Service through Advocacy, Education and Protection
Educating Legislators and Healthcare Workers to expand CRNA Practice Rights
Certified Registered Nurse Anesthetists Fact SheetHistory
Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years. The Certified Registered Nurse Anesthetist (CRNA) credential came into existence in 1956 and, in 1986, CRNAs became the first nursing specialty accorded direct reimbursement rights from Medicare. In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt-out of this facility reimbursement requirement. Prolific Providers CRNAs are anesthesia professionals who safely administer more than 50 million anesthetics to patients each year in the United States. As advanced practice registered nurses, CRNAs are among the nation's most trusted professions according to Gallup. Nurses have topped Gallup’s Honesty and Ethics list for 19 consecutive years and are ranked second in the 2021 U.S. News & World Report’s “Best Health Care Jobs” report. Rural America CRNAs represent more than 80% of the anesthesia providers in rural counties. Many rural hospitals are critical access hospitals, which often rely on independently practicing CRNAs for anesthesia care. Half of U.S. rural hospitals use a CRNA-only model for obstetric care, and CRNAs safely deliver pain management care, particularly where there are no physician providers available, saving patients long drives of 75 miles or more. Anesthesia Safety Numerous peer-reviewed studies have shown that CRNAs are safe, high quality and cost-effective anesthesia professionals who should practice to the full extent of their education and abilities. According to a 2010 study published in the journal Nursing Economic$, CRNAs acting as the sole anesthesia provider are the most cost-effective model for anesthesia delivery, and there is no measurable difference in the quality of care between CRNAs and other anesthesia providers or by anesthesia delivery model. Researchers studying anesthesia safety found no differences in care between nurse anesthetists and physician anesthesiologists based on an exhaustive analysis of research literature published in the United States and around the world, according to a scientific literature review prepared by the Cochrane Collaboration, the internationally recognized authority on evidence-based practice in healthcare. Most recently, a study published in Medical Care (June 2016) found no measurable impact in anesthesia complications from nurse anesthetist scope of practice or practice restrictions. Practice of Nursing CRNAs provide anesthesia in collaboration with surgeons, dentists, podiatrists, physician anesthesiologists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by a physician anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way. Autonomy and Responsibility As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. CRNAs are qualified to make independent judgments regarding all aspects of anesthesia care based on their education, licensure, and certification. They are the only anesthesia professionals with critical care experience prior to beginning formal anesthesia education. Practice Settings CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; ketamine clinics; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities. Military Presence Nurses first provided anesthesia on the battlefields of the American Civil War. During World War I, nurse anesthetists became the predominant providers of anesthesia care to wounded soldiers on the front lines. Today, CRNAs have full practice authority in every branch of the military and are the primary providers of anesthesia care to U.S. military personnel on front lines, navy ships, and aircraft evacuation teams around the globe. Cost-Efficiency The CRNA model, where anesthesia delivery is staffed and directed by CRNAs avoids duplication of services, promotes efficient utilization of anesthesia providers, and reduces cost. As interests compete for limited resources in healthcare, groups and facilities seeking to minimize the cost of anesthesia services can achieve excellent cost savings as compared to other anesthesia practice models by the implementation of an all CRNA model. Direct Reimbursement Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program and CRNAs have billed Medicare directly for 100% of the physician fee schedule amount for services. In 2020, U. S. Congress passed legislation that included a nondiscrimination provision to prohibit health plans from discriminating against qualified licensed healthcare professionals, such as CRNAs and other non-physician providers, solely based on their licensure. Supervision Opt-Out In 2001, CMS changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt-out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria:
