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The Podium

CRNAs can help reduce health costs

Nurses and doctors have demonstrably different roles in the delivery of health care, but they have at least two things in common: putting patients first and taking pride in their respective professions.

The two of us – one a certified registered nurse anesthetist , the other a facial plastic and reconstructive surgeon – also share an increasingly common-sense view that advanced practice nurses such as nurse anesthetists and nurse practitioners can play a greater role in health care. If we allow such highly skilled nurses to practice to the full extent of their education and training, we can find new ways to lower medical costs and to improve patient access to quality care.

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Any differences between nurses and doctors, whether philosophical or regulatory, should be put aside so that together we can achieve these goals while staying true to our respective practices. The philosophical differences may be more difficult to overcome, while the regulatory barriers that prevent CRNAs from practicing with greater independence — as they should in Massachusetts and already do in many other states – are ready to be taken down.

A bill before the Legislature would remove these barriers.

Physicians should not feel threatened by the bill because it in no way undermines physician anesthesia or physician care. Its aim is to remove burdensome regulatory requirements, such as mandating that nurses report to both the Board of Registration in Nursing as well as the Board of Registration in Medicine. No other licensed profession in Massachusetts faces such unfair and unnecessary dual oversight, and only five other states still have this outdated framework.

Contrary to the characterizations of the bill from some quarters, CRNAs are not trying to “take over” for anesthesiologists; they merely seek to practice in a way consistent with their training and to not be subject to requirements and limitations that make them less effective. For example, one rule limits the CRNA’s right to prescribe to within 24 hours of surgery, even though so many patients do pre-operative visits more than a day in advance.

The highly renowned Institute of Medicine has found no differences in safety and quality associated with state laws that allow advanced practice nurses to practice independently. And the Federal Trade Commission has spoken to the attributes of the bill in Massachusetts, urging lawmakers to consider its passage to improve competition in the health care marketplace to the benefit of consumers.

In Western Massachusetts, where we practice, health care services are not as omnipresent as they are among the many world class academic medical centers in and around Boston. There are fewer primary care doctors. Patients must drive farther to reach their providers.

Nurse anesthetists represent a critical piece in the access puzzle, ensuring that surgeries can proceed in some rural hospitals that otherwise would have no surgeries because they have no physician anesthesiologists. CRNAs are the sole providers of anesthesia care in many settings.

Health reform will result in many more insured people — a good thing overall, yet the unintended consequence is that physicians will be in shorter supply because of the increasing demand. CRNAs and nurse practitioners can fill the gap here and must be empowered to do so, through this legislation.

In the operating rooms and other settings where anesthesia is delivered, physicians consider nurse anesthetists to be critical members of the patient care team. Everyone on that team has the responsibility to ensure the best outcome possible for the patient.

Trudy Pierce, a member of the Massachusetts Association of Nurse Anesthetists, is a CRNA in West Springfield. Dr. William Truswell is the owner of Aesthetic Laser & Cosmetic Surgery Center in Northampton.
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