CRNAs can legally practice without physician supervision in 16 states, but New Jersey is not about to join their ranks anytime soon.
A state appeals court last week upheld the New Jersey Department of Health's regulation requiring an anesthesiologist to be present during induction, emergence and any critical change in status when an advanced practice nurse/anesthesia (APN/A) administers general or major regional anesthesia, conscious sedation or minor regional blocks.
The law at issue "did not grant APNs authority to administer anesthesia without supervision," writes the court, which says anesthesia administration falls under the umbrella of medical practice. The health department "is not regulating the practice of APN/As or the nursing profession. Rather, it is regulating the practice of administering anesthesia in a hospital setting."
The department is in a position to determine differences in practitioners' education, training and skill to establish anesthesia staffing regulations, the court continues. "Requiring the availability of an anesthesiologist to handle complications beyond the expertise of APN/As is a reasonable exercise of DHSS's regulatory authority and will better protect patients."
The American Society of Anesthesiologists and the New Jersey State Society of Anesthesiologists applauded the ruling , which follows legal arguments in October.
"Anesthesiologists are highly skilled physicians who have significantly longer and more extensive training than nurse anesthetists," says NJSSA President Mordechai Bermann, MD. "We are able to make split-second medical decisions in the operating room. The ruling will help protect the quality of health care in our state."
However, the evidence backing the decision's determination of quality is questionable, says Jay Horowitz, CRNA, of Quality Anesthesia Care Corp. in Sarasota, Fla.
"There's no bona fide science to suggest a poorer result without this mandate, and there are peer-reviewed studies to suggest otherwise," he says. "No other state has such a requirement. CRNAs are fully credentialed anesthesia providers who are held to the same safety standards and overall standards of care as anesthesiologists.
"To depict them as assistants to anesthesiologists contradicts state and federal regulations for practice and reimbursement, CRNA practice in the military and within the Veterans Administration system," he continues. "Although anesthesia may be the practice of medicine when provided by doctors, it's well documented in the law that, when provided by nurses, it is the practice of nursing."
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