John P. McDonough: Three key facts in support of nurse anesthesiologists

In a recent opinion column published in Florida Politics (titled “I am a physician anesthesiologist”), Dr. Leopoldo Rodriguez makes a spirited argument for his medical specialty while diminishing the role of advanced practice nurses who are certified and trained to deliver anesthesia safely: nurse anesthesiologists.

On behalf of my fellow nurse anesthesiologists, I feel compelled to share three important facts that I believe will help correct the record.

Fact #1: Nurse anesthesiologists administering anesthesia without the supervision of a physician is commonplace across the United States and beyond.

In 43 states, these professionals practice autonomously under the law. In the U.S. military, nurse anesthesiologists have full practice authority in every branch of service and are the primary providers of anesthesia care to U.S. military personnel on the front lines in Army medical facilities, Navy ships and aircraft evacuation teams around the globe.

Another health care setting in which nurse anesthesiologists commonly function independently without physician supervision is the rural hospital. These professionals represent more than 80% of the anesthesia providers in rural counties across the U.S.

Many rural hospitals are designated as critical access hospitals, which often rely on independently practicing nurse anesthesiologists for anesthesia care. Half of America’s rural hospitals use a nurse anesthesiologist-only model for obstetric care.

Fact #2: Numerous evidence-based, peer-reviewed studies demonstrate the quality, safety and cost-effectiveness of anesthesia care delivered by nurse anesthesiologists.

According to a 2010 study published in the journal Health Affairs, there are similarly low rates of adverse events for solo nurse anesthesiologists and solo physician anesthesiologists. Researchers studying anesthesia safety found no differences in care between nurse anesthesiologists and physician anesthesiologists based on an exhaustive analysis of research literature published in the U.S. and around the world.

This scientific review was prepared by the Cochrane Collaboration, the internationally recognized authority on evidence-based practice in health care.

Fact #3: Nurse anesthesiologists are highly trained professionals. It takes a minimum of 8 to 10.5 years of education and experience to prepare a nurse anesthesiologist to be certified in this profession.

Nurse anesthesiologists must hold a baccalaureate or graduate degree in nursing or another appropriate major, and have an unencumbered license as a registered nurse and/or advanced practice registered nurse in the U.S. or its territories and protectorates. They must have at least one year of full-time work experience as a registered nurse in a critical care setting. (In fact, the average work experience of RNs entering nurse anesthesia educational programs is 4.45 years.)

The aspiring nurse anesthesiologist must then graduate with a minimum of a master’s degree from an accredited nurse anesthesia educational program, which ranges from 24 to 51 months. Graduates of these programs have an average of 12,593 hours of clinical experience. Following graduation, they must then pass the National Certification Examination, and participate in the Continued Professional Certification Program focused on lifelong learning.

In closing, and in a spirit of collegiality and professional courtesy, I would like to point out that nurse anesthesiologists are among the most collaborative practitioners you will find in health care. We provide anesthesia in collaboration with surgeons, dentists, podiatrists, physician anesthesiologists, and other qualified health care professionals.

When anesthesia is administered by a nurse anesthesiologist, it is recognized as the practice of nursing; when administered by a physician anesthesiologist, it is recognized as the practice of medicine; when administered by a dental anesthesiologist, it is recognized as the practice of dentistry.

Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

In the past, our profession has used the terminology “Certified Registered Nurse Anesthetist” or “CRNAs” for our practitioners, but that title has been undergoing an evolution nationally. Recently, our professional society in Florida has adopted the new name of Florida Association of Nurse Anesthesiology.

We believe this title most accurately reflects the distinct role our professionals play as part of a patient’s health care team. We aim to continue that collaborative approach with our physician colleagues and other providers moving forward.

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Dr. John P. McDonough, EdD, CRNA, APRN, 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 Anesthesiology.