In rural communities across America, Certified Registered Nurse Anesthetists (CRNAs) play a vital role in delivering safe and effective care to patients. This month, as we observe National Rural Health Day on November 21, it is a good time to take a close-up look at how CRNAs function in these rural settings where there are fewer providers and scarce health care resources.
Today, after a long career as a CRNA in my home state of Florida, I have the privilege of practicing in a small, 117-bed hospital in rural Kentucky. The difference is striking. Here in Kentucky, as in many other states across the country, CRNAs are allowed to practice autonomously to the full scope of our training and experience. This stands in sharp contrast to Florida, which continues to require physician supervision.
Enabling CRNAs to practice independently greatly expands the capacity of a small hospital to provide care in a cost-effective and timely manner. In my role in Kentucky, I deliver anesthesia to patients in a broad array of medical specialties: obstetrics and gynecology, pediatrics, orthopedics, neurology, and general surgery. I am the one in charge and responsible for my patients while they are under my care. This model of care is especially beneficial for health facilities in rural areas. Rural settings often have less of everything when it comes to health care. Many small hospitals struggle financially. These issues have contributed to the closure of eight such hospitals in Florida since 2005. Recruitment of physician specialists is particularly difficult and can result in shortages. The people living in these communities often have less access to care due to limited transportation options and long distances to travel. To address these and other challenges, many rural facilities rely exclusively on CRNAs for anesthesia services.
For the CRNA profession, practicing autonomously is nothing new. The high-level education and training that CRNAs and other advanced practice nurses receive equips us to work independently. One of the best examples of how CRNAs have proven themselves effective in delivering care autonomously can be found in the U.S. military, where CRNAs have had full practice authority for decades. They are the sole anesthesia providers on forward surgical teams, on the front lines, on Navy ships, and for aircraft evacuation teams.
When I look at the current landscape for CRNAs in Florida, I am concerned about the future, not just for the delivery of care in rural areas but across the state. A recent survey of five nurse anesthesiology education programs in Florida showed that one out of three graduates leave the state each year to practice elsewhere. The vast majority of those who leave go to a state where physician supervision is not required, and they are allowed to use their full range of skills and knowledge to serve patients. Indeed, isn’t that the aspiration of everyone who puts in the time and effort to learn a difficult set of skills? People want to be able to do what they’ve been trained to do—to work to the very top of their abilities. Instead, Florida’s burdensome and unnecessary physician supervision requirement is driving highly skilled caregivers away.
As a native-born Floridian, I had the good fortune to grow up in Daytona Beach and then be educated and serve patients in that very same area for many years. As Florida’s population continues to grow—and to grow older—there will be a need for more health care providers, not fewer. It is time for the state to address this outdated requirement, stop the brain drain, and enable more of the CRNAs trained in Florida to stay and apply the full scope of their expertise to serving their neighbors.
William L. Self, DNP, CRNA, APRN, is a member and past president of the Florida Association of Nurse Anesthesiology. He earned a Master of Science in Nursing-Nurse Anesthetist Program and a Doctorate of Nursing Practice from the University of North Florida.