In mid-March, U.S. Representatives Lauren Underwood, D-Ill., and Jen Kiggans, R-Va., introduced legislation that would allow certified registered nurse anesthetists and physician anesthesiologists to provide anesthesia autonomously at the Veterans Health Administration.
This is one of many pieces of ongoing legislation that would allow CRNAs to practice autonomously, following bills in consideration in states such as Florida and Virginia.
Currently, CRNAs represent more than 80% of rural anesthesia providers, administering more than 50 million anesthetics annually to patients in the U.S.
According to the American Association of Nurse Anesthesiology, CRNAs are currently able to practice without the supervision of a physician anesthesiologist in 49 states and Washington, D.C.
While advocates of CRNAs practicing autonomously believe that such pieces of legislation will free up providers and alleviate ongoing anesthesia shortages, opposers question the safety and efficacy of allowing CRNAs to be left unattended.
The American Society of Anesthesiologists issued a statement “strongly opposing” the legislation, alleging that it would “dismantle the U.S. Department of Veteran Affairs’ proven and well-established physician-led, team-based model of anesthesia care and move VA hospitals and clinics nationwide to a rarely used nurse-only model that would lower the standard and quality of care for America’s Veterans.”
Becker’s spoke with ASA president Donald Arnold, MD, chair of the department of anesthesiology at Mercy Hospital St. Louis, about the ASA’s stance on CRNA’s practicing without supervision.
Question: Where does the ASA stand on allowing CRNAs to practice
autonomously within the VA setting?
Dr. Donald Arnold: ASA supports the well-established physician-led, team-based model of anesthesia care provided in VA hospitals and clinics nationwide and opposes a move to a rarely used, nurse-only model that would lower the standard and quality of care for America’s
veterans. We believe that veterans deserve the exact same standard of care as other
citizens in their state — not a different standard and not a lower standard. As physicians,
we recognize the unique healthcare needs of veterans as patients. These are not
healthy, deployable active-duty service members. Instead, these are older, sicker
patients who very often suffer with existing conditions that can increase the risks of bad
outcomes during surgery. For example, a newer generation of veterans now accessing
care in VA, the PACT Act Veterans, can have serious respiratory and other health
issues tied to their exposure to toxic substances like agent orange and burn-pits. These
patients deserve and require that care be provided by professionals with the highest
levels of medical knowledge and skills. Accordingly, we support VA’s existing policies
which recognize the gold-standard, team-based model of care and defer to state
licensure and practice laws and regulations. This standard has ensured that the
anesthesiologist-led model is the dominant model, by far, of anesthesia care throughout
the entire VA health care system. Millions of veterans have been assured access to
safe, high quality anesthesia care because of this model. Now is not the time to change
this important standard.
Q: Is the ASA concerned about an uptick of CNRA-focused legislation in states
including Florida, Virginia and California?
DA: No, ASA is not concerned about nurse-backed legislation because this is not a new or
advancing trend. Every year, across the country, CRNA-backed bills are introduced to
weaken existing state-based anesthesia care delivery standards. And every year, ASA,
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. Regarding this year’s legislation in Virginia, it did not pass out of any committee and the legislature has adjourned for the year. This is the 26th year in a row nurses introduced this type of legislation in Florida. Both the Florida and California bills are still active.
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 — the nurse-only model is rare. While there is only one state statute specifically requiring anesthesiologist supervision of CRNAs, virtually every other state in the union requires a physician to provide clinical oversight of a CRNA and the patient’s anesthesia. 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
demonstrate that patients overwhelmingly want and expect a physician to lead their
anesthesia care. ASA supports our patients.
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