CRNA push for Independence in NJ

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

drift

Full Member
10+ Year Member
Joined
Aug 7, 2010
Messages
104
Reaction score
0
December 04, 2010 /24-7PressRelease/ -- A suggested revision to current New Jersey Department of Health and Human Services (DHSS) regulations now requiring nurse anesthetists to work in tandem with anesthesiologists could mean big changes for operating rooms all over the state. The change would allow these nurses to administer anesthesia without direct doctor oversight, as long as physicians could be reached in emergencies.

The change would not be shocking for the medical community as a whole -- 30 states already let specially trained nurses administer anesthesia without supervision from physicians -- but the proposal is nonetheless making waves throughout New Jersey's health care field.

Both the American Association of Nurse Anesthetists and New Jersey Association of Nurse Anesthetists Inc. support the measure, which they argue would not only take some of the burden off of busy doctors (allowing them to attend to more pressing, emergency situations), but would let these highly educated nurses live up to their potential. To be certified as an Advanced Practice Nurse (APN with a specialty in anesthesia -- formerly known as a certified registered nurse anesthetist), a nurse must:
- Be a registered nurse (possessing a bachelor's degree in nursing and passing board certification)
- Have a master's or doctorate-level graduate degree
- Have at least one year of experience working in an intensive care unit

Physicians with the New Jersey State Society of Anesthesiologists (NJSSA) see the situation differently, however. They simply do not feel that even the rigorous education and training requirements put upon APNs are enough to take the place of the knowledge and skill of an on-site anesthesiologist. They fear that nurses are ill-equipped to handle unexpected emergencies that could affect patients being put under for surgery or treatment.

NJSSA is so wary of this new regulation that it has encouraged the state legislature (through a bill proposed by Assemblyman Neil Cohen) to codify into law the existing DHHS regulations requiring APNs to be supervised by doctors. This legislative action would force any changes to be made by state lawmakers instead of DHHS officials.

Only time will tell if the proposed revised regulation will be accepted, if the new law passes or what effect (if any) the lack of supervision of APNs would have on operating rooms across the state. In the meantime, however, if you or a loved one has been injured by the negligence or recklessness of either an APN or an anesthesiologist during surgery, seek the counsel of an experienced medical malpractice attorney in your area to learn more about possible legal recourse.

Article provided by Drazin and Warshaw, P.C.
Visit us at www.drazinandwarshaw.com

Source


If NJ is hit, then anything is possible. Being the most 'crowded' state in US, what kind of "access to care" nonsense applies here?!

Members don't see this ad.
 
Happened in California....why not NJ? Then all 50 states to follow.....as predicted.
 
Happened in California....why not NJ? Then all 50 states to follow.....as predicted.

Because their argument was "access to care" for the rural Californians. Now, NJ is literally void of ANY true "rural areas", so it's just a bunch of bullcrap with their "access to care" argument...
 
Members don't see this ad :)
Whether a state allows CRNA to practice independently doesn't really matter if individual hospitals require physician supervision of some form. Realistically, what hospital (which isn't located in the middle of nowhere) administration in their right mind would allow a CRNA to practice independently?? Heck, most decent anesthesia groups won't even hire an anesthesiologist who isn't board-certified or eligible; and most if not all hospitals require BC to be attained within 5 years usually. Let the CRNAs have their independence - after the first few inevitable deaths, the entire nurse anesthetist field will go down the toilet.
 
I hate that patient lives are being put at risk and we have to see the "inevitable deaths" you talk about for that whole house of cards to come crashing down.

So, with mixed feelings, I have to say - I can't wait to see the day when the word CRNA is banished from our lexicon.

Whether a state allows CRNA to practice independently doesn't really matter if individual hospitals require physician supervision of some form. Realistically, what hospital (which isn't located in the middle of nowhere) administration in their right mind would allow a CRNA to practice independently?? Heck, most decent anesthesia groups won't even hire an anesthesiologist who isn't board-certified or eligible; and most if not all hospitals require BC to be attained within 5 years usually. Let the CRNAs have their independence - after the first few inevitable deaths, the entire nurse anesthetist field will go down the toilet.
 
Whether a state allows CRNA to practice independently doesn't really matter if individual hospitals require physician supervision of some form. Realistically, what hospital (which isn't located in the middle of nowhere) administration in their right mind would allow a CRNA to practice independently?? Heck, most decent anesthesia groups won't even hire an anesthesiologist who isn't board-certified or eligible; and most if not all hospitals require BC to be attained within 5 years usually. Let the CRNAs have their independence - after the first few inevitable deaths, the entire nurse anesthetist field will go down the toilet.

Great point. We are not even considered unless we are board certified. Heck, if you are not board certified you cant find a job. And we are going to let crnas practice independently. What a ****ing joke? ENTER> ANESTHESIOLOGY ASSISTANT> ENTER PHYSICIAN ASSISTANTS IN ANESTHESIA
 
Great point. We are not even considered unless we are board certified. Heck, if you are not board certified you cant find a job. And we are going to let crnas practice independently. What a ****ing joke? ENTER> ANESTHESIOLOGY ASSISTANT> ENTER PHYSICIAN ASSISTANTS IN ANESTHESIA

Great Idea! But, a little teeny-weeny problem...























