ETA: The appropriate response to my post would be: "Yes, TheRunner, I see that the scope of practice for APRN's is defined by the Nursing Practice Act, which is actual written law. I also see that the Nursing Practice Act for individual states can by found very easily on the Board of Nursing websites. These statements, by you, are truly incontrovertible fact. Thank you for your wisdom and insight in these matters."
I tldr'ed most of this argument, and I was reading the thread backwards, but this particular post is very blowhardy and shows no understanding of what actually happens in hospitals.
I'm not trying to be a d:ck, and I'm not actually going to engage in an argument, I just have a few things to say. Where you are right: this "law," as you've presented it, does not limit the scope of practice of CRNA's with regard to what anesthetics they can administer, under the direct supervision of a licensed physician.
So the following is "true," but it's perpetuating fallacy:
The opinions of individual physicians aren't going to change the CRNA's legal scope of practice. The CNRA is still legally going to be able to do everything that the anesthesiologist can do, so long as he/she can find a physician willing to sign off on it. The willingness of physicians to sign off on certain procedures is naturally going to vary. Also, hospital policy is going to dictate this as well. However, none of that changes the actual legal scope of practice of the CNRA.
Why would physicians or hospital administration care to change the written law, when they can say "In this hospital (or on my cases, under my supervision) CRNA's will be responsible for xyz duties and/or portions of anesthesia" ?? And xyz can be quite as narrow as they decide? They don't need to effect changes in the law.
By law, I'm licensed to drive a motorcycle. But if someone hires me to drive their kids to school, they can tell me that I'm only taking them in a car. So if you want someone to cede that you did a good job Googling the "legal" scope of practice of APRN's, I offer you an electronic cookie. Don't type with your mouth full.
What other people are saying, which you've only feebly acknowledged, is that what actually happens in hospitals is vastly different from what the letter of the law allows. Have you spent any time in an OR? Where I'm at, anesthesiologists start cases and handle problems; CRNA's do a lot of "table up" / "table down," and push any drugs the surgeon orders, most of which are routine to the case and prepared ahead of time. If the patient codes on the table, guess who handles that? (Hint: not the CRNA)
There is another fallacy implicit in your argument, which you haven't addressed from one side or the other. You're focusing on administration of anesthesia only, and referring to this as the entire "scope of practice." Do you think that's all anesthesiologists do?
This whole thing started with two trollish questions (unedited, not my paraphrase):
1. If nurses are capable of everything an anesthetist-doctor does, will they take over Anesthesiology in the near future?
2. Tell me more: what does a physician do that a nurse doesn't?
You directed the questioner to one paragraph of the Nursing Practice Act, which doesn't actually answer either question.
Ironically, the one part of the law you
didn't bring into focus is the one from which all differences in practice arise. Just looking at what happens when the rubber meets the road, that is "in practice" rather than "in theory," physicians have something called "autonomy." All in all, it translates to a remarkably different day at work.
NP's and PA's function the most "like doctors" in family medicine/primary care settings, not as CRNA's. I haven't observed mid-levels in every setting, but I'll tell you that the difference between mid-levels and physicians is especially stark in the OR; probably more so than anywhere else.
