Comment: Relaxed training standards won’t fix hospital staffing

Legislation to license anesthesiologist assistants in hospitals will only increase costs for patients.

By Gregory Clopp / For The Herald

There is a staffing crisis across our state’s hospitals and clinics. In Olympia, the state Legislature is learning about a lot of ideas to address this crisis.

While there some good proposals to help patients, there is one controversial effort that would fall short of helping patients in favor of bolstering profits for private groups and increasing costs to hospitals. As a certified registered nurse anesthetist (CRNA), I’m sharing my perspective based on my experience providing anesthesia care in our community.

I’m originally from New Jersey, which is where I first started working in health care. I got my start volunteering in a first aid squad when I was in high school, which is what they call basic aid vehicles on the East Coast. I earned my basic EMT certification and a few years later completed paramedic training and went to work full-time as a paramedic. I went on to earn my degree in nursing, served patients in an ICU and then went back to school so I could become a CRNA.

CRNAs, on average, have four and a half years of clinical experience before starting their master’s program, and when we graduate we have more than 12,000 hours of experience working directly with patients. The advanced degree — where we use the same textbooks as physician anesthesiologists — and the significant amount of clinical experience are two reasons why CRNAs are authorized in our state (and many others) to provide anesthesia care to a patient independent of supervision by a physician. We have the same safety outcomes as physicians and while I have always been proud to care for my patients directly, I know that it’s especially helpful during a staffing crisis that a doctor doesn’t have to keep an eye on me when they could be providing care to another patient.

When you work in clinics and hospitals with patients you start to see some areas for improvement. Staffing starts with training and education, which is why I’m hopeful that we can invest more in higher education so that more staffing cohorts can be established where they are needed. We should also encourage greater collaboration between hospitals and universities to make it easier to get nurses and other health care workers the clinical experience they need while pursuing their degree. Unfortunately, not every big hospital allows CRNAs like myself to care for patients directly, even though state law allows us to practice independently. Updating those hospital bylaws would immediately make anesthesia care more efficient for everything from major surgeries to simple procedures.

For every common-sense solution to the staffing crisis, there are a few bad ideas in the mix. One controversial proposal would change state law to allow anesthesiologist assistants to work in the state. These assistants have much less training than a CRNA, which is why they are not allowed to practice without physician supervision. In a larger hospital, this will mean that a physician will have to supervise several assistants without actually serving more patients.

This might mean greater profits for private groups because they will have more people billing for the same procedure, but it will just raise costs for patients and facilities without doing anything to solve the staffing crisis. Today, CRNAs are the only provider of anesthesia in 72 percent of rural communities; we practice independently and at a lower cost than an anesthesiologist.

This independence is also why CRNAs are proud to be the primary providers of anesthesia care to our deployed military. Changing state law to allow for these assistants — who are not required to have previous patient care experience before beginning training — won’t help because they can’t practice independently. I hope that lawmakers set this idea aside since it’s just not needed in Washington; assistants like these typically only work in a handful of states that don’t allow CRNAs to practice to the full extent of their training, education and certification.

I am proud to care for my patients autonomously. It’s incredibly rewarding and I know it means that more patients can have access to high-quality care. As I care for each patient, I tell them that they will fall asleep and then wake up, but I will stay awake the entire time keeping them safe.

CRNAs are always working to serve our patients, whether it’s providing exceptional care during your procedure or keeping your interests at the center of the conversation in Olympia with lawmakers making health care changes in our state.

Gregory Clopp is a practicing certified registered nurse anesthetist. He lives in Lake Stevens with his wife and two children.

Senate hearing

Senate Bill 5184, concerning the liscensing of anesthesilogist assistants, is scheduled for a hearing before the Senate Committee on Health and Long Term Care at 8 a.m. Tuesday. Its companion bill in the House is HB 1038.

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