Nurse anesthetist

Nurse Anesthetist
Nurse Anesthetist providing independent anesthesia on a forward surgical team
Occupation
Activity sectors
Anesthesia, nursing
Description
CompetenciesAdministration of anesthetics and the elimination of pain
Education required
Varies by country
Fields of
employment

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy.

A survey published in 1996 reported that there were 107 countries where nurses administer anesthesia in some form, and a further nine countries where nurses act as assistants in the administration of anesthesia.[1] Depending on the local system of healthcare, they participate only during the operation itself, or may also be involved before and after (for preanesthetic assessment and immediate postoperative management).[2] In some localities, nurse anesthetists provide anesthesia to patients independently; in others they do so under the supervision of anesthesiologists.[2]

The International Federation of Nurse Anesthetists was established in 1989 as a forum for developing standards of education, practice, and a code of ethics.[3] Delegates from 35 member countries participate in a World Congress every few years.

In the United States

In the United States, nurse anesthetists are called Certified Registered Nurse Anesthetists (CRNAs). CRNAs account for approximately half of the anesthesia providers in the United States and are the main providers of anesthesia in rural America.[4]

Nurses have been providing anesthesia care to patients since the American Civil War.[5] The National Association of Nurse Anesthetists professional association was established by Agatha Hodgkins in 1931.[6] It was renamed the American Association of Nurse Anesthetists in 1939.[6] The group established educational institutions for nurse anesthetists in 1952, and established the CRNA certification in 1957.[6] AANA continuing education was established in 1977.[6] As of 2011, some 92% of CRNAs in the U.S. were represented by the AANA.[6]

Scope of practice rules vary between healthcare facility and state. Before 2001, Medicare required, that physicians supervise CRNAs in the administration of anesthesia.[6] In 2001, Medicare's rules changed, allowing individual states to decide whether CRNAs may administer anesthesia without physician supervision.[6] In the absence of a state requirement that anesthesiologists supervise CRNAs, individual healthcare facilities decide.[6] CRNA organizations have lobbied in many states for the ability to practice without anesthesiologist supervision; these efforts are opposed by physician groups.[6] In 2011, sixteen states granted CRNAs autonomy, allowing them to practice without anesthesiologist oversight.[6] In 2017, there were 27 states in which CRNAs could independently practice (that is, "without a written collaborative agreement, supervision or conditions for practice").[7] In 2020, there was no physician supervision requirement for nurse anesthetists in ambulatory surgical facilities in 31 states[8] In states that have opted out of supervision, the Joint Commission and CMS recognize CRNAs as licensed independent practitioners.[9] In states requiring supervision, CRNAs have liability separate from supervising practitioners and are able to administer anesthesia independently of anesthesiologists.[10][11][12][13]

A nurse anesthetist will need to complete two to three years of higher education, beyond the bachelor's of nursing degree. This field is required to attend accredited nurse anesthesia educations programs that covers all areas of anesthesia. This education will provide what anesthetics are needed for patients in a practice setting that is for any type of procedure or surgery. After completing an accredited program, CRNAs must pass a national certification exam to acquire this designation.[14] It is important to have the best education for this field for the significance of anesthesia. By 2025 the Council on Accreditation, the organization which accredits Nurse Anesthetist programs requires all graduating CRNA to be doctorate prepared.[15]

Dispute over use of term "nurse anesthesiologist"

The AANA recognizes Certified Registered Nurse Anesthetist, CRNA, nurse anesthetist, and nurse anesthesiologist as equivalent titles.[16] The use of nurse anesthetist is substantially more common than the use of nurse anesthesiologist.[17]

Use of the term nurse anesthesiologist has been criticized by those who argue that the term anesthesiologist should be limited to medical doctors.[17] For example, groups representing anesthesiologists and other medical doctors, such as the American Medical Association (AMA) and American Society of Anesthesiologists (ASA), oppose the use of this phrase to describe CRNAs and call it misleading.[18][19]

In 2021, after a year-long rebranding effort, the American Association of Nurse Anesthetists changed its name to the American Association of Nurse Anesthesiology. The name change was condemned by physician groups, including the AMA, ASA, American Board of Anesthesiology, American Board of Medical Specialties, and American Osteopathic Association. Physicians' organizations said that the name change was "title misappropriation" that was deceptive, misleading to patients, and cause confusion in care settings.[20][21][22]

