Opinion could change rural CRNA practices

A recent opinion issued by Kansas Attorney General Steve Six created concern among Certified Registered Nurse Anesthetists, commonly referred to as CRNAs.

The opinion, which Six released Jan. 26, states that CRNAs are not authorized under Kansas statute to “issue preoperative and postoperative orders for medications and diagnostic tests related to anesthesia or analgesia care.”

Kansas State Board of Nurses Executive Director Mary Blubaugh, MSN, RN, requested the opinion.

About 88 percent of Kansas hospitals do not have anesthesiologists, said Donna Nyght, CRNA, MS, department chair of the University of Kansas’ nurse anesthesia education program.

Hospitals that do not have anesthesiologists rely on CRNAs for anesthesia care. The facilities are typically located in rural areas.

CRNAs in the Kansas City area will not be as affected by the judge’s opinion because most work in collaborative practices with anesthesiologists.

“They should not be affected nearly as much as the CRNAs in solo practice, but there are some CRNAs in Kansas City who work independently, so I’m assuming that it could affect them,” Nyght said.

Bob Whitmore, MS, CRNA, ARNP, said his practice will not change because of the attorney general’s opinion.

“I’m in a team practice,” Whitmore said.

Whitmore works with anesthesiologists at Anesthesia Associates of Kansas City. He primarily serves at Overland Park Regional Medical Center and Overland Park Day Surgery.

Whitmore supports CRNAs who have individual practices.

“The Legislature needs to clarify this so there is no gray area about what CRNAs are capable of,” Whitmore said. “They should be able to fully practice what they are trained to do.”

Some nurses believe this opinion could limit services in rural areas.

“There are a lot of hospitals where anesthesia is only given by the nurse anesthetist,” said Sarah Tidwell, MS, RN. “That has been a practice that has been carried out for quite some time.”

Tidwell serves as legislative chair for Kansas State Nurses Association.

“The end result is patients will suffer and rural hospitals will suffer,” Whitmore said.

James Kindscher, MD, chair of anesthesiology at the University of Kansas Hospital, said rural hospitals should be able to maintain surgical services despite the opinion.

“I really see it as kind of a non-issue,” Kindscher said. “The surgeon can easily meet the needs of the patient without the CRNA needing to meet that role.”

The Health and Human Services committee introduced a bill that would change statutes to allow CRNAs to give pre- and postoperative orders.

Committee Chairwoman Brenda Landwehr, R-Wichita, said she does not plan to hear the bill until physicians groups and nursing groups come to an agreement about the issue.

“The parties have been instructed to work this out and find a solution,” Landwehr said.

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