Posted on 09/12/2022 5:40:41 AM PDT by CodeToad
Nurses in North Carolina can now be sued for following doctors’ orders when they cause harm to the patient. On Friday, August 19, 2022, a narrowly-split North Carolina Supreme Court struck down a 90-year-old precedent that protected nurses from liability. The opinion of the three justices in favor of overturning the ruling stated that because nursing had evolved, the decision was necessary. The two dissenting justices countered that holding nurses accountable for physicians’ decisions would create “liability without causation.” How this latest ruling will affect future cases is unclear. The full legal briefing can be found here.
(Excerpt) Read more at nurse.org ...
There are two ways to bill CRNA
Medically directed which means no more than. 1:4 and physically present for “induction emergency and periodically throughout the case or as necessary”. There is also medically supervised. This is when concurrency goes out of whack. It also has less of a collection. And the medical supervision could be any physician not necessarily and anesthesiology and not even necessarily on site.
Of course they can be sued.
They always could be sued.
Nurses can override a physician request (they ain’t orders!) if the nurse thinks that it will cause harm.
She can tell the physician that she is not going to perform the request, and why.
She can then contact her supervisors and explain the issue.
Many nurses have saved patients from outrageous medical malpractice, and physicians from huge mistakes.
Yes nurses nationwide carry malpractice.
Depends on whether the physician knows what he is talking about or not?
You are so correct. I learned early on ad a resident and continue to this day to teach colleagues a good RN saves you on a daily basis. I am blessed to work with the best of the best — critical care nurses. They have saved me from bad calls from time to time. I also thoroughly agree if a RN feels executing and order is not right I am happy to execute the order myself. But that is pretty rare when that happens. If I know I am doing something that may feel uneasy, we as physicians should use that to educate and show why we are doing something.
The culture of medicine is awful. It needs to change. It starts with us as physicians but I fear about the next generation who sees this as a job, not a calling.
It starts with us as physicians but I fear about the next generation who sees this as a job, not a calling.
appears that way. Sadly.
Older people in health care sit around shaking our heads.
When the CRNAs came onto the scene?
You do realize nurses were administering anesthesia long before physicians? And that the administration of anesthesia does not constitute practicing medicine…..even the courts have deemed that anesthesia is within the scope of nursing practice.
As far as CRNAs “telling you” they’re the same as physicians, I am not aware of any such statement. That is false. We readily admit we are nurses, our background is in nursing, and our educational degrees are also in nursing. None of us claim to be MDs.
If you have a problem with CRNAs doing pediatric cardiac cases then take it up with Texas Children’s, Children’s Hospital of Philadelphia, Children’s
hospital of Pittsburgh, Nemours, etc.
I’m not sure where you practice, sir, but where I come from CRNAs don’t just do ASA 1s and 2s. I myself have done extensive numbers of pediatric trauma and transplant cases.
And I never accused you of impugning the care team model. Your initial posts on this thread insinuated the patient had a negative outcome because of a lack of physician-involved anesthesia care. That is demonstrably false
You seem to have a pattern of saying something, then when it gets you called you, you backpedal and deny ever having said such statement or accuse the reader of twisting your words.
Once again, gaslighting.
Nope. I know many that practice without an anesthesiologist (MD) even on the premises.
I am always happy to have a nurse question any order I give. I have been saved from error by a good nurse many times. If I am correct it is a chance to do some teaching or bring someone up to speed on the treatment plan and if I’m not a thank you is in order.
You are not as educated or trained as well as an MD. Not only that, you charge the same. I told myself I would never see another midlevel again after being charged $261 for a five minute phone visit. The phone visit didn’t even resolve anything, I still had to see an MD.
I had a colonoscopy with a nurse anesthetist. No problem, I was younger and healthy. Would I trust a CRNA to take care of a family member ( esp pediatric) with multiple medical problems, including cardiac? Heck no!
I have also seen ( I am a retired RN) coworkers who got their NP. Most of it online, and the clinical portion of their training was very minimal. They even admitted to me they were scared, because they did not feel prepared , and they hoped the MD would train them. So not only is an MD liable for the midlevel practitioner, they also have to train them.
The new fad is to get a Doctor of Nursing Practice- DNP. They call themselves doctor in front of patients.
Patients need to be more assertive about their care. Ask for an MD if you are not comfortable with a midlevel. Midlevels are fine for routine stuff, but giving anesthesia to complicated pediatric patients is a big no.
One other story. I worked in an OB clinic for awhile staffed with nurse midwives overseen by MD OBGYNs. This particular midwife was a nasty piece of work. She though she was Gods gift. She thought she was so good she was managing the care of a patient with gestational diabetes. The rule of the clinic was those patients must have care under an MD. But, she thought she was great, and botched the pregnancy. I cannot remember the details, but it was a big malpractice case , baby had severe birth issues. The OB did not even know that patient existed. But guess who got sued? Both of them.
