When a patient is looking for a health care provider, it makes that task easier if the provider’s title is clear and unambiguous, consistent with the title given to other professionals with comparable expertise, training and certification. Unfortunately, a bill currently moving through the state Legislature would muddy the waters for patients by allowing one group of medical assistants to claim the same title as advanced, highly skilled nursing professionals.
House Bill 721 introduced by Rep. Ralph Massullo purports to be an effort to eliminate patient confusion by reserving the title “anesthesiologist” exclusively for medical doctors. But, as is often the case, there is more to this story than meets the eye. It all began several years ago when people who assist anesthesiologists began to move away from their past title of “anesthesiologist assistant” and started referring to themselves as “anesthetists.”
Since I am a certified registered nurse anesthetist (CRNA), this did not sit well with me and with my dedicated CRNA colleagues who have spent at least seven to eight years to acquire the education and clinical training to become experts in the administration of anesthesia to patients. By contrast, one needs only 24 months of training to become an anesthesiologist assistant.
So began a movement and consensus in the CRNA profession that “nurse anesthesiologist” is a better term to clearly distinguish for patients the unique role of CRNAs. In 2019 I petitioned the Florida Board of Nursing and received a unanimous declaratory statement that I could use “nurse anesthesiologist” as a descriptor for my role along with the official CRNA designation. This action placed Florida in step with the growing national acknowledgment of the term “nurse anesthesiologist” for CRNAs. The American Association of Nurse Anesthetists (AANA) has recognized the optional titles “nurse anesthesiologist” and “Certified Registered Nurse Anesthesiologist.”
Ironically, proponents of House Bill 721 contend that calling a CRNA a “nurse anesthesiologist” will imply that the CRNA is a medical doctor. Yet, they have no concern about the term “anesthesiologist assistant.” In fact, the American Society of Anesthesiologists has noted that 55% of the country does not recognize an “anesthesiologist” as a physician and acknowledged that these specialists have adopted the term “physician anesthesiologist” to make their credentials more clear. Don’t CRNAs deserve the same freedom to clarify the role of their profession?
A recent study by the AANA Foundation found that CRNAs have played a critical role on the front lines of patient care during the COVID-19 pandemic, putting their advanced skills to work and providing a steady hand for overwhelmed intensive care unit teams. More than half of the states in the U.S. now allow CRNAs and other Advanced Practice Registered Nurses (APRNs) to work autonomously. Numerous independent studies show no difference in the safety or quality of care when APRNs and CRNAs administer the services they have been educated and trained to deliver, compared to physicians providing the same services.
House Bill 721 (and its companion Senate Bill 1142) would create a murky and ambiguous landscape for patients, in which both highly trained CRNAs and significantly less-trained assistants describe themselves as anesthetists. Furthermore, this legislation would unfairly tie the hands of CRNAs by forbidding them to use a far better descriptor, “nurse anesthesiologist,” that clearly differentiates them from both physicians and assistants.
I strongly urge all Florida citizens concerned about the quality of health care and the clarity of patient communications to call on your state legislators to defeat this misguided and harmful legislation.
Dr. John P. McDonough, APRN, CRNA, EdD, is a nurse anesthesiologist, and serves as a professor of Nursing, Director of Graduate Programs for the School of Nursing, and Director of Anesthesiology Nursing at the University of North Florida. He is president of the Florida Association of Nurse Anesthetists.