In March 2020, CMS suspended the supervision requirements for CRNAs to increase the capacity of the U.S. healthcare delivery system during the COVID-19 pandemic. Several governors also removed many barriers to CRNA practice during this crisis. According to a January 2021 CMS report, CRNAs were among the top 20 specialties that served the most beneficiaries in non-telehealth care between March 2020 and June 2020—the height of the COVID-19 public health emergency. Malpractice Premiums On a nationwide basis, the average 2020 malpractice liability insurance premium for self-employed CRNAs was 36 percent less than it was in 1988. When trended for inflation through 2020, the reduction in premiums was even greater at 71 percent. AANA Membership More than 57,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or more than 80 percent of all U.S. nurse anesthetists). More than 40 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole. Education Requirements It takes a minimum of 7-8.5 calendar years of education and experience to prepare a CRNA. The minimum education and experience required to become a CRNA include:
Certification Before they can become CRNAs, graduates of nurse anesthesia educational programs must pass the National Certification Examination. CPC Program, formerly Recertification The Continued Professional Certification (CPC) Program, which replaced the former recertification program, focuses on lifelong learning and is based on eight-year periods comprised of two four-year cycles. Each four-year cycle has a set of components that include:
* Beginning Jan. 1, 2022, all students matriculating into an accredited program must be enrolled in a doctoral program. Updated: February 1, 2021 AMERICAN ASSOCIATION OF NURSE ANESTHETISTS 222 South Prospect Avenue, Park Ridge, IL 60068-4037 Phone (847) 692-7050 ▪ Fax (847) 692-6968 ▪ Email [email protected] |
Who We Are:
NVANA Mission Service through Advocacy, Education and Protection NVANA’s Vision NVANA: CRNAs collaborating to be Nevada’s
NVANA’s Desired Outcomes NVANA exists to create an environment where:
NVANA’s Lobbyist: Paul Young, J.D. Partner at Tom Clark Solutions NVANA’s Association Manager: Susan S. Radwan, CAE, SMP Government Relations Leads: Robert Erickson, CRNA PROTECTED: NVANA BYLAWS BYLAWS OF THE NEVADA ASSOCIATION OF NURSE ANESTHETISTSARTICLE I. NAME
This organization shall be known as the Nevada Association of Nurse Anesthetists hereby written as NVANA, hereinafter referred to as the Association. ARTICLE II. PURPOSE
The purpose of this Association shall be to promote the best interests of its members while at all times cooperating with the American Association of Nurse Anesthetists, hereby written as AANA, facilitate cooperation between nurse anesthetists and the medical profession, the nursing profession, hospitals and other agencies interested in nurse anesthesia. In general, the purpose of the association shall be to advance the science and art of nurse anesthesia. ARTICLE III. MEMBERSHIP
SECTION A: Qualifications Membership in this Association and procedures with respect to admissions to membership, maintenance of membership, classes of membership, qualifications thereof, and the exercise of the privileges thereof, shall be such as stipulated in the bylaws of the AANA. Any NVANA member whose nursing licensure is revoked by the Board of Nursing as a result of a felony conviction shall be immediately terminated from the association dating from the time of conviction. SECTION B: Equal Opportunity This Association shall not discriminate against any member or applicant for membership on the basis of race, color, religion, age, sex, marital status, or national origin. SECTION C: Conduct of Members Upon the determination of the Board of Directors of Association, the conduct of any member shall appear to be in willful violation of the Bylaws of this Association or the Bylaws of the AANA, the Board of Directors may by vote of two-thirds (2/3) of the entire Board, suspend of expel such member(s) according to the procedure set forth in the AANA Bylaws. SECTION D: Dues Dues and the payment thereof for the NVANA shall be such as are stipulated in the bylaws of the AANA. SECTION E: Fiscal Year The fiscal year of the NVANA shall (be) begin on August 1 of each year. ARTICLE IV. OFFICERS OF THE ASSOCIATION
The officers of this Association shall be a President, a President-Elect, Secretary and Treasurer. The office of the Secretary and Treasurer may be combined into a single office known as the Secretary/Treasurer. SECTION F. Officers 1. Prior to the Annual meeting, by mail ballot, the members shall elect the Following Officers; President, President-elect, Secretary and Treasurer, who shall serve the term specified for his/her office in these Bylaws beginning immediately following such meeting. The Office of the President shall automatically be filled by the former President-elect following such meeting. This Association will be dissolved upon notification to AANA. The President shall serve for a period of three (3) years consecutively. The President shall: Preside at meetings of this Association and of the Board of Directors. Appoint standing committees and special committees, subject to the approval of the Board of Directors. Be a member ex-officio of all committees, except for the Nominating. Prepare and read at each Annual meeting a report on the work of the year. Keep the President-elect informed of Association affairs. Appoint a new Continuing Education Director for each term of three years when it falls in his/her term of office. Initiate conference calls. The President may appoint an officer or will assume the duties of any officer that is not filled through regular elections process. 