Nurse Anesthetists
* As president of the American Assn. of Nurse Anesthetists, and educator in the Kaiser Permanente system here in Los Angeles, I felt it important to set the record straight after reading the Dec. 17 letter of Dr. Marie Kuffner’s (immediate past president of the Los Angeles County Medical Assn.) on the role of nurse practitioners, with special focus on certified registered nurse anesthetists (CRNAs). It is notable that Dr. Kuffner, although addressing nurse anesthetists, neglected to mention her own specialty--she is a practicing anesthesiologist.
CRNAs are most definitely sole providers in 85% of rural hospitals in the United States (whereby they serve 60 million Americans--a population mix three times the size of Canada.) These practitioners enable the rural medical facilities to provide obstetrics, essential surgical, emergency and trauma stabilization services. As professional registered nurses, CRNAs are independently licensed to practice nursing within the scope of nurse practice acts and other regulations in each of the 50 states. Some licensing laws require the CRNA to work under the “supervision” of or in “collaboration with” a physician, such as a surgeon, dentist, or podiatrist. (In the state of California, no such “supervision” clause is utilized in the statute.) However, as far as anesthesia is concerned, as CRNAs we are legally responsible for our own decisions and services.
CRNAs administer anesthesia for all types of surgical cases. Based upon a 1988 study by the Center for Health Economics Research, nurse anesthetists were regularly involved in the same kinds of anesthesia procedures--from the most simple to the most complex--as were anesthesiologists. Furthermore, multiple studies have not demonstrated any significant difference in quality of care between nurse anesthetists and anesthesiologists.
And, what about education? The most substantial difference between CRNAs and anesthesiologists is that prior to anesthesia education, anesthesiologists receive medical education while CRNAs receive nursing education. However, the anesthesia part of the education is very similar for both providers. Nurse anesthesia education programs involve 24-36 months of graduate work, including both classroom and clinical experiences. The classroom curriculum emphasizes the following in relation to anesthesia: anatomy, physiology, pathophysiology, biochemistry, chemistry, physics and a minimum of 90 hours of pharmacology. The primary clinical component provides experience with a variety of anesthesia techniques and procedures for all types of surgery and obstetrics.
Additionally, to hold the credential of CRNA, the graduate must pass a national certification examination, and thereafter, meet specific continuing education requirements biennially for the rest of his or her professional life.
LINDA L. CALLAHAN
Los Angeles
