The State of Nurse Anesthetist Practice and Policy: An Integrative Review

The enactment of the Affordable Care Act in 2010 prompted the Institute of Medicine to release The Future of Nursing report to help guide the necessary changes in nursing to accommodate millions of newly insured individuals. A key point of the campaign was for advanced practice registered nurses (APRNs) to practice at the fullest extent of their licensure to meet the needs of the newly insured population. Certified Registered Nurse Anesthetists (CRNAs) experience the most restricted scope of practice among APRNs. An integrative review was conducted to examine CRNA practice and policy since The Future of Nursing was released. Ten research articles were included in the final review. Key findings related to CRNA practice and policy that emerged from the review were (1) patient complications and mortality rates are no different under the care of CRNAs compared with anesthesiologists; (2) CRNAs are more accessible to vulnerable populations and rural areas; and (3) state legislators are being influenced by factors other than evidence, such as strong professional group influence, to make policy decisions for CRNAs. Future interdisciplinary research investigating outcomes from the patients' perspectives could help remove bias and strengthen the evidence of the quality of care given by CRNAs.