2. The President-elect’s term shall begin at the Annual meeting following the beginning of the second year of the President’s term of office and shall conclude upon his/her ascendance the following Annual meeting to the office of the President. The President-elect shall: Assume the duties of the President in the event the President is unable to so serve. Represent this Association at the AANA Assembly of States or appoint a representative from the Board of Directors. Approve selections of program Chairpersons for the Annual meeting of the years of his/her Presidency. 3. The Secretary shall serve for a term of two (2) consecutive years. The Secretary is eligible for re-election but shall not serve more than two (2) consecutive terms. The Secretary shall: Review the minutes of the meetings of this Association and the Board of Directors. Participate in conference calls as initiated by the President or the Board of Directors. Serve NVANA as is deemed timely and warranted by the Board of Directors. 4. The Treasurer shall serve for two (2) consecutive years. The Treasurer is eligible for re-election but shall not serve more than two (2) consecutive terms. The Treasurer shall: Give a written report at each Annual meeting and/or upon request of the Board of Directors. Explore the options and invest the monies of the Association as directed by the Board of Directors. In conjunction with the Board of Directors and President, review the books of the Association at the time of each Annual meeting and a formal audit shall be performed every three (3) years, unless otherwise advised by the President and/or the Board of Directors. 5. Additional duties of each officer shall be such as their titles, by general usage, would indicate and as may be assigned by the Board of Directors. 6. Each officer shall deliver any Association property and records to a successor or to the President within one (1) month after the Annual Meeting. 7. Removal or Resignation from Office 7(a) Any Officer or Director of this Association may be removed from office at any time by affirmative vote of the members present and voting on such removal for conduct not in the best interest of this Association. Whenever such removal is contemplated, the Board of Directors shall notify the Officer or Director in writing of the reasons for the proposed action and of the time and place of meeting of the members at which removal is to be considered. Such notice shall be delivered at least thirty (30) days prior to the meeting. At [this] meeting, the accused Officer or Director shall be afforded the opportunity to respond to the stated reason(s) and to be heard in his/her defense prior to the vote. Such removal of an Officer of Director in this manner shall be ratified by the affirmative vote of a majority of the members present and voting on such removal at the general membership meeting. 7(b) Any Officer or Director may tender his/her letter of resignation to the President of the NVANA at any time during his/her tenure. Any letter of resignation received by the President shall be affective when received by the President. Any Officer or Director, upon the tender of his/her letter of resignation, shall immediately return to the President any and all NVANA property. 7(c) Resignation by Non-Actively: Any Office or Director who fails to fulfill his/her duties, as defined within these Bylaws, shall be considered to have resigned from the NVANA as defined in paragraph 7(b). Failure to of duties shall include, but not be limited to, missing two (2) consecutive meetings or three (3) meeting total will be considered to have tendered his/her resignation. SECTION G: Board of Directors The Governing Body of this Association shall be vested in a Board of Directors consisting of four (4) Directors and the following officers of this Association; President, President-elect, Secretary and Treasurer. The Governing Body shall have the following duties and responsibilities: Control and management of funds and property of this Association. Selection of place for deposit of funds. Provide for annual compilation statements by an independent accountant. Formal audits by an independent accountant will be requested as deemed necessary by the Governing Body. Prescribe the amounts to be allowed toward defraying expenses of representatives to the annual convention of the AANA or to other meetings. Conduct the general business of this Association. Conduct business between meetings by mail or other means of communication. Fill vacancies of the Governing Body, with the exception of the office of President; the member so elected shall serve until the next election. In the event of a vacancy in the office of President, the President-elect and the Board of Directors shall elect another President-elect. In the event of vacancies occurring in committees, the President, subject to approval of the Governing Body, shall appoint members to fill such vacancies. In the event that a member of a committee fails to carry out the assignment, the Governing Body shall request the resignation of the member and select a replacement. Maintain a valid electronic mail address on file with the Secretary. Directors