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legal issues in nursing
legal issues in nursing
legal issues in nursing
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Throughout the years, there has been an ongoing controversy over whether or not nurse anesthetists (CRNAs) should be allowed to administer anesthesia. There are various legal issues surrounding nurse anesthetists ranging from the illegal practicing of anesthesia to physician supervision requirements. A nurse anesthetist is a specialized nurse who has been adequately trained to administer anesthesia—drugs that induce loss of pain or sensation. These types of nurses are registered and have completed additional years of college in order for them to practice anesthesia. At the minimum, it takes seven calendar years to become a nurse anesthetist. And before completing their studies, an average CRNA student completes 2,500 clinical hours and administers at least 850 anesthetics (AANA). So, ask yourself. Would you feel comfortable letting a “nurse” administer you anesthesia before your own surgery?
The first documented occurrence of anesthesia being practiced by civilian nurses was during the 1870s in the Midwest. Sister Mary Bernard, who founded the Sisters of St. Joseph in Kansas, entered the St. Vincent Hospital in Pennsylvania to train as a nurse. Only twelve months later, she took on the anesthesia obligations at the hospital (Nagelhout, Plaus 3). Her efficient administering of anesthesia caused this practice to repeat throughout the Midwest and eventually the United States.
In 1900, Agatha Hodgins went to Cleveland, Ohio to work at Lakeside Hospital. It was eight years later that Dr. George Crile selected her to be a nurse anesthetist. Alongside Crile, Agatha initiated the use of nitrous oxygen anesthesia, which was introduced in WWI and went on to open a conspicuous school for nurse anesthetists. It was then that nurse anesthet...
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...mpletely disagreed with it. Dr. Debbie Malina shot back arguing that it could be easily proven that nurse anesthetists handled all types of surgical procedures regardless of any types of physician or anesthesiologist supervision. Malina added that nurse anesthetists had little to no restrictions when it came down the cases they were involved with, the different types of anesthetics they could administer, and no limitations on what types of facilities they were allowed to work in. But, due to the many technological advances, the critical nature of anesthesia, and the increase in the amount of ill and “sick” people, doctors feel as if supervision of CRNAs is more essential than ever before. Several CRNAs added that they are able to provide proficient and efficient health care to all patients, given that most CRNAs were the primary caregivers in rural areas. (Medscape)
Brody, Michael, and Donald Martin. “The Role of Anesthesiologists.” Physicians Protecting Patients. N.p. N.d. Web. October 21, 2015. An anesthesiologist is a physician who has received at least 8 years of schooling and has completed a residency program dealing with anesthesiology. Now, a licensed physician, an anesthesiologist deals with the administration of anesthesia during many medical procedures, including surgical or obstetric procedures, and pain management for acute and chronic illnesses, or cancer related pain. Anesthesiologists are also in charge of “anesthesia care teams” that include the anesthesiologist, an anesthesia assistant, certified registered nurse anesthetist, and an anesthesia technician. As the leader of the care team, the anesthesiologist is responsible for assessing the patient before, during, and after medical procedures, as well as developing and monitoring performance and quality of practices and standards in regards to administering anesthesia. The entirety of
Both Nurse Practitioners and Nurse Practitioner-students work closely with patients to monitor their health and provide care for acute and chronic illnesses. However, in the academic-clinical setting, the NP-student may only perform this function at the discretion of the supervising NP. Although work environments and responsibilities bestowed upon these distinctive nurses can be quite different, Nurse Practitioners, Registered Nurses and students is bound to the same laws and regulations governed by all states and territories that have enacted a nurse practice act (NPA). The NPA itself is insufficient to provide the necessary guidance for the nursing profession, therefore each NPA establishes a state board of nursing (BON) that has the authority to develop administrative rules or regulations to clarify or make the governing practice law(s) more specific (NCSBN
Nuland, Sherwin B, M.D., F.A.C.S. The Origins of Anesthesia. Birmingham, Alabama: The Classics of Medicine Library, 1983.
Anesthetics were not used in surgery until October 16, 1846, in Massachusetts General Hospital (Youngson 51). The anesthesia was a inhaled gas known as ether. In 1847 a doctor by the name of James Simpson popularized chloroform as an alternative to ether. According to Simpson chloroform could do more with less, act faster and last longer than ether, is more pleasing to the senses than ether, and is cheaper (qtd. in Youngson 70). Chloroform also did not need an inhaling device like ether did; it could be placed on a piece of cloth and work just as well (Youngson 70).
