Nurses are increasingly being allowed broader responsibilities as the demand for their services rises, especially in the face of aging populations who will need more healthcare. Another factor that will soon play a critical role in expanding a nurse’s responsibilities is the implementation of the Affordable Care Act. It alone will dump 41 million new patients into healthcare.
So it comes as no surprise that recent court rulings in Colorado and California now allow certified registered nurse anesthetists to administer anesthesia to patients--without physician supervision. Certified registered nurse anesthetists personally administer approximately 32 million anesthetics to patients nationwide every year.
The Colorado Society of Anesthesiologists decries the ruling, claiming it diminishes the quality of patient care by removing physician oversight from a very complex aspect of medical care. But the Colorado Association of Nurse Anesthetists applauded the Colorado ruling, pointing to research that shows no differences in patient morbidity or mortality rates—with or without doctor supervision.
While Federal law stipulates that ambulatory surgical centers, hospitals and critical access hospitals must provide doctor supervision to CRNAs to receive Medicare payment, states can opt out if their governors consult with appropriate medical boards and determine that an exemption serves the healthcare needs of its citizens.
Scott Shaffer, DNAP, CRNA, president of the Colorado Association of Nurse Anesthetists noted that surgeons were often hesitant to relocate to Salida after learning that they must supervise CRNAs. “It’s a huge access-to-care issue, said Shaffer. “Prior to the opt-out, there was a perception of [increased] liability from surgeons, and it [inhibited] providers from coming this way.” Nurses already provide anesthesia services to 99 percent of the communities with surgical services throughout the state. In Colorado, CRNAs provide anesthesia services in 70 percent of the state’s hospitals.
Doctors remain unconvinced. “This ruling completely muddles who the surgeon is responsible for and when they are responsible,” said Randall Clark, MD. “It will create a gigantic burden on injured patients who will have to decide whose conduct contributed to their injuries.”
The California Medical Association (CMA) and the California Society of Anesthesiologists sued to block the opt-out. The CMA expressed disappointment at the state high court’s decision, noting, “Although nurse anesthetists can and do administer anesthesia, physicians are the most qualified to monitor the effects of the anesthesia and to react immediately when medically necessary.”
Colorado and California are among 17 states that have opted out of the federal rule. They follow Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin and Kentucky.
As more states take this stance, nurse anesthetists will need to be continually up to date on the latest techniques and technologies of anesthesiology. They will also have to carry more malpractice insurance, since they will be increasingly held responsible should problems occur during medical procedures.
Image by imagery majestic / freedigitalphotos.net
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