shall be elected at the Fall meeting for a four (4) year term of office. Two (2) of the Directors shall be elected in one year and two (2) Directors shall be elected in the next two (2) years, continuing this rotation. No Officer or Director may simultaneously be an Officer or Director of the AANA. The Governing Body shall meet immediately before and after the Fall meeting of this Association. Special meeting of the Governing Body may be called at any time by the President of upon request of a majority of the Directors. Notice of any special meeting setting forth the time and place thereof shall be sent to each Director at least ten (10) days before the meeting. A Director may waive such notice, and attendance of a Director at a meeting shall constitute a waiver of notice of such meeting, except where a Director attends a meeting for the purpose of objecting to the transaction of any business because the meeting is not lawfully convened. Neither the business to be transacted at, nor the purpose of any special meeting of the Directors need by specified in the notice or waiver of notice of said meeting. Business requiring special attention of the Governing Body may be conducted via electronic mail (e-mail) and or teleconference at any time by the President or upon request of a majority of the Directors. Motions created by business so conducted will be approved in the following manner: A majority of Board members will reply with notice of their approval/disapproval of the decision via their duly registered electronic mail address to the President, with a copy to the Secretary, within three days of electronic mail transmission of the notice by the president. If a majority is not reached in three days, this deadline may be extended at the discretion of the President. Any vacancy in the Board of Directors and any directorship to be filled by reason of any increase in the number of the Directors shall be filled by appointment of the Governing Body. A majority of the Governing Body of the Association shall constitute a quorum for the transaction of business. SECTION H: Board Policies Policies and procedures addressing the conduct of Association business, including activities not specifically mentioned in these bylaws, will be maintained by the Secretary in the following manner: All policies and procedures must be approved by a majority vote of the Board. Policies and procedures will be reviewed and either re-approved, revised or Deleted annually. Revised or deleted policies and procedures will be maintained by the Secretary as electronic records in an archive. ARTICLE V. COMMITTEES
SECTION A:Standing Committees The standing committees shall be as follows:
Members of committees shall serve for two (2) years or until their successors are appointed or elected Ad hoc committee members may remain on the committee until the issue is resolved. SECTION D: Duties The Chairman of the committee shall:
ARTICLE VI. MEETINGS AND VOTING
SECTION A: Meetings 1. The Association’s Annual Meeting shall be held, usually, the third week in September. The Governing Body and the President shall determine the time and place of the annual meeting. Notice of the annual meeting shall be given to each voting member at least 30 days in advance of the meeting. Notice may be given via USPS, email, or facsimile. 2. The purpose of the annual meeting shall be to receive: the reports of officers, the election results, reports of committees if applicable, and to conduct such other business to come before the members. 3. In the absence of a quorum: The Governing Body shall conduct the annual meeting and mail a written report of the proceedings to the members. In the absence of a quorum, any actions that require the vote of the membership shall be submitted to the membership by mail/and or electronic mail with directives regarding the deadline for returns. Members may choose to vote by mail, or vote by such electronic means available, telephone, fax or e-mail. SECTION B: Voting
ARTICLE VII. GENERAL PROVISIONS
SECTION A: Legal integrity of the Association The Association shall be a non-profit organization. All funds, property and assets of whatever kind or description, or wherever located, presently owned or hereafter acquired by the Association are, and shall remain, the sole and separate property of the Association and shall be held in trust for the membership thereof. ARTICLE VIII. PARLIAMENTARY AUTHORITY
In the absence of any provision in these Bylaws, all meetings of this Association, the Board of Directors, and Committees shall be governed by Robert’s Rules of Order, newly revised. ARTICLE IX. AMENDMENTS
These Bylaws may be amended at any business meeting of this Association by a two thirds (2/3) majority of those present and voting, provided notice of the proposed amendment has been mailed to members at least thirty (30) days prior to the date of the meeting by the President and the Governing Body. ARTICLE X. DISSOLUTION
The Governing Body shall, in the event of dissolution of the Nevada Association of Nurse Anesthetists, distribute the Association’s assets in accordance with state and federal laws. APPENDIX
STANDING RULE ORDER OF BUSINESS
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