Should Anesthesia Be an only MD Profession

gwenith, BSN, RN · Feb 26, 2004

Interesting because we do not have CRNA's here at all and there are severe limits to who can sedate/anaesthetise a patient.

kmchugh · Feb 26, 2004

I'm wondering why you ask this question. Who and what are you?

Sorry, but there is something about your initial post that set off alarm bells in my mind.

Kevin McHugh, CRNA

Berliner · Feb 26, 2004

Have you read up on your history of anesthesia? I would think if you are a nurse, you'd be able to answer this question yourself....so in agreement with the last poster- who/ what are you?

WntrMute2 · Feb 26, 2004

I knew this would get your attention.
This question is for those seeking, in current studies, and practicing anesthesia.
I understand the economics and statistics for various practice settings, hence the need in certain areas for CRNA's - so please save that - due to its obviousness.
But this question is an open to the debate ....."Is anesthesia really a nursing science?"
And For those practicing - Do "nursing interests" guide your daily practice
Why and why not......

Well I just happen to have done a short paper on the subject.

Anesthesia - the practice of Medicine?

Where does the administration of anesthesia belong? Is it the art of medicine, the art of nursing, or both? The accepted definition of medicine is the diagnosis and treatment of disease. While the definition of nursing is not so easily arrived at, the American Nurses Association defines nursing as the "diagnosis and treatment of human responses to actual or potential health problems." Is rendering someone unconscious, motionless and insensitive to pain while maintaining homeostasis medicine or nursing? In December of 1998, the American Medical Association attempted to claim anesthesia as their exclusive domain with a resolution entitled "Resolved that Anesthesiology is the Practice of Medicine."

Fortunately for nurse anesthetists and their patients, federal and state courts along with a number of attorneys' generals have consistently disagreed with the AMA's position. In decisions as far back as 1917 when a Michigan court decided that the scope of practice of a profession is what that profession's bylaws allow, not what some other profession stakes out as their domain - no court has seen fit to regard administration of anesthesia as diagnosis or treatment of disease or injury. The Texas Medical Association itself issued a statement during Tatro v Texas State Board of Education "the result that the same act when performed by a nurse under the direction of a physician is considered to be part of the practice of nursing and when performed by a physician is considered to be the practice of medicine." In the same statement, this medical association claimed there are two types of nursing functions recognized, dependent - done under order of a physician and independent - which are "performed by virtue of the nurse's education, training and experience, and which properly reflect the nurse's independent judgment." Anesthesia has been initiated and administered by nurses under the "prescription" implied by surgeons when scheduling patients for surgery for approximately 100 years making it both a dependent and independent function in the eyes of at least one state's medical association.

Also in Texas, the Board of Medical Examiners sought the attorney general's opinion which agency, the Board of Medical Examiners or the Board of Physical Therapy, had the responsibility to regulate the practice of electromyography. The response was that when physicians perform this procedure, the Board of Medical Examiners had authority but when performed by physical therapists, the practice was to be under control of their regulatory board.

The Missouri legislature, in 1975, changed the laws that governed professional nursing to eliminate the requirement that doctors directly supervise nurses. Furthermore, they used language removing the limitations on nursing; seeming to encourage the expansion of independent nursing functions. Eight years later the Missouri Supreme Court heard a case brought before it by the Missouri State Board of Registration for the Healing Arts contesting that a group of nurses were guilty of unauthorized practice of medicine. They were providing services such as family planning, obstetrics and gynecology. In a decision considered to be one of the most important to the practice of nurse anesthesia, the court stated that: "having found that the nurses' acts were authorized by the Nursing Practice Act, it follows that such acts do not constitute the unlawful practice of medicine for the reason that the medical practice Act is inapplicable to nurses licensed and lawfully practicing their profession within the provision of the Nursing practice Act." This case, Sermchief v Gonzales is considered a landmark case; illuminating that there is no definite line between professions, and that when nurses are practicing within their practice acts they are nursing and when physicians act within their governing acts, they are practicing medicine.

In Michigan v Beno, (1995) a chiropractor was performing a technique specifically allowed in the practice of physical therapy. The board that governs the practice of physical therapists tried to prevent the chiropractor from using this procedure to treat patients. The Michigan Supreme Court disagreed, claiming that just because physical therapists had the right to perform galvanic current therapy didn't limit doctors, nurses or chiropractors if their respective scopes of practices allowed the technique. The only pertinent question was whether the activity in question is within the scope of practice of that profession. There is no limitation that can be arbitrarily assigned on one profession by another, Michigan's highest court found.

