The independent practice of CRNAs is safe, affordable, and increases access to care.
LEARN MORE IN THE CRNA FAQs BELOW...Overview
- CRNAs have never been required to practice with direct physician supervision in the District of Columbia.
- Studies confirm CRNAs practicing independent from physicians is safe.
- Forcing CRNAs to collabrote will decrease health accessibility and increase costs.
- There have been no disciplinary complaints since the requirement for direct physician collaboration of CRNAs was removed in 1994.
FAQs on CRNAs
Who are CRNAs?
CRNAs are Certified Registered Nurse Anesthetists. CRNAs are advanced practice registered nurses who work with surgeons, obstetricians, dentists, and other healthcare providers to deliver safe, high-quality and cost-effective anesthesia care to patients in virtually every healthcare setting.
CRNAs have been providing care to patients in the United States for 150 years. In 1986, CRNAs became the first nursing specialty accorded direct reimbursement rights by Medicare.
Are CRNAs currently legally permitted to practice in the District of Columbia without direct physician supervision or collaboration?
Yes. CRNAs have never been required to practice with direct physician supervision in the District of Columbia. In 1995, the Health Occupations Revision Act (HORA) was amended and the requirement for “direct collaboration” and protocols for “direct collaboration” were removed.
Are CRNAs involved in every aspect of anesthesia service?
Yes. CRNAs are involved in every aspect of anesthesia services from pre-anesthesia evaluation, administering the anesthetic, monitoring and interpreting the patient’s vital signs and managing the patient throughout surgery.
Does research confirm that anesthesia care can be safely provided by CRNAs independently from physicians?
Yes. Studies confirm that care be safely provided by CRNAs independently from physicians. Health Affairs’ published a study, “No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians.”
How does permitting CRNAs to practice without collaboration impact access to care?
Allowing CRNAs in the District of Columbia to practice without required collaboration
allows the District to align with other states in allowing CRNAs to provide safe, high quality anesthesia care without unnecessary restrictions.
Restrictive physician involvement in CRNAs has not been required in the HORA since legislation removed supervision for all Advanced Practice Registered Nurses (APRNs) in 1995. They are able to practice independently.
Without the proposed change, there will be reduced access to healthcare in the District and medical costs will increase for the most vulnerable.
How many states have no physician supervision requirements for CRNAs?
19 states have no supervision, direction, collaboration, protocol, or other similar requirement for CRNAs in nurse practice acts, board of nursing rules/regulations, medical practice acts, board of medicine rules/regulations, or their generic equivalents. This is comparable to what is contemplated for CRNAs in the HORA bill.
For CRNA practice, 43 states, and the District of Columbia, have no supervision requirement concerning CRNAs in nurse practice acts, board of nursing rules/regulations, medical practice acts, board of medicine rules/regulations, or their generic equivalents.
Specifically for pain management services, 42 states, and the District of Columbia, have no supervision requirement concerning CRNAs in nurse practice acts, board of nursing rules/regulations, medical practice acts, board of medicine rules/regulations, or their generic equivalents. Only 6 states have a supervision requirement for CRNAs in nurse practice acts, board of nursing rules/regulations, medical practice acts, board of medicine rules/regulations, or their generic equivalents. Louisiana is the only state that outright prohibits CRNAs from performing pain management services.
What impact will reversing the District’s longstanding policy of permitting CRNAs to practice without direct physician supervision or collaboration have on the costs of service?
Without the proposed change, access to healthcare will be reduced and medical costs increases for the District’s most vulnerable residents.
Healthcare facilities that hire anesthesiologists to supervise CRNAs in an effort to manage risk, may more than triple the costs of anesthesia delivery without improving patient outcomes, lowering risk or reducing liability coverage costs.
Have there been any disciplinary actions before the Board of Nursing since 1994 when the District removed the requirement for direct physician collaboration of CRNAs?
No. There have been no disciplinary complaints concerning CRNA practice since the Hora was amended in 1995.
What is being proposed in the HORA/DC Bill?
While the Physician Anesthesiologists would like to reverse 30 years of established practice and require direct physician supervision of CRNAs, the District’s Department of Health is urging the removal of Section 603 of the HORA, which applies to ALL APRNs. Under existing law, ALL APRNs, including CRNA, are directed to collaborate with a “license health professional.” This practice is standard professional procedure for all APRNs, including CRNAs.
Collaboration is not supervision and exists already in all the practices; it is inherent to the scope of work of the profession and leaving the language in the Code creates confusion about the scope of work that CRNAs are already authorized to practice.
DCANA supports the efforts of the District’s Department of Health to bring clarity to this matter.