Victory in Louisiana!!

[Monty Python]

It's well established that CRNA's administer anesthesia. It is within their scope.

The question in this case was could pain management be considered part of nursing anesthesia? .

Sorry, my bad for misinterpreting your question, and going off on a tangent.

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[rmh149]

It's well established that CRNA's administer anesthesia. It is within their scope.

The question in this case was could pain management be considered part of nursing anesthesia? If it were, then they didn't need to go through the formal rules changing process. The Louisiana Supreme Court established that it is not and therefore the CRNA's have to request it formally. This is a legislative change. The CRNA's probably realized that it is unlikely that the BON, with resistance from the BOM, could increase the scope of CRNA's to include pain management which is long considered part of medicine. That's like saying CRNA's wanting to do solo surgery. It ain't gonna happen. CRNA's can argue successfully that they are qualified to give anesthesia, but it's far different than being qualifed to do anything beyond that.

I'll be interested to see if any state passes legislation that specifically allows CRNA's to do pain management.

I'll be interested to see what the ASA does about shutting down these CRNA pain clinic in all 50 states too.

I find it interesting as well. I always used pain management as an example when explaining the difference in CRNA's and anesthesiologists (among the other obvious differences). I had no idea CRNA's were trying to dip into this field untill I became active on this forum. Is there a massive shortage of pain specialists in the US? Are there not enough anesthesiologists to meet this need?

 

[Taurus]

Not exactly a new article, but I was taking some time to look at some other news sites and searching about anesthesiology and found this:

http://search.ama-assn.org/Search/amnews/cs.html?charset=iso-8859-1&url=http%3A//www.ama-assn.org/amednews/2007/02/12/prl10212.htm&qt=category%3Acontent+||+anesthesia&col=amnews&n=5&la=en

Is there any collaborative movement amongst the various physician groups dealing heavily with such issues to affect change? Taurus mentioned the ASA... what about the AMA?

Here's the full article.

Nonphysicians bypass legislatures, use own boards to expand scope
Legislatures are still the main avenue for change, but at least nine states have seen groups try to alter practice rules through regulatory boards.

By Myrle Croasdale, AMNews staff. Feb. 12, 2007.

A growing number of allied health professions seeking scope-of-practice expansion are going through their regulatory boards instead of state legislatures, physician leaders say.

Executives at national groups such as the American Optometric Assn., state groups such as the Texas Podiatric Medical Assn. and other organizations say their boards are amending regulations within their authority and that their professions are not putting patients at risk. But physicians view the actions as illegal and a threat to patient safety.

"To get a state board to issue an advisory opinion is a quick way to get [scope changes], and the only way to challenge it is in court, which is expensive," said John B. Neeld Jr., MD, past president of the American Society of Anesthesiologists. "If they get a friendly state board, they're home free. It's a big train that's left the station, and it's gathering momentum."

Oklahoma gained national attention in 2004 when the Oklahoma Board of Examiners in Optometry adopted rules permitting optometrists to perform surgery with a scalpel, a move the state legislature backed with legislation later that year.

The Texas Medical Assn. is in legal battles with the state's chiropractors and podiatrists, whose boards have made regulatory changes the TMA considers scope expansions. At least seven other state medical associations are seeing allied health professions pursue scope changes through their boards. Podiatrists, optometrists and certified registered nurse anesthetists are among the most active groups, the medical society leaders said.
Nonphysicians will try to expand their scopes of practice by lobbying legislatures in 30 states this year.

William A. Hazel Jr., MD, a member of the American Medical Association Board of Trustees, said allied professionals are overstepping their regulatory authority as they include aspects of medicine into their scope. Those in the allied professions may consider themselves competent to make diagnoses, prescribe drugs or perform invasive procedures, he said. But without a medical degree, they do not have the expertise, said Dr. Hazel.

"The problem with limited license boards expanding their scope is that the hardest thing to know is what you don't know," Dr. Hazel said. "As boards expand the scope of their licensees, they'll run into more things that have been done only by physicians before."

