Question about nurses and prescriptions?

[rondo341]

Why can nurse practitioners write prescriptions, but nurse anesthetists cannot? I know practitioners can't write them in Georgia, but anesthetists can't anywhere.

Nurse anesthetists are at the top of their field, yet they don't have the power to write prescriptions?

Why is this? Can CRNAs write prescriptions in any state?

[meandragonbrett]

CRNA programs are not intended to prepare advanced nurses for primary care.

Primary care has nothing to do with prescriptive authority. There are ACNPs, WHNPs, CNMs, PsychNPs that all have prescriptive authority and do not necessarily provide primary care.

[wtbcrna, MSN, DNP, CRNA]

NP's are allowed to act independently of an MD or other LIP and therefore have prescribing ability, CRNA's are not allowed to act independently and work under an MD.

That is incorrect. CRNAs can and do work independently. We do not have to work under physicians license. CRNAs can get prescriptive authority depending on the state they work in. Most of our prescribing would only be in the hospital setting. I have prescriptive authority in my state.

[wtbcrna, MSN, DNP, CRNA]

Not true. Many states use ACT models where the CRNA practices under an MDA. However, if you go out into the more rural parts of the country, you will find CRNA's practicing independently without the supervision of an MDA because of "opt out" states. It really comes down to the state you are practicing in.

This is mostly true, but opt out only has to do with billing independently for Medicaid/Medicare if you aren't billing for those then there usually is no stipulation for physician involvement in CRNA practice.

There are independent CRNAs in every state.

[wtbcrna, MSN, DNP, CRNA]

In my state at least NP's can practice without coordinating with an MD, most of our low-income clinics are staffed by only NP's without any MD's on staff or in positions of oversight such as medical director. Some of our hospitalists are also NP's who manage patients without coordinating with an MD. CRNA's in my state though must work under the direct supervision of an anesthesiologist, the initial assessment must be done by the MD, the set-up must be checked my the MD, and the MD must continuously round on any cases with CRNA's.

That is incorrect. Check your state board of nursing rules. That is an ACT practice that you are referring to, and it has to do with billing for supervision of CRNAs which is not a law just a billing requirement. MDAs can bill 50%, up to 4 cases at a time, for CRNAs and AAs essentially doubling their pay if they were in a room doing their own anesthetic. You can see why the ASA fights so hard to maintain ACT practices even though research has shown time an again it is nothing but a waste of money.

[MunoRN, RN]

There is no state that requires supervision of a CRNA by an anesthesiologist. Supervision and medical direction are two very things and are generally misunderstood.

CRNAs DO have prescriptive authority in a handful of states. CRNAs DO work in settings other than the operating room such as pain clinics.

Some states (16) have opted out of the Federal supervision rule, and yes it's supervision that CMS requires, not medical direction. This means that there are still 34 states that do require supervision of a CRNA by an anesthsiologist for medicare/medicaid providers, which is pretty much everybody.

http://www.aana.com/news.aspx?id=27835&terms=opt+out

[wtbcrna, MSN, DNP, CRNA]

FYI: The reason APNing is considered a practice of nursing and not medicine is because AANA fought that legal battle and won in the early 1900s well before there was NPs. That case is one of several landmark cases concerning APNs. CRNAs have successfully won legal battles and kept their independence paving the way for other APNs to maintain/keep their independence with many of the cases fought before there even other APNs.

CRNA and NP are very different career paths, but we are intimately tied together by history.

[wtbcrna, MSN, DNP, CRNA]

Some states (16) have opted out of the Federal supervision rule, and yes it's supervision that CMS requires, not medical direction. This means that there are still 34 states that do require supervision of a CRNA by an anesthsiologist for medicare/medicaid providers, which is pretty much everybody.

http://www.aana.com/news.aspx?id=27835&terms=opt+out

It does not have to be an anesthesiologist, and in most rural hospitals it is a standard order set for the surgeon to request anesthesia. Then it is just billed under the surgeon/dentist/podiatrist etc.

[wtbcrna, MSN, DNP, CRNA]

AANA legal briefs on supervision (one of most convoluted and misunderstood things in nurse anesthesia): http://www.aana.com/Resources.aspx?id=2335

http://www.aana.com/Resources.aspx?id=2375

http://www.aana.com/Resources.aspx?id=187&terms=Medical+direction

[ctersi01]

There is no reason for a CRNA to write a script. They give anesthesia during surgeries. They don't follow the patient after the case is over, the surgeon and or PCP does. Any pain management post-surgery would be handled by the docs.

[wtbcrna, MSN, DNP, CRNA]

There is no reason for a CRNA to write a script. They give anesthesia during surgeries. They don't follow the patient after the case is over, the surgeon and or PCP does. Any pain management post-surgery would be handled by the docs.

There are CRNAs that specialize in pain management, so in those cases they would be writing scripts. I also think some states/hospitals require CRNAs to have prescriptive authority to write orders in the hospital. I write orders all over the hospital independent of any physician.

[ZippyGBR, BSN, RN]

What need would a CRNA have to write a prescription?

to obtain and then administer prescription only and controlled drugs required for his/her practice as an anaesthetist ... ? the only none prescription-only drugs i can think of in use in anaesthesia practice are Oxygen and Nitrous Oxide which are( in the Uk at least) still licensed medicines but classified as general sales and Pharmacy supply only ...

also what about creating a direction for PACU staff to administer analgesia, anti emetics and put up further fluids as appropriate ... ditto floor / ward staff especially if there is a poor availability of junior cover ... also i see that the topic of CRNAs working in pain management and critical care areas has been raised ...

[ctersi01]

There are CRNAs that specialize in pain management

That's true. I guess I should have said that CRNA's in the OR setting have no need to write scripts, at least in large academic hospitals. Rural hospitals may be different.