Anesthesia - Physicians Vs Nurses

what are the opinions on nurses increasingly handling the duties of an anesthesiologist. I know this is becoming a major issue in US but I'm curious to know if there is a similar trend in Canada. Considering the desperate need for anesthesiologist, is it possible that out of sheer desperation, new legislations might be introduced such that nurses might be invited to handle the workload..it doesn't matter much now since there is alot of work for almost everybody but what about in the future when the demand may not be as high..anyone have any input on this issue?

This is from the CAS (Canadian Anesthesiologist's Society) president's message in there November 2003 Newsletter (Vol. 19 Number 1):

"In Canada, we have been carefully reviewing the scope of practice of anesthesia assistants (AA). The Standards Committee and the Board have spent considerable time over this issue, and have sought broad consultation with the membership. I believe we are close to developing a consensus on the topic. The essence of the recommendations include: 1) that the CAS continues to endorse the concept of one anesthesiologist with one patient; 2) that the CAS encourages the development of trained and certified AAs whose role is clearly to assist anesthesiologists and NOT to become independent practitioners. In the area of monitoring of patients under anesthesia our current guidelines state that the anesthesiologist, must remain continuously present in the OR except under emergency conditions. The recommendation is that this be altered to allow the monitoring to be delegated to an AA, under certain guidelines, thus allowing the anesthesiologist to temporarily leave the OR remaining immediately available to return."



In my opinion I think there will still be a large demand for the physician anesthesiologist. There will be a great deal of them retiring in the next 10 years or so. Even with the increasing roles of AA there will still need to be physician anesthesiologists available to supervise those with less training. I have heard that in the U.S despite the usage of nurse anesthetists there is still a large demand for physician anesthesiologists, just look at the number of residency spots in the U.S match.

Canada is a lot more restrictive on other health care providers compared with the US. Legally, CRNA's (certified RN anesthetists) cannot work in Canada, as far as I know. GP's can do an extra year of fellowship training and work as GP-anesthetists, although this usually takes place in more remote communities that don't have access to anesthesiologists.

Could this change? It could, but it's probably not anywhere near as likely in Canada. Even then, in the US (where the HMO competition and insurance pressures provide HUGE incentives to minimize costs to maximize profits), CRNA's have not managed to displace MD anesthesiologists to a great degree. Anesthesiologists are not going unemployed in the US, nor are they starving for a lack of good jobs.

Ian

This may be changing. Check out the following website:

www.school.nursing.ubc.ca...ioner.html

Apparently, if these NPs are anything like the ones that are in the US they will be allowed almost near autonomy in practicing in rural areas, where a shortage of FPs currently exists.

Heya,

Thanks for the heads-up on that. I went and poked a little into the Nurse Practitioner link that you enclosed. It looks like UBC and UVic have combined to offer a program that will take in 15 nurse practitioner students a year. I had a great deal of difficulty figuring out what the scope of clinical practice would be for each Nurse Practitioner.

The most detailed thing (which isn't all that helpful) I could find was within the UVic School of Nursing Questions and Answers on Being a Nurse Practitioner website, was the following:

WILL THE NP DESIGNATION GIVE ME MORE MEDICAL SKILLS/KNOWLEDGE?

Because the NP role overlaps with that of a physician, particularly in relation to assessment, diagnosis, treatment and prescribing, the NP program will provide you with more medical knowledge and skills than you would obtain in our ANP program. It is important to recognize, however, that the NP role is an advanced nursing role and the competencies to practice safely and effectively as a nurse practitioner include advanced nursing competencies as well as medical knowledge and skills. Nurse practitioners are nurses first.


WHAT KIND OF JOBS WILL I BE ABLE TO GET WITH THE NP DESIGNATION?

As a family nurse practitioner, you will be able to work in a variety of primary care settings including clinics, community health centres, rural hospitals, ambulatory care settings, outpost stations, and perhaps in long term care institutions. To the extent that acute care settings may be interested in hiring family nurse practitioners with primary health care skills, then there may also be openings in acute care settings.

Ian

This already exists in Canada though as far as I am aware only in Quebec. Here we have Anesthesia Assistants who are respiratory therapists with additional training. It's great because you can trade off for breaks and lunch. When there is a resident and an AA in a room the staff person is only around for induction and extubation. So there is a downside as you get less teaching.