During SB 1336 there was a great deal of discussion about modernizing the laws for CRNAs, many of which remain outdated. This was sometimes framed as "breaking up the team” or "changing standards" - a negative narrative that went so far, that in unprecedented fashion, national ASA leaders published an inflammatory video that failed to even speak to the issues at hand in Arizona. Dr. Plagenhoef stated to his members that CRNAs believed anesthesiologists don't matter. (direct download).
Nothing could be further from the truth. That’s why, also in unprecedented fashion, nearly 100 physicians and surgeons – including anesthesiologists – went on record in supporting our recent legislative efforts.
As the current president of Arizona Association of Nurse Anesthetists (AZANA), the sole organization representing Certified Registered Nurse Anesthetists (CRNAs) in Arizona, I am compelled to speak to this issue. I also approach this from a personal standpoint. I count many anesthesiologists as close, personal friends and some as clinical mentors. These anesthesiologists have always supported my full scope of practice and a teamwork approach - even when I work in teams where I am the only anesthesia provider, just like over 40% of practicing CRNAs.
The AZANA prioritizes patient safety, and as such promotes teamwork among all professionals involved in surgical and anesthesia care to promote the best possible patient outcomes. AZANA believes every professional on the team – CRNA, physician, nurse, surgeon, and others - should be giving their maximum contribution – so the team can offer our patients maximum benefit. The AZANA summarily rejects zero-sum scenarios, or an “us versus them” dynamic.
Removing members of the healthcare team is a preposterous notion based in fear. AZANA wants everyone on the team – using all their skills, education, and experience to do what’s best for the patient.
Let’s get real for a moment about the conflict between CRNAs and anesthesiologists: there are approximately equal numbers of physicians and CRNAs administering anesthesia both in Arizona and in the United States, and demand for our services is only increasing. It would be physically impossible for either profession to replace the other, and the AZANA has no interest in continuing the fight which has gone on since the start – and continued throughout - the 20th century.
AZANA’s efforts are patient-centered, and we advocate for patient safety and care by ensuring CRNAs are able to provide anesthesia services, ironically, often in teams with anesthesiologists. The “us verses them” narrative needs to stop. (direct download) – and we should all be thinking “patients first” - which is “win-win” for all parties.
Let’s imagine what we could accomplish together. With all the passion we put into patient care and at the capitol, together we could be one of the strongest advocacy groups in healthcare. We could tackle the toughest topics in the industry and make real progress – instead of spending hundreds of thousands fighting each other. How many times have we said that defensive medicine unnecessarily adds to healthcare costs? How often have we loathed the complexity and difficulty of anesthesia reimbursement? How many clinical advancements are we missing because we are not working together?
There’s one standard – one duty - in anesthesia care, regardless of model or setting: – putting patients first to ensure a safe anesthesia and surgical experience. It’s teamwork – real teamwork, where every member is valued and respected, where their contributions are welcome and not artificially limited for the sake of hierarchy – that ensures that patient care remains at the center of everything we advocate for as healthcare professionals.
Joseph Rodriguez, CRNA, AZANA President