Anesthesia provider groups are at odds over a proposed amendment to the Veteran's Health Administration's nursing handbook that would let nurse anesthetists within the system work as licensed independent practitioners without physician support, supervision or oversight.

If the handbook draft is approved, the VHA's advanced practice registered nurses would be required to attain independent status for continued employment.

The American Society of Anesthesiologists says the potential policy change directly conflicts with the VHA's physician-nurse, team-based anesthesia care. The ASA further argues that anesthesiologists are best prepared to address emergency situations prevalent in the types of patients the VHA serves.

Jane C.K. Fitch, MD, president elect of the ASA, trained as a nurse anesthetist before earning her medical degree. "The length and depth of training are dramatically different," she says. "As physician anesthesiologists, we trained for 12 to 14 years rather than 5 to 7. Nursing education and training did not prepare me for the level of care needed in the perioperative environment when seconds matter."

The American Association of Nurse Anesthetists countered what it called "inaccurate and misleading" statements from the ASA.

The AANA argues CRNAs are expert in the provision of anesthesia and related services, that the VHA's anesthesia handbook does not require physician supervision of CRNAs and that scientific evidence demonstrates there is no difference in outcomes between anesthesia care provided by CRNAs, care provided by anesthesiologists or care provided by CRNAs supervised by anesthesiologists.

Daniel Cook