...AA's are forbidden to practice in NJ due to the same CRNA opposition we face. The AANA also makes sure no PA's work as anesthetists here as well.


How ironic?
 
Last edited:
Whether a state allows CRNA to practice independently doesn't really matter if individual hospitals require physician supervision of some form. Realistically, what hospital (which isn't located in the middle of nowhere) administration in their right mind would allow a CRNA to practice independently?? Heck, most decent anesthesia groups won't even hire an anesthesiologist who isn't board-certified or eligible; and most if not all hospitals require BC to be attained within 5 years usually. Let the CRNAs have their independence - after the first few inevitable deaths, the entire nurse anesthetist field will go down the toilet.

I disagree.

I think there are plenty of small groups out there with non-BC docs. I don't know if they have a time limit on obtaining certification.

I also am quite sure that there have already been a few bad outcomes with CRNA only care. These events are sometimes in the local press but my personal opinion is that it is going to take some time for this sort of nonsense to be picked up on a global scale.
 
CRNAS:
They know not and know not they know not. I know not and know I know not.
 
In states where CRNAs already have independent practice rights, what has this done to the MDs? Are they having trouble getting jobs, have salaries gone down the tubes?
 
In states where CRNAs already have independent practice rights, what has this done to the MDs? Are they having trouble getting jobs, have salaries gone down the tubes?


Yes and yes.
 
No anesthesiologist should work in a hospital where crnas work unsupervised.


I agree but this is not reality. I have many friends who practice right along side CRNA's in Nebraska and Kansas and they hate it. Most of them say they get no respect in the hospitals and they are called in when the S#!% hits the fan even though they did not play a part in the S#!% hitting the fan. Not good.
 
I agree but this is not reality. I have many friends who practice right along side CRNA's in Nebraska and Kansas and they hate it. Most of them say they get no respect in the hospitals and they are called in when the S#!% hits the fan even though they did not play a part in the S#!% hitting the fan. Not good.
This is going to sound bad, but can't they just say no to bailing out "independent" CRNAs? I mean, how can you start putting a stop to this independence stuff if you're constantly bailing them out? Not only that, aren't you putting yourself at the risk of litigation by attempting to clean up a CRNA's mess? I'm genuinely curious and don't mean this in a jerky way.
 
This is going to sound bad, but can't they just say no to bailing out "independent" CRNAs? I mean, how can you start putting a stop to this independence stuff if you're constantly bailing them out? Not only that, aren't you putting yourself at the risk of litigation by attempting to clean up a CRNA's mess? I'm genuinely curious and don't mean this in a jerky way.
While it would be nice to let the independent assassins just start killing patients, that's not going to happen. When there is a code or pre code in the OR, everyone comes running. It would be nice to keep track of these events. We do.
Gather data, present data, help your specialty. If the CRNAs don't like it, tough shiite. Practice better.
I would not work in a place like that, not if there were other places to work. Your friends need to just suck it up and move. Or become the patient safety officer and gather the data for the big ASA abstract.
 
While it would be nice to let the independent assassins just start killing patients, that's not going to happen. When there is a code or pre code in the OR, everyone comes running. It would be nice to keep track of these events. We do.
Gather data, present data, help your specialty. If the CRNAs don't like it, tough shiite. Practice better.
I would not work in a place like that, not if there were other places to work. Your friends need to just suck it up and move. Or become the patient safety officer and gather the data for the big ASA abstract.
Yea, this is definitely a better idea than what I suggested. Whoops! :oops:
 
Yea, this is definitely a better idea than what I suggested. Whoops! :oops:
If your patient is exsanguinating, or having an MI and V-fib arrest, wouldn't you want everyone to come help? Of course! However, I am fine with the department keeping data on when I need an extra set of hands, and WHY. Something tells me the assassins would be upset about this data collection. How about real outcome data? More complicated, but possible. When my anesthetic plan would absolutely include a central line and aline, and "they" fail while trying to manage the patient with 2 PIVs (which I saw in the Navy multiple times) how about the Chairman actually calling them to the carpet. Time to man up Nebraska and Kansas.
If I had to work in one of those places, you bet your ass I would want them to get the ASA4 and 5E patients as well. I can do ASA 1 and 2 patients at least as well, right?:smuggrin:
You want to play in the big league, bring your A game, or head back to the minors.
 
I agree but this is not reality. I have many friends who practice right along side CRNA's in Nebraska and Kansas and they hate it. Most of them say they get no respect in the hospitals and they are called in when the S#!% hits the fan even though they did not play a part in the S#!% hitting the fan. Not good.

This is an important issue. If you have not taken part of the anesthetic plan preoperatively, you have not examined or spoken to the patient You have zero obliglations medico legally to the pateint or obligated to bail anyone out. Seriously. Even if I wallk by in the hallway and i hear whats goign on.. its not my case.. it aint my mess. horrible but thats why we practice in an anesthesia care environment where we are available for such things. some of us. That is why it is important to maintain the anesthesia care team. Safest approach to anesthetizing patients.
 
Top