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CRNAs: perfectly suited to meet today's healthcare challenges.

Certified Registered Nurse Anesthetists (CRNAs) have been providing safe anesthesia care in the United States for over 150 years. In fact, they were the first recognized anesthesia specialists dating back to the Civil War. Today, CRNAs practice in every healthcare setting, providing every type of anesthesia for patients of all ages and for any type of procedure requiring anesthesia. CRNAs are the primary anesthesia providers in the military, the VA healthcare system, in rural America and in medically-underserved inner-city areas.

When anesthesia is administered by a CRNA, it is considered the practice of nursing When administered by an anesthesiologist, it is considered the practice of medicine. The actual practice of administration, however, is exactly the same. CRNAs are RNs with a bachelor's degree and an average of three and a half years of critical care experience before entering a nurse anesthesia program These programs are currently a mix of master's and doctoral degrees, but by 2025, all CRNAs will graduate from accredited doctoral programs.

There are several models for the anesthesia delivery team. The care-team model consists of physician anesthesiologists supervising resident physicians and directing non-physician anesthesia providers, such as CRNAs. In no state in the US are CRNAs required to be supervised by anesthesiologists but some healthcare facilities can and do require it.

The all-MD model (anesthesiologists only) is the most expensive model and is not as common as it once was. In Oklahoma, though, there are still a few major hospitals that employ it.

In the all-CRNA model, CRNAs deliver anesthesia independently, without the supervision of an anesthesiologist. In states that require physician supervision, like in Oklahoma, that supervision can be provided by any MD, DO, podiatrist or dentist.

Then there is the MD-CRNA model, where anesthesiologists and CRNAs work in the same facility but practice independently of each other.

Studies have shown no difference in safety between anesthesiologists and CRNAs. And yet most states still require physician supervision. CRNAs are highly-educated, highly-trained specialists Their job demands constant vigilance and split-second decision-making. Honestly--how can surgeons possibly supervise a CRNA in a specialty in which they have little to no training and while they are performing complicated procedures that require their full and constant attention? Collaboration is a more appropriate term. CRNAs work in collaboration with physicians and other healthcare professionals.

The Oklahoma Association of Nurse Anesthetists has made several attempts to pass legislation that would change the language from "supervision" to "collaboration", to no avail. Influence by the physicians, namely anesthesiologists, on our state legislators is much too strong So the OANA has been involved with the Advanced Practice Group of the Future of Nursing Action Coalition since its inception. The mission of this group is to facilitate advanced practice nursing consensus, communication and practice to improve Oklahoma patient outcomes. Representatives of all four APRN groups meet regularly in a cohesive effort to achieve full practice authority for all APRNs. It will ultimately happen because it makes economic, efficient sense. The question is when? Please visit our Facebook page called "Advanced Practice Registered Nurses of Oklahoma."

CRNAs are a unique type of APRN. In Oklahoma, rather than obtaining "prescriptive authority", we obtain authority to "select, order, obtain and administer," which is rather superfluous considering that is what we do.

To learn more about CRNAs, please visit There are links to the many studies showing the safety and cost-effectiveness of the anesthesia care provided by CRNAs. There is scientific proof that we are indeed perfectly suited to meet today's healthcare challenges.

Liz Schultz, CRNA, MS

President, Oklahoma Association of Nurse Anesthetists
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Author:Schultz, Liz
Publication:Oklahoma Nurse
Date:Sep 1, 2015
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