Linda Young: Nurse anesthetists should work under physician supervision

Published: Friday, February 7, 2014 at 3:57 p.m.
Last Modified: Friday, February 7, 2014 at 3:57 p.m.

My patient was a young, extremely healthy man scheduled for a relatively minor surgery. That is about all that was routine regarding the anesthesia that day.

As a Certified Registered Nurse Anesthetist (CRNA), I was assigned to help provide anesthesia for his procedure. Upon initially administering the anesthesia medicines, he had an immediate and dramatic adverse reaction. His heart raced too fast while the level of oxygen in his blood plummeted dangerously low.

I understood that his life was in jeopardy!

With a four-year college degree in nursing, two years of clinical training, and over a decade of hands-on experience, I was not fully trained to handle on my own this unexpected and dire situation. My training as a nurse was to work the equipment, administer the medicine and to make sure that the technical aspects of the anesthesia delivery were working smoothly.

What I was not was a trained physician.

I did not fully understand medical diagnosis, medical response and the ultra-complex workings of human body systems –- especially when those systems are under the effects of a drug induced coma. Moreover, I was certainly was not prepared to put together a full diagnosis and treatment plan for my patient, not to mention how to handle this patient postoperatively, once the surgery was aborted. What would I do? Who would I call? How long would it take to get a physician consult to manage this critical event?

Thankfully, I was not alone. I was working under the supervision of a physician anesthesiologist who not only had twice the classroom experience and more than seven times the clinical training than I did, but a clinical training that was focused on rapid medical diagnosis, assessment and treatment.

Thankfully, with this team structure in place –-- physician and nurse working together –- the young man's life was saved and he suffered no lasting consequences.

My experience that day, and many others like it in the operating room, made me understand the limitations of my nursing background and education. Fast forward to today, when I have embarked on an educational journey to address my self-perceived limitations. This has taken me back through four years of medical school and into my third year of clinical training as an anesthesiology resident. Eighteen months from now, I'll become a full-time practicing anesthesiology physician.

My unique experience –- first as a working nurse anesthetist, and now as a near-fully trained anesthesiologist -– gives me a special understanding of the potential crisis in care that Florida could face if some Florida lawmakers had their way.

At the urging of the powerful nurse lobby, some in the Florida legislature feel it would be a great idea to allow nurse anesthetists to work independently and without the supervision of a physician –- any physician. It is bad enough that Florida law doesn't require them to work under a licensed anesthesiologist, but now they seek the ability to work far outside their scope of training/education and work without any doctor supervision whatsoever.

From my vantage point, this would be a disaster for Florida and for those patients who will be undergoing surgery in our state.

From my years of hands-on experience in surgeries, from VA medical centers to community hospitals and all points in between, I know that my prior training as a nurse simply did not equip me to make on-the-spot medical decisions that are required when adverse situations occur. These include crucial decisions that need to be made in the entire perioperative experience, up to and including the life-threatening situation I found myself in with that young man.

Don't get me wrong. Nurse anesthetists are well trained, regarded and important parts of the anesthesia care team. Our system depends greatly on them and they provide valuable services to our patients. But like the very competent co-pilot, when emergencies occur, you want the pilot, not the co-pilot to take the controls. Even in healthy patients, situations arise that require split second decisions and immediate interventions.

Florida lawmakers are confronted with the challenge of expanding access to care. With a pending shortage of both doctors and nurses, it would be a bad move for lawmakers to allow nurses to serve as doctors in the dangerous field of anesthesia.

Dr. Linda Young is a certified registered nurse anesthetist (CRNA) who served as a CRNA for 20 years. She is now a second year anesthesiology resident at UF Health-Jacksonville. She is a member of both the Florida Association of Nurse Anesthetists and the Florida Society of Anesthesiologists.

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