As of 2023, 75% of certified registered nurse anesthetists reported practicing independently without collaboration from physicians, according to a white paper from Medicus Healthcare Solutions published May 21.
CRNAs represent more than 80% of anesthesia providers in rural counties and administer more
than 50 million anesthetics to patients each year in the U.S., according to the report.
Several states have also recently introduced legislation that aims to give CRNAs full practice authority, including in Virginia. More than half of U.S. states allow CRNAs to practice independently.
In mid-March, U.S. Reps. Lauren Underwood, MSN, RN, D-Ill., and Jen Kiggans, MSN, RN, R-Va., introduced legislation that would allow certified registered nurse anesthetists and physician anesthesiologists to provide anesthesia autonomously at the Veterans Health Administration.
CRNA practice authority has been a long-debated topic in healthcare.
While advocates of CRNAs practicing autonomously have said such legislation will free up providers and alleviate anesthesia provider shortages, opponents question the safety and efficacy of allowing CRNAs to provide those services without supervision.
“Every year, across the country, CRNA-backed bills are introduced to weaken existing state-based anesthesia care delivery standards. And every year, ASA [American Society of Anesthesiologists], our state components and patient safety stakeholders work to defeat those bills. Last year alone, lawmakers refused to enact nurse-backed bills in 17 states,” ASA President Donald Arnold, MD, chair of the department of anesthesiology at Mercy Hospital St. Louis, told Becker’s. “The physician-led, team-based model of anesthesia is the most common model of anesthesia care in the United States. It is the gold standard of anesthesia and the model of care used in all the nation’s top hospitals. Different states use different language to describe their physician-led model, but the results are the same. ASA supports keeping the nurse-only model rare and preserving the physician-led, team-based model of care. We also note that survey after survey demonstrates that patients overwhelmingly want and expect a physician to lead their anesthesia care.”
The Association of Nurse Anesthetists is often at odds with the ASA’s stance on the matter.
“There have been numerous studies showing that nurse anesthetists’ outcomes are the same as physician anesthesiologists,” Melissa Picceri Croad, CRNA, APRN, government relations director for the Massachusetts Association of Nurse Anesthetists, told Becker’s. “It’s already happening — CRNAs are already working independently. If we were unsafe and killing people, we would know it. My response to that would be, ‘Where are we stuffing the bodies?’ The best study is the status quo. CRNAs are already working independently everywhere and we just don’t see a problem with that. Especially in the rural areas. In big Western states with large rural areas like Nebraska and Montana, they are receiving care from about 99% CRNAs. It is hard for me to qualify where they are coming from with safety concerns when this type of care is happening all day every day.”
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