• Evidence-Based Policy Toolkit Supporting Full Practice Authority for Veterans Affairs Nurse Anesthetists

      Popoola, Mariyam I.; Amos, Veronica Y. (2020-05)
      Problem: The Department of Veterans Affairs (VA) Office of Inspector General’s (VA/OIG) (2017) audit of the Veterans Health Administration (VHA) for the fiscal year 2015 determined approximately 80% of newly enrolled veterans seeking care waited more than 30 days, and 53% of newly enrolled veterans seeking care finished their first appointment greater than 30 days over the established eligibility date. To address veteran’s access to care issues, the VA finalized a rule, RIN 2900-AP44, granting full practice authority to three roles of the VA’s advanced practice registered nurses (APRN) but excluded certified registered nurse anesthetists (CRNAs) (VA/OPA, 2016). Purpose: The purpose of implementing this evidence-based health policy toolkit was to provide resources on how to amend the current rule, RIN 2900-AP44, to include CRNAs. Methods: The health policy toolkit along with the evaluation survey (Appendix F) was implemented via SurveyMonkey. Data was also collected via SurveyMonkey. Results: The survey revealed (Appendix G, Figure 4) most participants, 83.3%, strongly agree granting CRNAs full practice authority will decrease delays in patient access to anesthesia care in the VA vs. 16.7% who strongly disagree. The survey (Appendix G, Figure 10) also revealed 83.3% of participants strongly agree and 16.7% agree the health policy toolkit is needed and will likely be supported by a vast majority of VA CRNAs in Maryland. Conclusion: Data analysis demonstrates there is a need for the health policy toolkit, and granting CRNAs full practice authority would decrease delays in patient access to anesthesia care in the VA.
    • Evidence-Based Policy Toolkit Supporting Prescriptive Authority for Maryland Nurse Anesthetists

      Njapau-Dove, Myra N.; Amos, Veronica Y. (2020-05)
      Problem: Current Maryland law does not grant Certified Registered Nurse Anesthetists (CRNAs) prescriptive authority thereby limiting the number of providers able to help combat the opioid crisis. With opioid-related overdose deaths at 29.7 per 100,000, Maryland is above the national average of 13.3 per 100,000 (National Institute on Drug Abuse, 2016). The lack of prescriptive authority also strains an already burdened healthcare system by further limiting access to care and medical services for patients in rural areas. Approximately 47 million people in the United States are considered vulnerable (low-income, Medicare and/or Medicaid recipients) and most of this population resides in areas where CRNAs are the sole anesthesia providers (Liao, Quraishi & Jordan, 2015). Purpose: The purpose of this project was to develop, implement and evaluate an evidence-based health policy toolkit. The toolkit would be a resource used when meeting with policymakers and petitioning them to support legislation to grant CRNAs prescriptive authority. Methods: The toolkit and an evaluation survey were sent by email to CRNAs who met the inclusion criteria. Survey responses were anonymous and captured using SurveyMonkey. Results were analyzed via Excel. Results: Survey results indicated that 57.1% strongly agreed while 28.6% agreed that CRNAs should have prescriptive authority and that the lack of it hinders both the CRNA profession and patient access to care. Results also indicated that 71.4% strongly agreed and 28.6% agreed that the toolkit was needed and would be supported by CRNAs in Maryland. Conclusions: Data analysis illustrated that the toolkit is a valuable resource and granting CRNAs prescriptive authority would help mitigate the opioid crisis, decrease healthcare costs as well as increase access to healthcare. At this time, the toolkit has won CRNA approval, but it is yet to be utilized