Allied health professionals making regulatory changes say they are not dodging the lengthy legislative process or the unpredictability of legislators' votes. They say their boards are acting within their legislative mandate to regulate their licensees, which includes interpreting their governing statutes and amending them.

Jason Ray, an attorney for the Texas Chiropractic Assn., which the Texas Medical Assn. has sued, said legislatures commonly give regulatory bodies authority to define parameters in which they have responsibility. "Every regulatory agency that licenses a profession to some extent defines what that scope is going to be."

Most allied health professionals are still more likely to go to state legislatures seeking scope-of-practice expansions. This year, at least 17 nonphysician associations are expected to approach legislatures with bills in 30 states. But the regulatory route is becoming increasingly popular.

In Ohio, Todd Baker, executive director of the Ohio Ophthalmological Society, said optometrists there are using the regulatory process to expand on prescribing legislation passed in 1992. Using this law, he said, the optometric board has been adding drugs to its formulary, such as antivirals for treating shingles involving the eye. "This is the optometric community adding scope by adding new drugs," he said.

The executive director of the Ohio Optometric Assn. said the group does not view it as an expansion.

Elsewhere:

* In New York, nurse anesthetists have asked regulators to create a category of nurse anesthetists that would practice without doctor supervision.
* In Idaho, the Idaho Medical Assn. and Idaho Society of Ophthalmology, along with the medical board, approached the Idaho State Board of Optometry about its decision to include certain eyelid procedures within optometrists' scope.
* In Massachusetts, the state podiatric board, through a regulatory hearing, defined the scope of podiatry to include the ankle and amputation. That occurred after legislative attempts failed. The Massachusetts Medical Society has not decided whether it will pursue legal action.

Meanwhile, the Texas Medical Assn. is appealing an Austin district court decision upholding the podiatric board's action to define the profession's scope to include the ankle. The TMA's case against the chiropractic board for allowing needle electromyography and spinal manipulation under anesthesia is still in pretrial proceedings.

Mark J. Hanna, legal counsel for the Texas Podiatric Medical Assn., and Ray, for the Texas chiropractic board, said their boards were not expanding either profession's scope.

 

[Monty Python]

This guy has been advertising on TV as an "optometric physician" for at least a decade. I wonder why the BOM hasn't pursued it?

http://www.leblanceyecenter.com/ After his name you'll note "OD", not "DO" nor "MD."

I certainly wouldn't hesitate to address him as "doctor," after all he's earned a doctorate. But I think for him to call himself a physician is a bit over the edge.

 

[VA Hopeful Dr]

This guy has been advertising on TV as an "optometric physician" for at least a decade. I wonder why the BOM hasn't pursued it?

http://www.leblanceyecenter.com/ After his name you'll note "OD", not "DO" nor "MD."

I certainly wouldn't hesitate to address him as "doctor," after all he's earned a doctorate. But I think for him to call himself a physician is a bit over the edge.

THe optometric physician thing is tricky. It started as a way to get insurance reimbursements. If plan X only accepts physicians.... well, the ODs just started calling themselves optometric physicians.

That's how it started. Sadly, its changed quite a bit. Now you'll see lots of ODs who advertise that way to try and even the field between themselves and the ophtho folks. However, most of the ODs that I know are quite content with being optometrists.

 

[Disciple]

I had no idea CRNA's were trying to dip into this field untill I became active on this forum. Is there a massive shortage of pain specialists in the US? Are there not enough anesthesiologists to meet this need?

No, there is no shortage of interventional pain docs. There are enough Anesthesiologists, Physiatrists, Neurologists, Interventional Radiologists and Spine surgeons to meet the need.

4-6 years ago, before specific reimbursement cuts started, ESIs and other basic injections were way overpriced and some docs running high volume block shops were pulling in over 1 mil annually. I suspect some nurses have gotten wind of this.

 

[rmh149]

No, there is no shortage of interventional pain docs. There are enough Anesthesiologists, Physiatrists, Neurologists, Interventional Radiologists and Spine surgeons to meet the need.

