When the Gallup organization surveys Americans each year on which occupations they rate highest for honesty and ethics, the same profession has topped the list for 18 years: nursing.
As a registered nurse for more than two decades and a certified registered nurse anesthetist (CRNA) for the last dozen years, I am grateful for the trust patients place in us — but I also know that it’s time to modernize the way we view the role nurses play in the health care team.
As we embark on this new decade, we must find ways to make health care more accessible and cost-efficient for all of us. Our highly skilled nurses can play a crucial role in this transformation, but only if we empower them to use their full range of skills and expertise. Here in Florida, we have an opportunity to do just that in the 2020 state legislative session.
House Bill 607 would allow advanced practice registered nurses (APRNs), including CRNAs, to practice to the full scope of their training and education without the supervision of a physician. As the president of the Florida Association of Nurse Anesthetists (FANA), I strongly support this bill and applaud the efforts of House Speaker Jose Oliva and Representative Cary Pigman to make its passage a priority.
Why is this reform so important? Florida’s population is aging and growing, and we need to maximize the use of our health care providers to deliver quality care to more patients while keeping costs down. The antiquated physician supervision rule actually works against those goals.
Advanced practice nurses possess the knowledge and skills to provide safe and quality care in a cost-efficient way. That’s why more than half of the states in the U.S. now allow APRNs and CRNAs to operate autonomously.
APRNs undergo rigorous education and training. CRNAs, for example, have an average of 2.9 years of critical care experience as a registered nurse before even starting anesthesia training. We use the same textbooks that physician anesthesiologists use. CRNAs also have an average of 2,369 hours of training in clinical experience providing care for patients across the spectrum of ages and diseases.
We have the capability to administer every type of anesthetic in the health care setting, from insertion and management of central lines and arterial lines, to epidurals, spinals, and peripheral nerve block placements. All practicing CRNAs are board certified.
Numerous independent studies show no difference in the safety or quality of care when APRNs administer the services they have been educated and trained to deliver, compared to physicians providing the same services.
Likewise, in states where CRNAs practice independently, there is no evidence of increased risk to patients or claims. In fact, a recent federal government report pointed to the safety and effectiveness of care delivered by advanced practice nurses and recommended that more states consider changes to their scope-of-practice laws to enable these highly trained providers to use their full set of skills.
My own experience, starting out as an RN in the Philippines in the 1990s and then coming to Southwest Florida to continue my career, has been a journey of discovery. On that journey I’ve learned the full extent of what a nurse is capable of and just how significantly we can contribute to a patient’s care and well-being.
I clearly remember attending a national conference for our profession when I was still a student training to become a CRNA. Sitting in a lecture on leadership, I was dumbfounded by the collective knowledge and experience in that room. I had a similar reaction during my operating room internship, where I saw CRNAs in action who were smart, independent and decisive with their judgment in providing anesthesia care.
Today, in addition to being a CRNA in clinical practice, I also teach students who want to follow this same path. I see in their faces that same passion for serving patients and achieving the highest levels of expertise.
I urge you to support House Bill 607 so that today’s nurses and tomorrow’s can apply all of their knowledge and skill to make health care better for Floridians.
Jose Delfin D. Castillo III, PhD, MSNA, CRNA, APRN, is a certified registered nurse anesthetist clinical practitioner and educator based in Naples. He is president of the Florida Association of Nurse Anesthetists, and serves as an assistant professor in the Graduate Program of Nurse Anesthesia at Texas Wesleyan University in Fort Worth, Texas.