The TxANA Board of Directors has been hard at work on developing a TxANA Strategic Plan. This Plan will set a clear path for TxANA as we position ourselves for the 21st century. Many thanks to all the members of the Board of Directors for their contributions to this Plan. The role of the Nurse Anesthetist is vital to healthcare in Texas. This Strategic Plan will focus TxANA’s work in assuring that quality and affordable anesthesia care remains available for Texans.
Remember that CRNAs work as independent providers and are independently licensed and legally responsible and accountable for their own practices in Texas. They may practice as private practitioners on the basis of their own clinical privileges within hospitals or surgicenters; they may independently contract for the provision of anesthesia services in facilities; or they may be employed by a hospital, surgical center, a group of MDs, or a surgeon.
However the CRNA chooses to practice, there is only one CRNA provider in Texas under the Rules and Regulations from the Board of Nursing. We are one and the same provider, not CRNA educators, or anesthesia care team (ACT), CRNAs or independent CRNAs. We are one and the same under the classification of CRNA according to the laws of Texas.
In the state of Texas, physician supervision is not required to practice. The Board of Nursing for the State of Texas, which regulates CRNAs, say that the practice of anesthesia by CRNAs is the practice of nursing and that CRNAs function independently and do not require supervision from a physician. CRNAs do need an order from a physician for an anesthetic or anesthetic related service. Our previous 1995 Texas legislation passed into law that this "physician order" does not have to be drug, dose, technique of device specific. There is no need for protocols. There is a need for a CRNA to be credentialed through clinical privileging or job description to perform anesthesia, just as there is a need for anesthesiologist to be intuitionally credentialed.
As we know, the delivery of healthcare is mostly an interdependent activity, in which all health providers must work collaboratively to achieve patient care goals. Anesthesia is not given by CRNAs or anesthesiologists just for the sake of giving anesthesia; it is provided to patients to permit medical, dental or pediatric intervention to be accomplished. Furthermore, courts have not upheld that a physician’s legal obligation to supervise or direct CRNA practice (in states where that is a requirement) is enough to make them liable for the acts of the CRNA. In fact, seldom are these facts defined. Courts have ruled that it is the facts of the case that determine whether physicians who work with CRNAs, and for that matter anesthesiologists, are liable for the CRNA or anesthesiologist. There has to be proof or evidence that the physician exerted control over those acts.