Allow only physicians to be responsible for anesthesia care

Nov 13, 2010 | Posted by: roboblogger | Full story: The Times

Unpleasant as it may be, envision a situation in which you or a loved one are about to undergo surgery requiring anesthesia.

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LMD

AOL

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#1
Nov 21, 2010
 

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21 November 2010

Dear Editor,

I am writing to you regarding the recent Op-Ed "Allow Only Physicians to be Responsible for Anesthesia Care" by Ervin Moss, MD, Executive Medical Director,
New Jersey State Society of Anesthesiologists. Dr. Moss's letter is not only offensive to the profession of Certified Registered Nurse Anesthetists, but also contains inaccuracies.

Our extensive didactic and clinical education has been recognized for many years. Yes, we do attend four years of college, and then we must have a minimum of one year of acute care experience (many applicants have significantly more experience), PRIOR to attending a nurse anesthesia program, which is generally another 24-36 months, resulting in a Masters degree. The New Jersey Board of Nursing recognized CRNA's as advanced practice nurses in their regulations in 2009. Many other states had already done so. By law, advanced practice nurses in New Jersey do not work under supervision.

As per our training, certification and scope of practice, we are able to perform various types of anesthesia and we are trained to provide anesthesia to all patients undergoing any surgery in all settings. Many of my colleagues have been deployed and cared for our soldiers and wounded civilians overseas in combat situations, without physician supervision, providing excellent, life saving care.

It is true that anesthesia has become much safer. Much of this improvement is due to improved technology and safety measures, not because " the number of anesthesiologists had increased sufficiently to appropriately control the process". If that were in fact the case, why is there not an increase in morbidity and mortality in areas where there is not anesthesiologist supervision?

Although the current regulations state we must work 'under supervision', the reality is that we work in collaboration with all physicians. Prior to surgery, we discuss the anesthetic needs with the surgeon. Even here in New Jersey, when working with an anesthesiologist, our true working relationship has been one of collaboration, not of supervision. Recent research has demonstrated that there is no significant difference in outcomes whether anesthesia is administered by a Certified Registered Nurse Anesthetist or an Anesthesiologist.

As a Certified Registered Nurse Anesthetist, when I am involved with the care of a patient, I am in the room for the entire procedure unless relieved by another anesthesia provider for a break. During this time, my only focus is on the care of that patient. I am not involved with any other issues. Dr. Moss was correct about the fact that sometimes things do happen requiring the need to make quick decisions. As advanced practice nurses specializing in anesthesia, we are trained to make these quick decisions. In such a situation, there may not be time to wait for the anesthesiologist to come before responding. We also know when we need to call for more expert advice or assistance.
Anesthesiologists do have a very important role. I respect and work well with many of them. This issue is not about replacing them, however, it is about allowing Certified Registered Nurse Anesthetists to practice within their scope of practice which will only serve to enhance care and anesthesia services.

Sincerely,

Linda M. DeLamar, APN, CRNA, MSN, MS, CH, MAJ, USAFR , Retired
Anesthesia Provider

Winchester, VA

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#2
Nov 24, 2010
 
This above article is written by a biased physician and has inaccurate opinion littered throughout it. Terrible and untrue literature... Typical of any ASA propaganda.
know your provider

Howell, NJ

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#3
Nov 26, 2010
 

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With adequate anesthesiologist supervision, crna have an important support role. I have no axe to grind with crna. I would not allow an unsupervised nurse/crna to administer any anesthetic to me or to any of my patients. There is a huge difference between anesthesiologist supervised crna and "solo practice" crna. CRNA are highly trained nurses, nothing more, nothing less. Please read the comments made by "militant" crna carefully; these people sound like they are a lot more concerned with a paycheck than with patient safety. If I'm the patient having surgery and "quick decisions" have to be made regarding my anesthesia, I want them to be made by or supervised by an anesthesiologist.
Anesthesia Provider

