Is There a ‘Nurse Anesthesiologist’ Controversy?

• As one state prepares to educate students in the field of nurse anesthesiology, a proposed statute change in Washington, D.C., has reignited a debate over the ‘nurse anesthesiologist’ title itself. 
• Both developments come on the heels of positive job projections for CRNAs and conversations about nurse practitioner authority and “scope creep.” 
• The medical community has argued on both sides of the issue. 

As one state prepares to educate students in the field of nurse anesthesiology, a proposed statute change in Washington, D.C., has reignited a debate over the title itself. 

Wilmington University, ChristianaCare and Anesthesia Services PA recently announced plans to launch the first nurse anesthesiology education program in Delaware. The program will take 36 months to complete and include more than 2,000 hours of clinical experience. 

“With an emphasis on evidence-based practice and patient-centered care, our graduates will be exceptionally equipped to provide high-quality anesthesiology services in diverse healthcare environments,” Dr. Denise Wells, Wilmington University vice president of academic affairs, said in a statement. “This collaboration aims to cultivate a local pipeline of skilled registered nurses who will advance their careers as CRNAs, contributing to Delaware’s workforce and the surrounding region.” 

At the same time, the title of “nurse anesthesiologist” has become a point of contention in the District of Columbia. The district’s health department, according to a Beckers Hospital Review report, is “considering allowing certified registered nurse anesthetists to use the title ‘nurse anesthesiologist.’” 

Both developments come on the heels of positive job projections for CRNAs and conversations about nurse practitioner authority and “scope creep.” 

Education and Workforce Landscape 

There are more than 100 accredited nurse anesthesia programs and fellowships, according to the most recent data from the Council on Accreditation. However, the Wilmington University program is awaiting its accreditation and cannot yet accept students. 

Wells told Delaware Public Media that the program is more than a pipeline for ChristianaCare to pull CRNAs from. The “specialty concentration” will fill a “growing need nationally” as well as within the state. 

“There’s a shortage of CRNAs, of anesthesiologists,” Wells said. “Many are nearing retirement. Some of those healthcare services are hit hardest in the rural communities, and therefore you see just exacerbated healthcare disparity.” 

What’s the Issue in D.C.?

The D.C. Department of Health issued a Notice of Proposed Rulemaking that would allow CRNAs to use the “nurse anesthesiologist” title.  

Current D.C. statutes state that CRNAs can “plan and deliver anesthesia, pain management, and related care to patients or clients of all health complexities across the lifespan” either independently or in “collaborative interaction with other healthcare professionals.” 

Also Citing D.C. statute, the AMA has argued that the term “anesthesiologist” is only to be used for “those authorized to practice medicine.” The AMA stated in an October letter to the health department that the term “nurse anesthesiologist” is “misleading and confusing to patients.” 

“As the various types of health care professionals continue to increase, it is no surprise that there is often confusion among the public about who is providing health care,” James L. Madara, M.D., wrote. “Despite the increased confusion, the good news is that patients do recognize the distinction between the terms ‘anesthesiologist’ and ‘certified registered nurse anesthetist.’” 

Madara cited a recent AMA study that found 70% of patients said an “anesthesiologist” was a physician and 71% said a “nurse anesthetist” was not a physician. 

He also cited the differences in education between CRNAs and anesthesiologists. 

The Nurse Anesthesiologist Debate 

In May 2019, the American Association of Nurse Anesthesiology Board of Directors voted to recognize “nurse anesthesiologist” as synonymous with “nurse anesthetist.” At the same time, the AANA acknowledged that practitioners “should be aware of and comply with the title requirements of federal and state laws and facilities in which they practice.” 

AANA President Jan Setnor, MSN, CRNA, told Beckers that nurses have administered anesthesia for more than 150 years, “making ‘nurse anesthesiologist’ an appropriate title.” 

Three years ago, AANA changed its name from the American Association of Nurse Anesthetists to the American Association of Nurse Anesthesiology, prompting condemnation from the American Society of Anesthesiologists (ASA). 

“AANA’s title misappropriation is a deceptive use of established medical terms and is part of their continuing push for nurse-only practice, which can jeopardize our patients’ safety and well-being,” ASA President Beverly K. Philip, M.D., FACA, FASA, stated at the time. “It also misleads the public and engages in the pretense that nurse anesthetists’ education and training are equivalent to that of physicians.” 

The Bottom Line

Universities nationwide have been announcing new nurse anesthesiology programs in recent months, supporting job outlook reports that indicate a positive trend for CRNAs. But debates about “scope creep” and the nuances of anesthesiologist titles persist in the medical community. 

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