Letter: Nurse anesthetists say their record is excellent

To the Editor:

Despite the abundance of information and commentary in the Racine media about Wheaton-Franciscan’s recent decisions involving its anesthesia department, several critical pieces of information about nurse anesthesia somehow continue to elude coverage. All of these facts are easily confirmed through any number of sources, including the Federal Register, Wisconsin state law, published research, and more.

• In 2005, Wisconsin became the 14th state since 2001 to “opt out” of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs). What this means is that in Wisconsin, for nearly five years now, nurse anesthetists do not need to be supervised by a physician while providing anesthesia care to patients. A state’s right to opt-out of this unnecessary requirement was approved in 2001 by the Bush Administration following exhaustive analysis of the issue by the Centers for Medicare & Medicaid Services (CMS), including a thorough examination of existing anesthesia safety studies. CMS concluded that the studies show there is no difference in the quality of care provided by CRNAs and anesthesiologists.
• Many facilities in Wisconsin, particularly in the state’s vast rural areas, do not require physician supervision of the nurse anesthetists who typically are the only anesthesia professionals working there. CRNAs enable these facilities to provide surgical, obstetrical, and trauma stabilization services, otherwise citizens in these communities would have to travel great distances for necessary healthcare. Why don’t anesthesiologists work in these medically underserved outposts? Because the big bucks are to be made in urban/suburban centers such as Milwaukee and Racine.
• There is no federal requirement that nurse anesthetists must be supervised by an anesthesiologist, nor is there any such requirement in Wisconsin state law.
• Nurse anesthetists are the hands-on providers of more than 32 million anesthetics each year in the United States, and according to the Institute of Medicine, anesthesia is nearly 50 times safer than it was in the 1980s.
• Nurse anesthetists work collaboratively with physicians of all kinds on a daily basis, including surgeons, dentists, podiatrists, and anesthesiologists. For that matter, so do anesthesiologists. Anesthesia isn’t provided in a vacuum, it is provided for a reason—surgery and other procedures, delivery of a baby, trauma stabilization. There are always physician specialists involved in these scenarios.

Individual facilities such as Wheaton-Franciscan have a choice of going beyond the CMS rules and requiring physician or even anesthesiologist supervision of nurse anesthetists. However, such a requirement does not mean greater patient safety, just greater costs. The facts speak for themselves.

Wanda Wilson, CRNA, PhD
Executive Director, American Association of Nurse Anesthetists