CRNA Practice Models: Scope, Cost, and Team-Based Care
This paper examines the role of Certified Registered Nurse Anesthetists (CRNAs) across multiple anesthesia delivery models in the United States. Beginning with a historical overview of nurse anesthetist practice dating back more than 150 years, the paper covers the founding of the American Association of Nurse Anesthetists, the scope of CRNA and APRN practice under the Affordable Care Act, and the Institute of Medicine's recommendations for full-scope practice. It also analyzes the cost-effectiveness of CRNAs compared to anesthesiologists, reviews evidence on patient safety outcomes, and concludes with the importance of interprofessional team-based care principles in perioperative anesthesia delivery.
- Introduction: A Century and a Half of Nurse Anesthesia: Historical origins and legal battles of CRNA practice
- Scope of CRNAs and APRNs: ACA, IOM report, and CRNA practice settings
- Cost Effectiveness of Nurse Anesthetists: Medicare reimbursement and cost comparison to anesthesiologists
- CRNAs in Team-Based Patient Care: Interprofessional teamwork principles and perioperative roles
- Conclusion: CRNAs as interchangeable, cost-effective anesthesia providers
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What makes this paper effective
- The paper grounds its argument in historical context, tracing CRNA advocacy battles from 1912 to the present to establish professional legitimacy before making contemporary policy claims.
- It integrates quantitative evidence — such as 32 million annual anesthetics administered and comparative training timelines — to support its cost-effectiveness argument in a concrete, accessible way.
- The conclusion effectively broadens the argument from economics to interprofessional practice values, connecting IOM principles to team-based care roles and CRNA professional identity.
Key academic technique demonstrated
The paper demonstrates evidence-based policy argumentation: it moves from historical precedent, through regulatory and clinical scope, to a comparative cost-effectiveness analysis, before concluding with normative recommendations. This structure mirrors the logic of health policy writing, where empirical evidence is marshaled to justify practice and reimbursement decisions.
Structure breakdown
The paper opens with a historical narrative establishing CRNA professional legitimacy, then transitions into a policy-focused section on scope of practice under the ACA and IOM framework. A dedicated cost-effectiveness section compares CRNAs and anesthesiologists on training duration, reimbursement, and outcomes. The final section addresses interprofessional team care before a brief conclusion synthesizing the argument. Each section builds on the prior one, moving from history to evidence to practice recommendations.
Introduction: A Century and a Half of Nurse Anesthesia
Nurse anesthetists across the nation have administered anesthesia to patients for a century and a half — long before it became a physician specialty. Conventional training occurred in military or hospital-based programs ranging from several months to several years in length. Surgeons strongly supported Certified Registered Nurse Anesthetist (CRNA) practice rights and abilities, and continue to do so today.
Dr. George Crile, founder of the Cleveland Clinic Foundation and a general surgeon, was targeted in 1912 by physicians in Ohio through the state's Attorney General and Medical Board, owing to his advocacy of nurse anesthetists. Dr. Crile, together with Lakeside Hospital where he worked, was threatened with the withdrawal of physician payments and hospital appropriation funding in retaliation for his support of nurse anesthetist training and employment. Following a lengthy five-year struggle, the doctor and his hospital prevailed in their nurse anesthetist advocacy.
Crile's leading nurse anesthetist, Agatha Hodgins, who had held the position since 1908, went on to found the National Association of Nurse Anesthetists, which later became the American Association of Nurse Anesthetists (AANA). During this same period, other lawsuits and sanctions were brought against individuals who trained or employed nurse anesthetists in California, Kentucky, Pennsylvania, and New York (Malina & Izlar, 2014).
References
AANA. (2010). Patient-centered care: CRNAs and the interprofessional team. American Association of Nurse Anesthetists, 2.
Hogan, P. F., Furst Seifert, R., Moore, C. S., & Simonson, B. E. (2010). Cost effectiveness analysis of anesthesia providers. Nursing Economics, 28(3), 159–169. http://doi.org/10.1093/bja/aeh240
The future of nursing: Leading change, advancing health. (2010). Institute of Medicine. Retrieved March 11, 2016, from
Malina, D., & Izlar, J. (2014). Education and practice barriers for certified registered nurse anesthetists. The Online Journal of Issues in Nursing, 1–8.
Massie, M. L. (2014). The tipping point in health care: Using the full scope of practice of certified registered nurse anesthetists as advanced practice registered nurses. Springer Publishing Company, 7(1).
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