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The coronavirus disease 2019 (COVID-19) pandemic prompted profound shifts in the delivery of critical healthcare services. A mixed-methods study was conducted to explore the impact of the pandemic on Certified Registered Nurse Anesthetist (CRNA) practice. The quantitative component involved a survey of CRNAs during the initial period of the pandemic to determine changes in practice and any relationship to removal of state and federal barriers. Approximately 16% of 2,202 responding CRNAs reported practice expansion beyond their normal responsibilities, primarily outside the operating room and involving tracheal intubation, ventilator management, arterial line placement, and central line placement. CRNAs were more likely to experience an expansion of practice in states affected by removal of regulatory barriers. However, respondents also reported missed opportunities to use the full expertise of CRNAs because of state and institutional restrictions. Findings from the qualitative component of this study are reported in a separate article.
Keywords: Anesthesiology, COVID-19, nurse anesthetist, pandemic, scope of practice.
Major shifts in the delivery of critical healthcare services occurred as a result of the coronavirus disease 2019 (COVID19) pandemic, such as suspension of elective surgical procedures, increased intensive care unit (ICU) utilization, and interruption in primary care services. The US president declared a national public health emergency in March 2020,1 and a number of regulatory waivers and new rules were implemented to allow for greater flexibility in addressing healthcare needs related to the pandemic.2
Certified Registered Nurse Anesthetists (CRNAs) have long advocated for the ability to practice to the full scope of their education and training in all settings. The landmark 2010 Institute of Medicine report, The Future of Nursing, endorsed this position, advocating for removal of scope of practice (SOP) barriers for all advanced practice registered nurses (APRNs).3 Evidence has shown that removal of practice barriers for CRNAs and other APRNs improves availability and cost-efficiency of healthcare services,4-7 with quality outcomes similar to those of their physician counterparts.8-11 An important federal regulatory change that occurred because of the pandemic was removal of the physician supervision requirement of CRNAs.2 In addition, 20 state governors issued executive orders lifting various restrictions on CRNAs' and other APRNs' practice.
* State Regulation. Each state has varying levels of statutes and regulations affecting CRNA practice. These levels include physician supervision (Supervision-Level;...