Relaxed Nurse Scope of Practice Boosts Care Access During COVID-19

Removing scope of practice barriers for nurse anesthetists during COVID-19 lead to increased care access, according to a study conducted by the American Association of Nurse Anesthetists (AANA).

CMS temporarily suspended the physician supervision requirement for certified registered nurse anesthetists (CRNAs), thereby increasing the care delivery capacity of health systems at the onset of COVID-19. Some governors also removed scope of practice barriers to CRNA practice.

These policy adjustments allowed CRNAs to be begin leadership roles across the country in emergency care, patient evacuation, disaster management, and physical and psychosocial support and recovery.

The study, published in the April edition of the AANA’s official scholarly journal, describes how CRNAs successfully transitioned into these new roles and expanded access to care.

“The study revealed that CRNAs can assume expanded roles and apply their knowledge and skills to provide expert clinical care in a multitude of settings both in and out of the operating room,” said AANA Foundation CEO Lorraine M. Jordan, PhD, CRNA, CAE, FAAN in a press release.

Six major themes were collected through ethnographic interviews and focus groups within the qualitative component of the study. These themes outlined the fortitude CRNAs demonstrated at the onset of the pandemic, the researchers said.

First, the theme of CRNAs as part of the solution was highlighted. These CRNAs were able to use their education, experience, and skills to fulfill a variety of roles within the healthcare ecosystem during the pandemic, such as intensivists, innovators, educators, leaders, and ICU nurses.

Based on a January 2021 CMS report, CRNAs were one of the top 20 specialties that provided in-person care to the most beneficiaries during the height of the COVID-19 public health crisis (March through June 2020).

The next theme described by CRNAs related to “doing whatever it takes,” in the fight against COVID-19. CRNAs reported willingness to extend their care into settings outside the operating room and some even traveled to COVID-19 hotspots to provide care. CRNAs also expressed instances where they had to use or reuse inadequate PPE.

For instance, one CRNA reported that they adapted scuba diving face masks with an air filter positioned in the snorkel. CRNAs also noted that they had to put their health and their family’s health on the line by risking COVID-19 infection.

Next, CRNAs noted in the interviews and focus groups that the pandemic helped reveal their value-based care expertise to healthcare executives. For instance, one team of CRNAs helped transform a nursing home into a COVID-19 hospital, supporting it through airway management, arterial and venous line placements, and COVID-19 management.

CRNAs explained that the removal of scope of practice barriers lead to positive change, freeing them from burdensome paperwork and increasing patient access to care.  

The next theme recognized the “trying times” associated with providing care during a pandemic. The CRNAs uniformly acknowledged that their work had on a negative effect on their mental and/or physical wellbeing based on the fact that they were dealing with an unfamiliar virus and had stepped into roles they may not have filled before.

“While it was not uncommon for the CRNAs interviewed to experience fear and anxiety while caring for unprecedented numbers of patients infected with COVID-19, they simultaneously and unselfishly provided highly skilled care during a pivotal moment in our nation’s history,” explained Jordan, who also serves as the chief advocacy officer for AANA.  

Lastly, CRNAs expressed that the pandemic brought their expertise to light, not just within the clinical space, but within policy, leadership, and management as well.

While COVID-19 has led to a devastating loss of life, it has spurred people to work in innovative ways, said Jordan, noting that healthcare administrators and physicians were “able to witness the high level of education and expertise that CRNAs possess as well as their ability to apply this knowledge to a multitude of challenges during the crisis.”