In recent years, the Florida Legislature has expanded the kinds of services and procedures that health care professionals like registered nurses and pharmacists can perform.

Certified registered nurse anesthetists (CRNAs), however, have been left out of previous changes and are once again pushing for lawmakers to remove physician supervision requirements that result in too few anesthetists and limit patients’ access to care.

Michelle Canale, program director of the University of South Florida’s nurse anesthesia program and president-elect of the Florida Association of Nurse Anesthesiology, spoke with FLORIDA TREND about the efforts to remove practice barriers and other trends in the profession.

History Lesson: “Nurses were the first professional anesthesia providers. When you look back over history, we’ve been providing anesthesia services for more than 150 years. We’ve actually been around since before anesthesia became a medical specialty.” Today, CRNAs work in hospitals, day surgery centers, pain management clinics and most other settings “where anesthesia can be delivered or is needed,” Canale says. CRNAs are also the most common anesthesia providers on the frontlines of the military, working without supervision.

Lobbying for Independence: While more than 30 states — Michigan being the latest — allow CRNAs to practice independently, Florida still requires physician supervision, and Canale says the Florida Association of Nurse Anesthesiology will be back in Tallahassee again next session for the 10th year in a row to try to get those restrictions lifted. Multiple independent studies, she says, demonstrate that anesthesia care provided by independent CRNAs is “equal” in safety and quality to that provided by a supervised CRNA or an anesthesiologist alone. Consumers will benefit from an immediate increase in access to care (especially in rural areas where there are no physician providers) as well as reduced costs if supervision requirements are lifted, she says. “The CRNA independent practice model of delivering anesthesia care is about 25% less expensive compared to that where a physician anesthesiologist supervises a CRNA.”

Combating COVID: With expertise in airway management, pain management and hemodynamic monitoring, CRNAs have played a key role in helping hospitals care for COVID patients. “We are experts in all of those areas, so it was really a no-brainer to ask CRNAs to pivot from providing surgical anesthesia to providing intensive care services at an advanced practice provider level,” Canale says. She says the hospital where she practices part time had to convert its recovery rooms into ICUs to treat high numbers of patients, and it tapped CRNAs to relieve “exhausted” RNs. “They’ve had to more than double the size of our ICU, and they just didn’t have the nursing workforce to handle that number of ICU beds and all of this happened so quickly.”

Changing Requirements: CRNA degree requirements are changing, Canale says. By 2025, all CRNAs will need a doctorate, so master’s degree programs will sunset this year, and CRNA students starting in 2022 will enroll in doctor of nursing practice (DNP) programs in nurse anesthesia. Applicants to USF’s program (one of nine CRNA training programs in Florida) need a bachelor’s degree in nursing and at least one year of critical-care experience — but competition for slots is fierce, which raises the bar. “The average number of years of ICU experience for students in our USF nurse anesthesiology program is 3½ years prior to coming into a doctoral program for another three years of anesthesiology residency and coursework.”

 

Read more in Florida Trend's November issue.
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