Pennsylvania Association of Nurse Anesthetists
March 25, 2020
Re: Certified Registered Nurse Anesthetists in Pennsylvania
Hon. Tom Wolf, Governor
Commonwealth of Pennsylvania
Office of the Governor
508 Main Capitol Building
Harrisburg, PA 17120
Dear Gov. Wolf:
On behalf of the Pennsylvania Association of Nurse Anesthetists (PANA), which represents more than 3,700 certified registered nurse anesthetists (CRNAs) and students in Pennsylvania, we want to commend you and your administration for the aggressive actions to slow the spread of the coronavirus (COVID-19) and respond to this pandemic. We fully recognize that this unfolding situation has everyone anxious, and we appreciate your leadership on this issue.
As you know, certified registered nurse anesthetists are the hands-on providers of anesthesia care, operating safely in every setting where anesthesia is administered, including hospital operating and delivery rooms; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons; pain management centers and more. As frontline health-care professionals, we play a crucial role in the state’s response to this pandemic. Unfortunately, the full contribution of CRNAs is being limited.
Putting the Full Extent of CRNA Education and Training to Work
As our health-care system strains to address the demands created by the current crisis, one way to increase the number of health-care providers that can address patient needs is to grant advanced practice nurses, including CRNAs, the ability to practice to the full extent of their education and training. Many of the limits on CRNA practice are not based on any data or research, and CRNAs can safely practice beyond these limits (and often do safely practice in other states). States like New York, West Virginia, Maine and Arizona already have acted to remove barriers, allowing them to better utilize all available health-care providers without risking patient safety.
In Pennsylvania, education and clinical training for certified registered nurse anesthetists is extensive, requiring national board certification. In total, CRNAs ultimately complete approximately 9,000 clinical hours including their intensive care unit clinical experience, anesthesia clinical training and undergraduate nursing clinical experience before board certification as a CRNA. Patient safety data from these states do not differ compared to national statistics. In fact, numerous medical studies show there is no statistical difference in patient outcomes when a nurse anesthetist provides treatment, compared to an anesthesiologist, even for rare and difficult procedures.
We don’t know what demands will be placed on our health-care system in the near future, but freeing providers from unnecessary statutory and regulatory burdens will allow CRNAs to contribute more efficiently to the response.
Authorizing Professional Designation to Facilitate Crisis Response
Pennsylvania remains one of only two states that fails to recognize CRNA professional designation in some form. Because there is no formal definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, CRNAs are recognized only as registered nurses (RNs). This creates fiscal and logistical challenges that are magnified at times like this.
Pennsylvania ranks among the top draws nationally for CRNAs and students, with 13 highly rated nurse anesthetist programs serving every corner of the commonwealth and helping to sustain one of the largest contingencies of professionals in the country. In times of need, our professionals are in demand to help with crisis response. However, Pennsylvania-based CRNAs cannot be part of response teams in other states that are asking for help simply because our CRNAs lack formal credentials that nearly every other state already recognizes.
Neighboring states like Maryland, Ohio and Virginia, as well as Washington, D.C., all have declared states of emergencies. Because states of emergencies have been declared, Pennsylvania-based CRNAs and other medical licensees are able to work in these states, even if not licensed there. But, we have to practice according to Pennsylvania’s State Board of Nursing requirements, which again only define CRNAs as RNs, limiting our capacity to provide anesthesia as we are trained to do.
Professional designation legislation (S.B. 325) passed the Senate last year but has not yet been taken up by the House. The bill currently sits in the House Professional Licensure Committee. Additionally, a companion bill (H.B. 1064) by Rep. Tarah Toohil (R-Luzerne) has been introduced in the House and remains in committee. These simple professional designation measures would address the current issues that prevents CRNAs from acting in their fullest capacity to help out state and nation at this time of crises.
Other states already are allowing health-care providers to work across state lines. For example, New York Gov. Andrew Cuomo temporarily suspended state licensing laws “to the extent necessary to allow registered nurses, licensed practical nurses, and nurse practitioners licensed and in current good standing in any state in the United States to practice in New York State without civil or criminal penalty related to lack of licensure.” Not only does this allow health-care workers to move to areas that are hardest hit in order to provide care for the patients who need it most, it also greatly expands the possibility of using telehealth, as a nurse in one state would be able to address patient needs in any state. This helps to extend providers’ reach and efficiency, and alleviate demand on local practitioners.
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Our team continues to monitor the situation, relying on state and federal updates, while employing the most effective measures to keep our patients, providers and peers safe and well informed. Like the rest of the country, we are watching with deep concern as the COVID-19 pandemic continues to affect a world already brought to a standstill. Projections show the impact getting worse before things get better. We stand ready to do all we can in partnership with your administration to respond effectively to this crisis. We urge your support for these measures. Thank you.
SINCERELY,
Angelarosa DiDonato, DNP, CRNA
President
Pennsylvania Association of Nurse Anesthetists
Jessica Poole, DNAP, MHS, CRNA
Director, State Government Affairs
Pennsylvania Association of Nurse Anesthetists
cc: Pennsylvania Health Secretary Dr. Rachel Levine