CRNA profession at a crossroads
A recent labor dispute involving certified registered nurse anesthetists is putting a spotlight on the profession and its role in the industry.
Two hospitals owned by Warren, Mich.-based St. John Providence Health System, a part of St. Louis-based Ascension Health, recently outsourced their CRNA staff, a common move among hospitals under pressure to cut costs. But the hospital reportedly did so quickly, without much warning to its own CRNAs, leading to a public relations disaster and job losses for nearly 90% of the hospital’s existing CRNA staff.
Such poorly handled transitions can lead to not only the loss of qualified CRNAs, but frustration among the surgeons and anesthesiologists who work closely with them, said Joanne Spetz, an economics professor at the University of California at San Francisco’s Institute for Health Policy Studies.
But outsourcing can help cut costs as CRNA-related expenses rise. The average CRNA salary in 2014 was $158,900. Private practices and national management companies tend to better manage the costs that come with employing CRNAs, such as frequent overtime pay, said Jacob Babins, a Huron Healthcare consultant.
CRNAs, like many other advanced-practice nursing fields, are also asking for more authority. The American Association of Nurse Anesthetists has pushed to allow CRNAs to practice without the supervision of a surgeon or anesthesiologist. Most states don’t have specific language that requires CRNAs to be supervised by a physician, and 17 states have explicitly opted out of a CMS rule that requires such supervision, according to the AANA.
That lack of explicit language in some state laws creates administrative issues, AANA President Juan Quintana said. The AANA has successfully clarified CRNA roles in multiple states. “It becomes a political football, not related to our ability and the strength of our practice,” Quintana said.
The American Society of Anesthesiologists wants CRNAs to work in a team supervised by an anesthesiologist, said President-elect Dr. Jeffrey Plagenhoef. The group is concerned that CRNAs don’t have the training or education required to make quick decisions in acute situations. “It’s irresponsible of anyone to say that patients should receive care without physician oversight,” he said.