(Nagelhout & Plaus, 2010 Pg2). Thus, nurse anesthesia became a very autonomous practice from the advent. .
Background.
Social and Political Factors.
Today anesthesiology as a medical specialty is prestigious, well "paying, and the American Society of Anesthesiology (ASA) is strong. However, it's finding that its scope of practice is overlapping with nurse anesthesia. This has resulted in conflicts, as turf wars are being fought by both sides. It has since advocated for policies that maintain supervision requirements for nurse anesthetists. In fact, it opposed Centers for Medicare and Medicaid Services (CMS) proposal to remove federal Medicare supervision requirement for nurse anesthetists (CRNAs) in 2001, result of which is the current opt-out policy (Mason, Leavitt, & Chaffee, 2012 pg 282). .
The American Association of Nurse Anesthetists (AANA from here on) for its part has adopted a policy of networking with nursing organizations and other groups, in order to implore legislators to remove restrictive barriers such as supervision. AANAs concern has always been, intense lobbying by organized medicine dictating status of CRNA supervision at the state level (Mason, Leavitt, & Chaffee, 2012 pg. 284).
As a supporter of NC HB 181, ASA is clearly going against the interest of APRN goals and by default promoting a policy that would result in maintaining the current limited access and high cost of anesthesia care. In getting the state legislature to codify supervision requirements into state law, the ASA is surely torpedoing any future and current attempts by AANA in getting the state of NC to "opt out ". .
Economic Factors.
Non-medically directed Anesthesia administered by CRNA's is a bargain compared to Anesthesiologist only anesthesia. It is also of high quality and indistinguishable from other practice modalities i.e. CRNA supervised by Anesthesiologist at different ratios. In fact, the income of a CRNA is only one-third that of anesthesiologist on average (Mason, Leavitt, & Chaffee, 2012 pg.
