1. Nursing and Allied Health Database (ProQuest)
Barriers to Certified Registered Nurse Anesthetist Scope of Practice
Liz Messina & Zach Zenner
Background: Certified Registered Nurse Anesthetists (CRNA’s) are advanced practice nurses that provide anesthesia in many settings such as the OR, in labor and delivery with epidurals, and in pain management clinics.
Purpose Statement:
Our goal in this literature review was to present current research related to CRNAs and identify the barriers that are preventing them to practice their full scope. The hope is that by identifying the barriers, steps can be taken to break them down and allow for CRNA’s and Nurse Practitioners in all specialties to have full autonomy.
Methodology:
An integrative literature review was conducted looking at multiple articles published about CRNA’s legislation, autonomy, and scope of practice. Articles were found from databases such as PubMed, CINAHL, and ProQuest.
Results:
There are multiple barriers in the way of CRNA’s having full autonomy:
Combination of federal, state, and hospital policies.
Stigma from physicians, and the general healthcare profession that CRNA’s are not trained enough to practice alone.
As CRNA’s gain autonomy, anesthesiologists receive less money, but patients save more money with the same patient outcomes as demonstrated by current research, but more work is needed.
Discussion/Nursing Implications:
Nurses in research can focus their efforts on showing patient outcomes while under the care of CRNA’s as compared to anesthesiologists. Research can also be done in how the cost of CRNA’s is cheaper for patients than physicians. Nurses and CRNA’s can advocate for increasing scope of practice for CRNA’s and all nurse practitioners by becoming involved in the policy making at federal, state, and hospital levels.
Conclusion:
The biggest barrier to CRNA practice is the legislation at the federal, state, and hospital levels. Attitudes within the healthcare profession has also resulted in underutilization of CRNA’s which has prevented them from showing the full capabilities of their practice. By highlighting the barriers, direction has been given for further nursing research with the goal of increasing CRNA scope of practice.
Number of studies found using keywords
CINAHL Complete
N=262
Nursing and Allied Health Database (ProQuest)
N=40
PubMed
N=36
Number of studies meeting inclusion criteria
145 19 6
Number of studies after excluding duplicates
106 4 2
Number of studies after using exclusion criteria 5 1
Final number of studies selected 7
Figure 1. Table of review process and study selection.