Move reignites debate about the role of advanced practice nurses.


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A medical center in Wisconsin has replaced its anesthesiologists with certified registered nurse anesthetists (CRNAs), triggering an exchange on social media about patient care quality.


News about the staffing change at Watertown Regional Medical Center, a community hospital in a small city located between Madison and Milwaukee, came via a Twitter post March 28 of what appeared to be a memo from the hospital's chief executive. Superimposed on the memo was a comment from the unnamed poster, self-described as an Emergency Physician/Army Vet/Patient-Physician Advocate, according to an April 5 report in Medscape Medical News (see http://www.medscape.com/viewarticle/948723).


"This is not good news for the residents of Watertown, WI," the poster tweeted. "Watertown Regional Medical Center (courtesy of the private equity-backed, contract medical group Envision) removed all of its anesthesiologists for a 100% CRNA model. In a nutshell, they replaced physicians with nurses."


The comment reflects an ongoing national debate about scope of practice for advanced practice nurses generally, and whether nurse anesthetists should work in the absence of physician supervision specifically.


According to Randall D. Moore, chief executive officer of the American Association of Nurse Anesthetists, the situation at the Wisconsin hospital is not unique but rather a nationwide trend. "There are three major problems-access, quality, and economics-and we are seeing a significant number of practices and facilities that are reevaluating their methods of delivering anesthesia," he said. "It began before COVID and now has been accelerated."


The question is how can access be increased and cost decreased without jeopardizing quality. Outcomes data do not support physician arguments that nurses need to be supervised, according to Moore. "Nurses have been providing anesthesia safely for 150 years, and it is truly a false narrative that we are taking physicians' jobs away and providing substandard care. There is more than enough work for everyone."-Roxanne Nelson