Another attempt by CRNAs to increase their scope of practice

[ProRealDoc]

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Senator Ohio Senate
Sue Morano Statehouse 056
13th District Columbus, OH 43215

614.644.7613



MEMORANDUM

TO: Members of the Senate

FROM: Senator Morano

DATE: Monday, October 27th 2009

RE: Certified Registered Nurse Anesthetists

­­­­­­
I will soon be introducing legislation that will allow certified registered nurse anesthetists (CRNAs) to write orders for medications that will be administered by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and respiratory therapists (RTs).

In 2000, after the passage of HB 241, this became a common practice in hospitals. No cases of injury or untoward events attributed to this practice have been brought to the attention of the Ohio Board of Nursing. Not until 2008, when the Board of Nursing received an inquiry concerning this issue, was it found that CRNAs were allowed to administer medications, but did not have the authority to order medications to be administered by others.

This bill is drafted to require that the ordering and administration of these medications are done under supervision and only where anesthesia services are being rendered by the CRNA.

You can call her office at 614.644.7613 or via e-mail at [email protected]


So now CRNAs also want prescriptive rights? I am ok with them administering medications under direct supervision of an anesthesiologist but they have no business doing this independently. This bill claims that they will do so under supervision but does not state who will be "supervising". PLease contact this senator and let her know this bill is fraught with potential for endangerment of patient safety.

 

[Camel]

Senator Ohio Senate
Sue Morano Statehouse 056
13th District Columbus, OH 43215
This bill is drafted to require that the ordering and administration of these medications are done under supervision and only where anesthesia services are being rendered by the CRNA.

Forgive my ignorance, but if the bold section is true, does the bill not already address your concerns about supervision (or is it too ambiguous?)? Thanks for calling this to everyone's attention (I'm an Ohioan!), and in advance for helping to educate me.

 

[ProRealDoc]

Forgive my ignorance, but if the bold section is true, does the bill not already address your concerns about supervision (or is it too ambiguous?)? Thanks for calling this to everyone's attention (I'm an Ohioan!), and in advance for helping to educate me.

They already administer medications in the OR. There's no need to extend this outside the OR where there are physicians available. Besides, even in hospitals where there are no anesthesiologists, that's what the surgeons are for.

 

[coprolalia]

I'm not sure about the point of this legislation.

Can or cannot CRNAs now write post-op orders in the PACU?

Please clarify.

-copro

 

[cchoukal]

I'm not sure about the point of this legislation.

Can or cannot CRNAs now write post-op orders in the PACU?

Please clarify.

-copro

At my residency program, CRNAs could not write PACU orders (this was in Illinois).

 

[ProRealDoc]

I'm not sure about the point of this legislation.

Can or cannot CRNAs now write post-op orders in the PACU?

Please clarify.

-copro

Currently APNs (CRNAs currently fall under that umbrella) do not have the ability to order schedule II drugs in a PACU setting since postop care is typically managed by the surgeons (when an anesthesiologist is not available). NPs are fighting to have that rule abolished. Once you allow them to order medications, you are esentially legitimizing their beliefs of equality with anesthesiologists.

 

[proman]

CRNAs in Maryland can write PACU orders including Schedule II.

 

[rsgillmd]

I'm not sure about the point of this legislation.

Can or cannot CRNAs now write post-op orders in the PACU?

Please clarify.

-copro

Not at my residency program in NY, or where I am working now in TN.

 

[periopdoc]

UW CRNA's write their own PACU orders, epidural orders (after consultation with the pain service), and nerve block orders (supposed to be done after consultation with the pain service, but there are some that fail to even notify pain service that a catheter was placed.)

Other midlevels at our institution write the majority of prescriptions for outpatients and discharges (from surgical services). That is, of course, after discussion with the MD on the case.


- pod

 

[ProRealDoc]

UW CRNA's write their own PACU orders, epidural orders (after consultation with the pain service), and nerve block orders (supposed to be done after consultation with the pain service, but there are some that fail to even notify pain service that a catheter was placed.)

Other midlevels at our institution write the majority of prescriptions for outpatients and discharges (from surgical services). That is, of course, after discussion with the MD on the case.


- pod

In our dept no CRNA is allowed to write any orders.

 

[coprolalia]

UW CRNA's write their own PACU orders, epidural orders (after consultation with the pain service), and nerve block orders (supposed to be done after consultation with the pain service, but there are some that fail to even notify pain service that a catheter was placed.)

