Anesthesia: The Freedom to Practice (1 Class A CE)

Full practice autonomy for Certified Registered Nurse Anesthetists (CRNA) has been a point of debate for years. In the military, CRNAs are utilized as independent providers with full practice authority. In the Veteran Health Administration (VA), CRNAs practice in multiple practice models ranging from independent to medically directed. The VA has no standard practice model for CRNAs which has created system wide variations in CRNA practice. Inconsistencies in practice models exist between published VA Directives and the realities of day-to-day clinical practice. This quality improvement initiative recorded responses from nearly a quarter of all VA CRNAs to evaluate their levels of practice supervision, types of practice models, and other aspects of their practice. This analysis revealed inconsistencies in practices models across the country and highlighted areas of improvement for CRNA practice at the VA. With this clear picture of the actual practice of CRNAs within the VA, actionable next steps are offered with the hope of creating a rich practice environment for CRNAs at the VA and beyond.