The North Carolina legislature recently approved House bill -181; a bill seeking to preserve and codify the current state law requiring physician supervision of nurse anesthetists. The current federal law gives the states the right to opt out of physician supervision requirement for Medicare reimbursement. Many states are choosing to opt out, which is in line with the recommendations of the Advanced Practice Registered Nursing (APRN from here on) consensus model on regulation (LACE). .
The Licensure, Accreditation, Certification & Education (LACE) document advocates for removal of unfounded restrictions such as supervision in order to maximize the potential of APRNs. Thus, it would allow for innovations to emerge, increase provider access and improve quality of care (Mason, Leavitt, & Chaffee, 2012 pg. 398). .
At a time when states are scrambling for ways to cut healthcare costs and improve access for the majority of the population, this particular bill appears to be retrogressive at best. If assertions in LACE document hold true then NC state legislature may end up impeding access to care, and increasing the cost of anesthesia care to consumers. It is in light of these developments that we need to examine for an option that is affordable, and that would increase access without compromising quality of anesthesia care.
A Brief History of Nurse Anesthesia Autonomy.
At one time, nurses administered most anesthesia because it had limited prestige and low pay. Surgery as a specialty that relies on anesthesia was also at a developmental stage. Most Physicians chose to specialize in other fields and only administered anesthesia occasionally to gain a front row seat to surgery. Because of the shortage of anesthesiologists some surgeons pushed for and encouraged the development of nurse anesthesia as a profession. In short, they wanted a full time competent anesthesia provider who would also be comfortable with a subordinate role during surgery.