The Ohio Academy of Family Physicians joined eight other physician organizations in signing on to a letter reiterating deep concern about House Bill (HB) 548, a bill that would expand the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). The bill was heard in the House Health Committee on November 10.
CRNA scope was recently separated out from House Bill (HB) 216, the Advanced Practice Registered Nurse (APRN) independent practice bill. The co-signers of this letter all worked together to amend HB 216 and continue to work together on the separate CRNA-specific legislation. Physician organizations include the Ohio State Medical Association; the Ohio Osteopathic Association, the Academy of Medicine of Cleveland and Northern Ohio; the Ohio Chapter, American College of Emergency Physicians; the Ohio Chapter, American Academy of Pediatrics; the Ohio Chapter, American College of Surgeons; the Ohio Psychiatric Physicians Association; and the Ohio Society of Anesthesiologists.
HB 548 will allow CRNAs to prescribe medications for a surgical patient during the pre- and post-operative period and to allow the CRNA to give an order to another licensee, such as a nurse or respiratory therapist, to administer the medication to the patient. The bill also permits the CRNA to order another licensee to perform “clinical support functions” on a patient without stating or defining what these functions include.
Physician organizations value the role that CRNAs provide in anesthesia care and recognize their importance on the surgical team. Yet, this bill seeks to replace the prescribing judgment of the physician, whether it is a surgeon or anesthesiologist, for the prescribing judgment of the CRNA. This bill is not necessary and could cause confusion with duplicative or contradictory orders, jeopardizing patient care and safety.
While some argue to the contrary, this bill does expand the scope of practice for CRNAs. A CRNA cannot prescribe a medication for a patient during the pre- or post-operative period nor can the CRNA direct another licensee to administer a medication for the patient or perform clinical support functions on the patient. The Ohio Board of Nursing (OBN) in 2008 wrote a letter to the Ohio State Association of Nurse Anesthetists (OSANA) to state unequivocally that the scope of practice of CRNAs does not authorize ordering individuals to administer medications during the pre- and post-operative period. As the CRNAs continued to disagree with the OBN’s interpretation of the Nurse Practice Act over the next several years, the OBN requested an Attorney General’s (AG) Opinion.
In 2013, AG Mike DeWine issued an AG opinion that clearly stated that the Nurse Practice Act does not authorize a CRNA to order or prescribe a pre- or post-operative medication to be administered by another licensee.