Barriers Faced by Nurse Anesthetist Entrepreneurs Wishing to Implement an Office-based Anesthesia Practice

Abstract

Purpose: Certified Registered Nurse Anesthetists (CRNAs) are highly trained anesthesia professionals with a minimum of seven calendar years of nurse anesthesia education and clinical experience, who safely administer more than 40 million anesthetics in the United States every year. CRNAs may encounter barriers to full practice authority that limit their ability to practice anesthesia to the full scope of training and experience, and to meet the needs of the patients they serve. The removal of practice barriers remains a high priority requiring legislative changes at various levels of government. State regulatory restrictions of practice, and the requirement of physician supervision, may restrict nurse anesthetist entrepreneurs wishing to establish an office-based anesthesia practice (OBA). The purpose of this project was to determine what barriers exist for the CRNA when implementing an OBA practice, and develop a practice guide for CRNA entrepreneurs wishing to establish an OBA practice. Methods: An extensive literature review informed the formulation of a descriptive survey instrument to gather data on the barriers experienced by CRNAs when transitioning into autonomous OBA practices. The questionnaire was distributed online using Qualtrics® via social media venues, Facebook and Yahoo, to groups of CRNAs in autonomous OBA practices, yielding a sample size of 86 CRNAs .The survey data was analyzed to determine the perceived barriers encountered by CRNAs administering anesthesia in the physician office setting. Results: The analyses of the survey results revealed the following three primary barriers; (1) state statutes prevent CRNAs from practicing to the full extent of their education and training, (2) fair reimbursement for CRNA services by third party payers, and (3) challenges related to other disciplines recognition of the CRNA scope of practice. Of the 86 participants surveyed, 90% perceived state statutes to be the greatest barrier to OBA practice. Conclusions: Barriers to CRNA OBA practice are complicated and multi-factorial. CRNAs need to continue advocating for patient safety in physician office settings, and obtain support from federal and state governments, health insurers, healthcare professionals, and consumers of health services. This may assist in overcoming barriers faced by CRNAs establishing autonomous OBA practices. Continued research aimed at outcome data related to CRNA effectiveness and quality in providing anesthesia independently at an office location, is necessary to aid in the successful reduction of the perceived barriers to practice. As a conclusion of this project the author intends to publish a guide to assist CRNAs considering establishing an OBA practice, to overcome some of the barriers identified in this project. Data Sources: ProQuest, Medscape, PubMed, Cochrane Library, CINAHL, and Google Scholar. Keywords: Certified Registered Nurse Anesthetist (CRNA), nurse anesthetist entrepreneurs, office-based anesthesia practice, barriers faced by nurse anesthetists.