State legislatures are not in the business of creating monopolies or protecting domains of practice. Their business is creating laws that determines who governs whom. If nursing chose to use the AMA's logic we might easily limit physicians performing bedbaths or physicians changing bedpans. "Resolved that Bedpan Changing is the practice of nursing."

charles-thor · Feb 26, 2004

charles-thor · Feb 26, 2004

That was a very enlightening post Wntrmute2. Thanks. And by the way, who is Oldsalt?

Berliner · Feb 26, 2004

Great insight wntrmute! I'm going to print this one out! I was just alluding to the fact nurses have been practicing anesthesia longer, started the first schools for anesthesia etc.

manowar88 · Feb 27, 2004

I think it is Alice Magraw who is the "mother" of nursing anesthesia---history/practice goes back as far as the 1800's. I think that many years of practice gives you the right to claim it as a science. I like to think of nursing anesthesia being different from medical anesthesia in the care that we give and the philosophy we practice.

kmchugh · Feb 27, 2004

Apparently "Oldsalt" is trolling. Doesn't want to come back to let us know who he is.

Is it just me, or do there seem to be several posters of rather nebulous backgrounds "just asking questions" here lately?

KM

Oldsalt · Feb 27, 2004

Apparently "Oldsalt" is trolling. Doesn't want to come back to let us know who he is.
Is it just me, or do there seem to be several posters of rather nebulous backgrounds "just asking questions" here lately?
KM

The beauty of the internet is some degree of anonymity. I'm a CRNA, practicing for almost a decade - previously a faculty at a major university (instructing both 2nd year residents and fellows), just left the Army (also practicing as an Anesthetist. Worked in both team and independent settings - well versed at almost any type of technique.

I knew the degree of incongruity this could bring up but it is not the intent.

Furthermore - I am also well informed of the history of anesthesia - But I am very interested on personal views on legitimacy of practice.

Excellent post by WntrMute2 - thank you for the time and effort for the post.

This is also very real interview question and the degree of defensiveness that I see here would automatically recycle those applicants for another try.

Finally, it is a question that most MDAs ask me and I could based it on the historical and legislative prospectives - but I dont...

But when the metal (or should I say mettle) meets the road - I have found that they respect the CRNAs that share the equal workload, have an equal lateral degree of practice techniques (not just GEN/Central axis blocks), and the ability to discern medical issues in order to mitigate severe consequences.

Should it be an MDA only practice? Obviously not - but what is unsettling is how handicapped our profession had become

I have recently done some locums work and it is unsettleing to see that many CRNAs, in many settings, being regulated (and accepting) 2nd tiered

status - having to call MDAs on induction/emergence, allowing MDAs to push their meds, Not doing complete anesthesia workups (again letting MDAs complete it), and being completey restricted on almsot all peripheral blocks (ie. popliteals, axillarys, femorals, interscalenes, peribulbar, etc....).

I spoke with a MDA recently and his feeling was that the CRNAs are not treated equal because they dont want or are capable to handle the responsiblity or want to share in the eqaual workload (acquity levels/call, ect...).

When I ask CRNAs about these issue - they just shrug and say - "We are not allowed"

These instances are not just in one hospital - but I have been to 3 recently (interestinly one on the East Coast - Baltimore, One Near Chicago, and One Near Seattle) - all the bloody same.

The above MDA also indicated - that due to the shortage - many CRNAs are using this for better salaries (great) but demanding a smaller work load - thus creating an even greater divide in MD CRNA relationships.

By accepting greater delegation of limited scope or practice and turning around and demanding less work and responsibility - I am very concerned at where this profession could potentially go...hence my intial question. :rotfl:

New CCU RN · Feb 27, 2004

Thank you for your post old salt...I think your question is a great one and definitely something that all of those interested in or practicing anethesia should give a great deal of thought.

I am wondering though, how specifically is the anethesist practicing nursing? How is nurse administered anesthesia any different than doc administered anethesia?

(I know the current studies that there is equal outcomes in the administration of both safety wise, I know the history of nurse anethesia)