As care models evolve and policy barriers shift, certified registered nurse anesthetists are taking on broader, more autonomous roles within collaborative teams, according to Chris Gill, PhD, CRNA.
Dr. Gill, chief credentialing officer of the National Board of Certification and Recertification for Nurse Anesthetists, joined Becker’s to discuss the evolving role of CRNAs.
Question: Could you talk about the unique role of CRNAs in dealing with anesthesia shortages, particularly in rural or smaller hospitals?
Dr. Chris Gill: The percentage of CRNAs providing care in those settings exceeds that of anesthesiologists.
Struggling health systems — rural hospitals, critical access hospitals — may not have the financial resources to employ anesthesiologists or successfully recruit them.
We see more CRNAs there. CRNAs are essential for surgical throughput and access.
We’ve also seen an increase in coverage of off-site and non-OR anesthesia — GI, interventional radiology, electrophysiology, ASCs, joint replacements. That’s exacerbated the workforce shortage alongside increasing demand and an aging workforce. Many factors are bubbling up at the same time, creating a bit of a perfect storm.
Q: With that in mind, are there any new areas of skill you’re seeing becoming more important for CRNAs today versus five or ten years ago?
CG: I’d actually answer that simply: no. CRNAs have always been trained to be full-scope providers.
There have been artificial barriers where they weren’t practicing to their full scope. But a couple of things have happened recently — like COVID.
During the pandemic, constrained healthcare systems were looking for critical care providers who could do airway management, central line placement and life-saving procedures. That was a time when CRNAs saw relaxation of some imposed barriers.
Policy makers saw that expansion without negative effects to patients. That was an impetus to improve full practice authority in key areas. Healthcare facilities want providers operating at the top of their license. That’s good for recruitment, retention and patient care.
And independent practice isn’t truly independent — it’s autonomous practice, but we’re always working in a healthcare team.
At the hospital where I work, we had a terrible time recruiting CRNAs and anesthesiologists. There we all work independently alongside one another. That created a deep sense of respect among CRNA and anesthesiologist colleagues and allowed the system to function without extreme cost or duplicative staffing models.
Q: How do you see the CRNA workforce evolving over the next five years, given all these changes?
CG: I see policy thinking becoming more cemented: CRNAs providing anesthesia, anesthesiologists providing anesthesia. The numbers have always been roughly equal.
In ACT models, we’re missing out on one provider actually being able to perform an anesthetic. That constrains the number of ORs functioning each day — one OR can be five to 10 cases. That’s five to 10cases not getting done.
I see everyone practicing to the full scope of their training. I see malpractice insurers, state legislators and insurers valuing each person equally.