In 2021, the New Hampshire Supreme Court upheld a decision by the New Hampshire Board of Medicine that blocked nurse anesthetists from identifying themselves as anesthesiologists and limited use of the title to MDs and DOs specializing in anesthesiology.[23]

See also

References

  1. ↑ McAuliffe, M. S; Henry, B (1996). "Countries where anesthesia is administered by nurses". AANA Journal. 64 (5): 469–79. PMID 9124030.
  2. 1 2 McAuliffe, M. S; Henry, B (1998). "Survey of nurse anesthesia practice, education, and regulation in 96 countries". AANA Journal. 66 (3): 273–86. PMID 9830854.
  3. ↑ International Federation of Nurse Anesthetists (2007). About IFNA... Retrieved May 23, 2007, from http://ifna-int.org/ifna/page.php?16
  4. ↑ Daughettry, Lindsay (2010). "Is There a Shortage of Anesthesia Providers in the United States?". RAND Health. Retrieved September 30, 2018.
  5. ↑ "CRA Fact Sheet".
  6. 1 2 3 4 5 6 7 8 9 10 Matsusaki T, Sakai T (2011). "The role of certified registered nurse anesthetists in the United States". Journal of Anesthesia. 25 (5): 734–740. doi:10.1007/s00540-011-1193-5. PMID 21717163. S2CID 7991965.
  7. ↑ Laura Dyrda, 27 states where CRNAs can practice independently, Becker's ASC Review (January 18, 2017).
  8. ↑ Angie Stewart, [https://www.beckersasc.com/anesthesia/31-states-with-no-crna-supervision-requirement-in-ascs.html 31 states with no CRNA supervision requirement in ASCs, Becker's ASC Review (October 14, 2020).
  9. ↑ "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03.{{cite web}}: CS1 maint: archived copy as title (link)
  10. ↑ Joint Commission on Accreditation of Healthcare Organizations. "Standards Revisions Related to the Centers for Medicare & Medicaid Services (CMS)" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03.
  11. ↑ Gene Blumenreich. "A Surgeons Responsibility for CRNAs" (PDF). www.aana.com. Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03.
  12. ↑ American Association of Nurse Anesthetists (2013). "Scope of Nurse Anesthesia Practice" (PDF). www.aana.com. Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03.
  13. ↑ Gene Blumenreich. "Legal Briefs: Captain of the Ship Doctrine" (PDF). www.aana.com. Retrieved 2018-08-03.
  14. ↑ www.aana.com https://www.aana.com/membership/become-a-crna. Retrieved 2022-02-17. {{cite web}}: Missing or empty |title= (help)
  15. ↑ "Position Statements – Council on Accreditation". Retrieved 2021-09-12.
  16. ↑ American Association of Nurse Anesthesiology. "Accepted titles for CRNAs" (PDF). AANA.com.{{cite web}}: CS1 maint: url-status (link)
  17. 1 2 "Definition of NURSE ANESTHESIOLOGIST". www.merriam-webster.com. Retrieved 2021-09-16.
  18. ↑ Andy Nghiem, AMA: Anesthesiologists that aren't licensed shouldn't refer to themselves as such, Patient Daily (July 31, 2020).
  19. ↑ Christine Sexton,Nursing Board Signs Off on 'Anesthesiologist' Title, News Service of Florida (August 20, 2020).
  20. ↑ American Society of Anesthesiologists Condemns the American Association of Nurse Anesthetists' Misleading Name Change" Misappropriating medical titles confuses patients, risks safety (press release), American Society of Anesthesiologists (August 14, 2021).
  21. ↑ AOA statement on American Association of Nurse Anesthetists name change, title misappropriation and the importance of physician-led care, American Osteopathic Association (September 14, 2021).
  22. ↑ Lucy Hicks, Nurse Anesthetist Association Name Change Provokes Criticism, Medscape (August 20, 2021).
  23. ↑ Tanya Albert Henry, Court: "Anesthesiologist" title is restricted to MDs, DOs, American Medical Association, April 21, 2021.
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