With clinical opportunities sometimes in short supply, nursing programs have been turning to alternate ways for their students to get real-world experience. At Virginia Western Community College, nursing students have helped with on- and off-campus COVID-19 vaccination clinics. Courtesy of Virginia Western Community College.

I recently read with interest Megan Schnabel’s Feb. 18 article, “National nursing shortage highlights challenges of expanding nursing programs” in the Cardinal News and agree with many of the points made. However, the article failed to mention a much needed change that could easily reduce the nursing workforce shortage: removing the antiquated statutory requirement that is Virgnia’s supervision mandate.

In Virginia, more than 1,500 highly trained certified registered nurse anesthestists (CRNAs) are required to be supervised by a physician while administering anesthesia. Numerous studies conducted over previous decades show that CRNAs safely provide quality care while administering anesthesia without this additional level of supervision. In addition, more than 40 states already have removed or never required CRNA supervision in the first place. Unfortunately, Virginia still has this unnecessary mandate in place. 

As I speak with CRNAs across Virginia, it is clear the current way of doing business is not sustainable. Soaring costs at hospitals and care facilities are causing critical resources to be stretched thin. Using every advanced practice nurse to the full extent of their training and licensure will eliminate redundancies, lower costs and remove barriers for hospitals and care facilities. 

By removing this burdensome and antiquated mandate, Virginia would create a space for collaborative anesthesia care where all members of the care team are being used to their full potential. This would allow more operating rooms to open, increasing access and easing the shortage of people available to administer anesthesia. 

Requiring CRNAs to be “supervised” by the surgeon or proceduralist – whose last exposure to anesthesia may have been in medical school – to comply with an outdated mandate makes no sense. We know that many of these providers are “supervising” in name only. This often creates a false sense of unsubstantiated increased liability that can discourage the use of CRNAs. We already know the system works without the mandate because that model is currently in place at our nation’s military facilities and it would easily work in other settings from hospitals to dental offices.

Our armed forces depend on CRNAs as the primary providers of anesthesia, where they practice independently without a burdensome oversight mandate like Virginia’s. As CRNA Jan Setnor,  a retired U.S. Air Force colonel who served on the frontlines in Afghanistan, said, “You see the abilities of CRNAs and the advanced practice nurses in the military, and then when you come home, you fall under obligatory supervision of somebody who has not been there but still believes you require their supervision.”

I have my own experience with this as a CRNA in the Air Force where I was deployed as the sole anesthesia provider in charge of hundreds of troops and also worked in several facilities staffed only by CRNAs. The model clearly works for the military and if used across Virginia, the impact would be tremendous!

As a nurse anesthesia educator in Virginia, I see many graduates each year leave Virginia for other states that allow them to practice to the full extent of their training and licensure. If Virginia allowed full practice authority, that would foster an environment that would keep these CRNAs here in Virginia and help address the nursing workforce shortage.

CRNAs have earned the trust of the public and patients by providing excellent patient care and safety. Now is the time to end the burdensome mandate that Virginia health care facilities provide unnecessary supervision for CRNAs. Let’s give CRNAs full practice authority so we can lessen nursing shortages across Virginia. Learn more about CRNAs and the need for full practice authority at www.VirginiaCRNA.org.

Adrienne Hartgerink

Adrienne Hartgerink is a Certified Registered Nurse Anesthetist and president of the Virginia Association of Nurse Anesthetists. She also is the associate program director for the Nurse Anesthesia Program...