4-6 years ago, before specific reimbursement cuts started, ESIs and other basic injections were way overpriced and some docs running high volume block shops were pulling in over 1 mil annually. I suspect some nurses have gotten wind of this.

Again, it is always about the money isnt it?

 

[burntcrispy]

Again, it is always about the money isnt it?

Sometimes it is about pt safety and proper training for the job. But yes, just about everything in life is about money and people wanting to get it in the easiest way possible.

 

[core0]

No, there is no shortage of interventional pain docs. There are enough Anesthesiologists, Physiatrists, Neurologists, Interventional Radiologists and Spine surgeons to meet the need.

4-6 years ago, before specific reimbursement cuts started, ESIs and other basic injections were way overpriced and some docs running high volume block shops were pulling in over 1 mil annually. I suspect some nurses have gotten wind of this.

Or just boredom. No offense but there is no way that I could do what you guys do. I don't have enough focus to watch the machines for that long. I can imagine that some CRNA thought that anesthesia was going to be really exciting and found doing PE tubes all day wasn't the be all end all and started looking for something else to do.

If you want something really funny look over on allnurses.com. There is a post on CRNA's working as mid-level providers in ICU. I just see that. Hmm bored in the OR, I should just go do some stuff in the ICU. Never mind that I have no training in this. Never mind in the field of nursing there is a specific specialty that does this. And the funny part is when one of the NP's tried to point this out they jumped all over him.

David Carpenter, PA-C

 

[CremeSickle]

There is no place for CRNAs in the ICU. Their place is in the OR/PACU.

As far as money, yes. Every argument put forth by both the AANA and the ASA (and the members in the militant grp here) is about money. There is often a weak attempt to hide it (by both grps) but when pressed, it aways comes back to protecting their incomes.

Sad really, especially when ppl pretend its "for the pts" but clearly isnt.

ie:
CRNAs doing pain
MD/DO suggesting CRNA anesthesia isnt safe.

 

[rmh149]

Or just boredom. No offense but there is no way that I could do what you guys do. I don't have enough focus to watch the machines for that long. I can imagine that some CRNA thought that anesthesia was going to be really exciting and found doing PE tubes all day wasn't the be all end all and started looking for something else to do.

If you want something really funny look over on allnurses.com. There is a post on CRNA's working as mid-level providers in ICU. I just see that. Hmm bored in the OR, I should just go do some stuff in the ICU. Never mind that I have no training in this. Never mind in the field of nursing there is a specific specialty that does this. And the funny part is when one of the NP's tried to point this out they jumped all over him.

David Carpenter, PA-C

Do you have the link to that post. I have heard about some hospitals using CRNA's as midlevels in ICU's...covering the night shifts. Why is this bad?
The ICU's that I am used to didnt have any doctors, nurse practitioners, PA's or CRNA's in house. They were all at home sleeping if they were not in the OR. In the ICU it was all RN's.

 

[core0]

Do you have the link that post. I have heard about some hospitals using CRNA's as midlevels in ICU's...covering the night shifts. Why is this bad?
The ICU's that I am used to didnt have any doctors, nurse practitioners, PA's or CRNA's in house. They were all at home sleeping if they were not in the OR. In the ICU it was all RN's.

Why is this bad? Well because a CRNA has absolutely no APN training in critical care medicine. If you need someone intubated or a line placed I really have no problem with that (although as you can see that the thread quickly degenerates into wether CRNA's can intubate in the ICU). As someone who holds an independent nursing license it is up to the nurse to work within their scope of practice. I don't see critical care medicine in the CRNA scope of practice. The appropriate credential for a APN working in the ICU is the ACNP.

http://allnurses.com/forums/f16/any-crnas-mid-level-providers-icu-216648.html

David Carpenter, PA-C

 

[rmh149]

Why is this bad? Well because a CRNA has absolutely no APN training in critical care medicine. If you need someone intubated or a line placed I really have no problem with that (although as you can see that the thread quickly degenerates into wether CRNA's can intubate in the ICU). As someone who holds an independent nursing license it is up to the nurse to work within their scope of practice. I don't see critical care medicine in the CRNA scope of practice. The appropriate credential for a APN working in the ICU is the ACNP.

