Scope of Practice

CABG patch kid, BSN, RN · Feb 5, 2008

I'm pretty sure there is a section on the state board's website that defines the CRNA's scope of practice; at least I'm pretty sure I saw one on CA's site but maybe it varies per state.

allnurses Guide · Feb 5, 2008

How is scope of practice defined for CRNAs? Is it based on training in CRNA school? Based on common usage of techniques by CRNAs?

The AANA and state law are the main determinants for scope of practice. All CRNA schools have to cover a core material/specific clinical components in order to become accredited and stay accredited.

Here is AANAs statement on CRNA scope of practice and standards of care.http://www.aana.com/uploadedFiles/Resources/Practice_Documents/scope_stds_nap07_2007.pdf

Now the real question with the screen name of paindoc and the ongoing debates about letting CRNAs do pain management, why are you interested?

deepz · Feb 6, 2008

And so, just how is the scope of practice for an MDA determined?

Or are there no limitations whatsoever??!!

jwk · Feb 6, 2008

The AANA and state law are the main determinants for scope of practice. All CRNA schools have to cover a core material/specific clinical components in order to become accredited and stay accredited.
Here is AANAs statement on CRNA scope of practice and standards of care.http://www.aana.com/uploadedFiles/Resources/Practice_Documents/scope_stds_nap07_2007.pdf
Now the real question with the screen name of paindoc and the ongoing debates about letting CRNAs do pain management, why are you interested?

Scope of practice for CRNA's, strictly speaking, is determined by state law and/or regulations of state nursing boards. The interesting disagreements now are where the nursing boards attempt to go beyond their legislative mandates and grant practice rights that they don't have authority to grant. This appears to have been the case in Louisiana, where the courts have determined the BON exceeded their authority, and have now barred CRNA's from practicing pain management.

deepz · Feb 6, 2008

.....in Louisiana, where the courts have determined the BON exceeded their authority, and have now barred CRNA's from practicing pain management.

Correction: that was the finding of one judge and, contrary to the misapprehension A$A types would wish to foster as part of their ongoing anti-nurse propaganda, her opinion is far, far from final. The process grinds on......

allnurses Guide · Feb 6, 2008

Scope of practice for CRNA's, strictly speaking, is determined by state law and/or regulations of state nursing boards. The interesting disagreements now are where the nursing boards attempt to go beyond their legislative mandates and grant practice rights that they don't have authority to grant. This appears to have been the case in Louisiana, where the courts have determined the BON exceeded their authority, and have now barred CRNA's from practicing pain management.

One of the reasons why I am questioning Paindocs reasons for bringing this up is that very reason you just menitioned.

BONs work with state legislatures to determine scope of practices based on the what the AANA/APN associations have determined should be the APN scope of practice. So no matter how you look at it the AANA and the state BON determines the scope of practice. AANA provides the expert advice to the BON and the BON determines if they are going to follow it and if it is consistent with current laws in that state.

As far as the BON overstepping their legal bounds that is highly debatable. AMA/ASA is going to do everything in their power to keep the medical monopoly going as long as they can, and the APN associations are going to do everything they can to gain more autonomy for APNs.

paindoc · Feb 6, 2008

I am interested in determining what CRNAs think what defines their scope of practice. I am aware of the Louisiana ruling and the California events prior to that. But the AANA defined scope of practice is much broader than that of state boards of nursing. So I am curious as to how CRNAs themselves, not the AANA, determine their scope of practice. If they are one and the same, fine.

jwk · Feb 7, 2008

One of the reasons why I am questioning Paindocs reasons for bringing this up is that very reason you just menitioned.
BONs work with state legislatures to determine scope of practices based on the what the AANA/APN associations have determined should be the APN scope of practice. So no matter how you look at it the AANA and the state BON determines the scope of practice. AANA provides the expert advice to the BON and the BON determines if they are going to follow it and if it is consistent with current laws in that state.
As far as the BON overstepping their legal bounds that is highly debatable. AMA/ASA is going to do everything in their power to keep the medical monopoly going as long as they can, and the APN associations are going to do everything they can to gain more autonomy for APNs.

