HP 3 RESP 1 RUBRIC: 20 pts Exceptional One post written in response to fellow learners’ post between 100-150 words. Response is substantive insightful a

HP 3 RESP 1 RUBRIC: 20 pts

Exceptional

One post written in response to fellow learners’ post between 100-150 words. Response is substantive insightful and contain at least one reference

INITIAL QUESTION:

1. Locate and post a pdf or link of an official governmental healthcare policy. What governmental agency has stewardship over this policy? How has the policy changed over time? What are the consequences of failure to comply with the policy? What steps would need to be followed to alter the policy? Identify the links between this policy, clinical practice and organizational, population, and fiscal issues.

2. Take a moment to think of the potential impact that the policy you are exploring could have on a vulnerable population. Try to find a news story or blog post through internet search that discusses an actual case where this policy will make an impact (positive or negative). Complete the following learning activities with regard to this scenario:

a. Provide a link to the news story or blog and then summarize the scenario you found.

b. Summarize the nurse’s role in this situation.

c. In what ways could the nurse play a role in system or policy development/evaluation to promote a positive patient outcome in this scenario?

3. How can nurses collaborate with other disciplines to influence healthcare policy?

*** Provide scholarly references to support your answer from your book and from other scholarly sources.

STUDENT’S POST:

Official Governmental Healthcare Policy (Links to an external site.)  

In 2001, the Federal Government ruled that each state can decide if Certified Registered Nurse Anesthetists (CRNAs) can practice anesthesia without physician supervision (Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services, 2001). 

The Department of Health and Human Services Centers for Medicare and Medicaid Services has stewardship over this policy. The policy has not changed over time, since it states that each state can decide “which professionals would be permitted to administer anesthetics, and the level of supervision required for practitioners in each category, recognizing States’ traditional domain in establishing professional licensure and scope-of-practice laws” (Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services, 2001, para. 3).

What has changed over time is each state’s vote to opt-in or out of the decision. Also, each hospital within the state can impose more strict supervision rules. For example, in 2009, the state of California opted out of the physician requirement for supervision of CRNAs, and may still receive Medicare Part A and Medi-Cal federal dollars as reimbursement. The California Governor was required to send a letter to the Centers for Medicare and Medicaid Services (CMS) attesting that the state’s medical and nursing boards were consulted and that opting out was in the best interest of the residents of the state (California Association of Nurse Anesthetists [CANA], 2013). However, at many hospitals in California, including Zuckerberg San Francisco General Hospital (ZSFG), CRNAs are under medical direction. 

Clinical practice, organizational, and fiscal issues are linked to this policy. If CRNAs do not require medical supervision in order to practice anesthesia, then anesthesia services become less expensive and less they need staff to deliver anesthesia. Currently, the supervision of CRNAs at ZSFG requires a 2:1 ratio, meaning that two CRNAs are supervised by one anesthesiologist. At many other institutions (that also choose to demand medical supervision), the ratio is 4:1 (four CRNAs supervised by one anesthesiologist). It’s easy to see that if there was no requirement for supervision, it would save cost and staffing needs. 

State boards of nursing are “government agencies created by legislatures to protect the public through the regulation of nursing practice” (Milstead, 2016, p.25). 

https://www.aana.com/docs/default-source/sga-aana-com-web-documents-(all)/801-fact-sheet-concerning-state-opt-outs-pdf.pdf?sfvrsn=450743b1_26 (Links to an external site.)

https://www.medac.com/california-supreme-court-upholds-physician-supervision-opt-out-decision/ (Links to an external site.)

Take a moment to think of the potential impact that the policy you are exploring could have on a vulnerable population. Try to find a news story or blog post through internet search that discusses an actual case where this policy will make an impact (positive or negative). Complete the following learning activities with regard to this scenario:

Provide a link to the news story or blog and then summarize the scenario you found.

The Veteran’s Health Administration was urged to expand full practice authority to CRNAs after granting some APRNs full practice authority in 2016. This was denied to CRNAs initially but was temporarily granted in 2020 during the COVID-19 pandemic. This full practice authority would make a positive impact on access of anesthesia services for Veterans (Underwood, 2021). 

https://underwood.house.gov/media/press-releases/underwood-urges-veterans-health-administration-permanently-expand-full-practice

Summarize the nurse’s role in this situation.

In this situation, the CRNA first has a role to provide safe anesthesia care to all patients. Maintaining excellent outcomes and quality care is the first step to pushing any agenda. Second, the CRNA should be a paying member of the AANA, which is the national organization that advocates for CRNAs:

“concerning issues such as patient safety, access to quality healthcare services, scope of practice, educational funding, reimbursement, and many other legislative and regulatory matters in Washington, D.C. and across the country. As such, the AANA tracks state and federal legislation and regulation affecting nurse anesthesia practice, develops and carries out federal grassroots lobbying efforts, coordinates meetings with federal legislators and agency officials, testifies at federal and state legislative and regulatory hearings, and educates CRNAs and state associations regarding effective advocacy strategy and practice (American Association of Nurse Anesthetists” [AANA], 2021, para. 1). 

In what ways could the nurse play a role in system or policy development/evaluation to promote a positive patient outcome in this scenario?

The nurse plays a role in policymaking by establishing contact with legislators and agency directors. CRNAs can join or donate to the CRNA Political Action Committee (PAC). The CRNA PAC makes donations to CRNA-friendly political candidates for the US House and Senate and federal legislators. As a CRNA, donating to the PAC or attending the mid-year assembly national advocacy conference on Capitol Hill would provide support to advancing the interests of nurse anesthetists. This promotes positive patient outcomes by giving more people access to anesthesia care. https://www.aana.com/advocacy/federal-government-affairs/member-resources/crna-advocacy-and-crna-pac

How can nurses collaborate with other disciplines to influence healthcare policy?

Being the largest group of healthcare workers in the world, nurses bring numbers to the policy arena. By creating positive relationships with stakeholders, we can lead the movement of research, professional development, and education. We must establish contacts with legislators and political officials while exemplifying ethics and morals as patient advocates in order to mold the policymaking agenda to meet our needs (Milstead, 2016).

References

American Association of Nurse Anesthetists. (2021). CRNA advocacy and CRNA PAC. https://www.aana.com/advocacy/federal-government-affairs/member-resources/crna-advocacy-and-crna-pac (Links to an external site.)

California Association of Nurse Anesthetists. (July, 2013). Important information for California healthcare facilities California opts out of the Federal Reimbursement Condition for CRNA supervision. https://canainc.org/compendium/pdfs/C1.g.%20CMS-Supervision-Exemption_FAQs_Info-for-Facilities_09-02-13.pdf

Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services, 42 C.F.R. Part 416, 482, 485 (2001). https://www.govinfo.gov/content/pkg/FR-2001-11-13/html/01-28439.htm (Links to an external site.)

Milstead, J.A. & Short, N.M. (2016). Health Policy & Politics: A Nurse’s Guide. (5th ed.). Burlington, MA: Jones & Bartlett Learning. 

Underwood, L. (2021, March 16). Underwood urges Veterans Health Administration to permanently expand full practice authority to Certified Registered Nurse Anesthetists at VA facilities [Press release]. https://underwood.house.gov/media/press-releases/underwood-urges-veterans-health-administration-permanently-expand-full-practice

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