Benefits Of Certified Registered Nurse Anesthetists

The CRNA has deeper understanding of disease processes, pharmacological treatment and technological interventions when caring for patients. Advance practice comes with a high level of responsibility; furthermore, increased autonomy is why I aspire to advance my nursing practice. I want to be the nurse that eases my patient’s way through what may be the most stressful time in their life. During my anesthesia shadowing experience I witnessed the complexity and compassionate care that the CRNA provided safely and efficiently. Most importantly I observed clear communication that was vital to all involved in the care of the patient’s unique needs. My shadowing experience fueled my drive to continue to pursuing CRNA School and extend my knowledge at the

Anywhere anesthesia is delivered, CRNAs can be found, from hospital operating rooms, to outpatient settings, to military healthcare facilities. In many situations, such as hospitals in rural areas, where physician anesthesiologists are not available, nurse anesthetists are the sole providers of anesthesia to patients (“Nurse anesthetist,” 2012).

They also take care of patients anesthesia before, during, and after surgery. They even give mothers epidurals during child birth for pain management. A CRNA can also perform physical assessments, participate in preoperative teaching, administer anesthesia to keep patients pain free, oversee recovery from anesthesia, prepare for anesthetic management, and follow the patients postoperative course from recovery to the patient care unit. These types of nurses are the only certified personnel to deliver anesthesia in most rural hospitals in the United States (Lippincott Williams & Wilkins 42).

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

A registered nurse’s earning vary depending on the position, experience, level of profession, skills, education, assignment with some states paying a higher income.

Given our rural veterans' and other non-veterans need for access to high quality healthcare, allowing nurse practitioners to practice with full authority in the rural and underserved areas will increase access to care, decrease lengthening delays in healthcare delivery, decrease healthcare costs, and promote patient safety. This is why I urge you to move forward with the proposal to recognize nurse practitioners to practice within their full scope in the rural and underserved urban

The history of the Nurse Anesthetist dates back prior to the Civil War and were considered by many as the pioneers of the practice of anesthesia. As the complexity of administering anesthesia increased, physicians deemed the practice of anesthesia to be equivalent to the practice of medicine. As time progressed, some physicians attempted to have the practice of anesthesia banned from the nursing scope of practice. It was not until a case was brought in front of the California Supreme Court where they ultimately established the legal precedent granting nurse anesthesia its legality. Specifying that nurses can administer anesthesia and that they would be operating under their scope of practice as long as it was done under the guidance of a supervising physician (Hamric, Tracy, & O 'Grady, 2014). That law was federally mandated until 2001, when the Centers for Medicare and Medicaid changed the federal supervision rule of Anesthesiologist and Nurse Anesthetists in order for facility to receive reimbursement of care ("Certified Registered Nurse Anesthetists Fact Sheet", 2016). This offered states an “opt-out” rule allowing the unsupervised practice of nurse anesthetists. This change led to conflict in the anesthesia community between physicians and Certified Registered Nurse Anesthetists (CRNA) as the debate of a CRNA’s ability to practice autonomously was now the center of attention. With the costs of healthcare rising and the

The Rural Accountable Care Organizations Improvement Act of 2015, introduced to the United States Senate in May and now being reviewed by the Senate Finance Committee, will amend part of the Social Security Act to try and improve the way the Medicare shared savings program assigns beneficiaries by basing the assignments on services of primary care offered by providers, including Nurse Practitioners (Govtrack.us, 2015). For Nurse Practitioners specifically, this new legislation will allow nurse practitioner patients to be assigned to Medicare shared savings Accountable Care Organizations (ACOs) (AANP, 2015).

In order to more fully delve into this issue, this literature review will be focusing on three main areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the Affordable Care Act. These areas of focus will include

The United States has a significant “delivery of care” issue wherein physicians (and other HCPs) are concentrated in and around major cities and densely populated areas. This leaves rural populations with fewer physicians and more difficult access to care.

Given that there is a shortage of physicians nationwide it is important to expand the scope of mid-level practitioners such as nurse practitioners and physician’s assistant, who are pivotal in treating the mass influx of patients, especially in underserved areas. Rural communities tend to be poorer, and unable to afford to hire enough physicians, and many rural Americans are less well insured, driving the cost of treatment up (RHF, 2015). The lack of resources and funding in underserved areas means even less incentive for physicians to practice in rural areas. Mid-level practitioners are trained to treat patients with low-level illnesses, provide care to patients with chronic and acute diseases, as well as refer patients with more complex issues

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

It is also pointed out that the rigidity of practice restrictions of APNs seems to be somewhat more lenient when the APN is providing care to rural and underserved communities (Safriet, 1992). Safriet (1992) describes the hypocrisy

If the Centers for Medicare & Medicaid Services (CMS) change their payer regulations and accreditation requirements, hospitals would need to accommodate their requests for continued supplemental payments. In other words,

Healthcare reforms including Obama Care, formally named the Patient Protection and Affordable Care Act greatly impacts physicians and nursing shortages. There are several provisions which could direct impact physicians and nurses through incentives for potential recruitment, grants, training and retention. Through potential initiatives, the act may indirect effects that may question or present new reimbursement alternatives and models of health care delivery options. Healthcare reforms will allow millions of additional working as well as no working Americans to obtain healthcare coverage and this