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  1. Opinion

Nurses rate high for honesty and ethics. So why don’t we give them more responsibility? | Column

A Certified Registered Nurse Anesthetist makes the case for the ability to work without a doctor’s supervision.
A nurse helps a patient. [Shutterstock]

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 healthcare team.

As we embark on this new decade, we must find ways to make healthcare 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.

HB 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 Rep. Cary Pigman to make its passage a priority.

Jose Delfin D. Castillo III, PhD, MSNA, CRNA, APRN, is a Certified Registered Nurse Anesthetist clinical practitioner and educator based in Naples, FL. 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, TX. [File photo]

Why is this reform so important? Florida’s population is aging and growing, and we need to maximize the use of our healthcare 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 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 healthcare 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.

I urge you to support HB 607 so that today’s nurses and tomorrow’s can apply all of their knowledge and skill to make healthcare 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.

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