Nurse Anesthetists working without physician oversight

[scrub-jay]

Just curious - what do you think of Nurse Anesthetists working without physician supervision? If it were me, I would want an Anesthesiologist in my operating room. I'm trying to find more information regarding Nurse Anesthetists malpractice coverage when working without physician oversight. Love to hear what you think - or if you live in a state that allows this, how has this worked.

http://www.colorado.gov/cs/Satellite.../1251580924371

Thanks!

[MissCrabette]

I'm personally against it, but it will probably go on for as long as the public is as uninformed as it is now. Speaking from personal experience, people in Romania and Ecuador don't even think of Anesthesiologists as doctors. I remember when I was pushing for Andrew to go that route and our families were all asking why he wasn't going to be a REAL doctor. Uneducated people simply see them as "technicians" helping the "real" doctor. That's all I have to add, unfortunately.

[oceanchild]

I asked DH about it, and he thinks there should be an anesthesiologist in the hospital. Doesn't think there needs to be one in every operating room, but that one should be easily available if something goes wrong. That sounded reasonable to me.

[scrub-jay]

I asked DH about it, and he thinks there should be an anesthesiologist in the hospital. Doesn't think there needs to be one in every operating room, but that one should be easily available if something goes wrong. That sounded reasonable to me.

Wouldn't that count as physician oversight? From what I can tell, this is made to allow rural hospitals without Anesthesiologists to be able to do operations. My DH was saying something about a surgical "Captain of the Ship" rule, where a surgeon can refuse to operate under unfavorable conditions - such as not having an MD Anes. From what I can tell, the Nurse Anes. do not need to carry additional malpractice insurance - so if something did go wrong - would it fall to the surgeon's malpractice?

[oceanchild]

Wouldn't that count as physician oversight?

Yeah. You had just said something about having an anesthesiologist in the room. He disagrees with the governor's decision.

The Denver Post article today says: "Colorado law makes the physician performing an operation liable for the actions of anyone in the operating room." But my guess is it would have to actually be litigated to see what happens with malpractice. I wonder how that's gone in the other 14 states.

[v-girl]

Having had one cause me incredible pain when I went in for my c-section to deliver my 3rd child, I say an anesthesiologist should be in the room. My OB had to stop the nurse on his 5th attempt at my spinal block. My L&D nurse would have decked the guy had she not been holding me up as my legs shot out with each poke.

[GrayMatterWife]

My L&D nurse would have decked the guy had she not been holding me up as my legs shot out with each poke.

L&D nurses RULE!!! Just an aside. If I were smarter at science, significantly more laid back, and generally had my pre-law school level of compassion--if I had it to do all over again--I might go into L&D nursing. They are just so relaxed, confident, and collected. They really "made" my delivery experiences...were much more important than the MD. Or my husband (hahaha!).

Personally, I have no issue with using a CNA, provided that the CNA does have some oversight by an MD--it is my spine, you know? Let's get the highest-degree person overseeing the plan. However, that being said, I would not necessarily choose to have the MD do the procedure over the CNA. I don't think I would care. They are both pros at the procedure, I figure. I've had some medical field friends tell me that CNAs are actually better.

I would NOT, however, allow a resident to do ANYTHING remotely close to my spine. Period. Even my DH (NSG covers spine call here, splitting it with ORTHO).

[scrub-jay]

Personally, I have no issue with using a CNA, provided that the CNA does have some oversight by an MD--it is my spine, you know? Let's get the highest-degree person overseeing the plan.

But that's the rub. This new law allows CRNAs to work without MD oversight, at all.

Here is the letter from the Colorado Medical Society against the CO governor opting out of the Medicare requirement of physician oversight of CRNAs. http://cms.org/ASAP/ASAP.html

[GrayMatterWife]

But that's the rub. This new law allows CRNAs to work without MD oversight, at all.

Here is the letter from the Colorado Medical Society against the CO governor opting out of the Medicare requirement of physician oversight of CRNAs. http://cms.org/ASAP/ASAP.html

Right...I guess my answer (FWIW) is, I don't think unsupervised CRNAs is a great idea. They are nurses, not doctors. But--and you guys with spouses in the military, correct me if I'm wrong--I think nurses of all training and education get a LOT more latitude in their nursing practice in the armed forces. They can do a lot of things that only MDs can do in the civilian world. So, maybe my opinion is ill-informed. I don't know, I'll admit it!

[scrub-jay]

The arguments for this generally come from small, rural practices where there may or may not be an MD Anes. in the area. With the advent of amazing telemedicine technology (used frequently in rural communities in CA for example), why couldn't we expand the allowances for oversight via telemedicine when in rural situations?

I guess my biggest concern is what will this open the door for? If mid-level practitioners aren't required to have MD oversight, where will that leave the face of medicine?

(Now don't get me wrong, I've known some AMAZING mid-levels who I trust more than MDs, but then again - I've seen that swing both ways).

[DCJenn]

The military uses nurses a LOT- which you kind of have to do when everyone and their brother is deployed. I've only had MDs do any of my various procedures though- but I'm at a major training hospital so it could have been an MD who is brand new which is scarier than a CNA with tons of experience, as far as I'm concerned.

J.

[PrincessFiona]

Here is the rub for me: it cheapens the medical training process including residency and fellowships both literally and figuratively.

My mom is a geriatric NP and I have seen an NP regularly for primary care. Regardless of what it might say about med school and residency training for primary care, I am satisfied with the quality of care I have received. Medicine is a lot about experience and experienced NP's/PA's have been shown to be as effective in primary care in research studies.

I was given an oncology follow-up appt with new grad NP and I pitched a fit. There is a certain level of knowledge, experience and training that I expect from specialty care.

If a mid-level can adequately do that job (and perhaps they can) what does that say about medical training and justification for higher incomes?

Ultimately, with the demands for healthcare reform, it is the wave if the future. My prediction? Primary care will be performed almost exclusively by mid-levels in the future. Specialty care? Who knows.

[Michele]

I'm with Kris. I think it cheapens what our spouses are doing. Optometrists were allowed to do some surgeries in Oklahoma...I think it's crap. ODs do not get the same level of training as MDs. Nurse anesthetists need an anesthesiologist in the building.....or I think the surgeon should be allowed to refuse the procedure if s/he is the one ultimately responsible for outcome.

[oceanchild]

See, the "protect the medical degree" argument is my least favorite. If there's no need for anesthesiologists, keeping spots for them for the sake of keeping spots for them is just dumb. Now, I don't think that's true in this case. According to DH, when things go wrong with anesthesia, they go wrong really quickly, and CNAs aren't trained as well for the true crises. So to me, that's the value of having an MD available.

If medical training is valuable (and I think it is), its value should be apparent. If it isn't, maybe that's something we need to take a closer look at.

[Vanquisher]

I am not okay with the anesthesia liability being on the back of the surgeon. They are not trained in this. I definitely feel that CRNAs should be supervised my an MD. At DH's hospital CRNAs do a lot of cases, but there is always an anesthesiologist there, and they do the intubations and extubations at the beginning and ending of cases and are there in case something goes wrong.

I do think that NPs and PAs are invaluable members of the healtchcare team; however, I agree that it cheapens what our spouses do. Although, I am much more comfortable seeing an NP, PA, or optometrist than a podiatrist or chiropractor. DH has a huge problem with chiropractors and podiatrists and considers them pseudo-doctors.