Winchester, VA

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#4
Nov 27, 2010
 
" If I'm the patient having surgery and "quick decisions" have to be made regarding my anesthesia, I want them to be made by or supervised by an anesthesiologist"... That is your opinion and just that, nothing more, and nothing less...but know that you make conflicting points about paint care. Solo CRNA anesthesia IS safe and IS practiced daily all over the US... Your opinion is yours and you are certainly entitled to that mindset ....as cavalier and biased as it is.
Anesthesia Provider

Sardinia, OH

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#5
Nov 29, 2010
 
I am a practicing CRNA of 23 years and this territorial argument has been going on forever where anesthesiologists think they are more competent than CRNAs. Unfortunatley there are clinicians on both sides who prove that to be true. However, when examining the actual practice of anesthesia, there are more CRNAs clinically administering anesthesia than anesthesiologists. I have worked in various settings....no supervision, 1:2 supervision and working simultaneously along side physicians. In the "no supervision" facilities it has been designated as such because the hospitals determined that the CRNAs were just as competent and sometimes more so than the anesthesiologists they hired to "supervise." Truly the working environment that is probably the best for the patients and for the anesthesia profession as a whole is the "working along side" environment. This allows the physicians and the CRNAs the opportunity to provide quality patient care as well as collaborate on more difficult cases. It keeps all the clinicians up to speed on their skills.

Personally I am very tired of this "turf battle" and just want to focus on quality care. In todays health care reform it is important that we as anesthesia clinicians provide safe, quality and cost effective care to benefit every patient. We must set egos aside and look at what is best for our profession and society as a whole. Every anesthesiologist and CRNA has a place and it is up to us to assure that where ever that place may be, an independent practice or as a team, the care is
superior for each and every patient.
CRNA

Lancaster, NY

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#6
Nov 30, 2010
 
That's all I can say it's all biased and money speaks. MD anesthesiologist have no data to support their arguments (as usual). and now they are playing dirty.
CRNA

Frisco, TX

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#7
Nov 30, 2010
 
I have been practicing anesthesia for over 25 years. This discussion has been going on for as long as I can remember. I have been in hospitals that have opted to have only physician anesthetists and within months have recruited the CRNAs back. The only MD approach does not work for many reasons and not appreciating the role each brings to the table misses the point that it is about the patient. CRNAs are competent and do not need supervision. All physicians have specialty MDs to consult with when problems arise and CRNAs do the same every day. The difference is that the specialty MDs don't obtain a fee for the referral as anesthesiologists get a fee for the supervision of CRNAs. For the MDs, it is all about the money.
CRNA OH

Englewood, OH

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#8
Nov 30, 2010
 
I find it sad that we are still arguing about who can/ cannot administer anesthesia and who can do it better. In the end, both anesthesiologists and nurse anesthetists are needed. Like any profession there are the good and the bad. We would do better to focus our efforts on the patient instead of constantly bickering like children. And yes anesthesia is much safer today than 50 years ago, but it in great part due to technology like pulse oximetry and capnography. Let's not resort to scare tactics. Our patients deserve better.
crna

Oxford, MS

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#9
Nov 30, 2010
 
I am a Certified Registered Nurse Anesthetist. I have and do make those "quick decisions" everyday I anesthetize a patient. I am in a medical direction/supervision model. Trust me when those "quick decisions" have to be made there are no anesthesiologist around. If even I could get them in the room...in the amount of time it took to "get them there". I have already made that "quick decision".
HKcrna

AOL

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#10
Dec 1, 2010
 
It is very sad to see this kind of biased article, especially in NJ where I used to practise my bedside nursing. The article did not tell the whole true about CRNA training. I had 8 years in critical care nursing (IUC,CCU,OPEN HEAT) before attending CRNA school (not in NJ). We were trained in different specialties in CRNA training.
From my daily practices, you cannot really say a CRNA or an Anesthesiologist is better than the other. You got bad apples on both sides. But to say an anesthesiologist provides better anesthesia care than a CRNA is just fictional. I have anesthesiologist asking me to give her anesthesia than the other anesthesiologists. So you figure it out !! The bottom line, to my opinion, it is about money and authority/power. In this era of health care, safety, quality, and cost effective are the determining factors. It is a team approach of health care, no more "physician only" dictating health care.
CRNA WA State

Kirkland, WA

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#11
Dec 1, 2010
 
Another scare tactic by a threatened Ane$the$iologist! Absolutely no data to support his claims. How can anyone trust that article, when even the basic description of CRNA education is wrong. Dr. Moss, please get your facts straight, or are you too busy drinking coffee in your office.

