Late last year, a malpractice lawsuit made nationwide headlines. The case involved a Dallas man who had undergone orthopedic surgery to repair a fracture sustained during a fall. During his surgery, it was reported that the patient had a hypoxic episode (a period where a low level of oxygen was perfusing the brain due to low blood pressure), resulting in a brain injury called encephalopathy. There were many factors involved in the development of the injury; however, when the Dallas jury awarded in excess of $21MM to a patient’s family, the plaintiff’s lawyer was quoted as saying that CRNAs “may have a nursing degree and an extra year of training.” This statement is false, and as a practicing CRNA, I have chosen to write this editorial to set the record straight.
Anesthesia, like many medical specialties, had a rough beginning. Methods were crude, morbidity aggravated, and mortality was high. Initially, anesthetizing patients was relegated to medical students, nurses, and even orderlies. Over time, however, the task was given to nurses[a] …
As surgical techniques improved and the demand for anesthesia increased, surgeons believed anesthesia to be a “mixed blessing” because patients were aware of the existence of pain-free surgery, but anesthesia was associated with high mortality, and there was a shortage of qualified anesthetists [b], [c], [d], [e]. Thus, the job fell to anyone who was willing and available: mostly medical students and less senior physicians. However, most physicians were not interested in a position they considered to be subordinate and were more eager to learn the skills and techniques of the surgeon. Surgeons, on the other hand, were eager to find well-educated and intelligent professionals to fill the role of anesthetist. Unable to convince enough other physicians to undertake the administration of anesthesia, surgeons turned to graduate nurses to fill this role. [a]
Catherine S. Lawrence (1820-1904) has been identified as the first nurse to administer anesthesia, which occurred during the Civil War, 1861 to 1865 [a], and countless others have come behind her. There are currently 130 accredited Nurse Anesthesia programs and nearly 59,000 practicing CRNAs in the United States. They can practice as a part of an Anesthesia Care Team (ACT) comprised of Anesthesiologists and CRNAs working together, and in many states, they practice independently – either as the sole provider or with a team of other CRNAs – without the supervision of a Physician Anesthesiologist. In fact, this is the case in most rural hospitals (~80%), where CRNAs are the sole anesthesia provider; and in the military, they are the primary providers to our service-men and -women.
Research confirms that care provided by Certified Registered Nurse Anesthesiologists (CRNAs) is just as safe as when that care is delivered by a Physician Anesthesiologist (MDAs). [f] [g] In fact, “An analysis of Medicare data for 1999–2005 finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications.” [h]
Many people who have undergone anesthesia had it delivered by a CRNA! Even in this day and age, a vast number of people assume we are Physician Anesthesiologists. So, I will leave you with the facts about CRNAs in hopes that you will better understand who those wonderful souls are that watch over you while you sleep: [i]
- It takes a minimum of 7-8.5 calendar years of education and experience to prepare a CRNA.
- Nurse anesthesia programs range from 24-51 months, depending on university requirements. Programs include clinical settings and experiences. Graduates of nurse anesthesia programs have an average of 9,369 hours of clinical experience, including 733 hours during their baccalaureate nursing program, 6,032 hours as a critical care registered nurse, and 2,604 hours during their nurse anesthesia program.
- In 2001, CMS changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement. To date, 22 states and Guam have opted out of the federal physician supervision requirement, including Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, Kentucky, Arizona, Oklahoma, Utah, Michigan, and Arkansas. Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so.
- In March 2020, CMS temporarily suspended the supervision requirements for CRNAs to increase the capacity of the U.S. healthcare delivery system during the COVID-19 pandemic. Several governors also removed many barriers to CRNA practice during this crisis. According to a January 2021 CMS report, CRNAs were among the top 20 specialties that served the most beneficiaries in non-telehealth care between March 2020 and June 2020—the height of the COVID-19 public health emergency.
- Before they can become CRNAs, graduates of nurse anesthesia educational programs must pass the National Certification Examination.
- Effective January 1, 2022, all students matriculating into an accredited program must be enrolled in a doctoral program. As of January 1, 2025, all students graduating from an accredited program must be awarded a doctoral degree.
It is truly an honor for us to serve our communities in this capacity. It is my hope that these facts have increased your awareness into those eyes you’re looking into as you drift off to sleep. Sweet dreams!
Your Favorite Bartender 😉