA

CraigB-RN, MSN, RN · Jun 14, 2004

Well here in Rural KS there is not way we'll get a pain Doc out here. Our CRNA will be working with a family practice doc here locally and a pain doc over telemedicine. Here in KS unless they are an NP also they can't write the scripts and must have a provider order to do the procedure.

pnurseuwm · Jun 14, 2004

I've also been searching for answers to this question for over a year. I hope someone can provide some insight.

purplemania, BSN, RN · Jun 14, 2004

I get the impression that the program is designed to educate CRNA's in pain management, but only within their current scope of practice. Article 15, around line 200, lists objectives that are very much like what staff nurses already do in an acute care facility. JCAHO's patient safety goals, and guidelines from the Institute of Medicine, emphasize pain management education. My thoughts are that this program is a way to comply with governing bodies expectations.

alansmith52 · Jun 14, 2004

there is a CRNA in one of these midwestern states. I want to say iowa that does Pain clinic only. 9 neuro surgeons refer to her clinic and she does neuroaxial steroid injections (if thats the proper name for it) anyway you know the whole deal witht he fluroscope and the needles with the steroid at the nerve root. I think that is what this fellowship is going to be geared toward.

I get the impression that the program is designed to educate CRNA's in pain management, but only within their current scope of practice. Article 15, around line 200, lists objectives that are very much like what staff nurses already do in an acute care facility. JCAHO's patient safety goals, and guidelines from the Institute of Medicine, emphasize pain management education. My thoughts are that this program is a way to comply with governing bodies expectations.

loisane · Jun 14, 2004

Some CRNAs are already functioning as Pain specialists. CRNA scope of practice already includes the interventional aspects of the block techniques. I believe it is these blocks that are the core of these practices. Although, some CRNAs do qualify for prescriptive privileges, depending on the specific state's rules and regs.

As I understand it, the proposed CRNA pain fellowships is being developed with the goal to formalize this sub-specialization process.

loisane crna

qanik · Jun 18, 2004

I believe the pain clinic at Cottage Hospital in New Hampshire Is CRNA run.

Hellllllo Nurse, BSN, RN · Jun 18, 2004

A different situation- from an RN, not a CRNA.

When I worked at an independant, freestanding, hospice unit, any RN on staff could initiate an MS04 drip (and many other meds), with only our written standing orders.

With every new admit, the nurses would assess the pt, write a care-plan and pain and sx mgmt plan, and start med regimes to address the pts' issues, as they saw fit. We called the pharmacy with our decisions, and the meds were sent.

We also decided on the Rx that the pt would be sent home with, and arraged for the meds to be delivered.

The doc was usually not even aware of any of the orders until several days after the fact.

BigDave · Jun 18, 2004

Not exactly related, but plays on the turf issues in nursing/medicine...

One of our nurse managers has her Masters specialty in accupuncture (even had her own practice before entering the military). She was invited to go to DC to shadow a well-known authority in the field for two weeks, an honor.

After the two weeks were up, he informed her that as the consultant to the Surgeon General of the AF, he felt that accupuncture is the realm of physicians only and she should cease performing such services for the rest of her time in the AF (was doing accupuncture in the pain clinic one day/week).

I met the physician who does accupuncture at the Army hospital here (BAMC) a couple of years ago. His training consisted of a two week seminar at UCLA. It seems that qualifications are not the only issues at work...

jwk · Jun 18, 2004

A different situation- from an RN, not a CRNA.
When I worked at an independant, freestanding, hospice unit, any RN on staff could initiate an MS04 drip (and many other meds), with only our written standing orders.
With every new admit, the nurses would assess the pt, write a care-plan and pain and sx mgmt plan, and start med regimes to address the pts' issues, as they saw fit. We called the pharmacy with our decisions, and the meds were sent.
We also decided on the Rx that the pt would be sent home with, and arraged for the meds to be delivered.
The doc was usually not even aware of any of the orders until several days after the fact.

Just curious - does this technically fall outside your scope of practice? (it may not, I don't know, that's why I'm asking) Maybe there are some different laws for hospice. Seems like ordering scheduled narcotics, which really is what you're doing, would be problematic, if not for you, then certainly for the pharmacy. I'm surprised they'll take the order. Don't orders/prescriptions for scheduled drugs require a physician signature, particularly Morphine which is Schedule II?

Hellllllo Nurse, BSN, RN · Jun 18, 2004

Just curious - does this technically fall outside your scope of practice? (it may not, I don't know, that's why I'm asking) Maybe there are some different laws for hospice. Seems like ordering scheduled narcotics, which really is what you're doing, would be problematic, if not for you, then certainly for the pharmacy. I'm surprised they'll take the order. Don't orders/prescriptions for scheduled drugs require a physician signature, particularly Morphine which is Schedule II?

New hire nurses all were sent to an orientation, in which the legality of this practice was presented. The company told us it was legal and within our scope of practice.

I worked for this company for 4 years, and this practice was not changed.

The pharmacy required a written script within so many days. We wrote out the scrips, the doc signed them, and we sent them over to the pharm. We had a supply of MS and other drugs in stock at our facility. The pharm did not deleiver meds at night.

We had 2 different medical directors during my employment. Both docs often stated that they loved the arrangment, as they were never called at night. I worked nights.

If a pt chose to retain their primary doc, and not have our doc take over their care, the standing orders did not apply,

These docs had to be called at all hours for everything except laxatives and Tylenol. Quite a few of them were verbally abusive when called at noc.

I sometimes felt uncomfortable with the standing orders- which included nursing being able to initiate MS doses of up to 20mg per hr, IV or sc (clysis method).

I felt that if a pt ever had a bad reaction to a narc, the doc would have a legal way out, and the nurses would be liable.

Our standing orders included MS, phenobarb, Ativan, metoclophan supps, decadron, thorazine, atropine, and others.

Nursing assistants are now doing med passes, foley insertions, sterile dressing changes, and other procedures formerly done by licensed nurses only.

InterestedRN · Jun 29, 2004

A different situation- from an RN, not a CRNA.
When I worked at an independant, freestanding, hospice unit, any RN on staff could initiate an MS04 drip (and many other meds), with only our written standing orders.
With every new admit, the nurses would assess the pt, write a care-plan and pain and sx mgmt plan, and start med regimes to address the pts' issues, as they saw fit. We called the pharmacy with our decisions, and the meds were sent.
We also decided on the Rx that the pt would be sent home with, and arraged for the meds to be delivered.
The doc was usually not even aware of any of the orders until several days after the fact.

This is an entirely different issue. You're working from "standing orders"