Scope of Practice

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

It does not set "precedent" as the ruling was based on the louisina BON wording on the scope of practice. The only way this is a national pecedent or a precedent of any kind is if another state BON has the same problem with the same regulation.

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Still no answer, n g, regarding your educational background....

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Personally, I am have picked out the most CRNA friendly states that I would eventually like to practice in when I retire from the military, but to each their own.

Does the military allow their CRNA's do practice chronic pain management?

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Specializes in Anesthesia.
Does the military allow their CRNA's do practice chronic pain management?

I don't think so unless it is very limited....such as doing interventional procedures under orders from the attending physician. We have one Navy instructor that used to work/ do pain research in the pain clinic at NNMC, but I don't know the specifics of what he actually did there. I will ask him and get back with you. So other than the one CRNA working in the pain clinic I haven't met any others that I know of.

The military is really behind the civilain sector on utilizing APN nurses. For example: RNFAs are still rather new idea in the AF, and the AF still doesn't recognize ACNPs.

Although if you want to discuss the differences in the military and civilian sector we should start a new thread.

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It does not set "precedent" as the ruling was based on the louisina BON wording on the scope of practice. The only way this is a national pecedent or a precedent of any kind is if another state BON has the same problem with the same regulation.

The BON attempt at expanding scope without going through the legislature was the case that went to the Louisiana Supreme Court.

This is a different case. In this one, the plaintiffs wanted the courts to declare specifically that pain is medicine and not nursing.

If the appeals fail, how could this have national implications? Anywhere else in the country where there is a CRNA who is practicing pain, some MDA will file a lawsuit and ask the courts to declare that pain is medicine. Those courts will then carefully review this case to make their decisions.

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Specializes in ICU, currently in Anesthesia School.
The BON attempt at expanding scope without going through the legislature was the case that went to the Louisiana Supreme Court.

This is a different case. In this one, the plaintiffs wanted the courts to declare specifically that pain is medicine and not nursing.

If the appeals fail, how could this have national implications? Anywhere else in the country where there is a CRNA who is practicing pain, some MDA will file a lawsuit and ask the courts to declare that pain is medicine. Those courts will then carefully review this case to make their decisions.

n_g: Please study more than politics before making legal assertions (This is two now).

The challenge brought before the court was that the BON had not followed procedure in issuing an advisory statement to a single CRNA and that the statement was in effect a "rule" by the board which required procedurally more involvement than what was followed. The decision of "pain management is the exclusive practice of medicine" is well beyond the scope of this particular trial and due to this technicality will most likely result in some modification or kick back to the district for review. Should appeal not occur or for some unkown reason be unsuccessful, it still sets no precedent for other states unless similar circumstances exist that would make the case germaine (Ex-A crna petitions for a statement of scope and recieves it in a manner that violates that particular states rules and regulations for rule making.) Not that big of a landmark case except for the CRNAs in LA.

And now my dodgy friend-there is still the pending question as to your backround so that others may see the particular bias in your comments. (Mine is clear, as is jwk's and pain doc's.)

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In anesthesia, there is no diagnosing.

:twocents:

To be polite - that is inaccurate...identifying conditions or states based on their presentation is something that a good educated clinician does all the time....you have to make differential diagnosis all the time to accordance with surgical conditions

For example, In aggressive trauma resuc. or vascular cases - Using TEG how do you differentiate between the cause of delayed clot formation between anticoagulation or a true factor deficiency? or if the 25% rise in INR related to the blood loss or the 30ml/kg hespan that was given? or... Is the increase in BE related to volume issues or some other anion gap issue? or when consumptive coags. are refractory what is the next option?

These are all basic and rhetorical questions -

...we do advance diagnosis in the process of everyday procedures...day in and day out..

OS

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Specializes in Anesthesia.

N G,

I have briefly read most of your 70+ odd posts, and it appears that you continue to degrade APNs in your posts. Now obvisously that may not be your intent, and merely my interpretation.

It does also appear rather obvious that for some reason you are ashamed of your educational level, because you refuse time and time again to enlighten us to your educational/motivational background.

Can your educational background be that bad?

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CRNA's have nothing to worry about this little insignificant trial. They should just go on practicing pain. Nobody will care, right? It'll take a few years for this to all shake out. As far as I'm concerned, I'll wait to hear the rulings by the courts.

Look at this way. If the Louisiana ruling does stand, why wouldn't some MDA in a different state feel emboldened to challenge any CRNA who does pain? People who think that this is contained just to Louisiana are fooling themselves. This has national implications.

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Specializes in Anesthesia.
CRNA's have nothing to worry about this little insignificant trial. They should just go on practicing pain. Nobody will care, right? It'll take a few years for this to all shake out. As far as I'm concerned, I'll wait to hear the rulings by the courts.

Now N G, why are you so opposed to divulging your educational background? Have you even attended college? Well with no feedback from you I guess we are just to assume you either a) have no college education or b) are a pre-med student, but either way like to express the views from SDN.

I see no reason for any of us to continue to discuss this matter with you. Especially, when you can't be honest and forthright from the beginning.

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Specializes in Nurse Anesthetist.

NG is right. We have to watch what is happening to our peers in other states. We have to be pro-active and not reactive. We need to support our state PAC and encourage others to do so. The A$A has TONS of money in their PACs and are very powerful.

Just one day's pay should be what you donate to your state PAC. That's not much to insure you can your scope of practice is well taken care of.

IMHO

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Specializes in Anesthesia.
......It's not one judge. It went all the way to the Louisiana Supreme Court and they decided that pain management is medicine. .....

Sheesh. Get your facts straight before you insist the sky is falling.

From the AANA press release:

"In early January 2008, the Louisiana District Court, Judge Janice Clark, issued a judgment in favor of an anesthesiologist pain management group (Spine Diagnostics Center of Baton Rouge), and against the Louisiana State Board of Nursing (LSBN) and an individual CRNA who had performed chronic pain management procedures."

District court.

One judge.

And BTW, ng, what ARE your qualifications?

??

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