In the 1700’s things were very different to life today; this included the medicine of the time. The idea of medicine came from the Greeks and they came up with the four humours (consisting of water, fire, air and earth.) By the 1840’s most anaesthetics were accepted as James Simpson presented a powerful case for them; however they didn’t make surgery safer and the amount of people dying from operations increased. The final breakthrough for anaesthetics was when Queen Victoria accepted the use of Chloroform during the delivery of her eighth child. Even though being anesthetised was less painful surgeons did not take any precautions to protect open wounds and infections were spread by the reuse of old bandages!
The Certified Registered Nurse Anesthetist (CRNA), also called nurse anesthetists, is a registered nurse that has specialized in delivering anesthesia during surgery and other procedures, as well as monitoring vital signs and maintaining the patient’s airway. A CRNA can also further their specialty specifically for pediatric, bariatric, cardiac care, etc. patients. To become a CRNA, an extensive education, as well as experience, is required before even being considered to enter the anesthesia educational program. CRNAs have a variety of work settings to choose from, such as dentist offices, operating rooms, and endoscope procedure units. The salary range for a CRNA varies due to experience and subspecialty, but the profession is one of the top paid nursing practices. Education, work setting and conditions, salary, and job prospects all vary on location but certification and recertification remain the same nationally.
In their capacity as primary care providers, APNs have the authority to diagnose and treat any patient with an acute or chronic illness; and have prescriptive authority according to their state regulations (Begley et al., 2013). On the other hand, a staff nurse follows orders and assist physicians with patient examination and treatments, cannot diagnose a patient, and does not have prescriptive authority; RNs can only administer medication prescribed by physicians (Begley et al., 2013). The beginning and the evolvement of the role of the RN was first achieved with the modernization of nursing practice through regulation and education, attained through the essential first-level standard of nursing skill as an RN (Stanley, 2011). According to Barton et al. (2012), nurses continue to strive to redefine their skill set and practical ability as specified within the
In the early 1800’s, before the use of anesthesia, many patients with life threatening issues would forgo surgery and choose the permanent path of death rather than undergo a painful, emotionally scarring procedure such as surgery before anesthesia. When surgeries did take place, they would be performed on the top floors of hospitals so that the other patients couldn’t hear the screams. More than 8,000 anesthesia-free operations were performed in the Ether Dome at Mass General Hospital, coincidentally the birthplace of the first surgery “without pain” (Mass General).
Identifying and maintaining the appropriate number of mixed nursing staff, RN/LPN/CNA, is critical to the delivery of quality patient care. Many studies reveal an association between a higher level of experienced RN staffing and lower rates of adverse patient outcomes (“Nurse staffing plans,” 2013). The nurse-patient ratios will in turn improve the nurses working conditions, decreasing the risk of errors to patients.
Wall, Barbara Mann. “History of Hospitals.” NHHC Articles (n.d.). 1-9. Penn Nursing Science. Web. 6 Nov. 2013.
Still today, nurse staffing is a crucial health policy issue. Since the 1980s, the nursing profession has taken on more prominence in America with a large focus on research studies. In fact, U.S. Public Law 99-158, Health Research Extension Act of 1985, authorized the National Center for Nursing Research (NCNR) at National Institutes of Health (NIH) (Health Research Extension Act of 1985, 1985). With U.S. Public Law 103-43, NIH Revitalization Act of 1993, the NCNR was formally changed to the National Institute of Nursing Research (NINR) (NIH Revitalization Act of 1993, 1993). The NINR started constructing purposeful research projects, which produced a positive correlation between the number of staff and quality of care. However, the 1996 Institute of Medicine (IOM) report expressed, at that time, no significance between nurse staffing and clients’ outcomes in acute-care hospitals (Institute of Medicine Staff, Davis, Sloan, & Wunderlich, 1996, p. 9).
"History of Nursing in the United States." Nursing Degree Guide. N.p., 2014. Web. 19 May 2014.
...iation. (2009). ANA Position Statement: Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment. Washington, DC: Author.
With all of the different specialties in healthcare, some get overlooked or may be under the radar. An uncommon and often disregarded career choice in healthcare is that of a Certified Registered Nurse Anesthetist or a Doctorate of Nurse Anesthesia Practice. Although not many people know about these healthcare careers, they play a vital role within the healthcare team. This field is growing rapidly and the likelihood of coming into contact with a nurse anesthetist during a hospital stay is on the rise. Knowing the history, education, responsibilities, and career outlook for a Certified Registered Nurse Anesthetist or a Doctorate of Nurse Anesthesia Practice can aide in understanding their very specific role in the care of patients.
Davenport, Joan M., Stacy Estridge, and Dolores M. Zygmont. Medical-surgical nursing. 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2008, 66-88.