http://allnurses.com/forums/f16/any-crnas-mid-level-providers-icu-216648.html

David Carpenter, PA-C

I don't completely disagree with you. I also have no idea what capacity the CRNA's held while covering the ICU. I can't really comment on an ACNP because I have no idea what kind of education they have. It just depends on system the hospital has set up to maintain standards of care. I have worked in ICU's that would call the respiratory therapist to intubate a patient (bad idea in my opinion). Some had CRNA's covering the ICU because the anesthesia group was active with CCM. Every place had a different mix-up of staff. It truly is difficult to debate this issue without looking at the each individual hospital system.

 

[Monty Python]

If you want something really funny look over on allnurses.com. There is a post on CRNA's working as mid-level providers in ICU. I just see that. Hmm bored in the OR, I should just go do some stuff in the ICU. Never mind that I have no training in this. Never mind in the field of nursing there is a specific specialty that does this. And the funny part is when one of the NP's tried to point this out they jumped all over him.

David Carpenter, PA-C

Unless the CRNA is also a credentialed FNP with a collaborative practice agreement then this is completely improper.

I would never dream of doing this - my education didn't cover this, my certification doesn't, my malpractice doesn't, etc. And certainly the nurse practice act doesn't cover it.

 

[rmh149]

Unless the CRNA is also a credentialed FNP with a collaborative practice agreement then this is completely improper.

I would never dream of doing this - my education didn't cover this, my certification doesn't, my malpractice doesn't, etc. And certainly the nurse practice act doesn't cover it.

Makes sense...I have to agree. My place is at the head of the bed....that is where I am going to stay.

Again, I wonder what capacity of the CRNA's that were doing ICU duty. Were they there strictly as a resource person without going beyond the scope of the "RN" in the "CRNA"? I can see that happending....writing orders as an RN with the attendings name behind it. Hell, in Tennessee I see RN's doing that all the time. Thats too much trust from the attendings point of view if you ask me....but thats what prevents them from being called constantly throughout the night. Come to think of it....I have never seen an ACNP or a PA in the ICU.

 

[Disciple]

Perhaps,

They will team up with a non-invasive Pain Doc Boarded by the American Academy of Pain Medicine. This way the CRNA can do the procedures and the Doctor can admit the patients. Since neither of these individuals can do the entire job alone they will work together as a team. CRNA's are very creative individuals and once the AANA creates a pain pathway (and they will) you can expect the BON's and many CRNA's to take it. I fully expect Pain Fellowships after the DNAP. It is the AANA's natural progression.

Blade

I'm not convinced that this would fly from a medicolegal standpoint. For example, if a pain doc gets a referral from a surgeon to do a transforaminal ESI, he/she must do his/her own H&P and formulate his/her own diagnosis and management plan. To bill Medicare and in the event something should go wrong, the pain doc can't just say, "Uh, well, it was Dr. So and So's (Neurosurgeon) diagnosis and treatment plan, I just did the block".

 

[johankriek]

The ICU's that I am used to didnt have any doctors, nurse practitioners, PA's or CRNA's in house. They were all at home sleeping In the ICU it was all RN's.

maybe the housekeeper can double up and manage the ICU after cleaning the bedpans and making the beds. I mean the doctors need their sleep. and if the housekeeper has trouble formulating a plan from the abgs maybe the head nurse can step up and try to make a decision. and wait til the patient really decompensates.. then think about calling the physicians... actually there are no studies that show calling the doctor when something is wrong helps at all.

hey rmh, go back to the allnursing forum group where you belong... you wannabe

 

[CremeSickle]

Johan

You are exactly the unprofessional boob that makes us all look bad. One day, you are going to learn your lesson the hard way. Hope its sooner than later before your arrogance/ego impacts your patients by not allowing you to ask for help from those you see as "inferior". Believe me, its coming.