CRNAs offer safe, affordable solution for care as rural hospitals continue to close

Reviewed by Kate Anderton, B.Sc. (Editor)Jan 24 2020

As the 2020 presidential candidates propose to fix U.S. healthcare, rural hospitals across the country continue to close. Since the 2018 midterms, about 66 percent of primary care physician shortages have been in rural and partially rural areas.

"Rural healthcare systems are fighting for their lives," according to Randall Moore, DNP, MBA, CRNA, and CEO of the American Association of Nurse Anesthetists (AANA). "Statistics remain grim."

Since 2010, 118 U.S rural hospitals have closed-;17 closures in 2019 alone, outpacing previous years. Rural closures also were associated with a 5.9 percent increase in inpatient mortality.

"Clearly the nation cannot continue to do what we have always done," said Moore. One solution gaining traction among U.S. policymakers is allowing advanced practice registered nurses, such as Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice providers, to practice at the full scope of their education and training.

Fortunately, CRNAs are in rural communities- we are the sole anesthesia providers in the majority of rural hospitals, providing care ranging from surgical, obstetrical, and trauma stabilization services to interventional diagnostic and pain management services."

Randall Moore, CEO of the American Association of Nurse Anesthetists

Charles Button, MBA, CEO of Regional Medical Center in Manchester, Iowa, said that utilizing a CRNA-only anesthesia delivery model "is the perfect solution."

Button's facility employs a team of CRNAs from Iowa Anesthesia, and no physician anesthesiologists. "It would become cost prohibitive to employ [physician] anesthesiologists," he said. "High quality anesthesia delivery is critical. You need someone 24/7, and CRNAs play an absolutely essential role. We are very impressed with the level of knowledge, availability, and personability of our CRNA team. We would not want it any other way. CRNAs are competent and affordable for rural America doing obstetric" and other anesthesia care.

Since 2000, 33 rural hospitals in Iowa have closed their OB department. Button attributes closures in part to staffing. In rural areas, "obtaining trained OB staff can be difficult and costly."

Requirements to increase physician anesthesiologist involvement in OB can threaten rural facilities with additional, unnecessary expenses and jeopardize access to care for maternal patients-;many of whom travel great distances for OB care.

"We work to provide a first-rate delivery experience for expectant families. Otherwise, why would we consider it? There's too much at stake. Rural [hospital administrators] must be confident and have the support needed, since they are not as resourced as city hospitals. Our community wants us to provide delivery services, and we want what the community wants," said Button, adding that his medical facility is building a new unit for its OB services.

Qualified to administer every type of anesthesia in any healthcare setting, CRNAs provide more than 49 million anesthetics every year in the United States.

Serving patients who need us most, when they need us and where they need us, is woven into the fabric of our profession. CRNAs have the skills, education and, most importantly, the will to provide rural patients with quality anesthesia care, particularly in labor and delivery anesthesia."

Kate Jansky, MHS, CRNA, APRN, USA LtC (ret), AANA president