The from a 2001 Medicare and Medicaid regulation

current raging debate and controversy over whether certified registered nurses anesthetist
(CRNAs) should permanently be under the Physician anesthesiologists or be
granted autonomy of practice is becoming a matter of grave concern. This is
because, despite all odds, certified registered nurses have been known to have
been rendering invaluable anesthesia care services to the American populace for
decades. For example, it is estimated that the certified registered nurse
anesthetist serve well over 43 million American patients each year, according
to the American Association of Nurse Anesthetists 2016 Practice Profile Survey.
Besides, it is also a well known fact that CRNAs adequately make up for the
short fall of professional anesthesiologists, especially in the rural areas of
the United States of America, where there is an acute shortage of medical anesthesiologists.

contention appears to have found its root from a 2001 Medicare and Medicaid
regulation which allow states to “opt out” of a requirement that hitherto,
makes it mandatory for certified registered nurses anesthetists to be
supervised. As it stands now, in some states like Colorado, the contention has
assumed an alarming dimension, leading to legal battles between the nurse
anesthetists and physician anesthesiologists. While the certified registered
nurse anesthetist claim that they are specialized in administering anesthesia,
and are therefore qualified to treat patients, the anaesthesiologists argue
that they are physicians and that nurses do not possess the requisite
educational and professional qualification to empower them to perform such a
risk-prone medical service without adequate professional supervision. In all,
this whole debate appears to be part of an on-going broader “turf” war over how
much power nurses should or should not have in the treatment of patients.

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with the removal of the requirement, it is envisaged that, there will be
increased access to health care for vast American citizens in the rural areas.
As pointed out by Scott K. Shaffer, President of the Nurse Anesthetists
Association in Colorado, Colorado happens to be one of the 17 states that have
chosen to allow nurses to deliver anesthesia to its populace without physician
supervision. He goes further to state that, since the Colorado’s rural hospitals
were exempted from the supervision regulation, some medical facilities that
would not have employed the services of anesthesiologists, have been able to
attract some specialists, because there is no more concern about who should
administer anesthesia or supervise it. Scott concludes that patients don’t have
to be taken to Colorado Spring or Denver, when they can be cared for in their
own town.

many strong argument in favour of CRNAs, especially considering the benefits of
the “opt out” option on rural dwellers, as is the case with the state of
Colorado, it should be noted that, the suits in 2001 by the anesthesiologists
and medical societies against the autonomy of the certified registered nurses,
asserts that, allowing nurse anesthetists to deliver anesthesia without
personal supervision of a physician, runs counter with state law. It should
also be noted that, though a Judge ruled in favour of granting the nurse
anesthetists autonomy, that decision was appealed against in May of that year by
the medical doctors association group.

appealing the Judge’s ruling in favour of the registerd nurses, the medical
group argued that there is a vast different background between the nurses and
the physicians both in education and in training. Dr. Randell Clark, a notable
figure and spokesperson for the Colorado Society of Anesthesiologist, spoke
very strongly against the “opt out” option given to States. He argued that
anesthesia is a very complex and technically demanding area of medicine which
should be performed by a physician or supervised by one. He maintains that,
regardless of concerns for increased access to health care, his group believes
that there are more anesthesiologists than nurse anesthetists presently working
in the nearly 50 Colorado rural hospitals that were affected by the so-called
“opt out” decision.  According to him, in
those instances, when a hospital does not have a staff anesthesiologist, it is
still safer to have a physician on hand to supervise, before any complication

of whatever arguments the physician anesthesiologists may advance, the fact
remains, that CRNAs are primary providers of anesthesia care in rural America.
They enable health care facilities in these medically disadvantaged areas. They
offer pain management, obstetrical, surgical, and trauma stabilization
services. Some states of the U.S., certified registered nurse anesthethist are
known to be the sole providers in almost 100 percent of the rural medical
outfits and hospitals, where it is almost impossible to find any
anesthesiologist. CRNAs benefits to those rural areas are of great importance.

CRNAs also provide anesthesia in conjunction with surgeons, anesthesiologists,
dentists, and other qualified health care providers and professionals. Besides,
when a nurse anesthetist administers anesthesia, it actually recognized as the
practice of medicine, with no contrast in care. This goes to show that,
regardless of one’s educational background, whether nursing or medicine, all
anesthesia professionals administer anesthesia the same way. In other words,
there is no way of differentiating between an anesthesia service offered by a
physician anesthesiologist and that of a nurse anesthetist.

all advanced practicing CRNAs practice with high sense of commitment, autonomy,
and professional efficiency. They demonstrate respect to rules and take
responsibility for their services and are equally rewarded and remunerated
accordingly. The CRNAs work in every place where anesthesia is delivered. These
include the traditional hospitals, surgical suites, obstetrical delivery rooms,
critical access hospital, and ambulatory surgical centers. Others include the
office of the dentists, ophthalmologists, plastic surgeons, pain management specialists,
public health services, as well as the U.S. Military and the Department of
Veterans Affairs health care facilities.

the U.S. military Services, nurse anesthetists have also been known to be the
main providers of anesthesia care to the U.S. army personnel since the World
War one. They equally provided anesthesia to wounded soldiers during the Civil
War. In fact, according to the 1999 report of the Institute of Medicine,
anesthesia care is about 50 times safer than it was in the early 1980s. Added
to these facts, numerous other studies in the recent past have also shown that
there is no difference in the quality of care provided by CRNAs as against
those of their medical or physician counterparts. In actual fact, the CRNAs provide
high quality anesthesia care at a reduced cost to patients and insurance
companies. The prudent management of anesthesia services by CRNAs saves
individual patients, insurance companies, and the states government’s alike,
huge sums of money every year, and helps in the control of escalating cost of
health services.

The fact that the CRNAs are subjected to
serious academic and professional scrutiny is also another factor that must be
put into consideration. For instance, their academic requirement include a
degree in nursing or its equivalent in other appropriate major; an unrestricted
license as a registered nurse; a minimum of one year full-time work experience as
a registered nurse in an intensive care setting; a graduation with a minimum of
a Master’s degree from a nursing anesthesia educational program accredited by
the Council on Accreditation of Nurse Anesthesia Educational Program. Added to
these requirements, the CRNAs are also expected to pass the National
Certificate Examination following graduation. And of course, all CRNAs who
certified or recertified in 2016 are now required to be part of the National
Board of Certification and Recertification for nurse Anesthetists (NBCRNA),
Continued Professional Certification (CPC) program.

against the backdrop of their track records, CRNAs can actually stand on their
feet without the physician anesthesiologists as their watch dog. A clear
evidence of respect for CRNAs was first recognized nationally by congress
enacting the federal legislation called the Direct Reimbursement Legislation,
which was passed by Congress in 1986, it included nurse anesthetists as the
first nursing specialty to be afforded the right to direct reimbursement under
the Medicare program. This is a clear evidence that even the federal government
is cognisant of the excellent performance records of the CRNAs. Another example,
in 2016, the average malpractice premium for self-employed CRNAs stood at 33
percent lower than in 1988, which show the great improvement in safety of
practice of CRNAs. In the area of physician supervision, to date 17 states have
opted out of direct physician supervisor of certified registered nurse
anesthetist, and from the look of things the way health care is going currently
due to shortage of anesthesiologist, and the high cost of payment to them, the
future seems better and brighter for certified registered nurse anesthetists.