The American Association of Nurse Anesthetists (AANA) has asked for states to lift barriers to full utilization of nurse anesthetists. The COVID-19 crisis gave the AANA an opportunity to show the benefits of lifting physician supervision statutes, as a dozen states made temporary changes during the pandemic.
“The vast majority of states in this country have no physician supervision in statute,” says AANA CEO Randall Moore, DNP, MBA, CRNA. Twelve additional states changed their requirement for physician supervision of nurse anesthetists through an executive action that is temporary.
“They made the decision that with COVID-19, there is a significant concern around the surge of patients and ensuring we have enough providers to take care of patients,” Moore explains. “While it is an executive action, we think it is obviously the right thing to do.”
Governors in New York, Michigan, Maine, and West Virginia removed physician supervision for certified registered nurse anesthetists (CRNAs). Governors in Alabama, Kentucky, Louisiana, Maryland, Massachusetts, New Jersey, Tennessee, and Wisconsin also temporarily removed other aspects of physician involvement with CRNAs, says Anna Polyak, RN, JD, senior director of state government affairs for AANA. “CRNAs can play an important role in providing life-saving critical care management for patients impacted by the COVID-19 virus in their advanced practice registered nurse [APRN] role,” she says.
There are 33 states with no supervision of CRNAs in state laws. “There is no evidence that anesthesia care in states that do not require supervision is in any way inferior to anesthesia care in states that require supervision,” Polyak notes. “CRNAs provide high-quality anesthesia care, regardless of whether the state in which they are working requires supervision.”
Even before COVID-19, there was evidence that antiquated rules and regulations regarding CRNAs did nothing to improve safety, Moore says. States with these restrictions typically require a physician to be physically present and sign charts for nurse anesthetists. This increases inefficiency and cost, he adds.
Removing physician supervision of CRNAs is a top priority for AANA. “We’re focused on removal of barriers for full utilization of nurse anesthetists,” Moore says. “We work with state chapters/associations, advocating at the state level, and we also work at the federal level.”
Restrictions on CRNA practice are contrary to the national trend, which is allowing each practitioner to practice to the full extent of his or her education and training, Polyak says. “The excellent safety record of CRNAs is reflected in a landmark national study conducted by RTI International,” she explains. “It determined that there were no differences in patient outcomes when anesthesia services are provided by CRNAs, physician anesthesiologists, or CRNAs supervised by physicians.”
Polyak also says CRNAs provide essential medical care, such as anesthesia for women in labor, in many underserved communities, as well as support for many members of U.S. armed forces.
After the COVID-19 pandemic ends, AANA leaders will meet with legislators to discuss advantages to lifting supervision restrictions on CRNAs’ practice, Moore says.
“Hopefully, when we see this thing in our rearview mirror, we’ll start having conversations about what we have learned about the healthcare in the states [with temporary orders],” Moore offers. “We’ll see what needs to be evaluated with these executive orders, and see how these had a material impact on increasing access to care.”