The Ohio Academy of Family Physicians has signed onto a letter opposing soon-to-be introduced legislation to expand the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). Physician organizations wanted to let potential bill sponsors know of their opposition to the bill at the earliest possible date. The letter to potential bill sponsors states:
“CRNAs are a type of advanced practice registered nurse (APRN) who administer anesthesia in a care team model with the supervision of a physician. They do not have the authority to prescribe drugs for a patient as their practice relates to the administration of anesthesia and performing clinical support functions, not providing primary care services as are provided by other types of APRNs.
Physicians greatly respect the services that CRNAs provide to the anesthesia care team. However, we are concerned that they want to expand their scope of practice to prescribe drugs by ordering medications for patients, including pain medications. CRNAs have yet to identify why this is necessary when there are ample physicians available to order medications during the critical perioperative period. Patient specific protocols further address the patient’s medication needs. To risk contradictory medication orders by the physician and CRNA can seriously compromise patient safety.
There are no documented problems with Ohio’s current anesthesia care team model. And, despite CRNA claims in the past that their bill will not expand their scope of practice, Attorney General (AG) Mike DeWine made it clear in a 2013 AG opinion that their scope does not authorize them to order medications for other health care professionals to administer.
We have worked with APRNs in the past, most recently in House Bill 216 last year, to expand scope of practice. We are willing to dialogue with legislators and CRNAs on any concerns with patient care in the current team-based collaborative care model. However, as CRNAs seek to be added in law as prescribers to order pain medications during Ohio’s current opioid crisis and the lack of evidence that there are problems with current anesthesia care in Ohio, we are currently opposed to expanding CRNA scope of practice.