I work in a group of anesthesia providers (4 MDA and 3 CRNA), we are independent providers. I am not supervised, I do my all cases from A to Z, I am completely autonomous, not supervised by the surgeon or the anesthesiologists. If I have a clinical question or need input, I consult with any of my colleagues, MDA or CRNA, and they do the same. In my facility and the State of Washington, I practice to the full unrestricted extent of my license, APN-Anesthesia with prescriptive authority, and this is the way it should be in all 50 states!

Dr. Moss, good luck to you in your future endeavors...but your article is not worth the money it's printed on. I sure hope you can give a better anesthetic than the way you can state the facts!
Anesthesia Provider

Winchester, VA

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#12
Dec 2, 2010
 
Dr Moss is confused.
Rural Oregonian

Walla Walla, WA

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#13
Dec 2, 2010
 
I have read and carefully considered the recent editorial by Dr. Moss on the subject of physician supervision of anesthesia, and I wish to make the following opportunity available to the doctor, so that the delivery of anesthesia can be overseen properly in my area.

If you wish, you and your family can leave the urban location you now practice in, and move to this rural locale, where you will be responsible for providing all anesthesia services required by both the main operating room, and the 24/7 coverage demanded by the obstetrical service.

Please be aware that this will include trauma anesthesia, and emergency surgeries of all types, and at all hours. Importantly, you will be obliged to provide the anesthesia personally, because there is currently a national shortage of both anesthesiologists and nurse anesthetists, particularly in small towns such as this. Unfortunately, no anesthesia tech services are available at this hospital to help with this work.

Additionally, the population here is more than 60% Medicare and Medicaid, so please expect your compensation to be about 50-67% lower than what you could earn in working in a major city. Call will be very third night, but you will have the opportunity to work every post call day, at least until the staffing here is up to capacity, which may take years to achieve, if it is possible at all.

If you do not wish to take advantage of this opportunity, please understand that nurse anesthetists, working without anesthesiologist supervision, will continue to provide services here, as they have done for nearly the last century.
Anesthesia Provider

Winchester, VA

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#14
Dec 2, 2010
 
Rural Oregonian ... That was the single BEST post I've ever read... Well done.
safe anesthesia

Pittsburgh, PA

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#15
Dec 7, 2010
 

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Please understand that your anesthesia will be provided by a nurse with no aneshtesiologist backup............scary for me...and for most thinking people
stanley

Shelbyville, KY

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#16
Dec 7, 2010
 
please understand you do not have a clue what you are talking about....scary for me and most thinking people.
Anesthesia Provider

Winchester, VA

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#17
Dec 8, 2010
 
whoever this "safe anesthesia" is... Stop wasting our and your time with these worthless posts
safe anesthesia

Pittsburgh, PA

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#18
Dec 14, 2010
 

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so called "anesthesia provider" and stanley (aka idiot nurse): you have done a great job informing the public as to why they don't want an unsupervised nurse performing their anesthesia.......you both are disrespectful and jealous of true professionals..........I would say: "stick to nursing" but that's probably over your heads.
stanley

Shelbyville, KY

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#19
Dec 14, 2010
 
It is nice to see that such a mature thoughtful post. When given facts call names, I wonder why an administrator of some type feels so threatened?
Methinks the poster doth protest to much.
safe anesthesia

Pittsburgh, PA

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#20
Dec 14, 2010
 

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stanley is right; my calling him idiot nurse was totally wrong.............I'm not an administrator (of any type)............my bad.......

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