Nurse Anesthetists: Should They Be Allowed to Practice On Their Own?
Physicians have been fighting with nurses over turf issues for many years. In primary care, nurses with advanced training claim that they can provide pretty much the same care as doctors, but physicians disagree. Now there's a new battlefield: anesthesia. Nurse leaders argue that nurse anesthetists are just as qualified as medical doctors to administer anesthesia and should be allowed to do so without a physician's supervision. Here, perhaps, nurses are overreaching.
The issue reached a head recently when Colorado Gov. Bill Ritter decided to opt out of a Medicare rule so that nurse anesthetists could provide anesthesia on their own in rural hospitals. The Colorado Society of Anesthesiologists (CSA) and the Colorado Medical Society both sued the state, arguing that the governor's decision put patients in danger.
Ritter maintains that his move, which is in line with what 15 other states have already done, will actually enhance patient safety in areas where doctors -- let alone anesthesiologists -- are few and far between. But CSA president Daniel J. Janik, MD, said this in a letter to Ritter:
Quality of care will be imperiled. Outcomes research...found 25 to 60 more deaths per 10,000 anesthetics when physicians were not involved...Patients [also] want physician involvement in their anesthesia care. A 2001 national survey of 1,004 consumers found that 77 percent of Medicare patients opposed allowing anesthesia nurses to administer anesthesia without medical supervision.
A similar tit-for-tat occurred at a national level when Kenneth Elmassian, MD, president of the Michigan Society of Anesthesiologists, responded in the Detroit Free Press to a Baltimore Sun op-ed piece by Catherine L. Gilliss, dean of the Duke University School of Nursing.
"Today, postgraduate education and clinical training in the specialty of anesthesia is remarkably similar for both [doctors and nurses], occurring in the same settings. As a result, both groups can independently provide an equivalent level of safe and effective anesthesia care," Gilliss wrote.
Responded Elmassian, "While we all recognize that nurses are competent professionals, they simply do not have the advanced medical education and training to manage the complete needs of patients, especially those undergoing an anesthetic."
Nurse practitioners, who have training at a level similar to that of nurse anesthetists, already function pretty independently in rural areas, where their supervising doctors are far away most of the time. Many have prescribing privileges and hospital privileges. NPs also staff retail clinics, where they are supervised at a distance. And in many busy primary care practices all over the country, patients are more likely to see an NP or a PA than a doctor, because there aren't enough physicians to see everyone.
Some research indicates that nurse anesthetists perform their job as well as anesthesiologists do. Personally, though, I'd be a little concerned about what might happen if I had an adverse reaction to anesthesia and there was no physician around who knew how to save me. Rural hospitals may need to compromise in some cases to save patients, too, but nurses are still no substitute for doctors.
Image supplied courtesy of U.S. Army.
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