Scope of Practice

sweetdreams · Nov 14, 2003

I think the least restrictive states would be the ten states that have "opted out" of the federal supervision law. In these states scope of practice is defined by the individual hospital. As far as most restrictive I'm not sure of the individual states, but have heard that the more urban states are more restrictive due to a higher population of MDAs

Dave

jdpete · Nov 14, 2003

where we work we get to do anything--all epidurals, all spinals, ankle blocks, interscalene blocks, axillary blocks, etc. Many places in WV let you do everything, however some hospitals here let you do nothing---I am lucky

WntrMute2 · Nov 14, 2003

Well I did a project on state regulation and this is what I found out. NO state restricts what a CRNA may do. Basically, you are allowed to do whar you are trained to do. On the other hand, many, many hospitals have much more restrictive policies. Interestingly, these are usually the hospitals that employ a "group" of anesthesiologists and the CRNAs are hospital employees. At those hospitals that hire anesthesiologists directly and employ CRNAs, and those that use CRNAs that are employees of the "group" of anesthesiologists, these issues are less. In those 2 situations, CRNAs are allowed to do whatever they feel comfortaple doing because THERE IS NO COMPETITION FOR THE DOLLAR. In the situation where a group of anesthesiologists are contracted to provide service and the CRNAs are hospital employees, jthe restrictions on scope of CRNA practice is great. Every spinal, epidural, central line not placed by a member of the "group" is dollars lost to the MDAs. Folloe the money!

Athlein · Nov 17, 2003

WntrMute2 has it spot-on.

I have also heard that Florida, Colorado metro areas, and California can be tough in terms of scope of practice (not from a legislative point-of-view, but from one of limited scope by hospitals and MDAs [excluding the managed care setting of Kaiser Permanente]). Desirable areas attract more physicians, generally speaking.

Also, there is a funny rule about CRNAs + ambulatory surgical centers + pediatrics in Florida, but I do not know the specifics. Maybe one of the Barry SRNAs can give us the scoop.

Brenna's Dad · Nov 17, 2003

Interesting stuff Wtrmute. I suspected that this was how it worked.

CougRN · Nov 17, 2003

I researched this a little myself and wntr is right on. Just as more info phoenix, az is also a very tough place for CRNA's to practice. not a lot of hospitals employ them due to the strength of MDA presence and MDA groups that don't hire CRNA's. just a bit of info for those interested in the area.

loisane · Nov 17, 2003

WntrMute2, your project sounds very interesting. Did you collect actual data to support these conclusions? Of course, your conclusions make absolute common sense, but I was interested in the possibility you might have done a survey, or something similar.

If so, it sounds like something very publishable to me. Seriously consider this. I think students don't always believe enough in the value of their work.

Even if you don't feel like you have it quite nailed down enough in its present form, hang on to what you have. Down the road you may want to build on what you have already done, and develop it more fully.

Hey, I have a pile of these "half done" journal submissions. One of these days, I am going to see one through. I'll announce it, when you can look for my name in print.

loisane crna