You seem to not understand plain English
I told you to read the original complaint. You haven’t. You read the analysis of the law. The original complaint and trial transcript os far murkier than you make out
Also I don’t think you know what gaslighting means.
Finally. Answer the question. Should you be allowed to practice independently. And speak to the fact you said you are not a nurse practitioner to kaila. That would be gaslighting. Saying something untrue to the point of absurdity
1. Do you think you should be allowed to practice independently
2. Do you think you have the same training and understanding as an anesthesiologist. (MDA)
3. Do you believe you are not a nurse practitioner?
Simple questions. You avoid them.
You are so correct. Thanks for pointing out the obvious to the Nurse anesthetist. All you have to do is go to the AANA website. They like to call or nurse anesthesiology.
I love how she drops that anesthesia was originally done by nurses and it’s a nursing scope. Well historically it is marginally accurate that all changes in the middle part of the 20th century.
Physicians now direct anesthesia care and a lot of us sit our own cases. A CRNA will tell you loud and long they are as well trained. But let something go wrong and they are happy for us to save their ass. I just reviewed a case of a CRNA independently practicing where he killed a patient straight up. It wasn’t even that hard of a case.
I have always said if they want to play doctor let them enjoy the liability. I for one at glad the CRNA is being held liable. And honestly we anesthesiologists need to stop training CRNAs.
They have to do clinicals with us. They have to have some or time with us. We are stupid to continue to train them with the cliff notes and then have them say they are as good as us
And you are also correct. No way should a CRNA be involved in a pedi heart not 1:1.
I have never avoided your question. Define what you mean by “independent”? Medical supervision does not require an anesthesiologist. So a CRNA can provide anesthesia under the supervision of another doc. You know that. So while it’s not technically independent, the CRNA is the lone anesthesia provider. I practice that way, but I also work in a care team model.
Oh and GASP!! I used to do pedi hearts at my old job, and I have colleagues from gas school doing them all over the country.
If you aren’t aware that CRNAs can & do provide safe anesthesia care for high acuity cases, then maybe you should get out more. You seem unfamiliar with how anesthesia care is delivered in pediatric hospitals.
Also, CRNAs (certified registered nurse anesthetists) are not CRNPs (certified registered nurse practitioners). Different credentialing exams, different credentialing bodies, different education programs. So when I told Kaila I am not a nurse practitioner that is what I meant.
I have never said I am educated in the same manner as an MD. Again, you are putting words in my mouth. Nor do I charge the same. MDs make much more than CRNAs and their time is billed at a higher rate.
You also seem unfamiliar with how anesthesia care is delivered in operating rooms. As for the care team model, where I work the MD sees & evaluates the patient, and obtains consent for anesthesia. The MD forms an anesthetic plan, collaborates with the CRNA (who also sees the patient...I never anesthetize someone without examining them myself). The MD is present for induction, and the CRNA administers the anesthetic for the duration of the case, and typically emerges the patient alone. If I need help, I call for it. The MD sometimes stops by throughout the case, but not always. Depends on the dr. Some are more involved than others. I work with a good group, but it wasn’t always that way. There are a lot of anesthesiologists who sit on the couch in the lounge all day. Just like everyone else, there are good ones and there are bad ones. Patients often think the MD is present for the duration of the anesthetic - they are not.
Also, CRNA practice is much different than midwives and nurse practitioners. If you aren’t familiar, then perhaps you should refrain from being so judgemental. You make a lot of uninformed statements here.
It was crna not an rn.
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There are a lot of states that allow nurse practitioners have full practice rights as far as treating and prescribing medications independently.
If North Carolina was one of those states, I would agree with the ruling.
However, North Carolina is not one of those states. They need a physician oversight to prescribe, diagnose, and treat patients.
I believe the court made a bad ruling.
So basically you are saying that you need an MD to practice. How about going for independent practice so the MD is not on the hook for midlevel mistakes? Do you think you are as good as an MD anesthesiologist?
Thats the problem. Its puts the blame on the physician, who is given a regular workload, plus has to be responsible for midlevels. If the “ advanced practitioners” want to increase their scope of practice, then they should accept all the responsibility. Its a dumbing down of care, to the benefit of hospital CEOs because midlevels are cheaper. Yet, the patient is paying full price.
These episodes can quickly become emotionally heated. In my case such things were infrequent. I had one Physician order me to set an I-Time of .4 seconds. I absolutely refused. Such a rapid Inspiratory Time could quickly result in lung shearing and barotrauma. Ordinarily, a Doctor would never order a specific I-Time. That setting was never ordered. We just assessed and dealt with the I to E Ratio and we were never questioned, not ever. This guy was off the wall.
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