Providing affordable anesthesia services in Alabama is a tricky proposition. A large rural population and a shrinking number of providers and surgical centers have led to disproportionate patient access to care. In an attempt to address shortages in anesthesia providers across the state, Governor Kay Ivey signed into law Alabama House Bill 268 on April 18th, 2022. Certified Registered Nurse Anesthetists (CRNAs) are now allowed to provide anesthesia services in coordination with a physician, podiatrist, or dentist, instead of exclusively alongside an anesthesiologist. This law recognizes what professionals in the field have long known, that CRNAs’ training, education, and expertise qualify them to provide anesthesia services when an anesthesiologist is not present. Now that we are two years into the provisions established by HB 268, let’s take a look at what’s changed and how Alabama patients are benefitting.
HB 268: The Provisions
In the healthcare system, CRNAs have a specialized role as a providers of anesthesia services. As opposed to the two to four years of schooling required for an RN, a CRNA will take seven to eight years of education and experience in order to practice. RNs provide many different functions in patient care both inside and outside of the operating room, while CRNAs provide the patient with anesthesia care before, during, and after a procedure. This is an important responsibility as the unpredictable nature of anesthesia requires special care and attention.
Before HB 268, CRNAs were only able to practice while under the supervision of an anesthesiologist. This cramped the ability of most hospitals and surgical centers to operate at their peak efficiency. COVID-19 exacerbated these operational issues as it strained an already stretched healthcare system. While others in the medical field have long known of the importance of CRNAs, through HB 268 the Alabama legislature is recognizing these roles and responsibilities formally. To be clear, however, CRNAs cannot provide anesthesia services with no anesthesiologist, physician, podiatrist, or dentist present; one of these supervising roles still must still work in conjunction with the CRNA. The text of the bill stipulates:
“When an anesthesiologist is not physically present, the working relationship between a physician, a podiatrist, or a dentist and a certified registered nurse anesthetist licensed to practice in this state. Each contributes his or her respective expertise in the provision of patient care, which includes the discussion of patient treatment, diagnosis, and consultation.” (x)
In addition to practicing while under the supervision of a physician, podiatrist, or dentist, CRNAs can also now order medications and tests for patients during the anesthesia process, which includes the care before and after the actual surgical procedure. This expands the CRNAs' roles to match their expertise.
Significance and Impact
There are many challenges facing anesthesia providers in the field today, including staffing shortages, Medicaid reduction, and an increase in demand due to an aging patient population. Let’s look at the numbers. According to US News & World Report, there are only 651 licensed anesthesiologists in Alabama to serve the 128 hospitals and eight integrated delivery networks in the state. The math simply doesn’t work. So, when the state’s 2,032 active CRNAs are allowed to practice at their full capacity, Alabama as a whole benefits. While CRNAs are not a full replacement for anesthesiologists, HB 268 is an acknowledgment that the anesthesia delivery system in Alabama needs CRNAs to operate effectively. The expansion of the abilities of CRNAs through HB 268 in Alabama has been championed by many in the medical field as part of a solution to address critical issues in the state.
"Removing barriers to CRNA practice will allow Alabama healthcare facilities to maximize their workforce and increase access to safe, affordable care for our patients,” Wesley Canerday, CRNA, president of the Alabama Association of Nurse Anesthetists, said in the news release. "By signing this important legislation, Alabama recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification."
CRNAs are one of the most trusted professions and remain on the frontline as the only anesthesia providers at many of Alabama’s critical access hospitals, and HB 268 recognizes this. Two years since the passing of this historic bill, Alabama patients have had increased access to affordable, safe anesthesia services.
