According to a news release by the American Association of Nurse Anesthesiology (AANA), over 260 healthcare and community groups have endorsed the Improving Care and Access to Nurses (ICAN) Act. The legislation is designed to remove practice barriers for advanced practice registered nurses (APRNs), including Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists. The organizations are calling on Congress to pass this legislation.
Healthcare Innovation recently spoke with the president of AANA, Jan Setnor, about the new legislation.
Could you explain what the ICAN Act entails?
The ICAN Act was introduced last year or two years ago. For some unknown reason, it did not pass through. Its proposed federal legislation aims to expand the ability of advanced practice nurses, including CRNAs, to practice to the full extent of our education and training within the Medicare and VA systems.
Why wasn’t it implemented at that time?
It was just delayed. We had bipartisan support, but we did not have enough support. It was very puzzling to me as well that it didn’t go through, because it’s a very simple and logical ask. That’s the reason that it’s being reintroduced now, especially with the changes in Medicare.
We’re looking at the ability to remove barriers to care. We’re looking at increasing access to care given by APRNs. We’re looking for support in the veterans’ healthcare system and enhancing the Medicare and Medicaid Services.
How would this bill increase access to healthcare?
There are a number of ways, such as cutting the red tape for advanced practice nurses, in particular, CRNAs—the ability to practice to the full extent of your education and training. When you look at the way the practice is now, 49 states don’t require any supervision from a physician anesthesiologist, and it’s very minimal supervision in general. When CRNAs go to school, the training that we get helps us become autonomous providers. Having the ability to practice to the full extent really does increase access to care; it opens up the ability for CRNAs to practice without having a physician watching their work. Two people are doing the same job, so it’s redundant and an expensive care model. To remove the supervision, removes that added layer of payment that goes in there. It’s very wasteful.
What role does Congress have in addressing current healthcare challenges?
We’re looking at the DOGE model. We’re looking at efficiencies and anesthesia. We have an efficiency model where the most expensive model is medical direction or supervision, where you have a physician watching CRNAs or other nurses. You have a physician watching them work, and you’re getting paid the same to do the same job. And that’s rather wasteful.
There’s a lot of peer-reviewed data that shows that CRNAs, when practicing autonomously, provide the same level of care as our physician colleagues do, so the patient outcome is the same. Patient satisfaction is really high. It’s just the ability to cut the red tape and get rid of that supervision model. CRNAs do the majority of the anesthesia.
When you look at the fact that the heaviest concentration of physicians is going to be in zip codes in the urban areas, whereas CRNAs and APRNs practice in more rural areas, that’s where the greatest area of need is. We practice in the areas of critical access hospitals and rural hospitals.
One of the biggest areas where access could definitely be increased is the area of pain management, and these rural areas don’t have the ability to practice autonomously. It would help with the opioid crisis. Instead of throwing more opioids and drugs at these individuals who have pain issues, we can send them to CRNAs. They can help manage their pain by utilizing other methods of treatment, multimodal anesthesia, and different types of injections and treatments. That alone would increase the access and the ability to care for individuals, especially in the rural areas.
Can you speak about the controversy around the bill?
There’s always controversy when nurse practitioners are looking at the ability to practice to their full scope. The controversy mostly comes from the American Medical Association (AMA) and the American Society of Anesthesiologists (ASA), which are looking at our practice models. They call it scope creep, where they feel that the advanced practice nurses are practicing outside of our scope. I can assure you we are not practicing outside of our scope.
To speak specifically to the nurse anesthesia community: To get into the program, we have an average of four to 10,000 hours of critical care experience before entering the program. We have a Bachelor of Nursing degree. Our medical colleagues come through medical school but may not have the critical care content when they enter the program. When we enter the anesthesia program, we use the same textbooks and train on the same equipment, and when we graduate, we are expected to practice at the same standard of care as our physician colleagues. So, there is no difference there.
So, to say it’s scope creep, that’s not true. We practice the art of nursing; they practice the art of medicine. But in essence, we are practicing the same medical treatment when taking care of patients in the operating room.
What additional thoughts do you have regarding this?
Anesthetists are anesthesia- and airway experts. We have 10,000 hours of critical care content before we ever touch our first patient in anesthesia school. We go through rigorous training in the program. We come through it with the kind of training so that when we graduate, we can independently make life-saving critical care decisions in a split second. That’s our training, our area of expertise, so our safety is unrivaled. If you’re being cared for by a nurse anesthetist or other APRN, you are in good hands.
