State Practices
From CrnaBIZ-Wiki
Oregon
On December 5, 2003, Oregon became the 11th state to Opt out of federal physician supervision requirements for Certified Registered Nurse Anesthetists (CRNAs).The final paragraphs from Governor Ted Kulongoski's December 5, 2003 letter to the Administrator for the Centers for Medicare and Medicaid Services concludes:
"...Oregon Law assures that those closest to, and who know the most about health care delivery, are the primary decision-makers accountable for the outcomes of patients care.
CRNAs have for years, provided safe high quality anesthesia services to Oregon citizens.Exercise of the federal 'opt out' should provide clarity and consistency between Oregon and federal law, ameliorate confusion regarding supervision and liability issues for physicians and surgeons, and ensure access to anesthesia care for rural Oregonians."
Oregon offers a variety of CRNA practice settings. In Portland and Eugene, the Anesthesia Care Team (ACT) is the most prevalent, with Kaiser Permanente' being the largest CRNA employer. In the past decade the Oregon Health Sciences University (OHSU) has developed an ACT and recently developed a CRNA Post Graduate training program.
Outside of the Portland area, in the smaller communities, there are hospital employed CRNAs and CRNA only groups which provide anesthesia...
Anesthesia in a Dentist's Office in Oregon
Oregon Law considers CRNAs and Anesthesiologists as "qualified anesthesia Providers". Oregon Board of Dentistry Administrative Rules
Wisconsin
On September 19, 2007 the Department of Regulation and Licensing issued a press release. “The Medical Examining Board issued an order determining that a Certified Registered Nurse Anesthetist (CRNA) who is also certified as an Advanced Practice Nurse Prescriber (APNP) and who administers anesthesia is lawfully practicing within the scope of a certificate granted to practice professional nursing, is not required to have a license as a physician or be supervised by a physician, and must work in a collaborative relationship with a physician. However, a CRNA who is not certified as an APNP may administer anesthesia only as directed, supervised and inspected by a physician.”
What does it mean?
The administration of anesthesia by a CRNA is part of the practice of professional nursing.
CRNAs continue to work collaboratively with physicians.No supervision of CRNA APNPs is required in Wisconsin. (Recall: hospitals have the right to establish rules that are more restrictive than WI state rules)
WANA and the Wisconsin Nurses Association also defended APNPs right to give telephone and/or verbal orders.
Advanced Practice Nurse Prescribers (APNP) – short and sweet version DO NOT give orders, telephone, verbal or written, unless you hold an APNP certificate.
All CRNAs should hold an APNP certificate!
All CRNA APNPs must have a documented collaborative relationship with a physician.
Verbal orders are for emergency situations only (JACHO rule). Consider an emergency situation as a time when the patient would be harmed without your order and you cannot physically write the order yourself. Authenticate your verbal orders within 48 hours.
If you have nurse anesthetist scope of practice questions please submit them to the WANA Scope of Practice work group – president@wiana.com
Quoted from WANA Fall 2007 Newsletter. Authored by John Buonora, CRNA, APNP. Transcribed from WANA Fall 2008 Newsletter by Jim Carroll, CRNA, APNP--jimcarrollcrna 21:02, 30 January 2008 (PST)