At SOME point, don't SOME things cross the line from nursing to medicine?

My guess is a lot of state BON's are simply taking it upon themselves (or being pushed by various nursing organizations such as the AANA) to expand the scope of practice where it was never intended or thought of 20 years ago. Then they run into a state like Louisiana where someone actually puts there foot down and says STOP - this crosses the line into the practice of medicine.

allnurses Guide · Feb 7, 2008

At SOME point, don't SOME things cross the line from nursing to medicine?
My guess is a lot of state BON's are simply taking it upon themselves (or being pushed by various nursing organizations such as the AANA) to expand the scope of practice where it was never intended or thought of 20 years ago. Then they run into a state like Louisiana where someone actually puts there foot down and says STOP - this crosses the line into the practice of medicine.

So by your reasoning no one should seek to expand their scope of practice, because it wasn't what was done 20yrs ago.

And you know as well as I know that: Anesthesia practiced by nurses is considered in the realm of Nursing and Anesthesia practiced by MDAs is in the realm of medicine. That is the one of the landmark court decisions that continues to determine Nurse anesthesia scope of practice.

The legal agrument over pain management is all about money, physician egos, and Nurse Anesthetists' autonomy. Pain management is fairly natural branch off to what CRNAs already do. Just as it is natural branch off to what MDAs do.

I will support any effort to decide that CRNAs cannot work in pain management or independently if someone produces any valid/reproducable research that can prove CRNAs aren't A) just as effective as MDAs and/or B) CRNAs are unsafe w/o supervision from MDAs. Until then it looks like I just need to donate more money to AANA's CRNA-Political Action Committee.

jwk · Feb 7, 2008

So by your reasoning no one should seek to expand their scope of practice, because it wasn't what was done 20yrs ago.
And you know as well as I know that: Anesthesia practiced by nurses is considered in the realm of Nursing and Anesthesia practiced by MDAs is in the realm of medicine. That is the one of the landmark court decisions that continues to determine Nurse anesthesia scope of practice.
The legal agrument over pain management is all about money, physician egos, and Nurse Anesthetists' autonomy. Pain management is fairly natural branch off to what CRNAs already do. Just as it is natural branch off to what MDAs do.
I will support any effort to decide that CRNAs cannot work in pain management or independently if someone produces any valid/reproducable research that can prove CRNAs aren't A) just as effective as MDAs and/or B) CRNAs are unsafe w/o supervision from MDAs. Until then it looks like I just need to donate more money to AANA's CRNA-Political Action Committee.

You sidestepped that so I'll ask it again - not trying to be a pain, just want to understand where you're coming from.

Is there a point, somewhere, where procedures done by a CRNA (or NP or CNM, etc.) cross the line to the practice of medicine? For example - CNM's attend deliveries, but they don't perform C-Sections. Where is that line for CRNA's?

allnurses Guide · Feb 7, 2008

You sidestepped that so I'll ask it again - not trying to be a pain, just want to understand where you're coming from.
Is there a point, somewhere, where procedures done by a CRNA (or NP or CNM, etc.) cross the line to the practice of medicine? For example - CNM's attend deliveries, but they don't perform C-Sections. Where is that line for CRNA's?

No...I don't think I side stepped the question. As long as it is natural extension of anesthesia I do not believe it is stepping into the legal definition of the "practice of medicine". What you are discussing is pure skill sets learned in residency. Where do you draw the line for physicians or are they allowed to do everything soley because they went to medical school?

Nursing and medicine continue to evolve daily. Things that nurses do today would only have been done by physicians 30-40 years ago. Do you think starting IVs should only be done by physicians...probably not since as an AA you probably start several a day. I have worked with nurses that still remember not being allowed to start IVs, because only physicians were allowed to do them when they 1st started nursing. It all is just a natural evolution of skills as more complicated skill sets evolve physicians will naturally lead the way in most of them, and nurses will take over other skill sets that only physicians used to do.

If you removed the money factor and egos (some on both sides) do you really think that pain management would be any real issue? There is no research, that I know of, that states that CRNAs are inferior to MDAs in pain management, so why not allow them to practice pain management if not for physician egos and loss of income issues?