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Are nurse anaesthetists needed? Should the Nursing Council endorse nurse practitioners in anaesthesia? One leading anaesthesia specialist argues against nurse practitioners as providers of anaesthesia services.

Readers of Kai Tiaki Nursing New Zealand are well aware of the debates about the development of the nurse practitioner (NP) role, its scope of practice and of the profession's right to develop a career path for nurses. The New Zealand Society of Anaesthetists (NZSA) supports the concept of NPs, but does have serious concerns about their gazetted scope of practice, as it appears to be almost identical to that of a medical practitioner.

The society is particularly concerned at the lack of debate about the need for or introduction (planned or otherwise) of NPs in anaesthesia. The society is also aware of some incorrect comments regarding its position on NPs and the nursing profession in general, so we have taken this opportunity to put forward our views, so nurses can be clear about our position.

The society does not support the introduction of independent NPs in anaesthesia (nurse practitioner[TM] perioperative anaesthetics). The position of the society on this matter is simple and transparent. We consider the Australian and New Zealand College of Anaesthetists' (ANZCA) training programme provides the standard necessary to provide the high quality anaesthesia care the New Zealand public receives. Any alternative providers of anaesthesia services should match the present "gold standard".

The training required for the proposed scope of practice of NP perioperative anaesthesia is qualitatively and quantitatively lesser to the present ANZCA training. It is the level of training, rather than nurse anaesthetists per se, that is our concern.

The NZSA is aware of the high quality service offered by certified registered nurse anaesthetists (CRNAs) in the United States (US). A critical analysis of the situation in the US reveals that the entire operating theatre milieu in that country is different to that in New Zealand. One example is that in the US, surgeons take a much more active role in anaesthesia management during an operation than do New Zealand-trained surgeons. US-trained CRNAs work under varying arrangements of autonomous practice in different states, with very different supervision arrangements, and with theatre systems designed to facilitate this arrangement. Theatre systems and employment arrangements are team-based and responsibility for patient care ties with the clinical leader. For this reason, the NZSA believes the introduction of a US-based model should be based on a team approach, rather than the selection of one member of the team, the CRNA.

We have also heard comments that NP anaesthetists could do the "minor anaesthetics", while medical practitioner anaesthetists could do the "more difficult" cases. The NZSA believes this argument is flawed, as a minor anaesthetic is one that is finished and went uneventfully. Even the simplest anaesthetic has the potential to fully test the skills and expertise of a specialist medical anaesthetist, using art of his/her resources and training, should something unexpected intervene, eg an anaphytactic reaction to an intravenous drug during induction.

Despite allegations, medical specialist anaesthetists have no desire to "exert control over the nursing profession". On the contrary, we recognise that high quality anaesthesia delivery is dependent on the smooth functioning and interaction of a team working collaboratively. An operating theatre team may include medical practitioners, anaesthetic technicians, nurses and other health professionals and constitutes a dynamic process. The interface with anaesthetic technicians, surgeons and theatre nurses has not been acknowledged by Nursing Council. It is the potential breakdown of this team approach at the "coal face" which is of major concern to us. The Nursing Council feels this is an "industrial issue", but we believe it is a patient safety one.

This putative NP role has arisen without any impact assessment to establish whether the introduction of a new NP workforce is needed, desirable, or even workable in our employment environment.

There is no shortage of medical specialist anaesthetists in New Zealand at present, although some areas, particularly rural, are short of optimum levels. The reason is that it is hard to attract medical practitioners to provincial areas and this would equally apply to a NP workforce. The tack of peer support, tack of continuing educational opportunities, fewer educational and employment opportunities for family members applies equally to all professional workforces. Also, the tack of suitable supervision arrangements would be profound in these areas, should a nurse wish to set up and deliver independent anaesthetic services.

The society believes the best approach would be to acknowledge the highly specialised and quality anaesthesia services already provided and look to how these services can be retained, and the spread of services improved. We are always willing to debate how best this can be achieved with nurses and nursing organisations with a specialised interest in this area of practice. But our focus will always remain on patient safety.

Nursing Council chair Annette Huntington responds: Like the New Zealand Society of Anaesthetists the focus of the Nursing Council is always patient safety. The Council believes that it, with the support of the nursing profession, has developed a robust and rigorous process for ensuring nurse practitioners (NP) are safe to practise in their chosen clinical areas. To date, medical colleagues have been involved in the NP approval process and this would be the case if a NP applicant wanted to administer anaesthetics as part of his/her practice in the area of peri-operative nursing. The way in which NPs are employed, for example how a NP (peri-operative care) would be used within the anaesthetic team, is deafly outside the legislated role of the Nursing Council.

Mark Bukofzer, MBCHB, FANZCA, is the president of the New Zealand Society of Anaesthetists (NZSA). He works at North Shore Hospital and also works in private practice. The NZSA was set up in 1948 to promote education and publications in anaesthesia, to develop the quality of anaesthesia training, to encourage research into anaesthesia, and to promote anaesthesia as a discipline. The society's constitution allows nurse anaesthetists as members, in the interests of promoting safe practice and continuing education.
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Title Annotation:VIEWPOINT
Author:Bukofzer, Mark
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Apr 1, 2005
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