PANA Members Discuss What Blanket Waiver During Pandemic Really Means

Blanket waiver removing physician supervision requirement benefits health-care facilities, patients during pandemic

The Pennsylvania Association of Nurse Anesthetists achieved a significant victory for the profession in May when Gov. Tom Wolf announced a temporary blanket waiver removing the physician supervision requirement for certified registered nurse anesthetists (CRNAs).

The waiver has been hugely important as part of the state’s response to the health-care crisis caused by COVID-19. Advanced practice nurses like CRNAs can finally practice to the fullest extent of their education and training.

That avails more physicians to provide hands-on care. It expands the capacity of both CRNAs and physician providers. It augments the state’s health-care system to continue to meet growing demands during this pandemic. And it ensures patients get the best care.

But what has this waiver really meant for CRNAs, health-care facilities and the patients we serve? Here are some firsthand accounts from CRNAs on the frontline. (Please note that the names of the CRNAs and their facilities have been removed to ensure their anonymity and protection in the workplace.)

“I work in a critical access hospital and since the governor removed the supervision requirement, the anesthesiologists are now running their own room and I’m working in another room with my surgeon --- which means we are able to provide two times the services!”

“We at our local Hospital started a COVID response team in conjunction with the ER and ICU. We responded to all COVID intubations, put in an arterial line, a central line, and intubated the patients. We also helped manage vent settings/unstable patients as needed.”

“My hospital told our anesthesiologists that they will be taking their own assignment and that the CRNAs will work alone until we get caught up on elective surgeries. Many of our anesthesiologists resigned because they don’t want to give anesthesia.”

“Yes, we have provided a CRNA from our department for 24-hour coverage of the COVID units to act as an NP to help assess patients, place lines, and act as extenders for the critical care intensivists in our county. The chief in my group was able to use the supervision waiver for us to work outside of the OR and in the OR without supervising anesthesiologists.”

“The orthopedic surgeons at my hospital have always wanted an ologist available. That has all changed. The CRNAs are working alone and our ologist was given the option of working in a room or taking time off unpaid.”

It’s clear: Gov. Wolf’s decision to issue that temporary blanket waiver and remove the physician supervision requirement for certified registered nurse anesthetists is making a real difference.

The waiver was included in an executive order that the governor signed to protect health-care practitioners for good-faith actions taken in response to this crisis, and it remains in effect for the duration of the governor’s disaster proclamation, which gives him broad powers to manage this public health emergency.

The proclamation was renewed for 90 days in early June. Lawmakers challenged the extension. But state judges sided with the governor. That means the proclamation remains in place for at least two more months. As long as the governor’s disaster proclamation remains in place, so does his blanket waiver removing the physician supervision requirement for CRNAs.

Stories like these from our CRNAs prove that this policy shouldn’t just be implemented during a pandemic, but instead be permanent to ensure patient health and safely and to give greater options to health-care facilities to provide the best care to those in need.

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