Posted on 09/12/2022 5:40:41 AM PDT by CodeToad
This isn’t an RN. This is a CRNA so an advanced practice RN. She was practicing under very strange rules to most. It was not a medically directed case. It was a “medically supervised” case which is required in NC. The CRNA was essentially acting independently.
Important to know the actual facts. It has nothing to do with bedside RN. It has everything to do with APP increasing their scope. It is the correct ruling.
Bill Clinton gave us independent CRNA practice. They should enjoy the liability as well
Malicious compliance or insubordination. Damned if you do, damned if you don’t.
Are any of these state judges running for office this year. This voter wants to know!
The billing code was medically supervised. Typical of a CRNA whose society is now trying to call themselves the American association of nurse anesthesiology.
CRNAs should not have independent practice and should have strict supervision. If you don’t want that then please feel free to get to medical school and residency.
A stupid ruling if ever there was one
Nurses carry liability insurance for their mistakes not doctors mistakes
I’ve known nurses that confront doctors over questionable orders. Many times the order is changed with a grumbled thank you.
That’s not what this is about
Yes they do
If working in a hospital setting the hospital Carrie’s an umbrella policy for nurses. Most nurses I know also carry their own private insurance
This has been true for decades
Correct drug, correct dose, correct frequency, correct timing, correct route.
A CNA is just that an assistant. They do not have training at the level of an RN
While necessary for a smooth hospital experience they are not qualified to question anything
Good.
So lower middle class people will get ruined when their boss eff’s up…
I could see a negligence angle, if the doctors orders were so egregiously bad that someone with basic nursing training should realize it and question it… but in the general case?!? That a nurse is responsible if what the doctor tells them to do goes wrong?
Insanity.
“CRNAs should not have independent practice and should have strict supervision. If you don’t want that then please feel free to get to medical school and residency.”
That’s your opinion and not the reality of how anesthesia care is delivered in the United States. More than 60% of all anesthetics are administered by advanced practices nurses (CRNAs). If you can’t stand us then go work in a physician-only department. Otherwise care team models and CRNA independence is a factual reality
Certified nursing assistant (CNA) is not what this article is about. The case involved a CRNA, a certified registered nurse anesthetist
“The CRNA was essentially acting independently.”
The brief states clearly that the sevoflurane induction was the anesthetic plan formulated by both providers. I don’t see independent action on the part of the CRNA. It was wildly inappropriate and both providers exercised incredibly poor judgement. Both have been held legally accountable.
to Mom MD
Good job on actually reading the article cited and showing that people (can) make bone-headed comments by swallowing the bait of a poorly constructed headline.
Well, maybe the headline was constructed deliberately to put a certain slant on the situation ...........
I haven’t read most of these comments. This suit involves a CRNA, not an RN. In my opinion as a physician, CRNA operate at a high level of autonomy. CRNAs often work without direct physician supervision. This decision is perfectly reasonable. IMNSHO.
I never said boo about the care team. It is an acceptable model. Anesthesiologists need extenders as there are far more anesthetizing locations than the OR. Don’t twist words.
I said midlevel providers should have tight oversight. Bill Clinton allowed the opt out. The AANA had increasingly blurred lines and lied about the overall safety of CRNAs putting them on the same level of anesthesiologists. Irbid untrue.
I have worked with excellent CRNAs in my life. As a team concept it is wonderful. I have worked with a lot of CRNAs who believe they are anesthesiologists and don’t want or need supervision. That’s dangerous.
I have reviewed numerous cases of unsupervised or medically supervised (not medically directed by an anesthesiologist) with horrendous results.
I think 1:4 supervision is ok at a maximum. If you have routine ASA 1-2 patients that is a decent ratio. Hearts should be no more than 1:2. Some cases should be MD administered only.
You cleverly twisted my statement. So I am of the opinion you needed clarification. Do you think CRNAs should be allowed to practice independently?
I work in a field where there is enormous potential liability for professionals. I never had "malpractice insurance" (it's professional liability insurance in my industry) when I worked for others. I couldn't do business without it -- most of my clients REQUIRE proof of insurance before they'll hire me -- now that I'm working on my own.
Great!
Just what we needed now ... A bunch of nurses second-guessing a doctors orders!
(not that some of them are not SMARTER than some doctors I’ve seen)
This has nothing to do with nurses in the traditional sense. It has to do with mid level providers. Nurse Practitioners and CRNAs. Many of these providers want to practice independently and will often go so far as to get DNPs and think they earn the title doctor in the clinical setting.
In Florida a few years ago DNP CRNAs started to introduce themselves as Doctor so and so and called themselves nurse anesthesiologists. The court put a stop to that as fraudulent representation. A CRNA has a baseline requirement of a masters degree and two years of clinical practice. Many nurses coming out will point blank tell you they got a BSN will spend exactly 24 months as an icu bedside nurse then get a masters and say they are ready for independent practice. They have minimal impactful clinical experience
Contrast to an actual anesthesiologist who spends beyond his bachelor degree often in biology or chemistry four years in medical school passing three US Medical licensing exams. Then is selected to a rigorous residency often needing to be in the top of his or her medical class. Spends one year in surgery or internal medicine before even being introduced to clinical anesthesia. After this base year, there is three years of rigorous supervised clinical experience including tests every year called in service tests to monitor progress.
All this pays off at the end of four years in a very difficult written board certification examination. If you pass the written you practice for a year and then are invited to an oral examination at a minimum 18 months beyond residency.
It is only after a decade of advanced training we are allowed to say we are board certified. Contrast that to two years.
Patients should always ask and advocate for themselves. In this case patients should always ask if they are being attended to by an anesthesiologist or a nurse. If a nurse is involved ask if the anesthesiologist is in the hospital and how many rooms they are supervising. Demand to see the anesthesiologist before going to the OR
If the mid level is an anesthesia assistant (AA) you can take comfort that AAs are trained to work only strictly supervised and are not asking the federal government to grant them independent practice.
There is certainly a role for mid level providers. But independent is not it. They are referred to as physician extenders because of scarcity of resources and increasing numbers of procedures requiring anesthesia. You are safest in the hands of an anesthesiologist who is personally administering your anesthetic or supervising no more than 4 cases
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