Senate Republican files autonomous practice measure, seeks to retain Florida nurse anesthetists

by | Dec 11, 2023



  • Senator Blaise Ingoglia has introduced a bill aiming to expand autonomous practice for Advanced Practice Registered Nurses (APRNs) and Certified Registered Nurse Anesthetists (CRNAs) by removing the requirement for a written supervision agreement with a physician or dentist.
  • The bill would allow CRNAs to order pre-anesthetic medication without the constraints of the current supervision protocol. Proponents argue that the existing supervisory relationships, often lacking in specialized training in anesthesia, do not enhance patient care or safety.
  • If adopted, the regulation repeal is expected to lower healthcare costs and address the supervisory protocol that often involves a financial component for CRNAs.

Sen. Blaise Ingoglia filed legislation on Friday that, if adopted, would expand the scope of autonomous practice for advanced practice registered nurses (APRNs) in Florida by removing established protocol regulations, ultimately lowering healthcare costs.

The measure, if passed, would eliminate the current requirement for a written supervision agreement with a physician or dentist for APRNs, as well as Certified Registered Nurse Anesthetists (CRNAs). Under current Florida law, CRNAs must have written supervisory protocols, meaning that to practice, they need a formal agreement with a supervisor that often involves a financial component where CRNAs pay a percentage of their collections to the supervising physician.

Ingoglia’s bill would also grant CRNAs the authority to order pre-anesthetic medication beyond the constraints of the supervision protocol. An inquiry for comment from Sen. Ingoglia was not immediately responded to.

Proponents of the bill note that many of the physicians or dentists who sign these supervisory protocols do not have specialized training in anesthesia. Thus, the supervision does not contribute to enhanced patient care or safety in anesthesia administration and largely serves as a statutory formality rather than a clinically significant supervisory relationship.

“Right now a lot of CRNAs provide this same service, yes, with paper supervision, but without any physical or real supervision. And everybody is just fine,” Giallombardo, who filed companion legislation in the House last month, told The Capitolist. “If we can remove this paper supervision, I think we’d also see savings and healthcare costs in the anesthesia component [of healthcare].”

Supporters further contend that the supervisory requirements contribute to the shortage of CRNAs in Florida, as many choose to practice in states with less restrictive regulations. This shortage is particularly acute in rural areas and is leading to the closures of healthcare services like obstetrics departments in hospitals.

According to data aggregated by the American Association of Nurse Anesthesiology, the state of Florida loses 32.8 percent of nurse anesthesiology graduates to other states each year. A secondary subset of data shows that 84.5 percent of graduates leaving Florida relocate to one of the 43 states that do not hold supervision requirements in their nursing or medical laws.

Between 2018 and 2023, Florida State University experienced the highest rate of nurse anesthesiology graduates relocating, with 65 percent of its students moving away. This was followed by Keiser University, where 55.9 percent of graduates left Florida, and Florida Gulf Coast University, with a 43.3 percent departure rate. The University of Miami saw 29.5 percent of its graduates leave the state. Meanwhile, Barry University and the University of North Florida had departure rates of 23.6 percent and 24.8 percent, respectively. Advent Health University reported that 22.8 percent of its graduates left Florida, while the University of South Florida had a slightly higher rate at 23.7 percent. Florida International University had the lowest rate, with 20.3 percent of its graduates moving out of state.

“I look at this as a health care workforce bill,” said Giallombardo. “I think it’s important to note that because we do have an increasing amount of CRNAs and anesthesiologists that leave the state, and partly because of this protocol … it’s going to be important for us to ensure that we have the health care workforce that we need.”

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