Impact of Legislation on Scope of Practice Among CRNAs
Impact of Legislation on Scope of Practice Among CRNAs
SOP generally refers to the legal parameters within which a provider is expected to practice. The legal authorization to practice as a CRNA is almost universally found in the individual states' regulations set forth by their respective board of nursing and/or Nurse Practice Acts. Although SOP and prescriptive authority are specifically defined within these legislative documents, other regulations such as insurance mandates, Centers for Medicare and Medicaid Services policies, and hospital bylaws greatly affect reimbursement and actual anesthesia practice. Individual hospitals are charged with determining credentialing limitations within their facility through the bylaws and approval of the medical staff boards. Despite federal and state laws regarding SOP, individual group practices and hospitals often decide how to interpret those laws, which frequently leads to a reduction on SOP despite more liberal legislative rules.
SOP is a multidimensional phenomenon that is difficult to measure directly or assign to a given anesthesia delivery model (anesthesia care team, supervisory, or independent practice). For example, it refers to the regulatory and statutory limitations on practice; the supervision or collaborative requirements for nurse anesthetists to practice; and the individual's knowledge, skills, and competency related to patient care. The concept of SOP also goes beyond measuring what a provider is clinically allowed to do from a licensing perspective. A subjective component related to professional respect, autonomy, authority, and accountability must also be considered. The concept of an SOP visual analog scale (VAS) was developed because it is ideally suited to determine an individual's SOP within the regulatory confines of their unique practice environment and according to their personal perceptions of the supervisory interactions with the collaborating physicians if applicable. A VAS can be used to quantify a global measure of SOP, which incorporates multiple aspects of practice simultaneously. The SOP-VAS, a novel tool, has been validated for use with practicing CRNAs.
Defining SOP
SOP generally refers to the legal parameters within which a provider is expected to practice. The legal authorization to practice as a CRNA is almost universally found in the individual states' regulations set forth by their respective board of nursing and/or Nurse Practice Acts. Although SOP and prescriptive authority are specifically defined within these legislative documents, other regulations such as insurance mandates, Centers for Medicare and Medicaid Services policies, and hospital bylaws greatly affect reimbursement and actual anesthesia practice. Individual hospitals are charged with determining credentialing limitations within their facility through the bylaws and approval of the medical staff boards. Despite federal and state laws regarding SOP, individual group practices and hospitals often decide how to interpret those laws, which frequently leads to a reduction on SOP despite more liberal legislative rules.
SOP is a multidimensional phenomenon that is difficult to measure directly or assign to a given anesthesia delivery model (anesthesia care team, supervisory, or independent practice). For example, it refers to the regulatory and statutory limitations on practice; the supervision or collaborative requirements for nurse anesthetists to practice; and the individual's knowledge, skills, and competency related to patient care. The concept of SOP also goes beyond measuring what a provider is clinically allowed to do from a licensing perspective. A subjective component related to professional respect, autonomy, authority, and accountability must also be considered. The concept of an SOP visual analog scale (VAS) was developed because it is ideally suited to determine an individual's SOP within the regulatory confines of their unique practice environment and according to their personal perceptions of the supervisory interactions with the collaborating physicians if applicable. A VAS can be used to quantify a global measure of SOP, which incorporates multiple aspects of practice simultaneously. The SOP-VAS, a novel tool, has been validated for use with practicing CRNAs.
Source...