Other midlevels at our institution write the majority of prescriptions for outpatients and discharges (from surgical services). That is, of course, after discussion with the MD on the case.


- pod

This was my point. I'm not sure what all the fuss is about. This is precisely the practice of other midlevels in most institutions. It doesn't change anything.

-copro

 

[doctadre]

UW CRNA's write their own PACU orders, epidural orders (after consultation with the pain service), and nerve block orders (supposed to be done after consultation with the pain service, but there are some that fail to even notify pain service that a catheter was placed.)

Other midlevels at our institution write the majority of prescriptions for outpatients and discharges (from surgical services). That is, of course, after discussion with the MD on the case.


- pod

CRNAs do regional blocks?

 

[jwk]

CRNAs do regional blocks?

As in spinals, epidurals, interscalene, femoral, etc.? Yes.

Blocks for chronic pain management is another issue and the subject of much debate.

 

[jwk]

Currently APNs (CRNAs currently fall under that umbrella) do not have the ability to order schedule II drugs in a PACU setting since postop care is typically managed by the surgeons (when an anesthesiologist is not available). NPs are fighting to have that rule abolished. Once you allow them to order medications, you are esentially legitimizing their beliefs of equality with anesthesiologists.

Scope of practice, for all licensed practitioners, is determined by

1) state law
2) medical staff / hospital policy

Medical staff and hospital policies can be more restrictive than state law, but not less. I believe there are still states where PA's and APN's cannot write prescriptions at all, or on a limited basis only, and then there are some with essentially full prescriptive authority. Some also differentiate between hospital orders and actually writing a prescription for a patient's use outside the hospital. It's on a state by state basis - there are no federal scope of practice laws.

 

[flashgordon]

UW CRNA's write their own PACU orders, epidural orders (after consultation with the pain service), and nerve block orders (supposed to be done after consultation with the pain service, but there are some that fail to even notify pain service that a catheter was placed.)

Other midlevels at our institution write the majority of prescriptions for outpatients and discharges (from surgical services). That is, of course, after discussion with the MD on the case.


- pod

Are you saying that the nurses there place epidurals & perform nerve blocks? That is completely unacceptable. The only thing they should be allowed to do is place an IV. Who teaches them? Why does your residency program director or department chair allow such behavior? These skills, regardless if you call them "monkey skills", should not be taught to nurses. Your attendings should be shot and hung to dry- they are the reason why nurses think they can do our job.

Scope of practice should be determined by COMMON SENSE. Just because you think you can do something, doesn't mean you should. As MDs, we are liscensed to perform surgery. I've helped remove plenty of gallbladders and appendixes on my surgery rotations, does that mean I should be allowed to do them? I can operate that laparoscope like my 3rd hand. Pretty easy **** right?

And nurses writing prescriptions? What a joke.

Only in this fu cked up country of ours can nurses play doctor.

 

[loykastj]

As in spinals, epidurals, interscalene, femoral, etc.? Yes.

Blocks for chronic pain management is another issue and the subject of much debate.

I believe they do them at Harborview as well.
I was in the PACU and saw a resident learning how to place a nerve block with an attending and a CRNA mentioned they have to compete with the residents to get to do procedures such as that.

 

[AKMD_1984]

not that i hate crnas, but i personally dont take any nurses or crnas seriously after a certain threshold. i would rather trust a medical student's physical exam findings than a nurse's - and thats what my attendings have instilled in me as well. they want someone who knows about pathophys and WHY we give a drug, not just HOW.

most nurses are great. esp. the male nurses are awesome, and i get along with them fine (mostly because they miss the monthly hormonal changes)...but its the 15-20% of the nurses that are:
a) RUDE
b) completely unaware and ignorant to the sacrifices doctors make to get where they are, and have the audacity to compare and try to be equivalent to us. esp. in terms of crnas...omg...i wanted to kick this crna in the uterus (jk) who i was assigned to for one case during my rotation...she kept criticizing one of the senior attending's persistence with the curved blade for intubation, by saying that 'she didnt learn it that way in her training, and its not proper - we should ALL use the striaght blade' when infact 1) it doesnt matter, 2) who cares, 3) you are on average 5 years behind the attending in terms of professional training and education, so he can probably use curved, straight, twisted, or any kind of blade he wants.

for this reason, i never take these nurses more seriously than they deserve to be. they just dont 'get it' and their inferiority complex dominates them. these days we need to wait for nurse's aids to take blood pressures because 'its not the nurse's job'...effin ridiculous.