The Tipping Point in Health Care: Using the Full Scope of Practice of Certified Registered Nurse Anesthetists as Advanced Practice Registered Nurses

摘要

Malcolm Gladwell (2002) described the tipping point phenomenon as "the moment of critical mass, the threshold, the boiling point" (p. 12). That moment has arrived in the health care system. The idea seems so simple: Use certified registered nurse anesthetists (CRNAs) and other advanced practice registered nurses (APRNs) to their full scope of practice to provide high-quality, cost-effective care with increased access for patients that will be necessary with the implementation of the Affordable Care Act. The Institute of Medicine (IOM) report in 2010 justifies just that. The report recommends, "APRNs should be able to practice to the full extent of their education and training," (IOM, 2010, para. 2) but nothing is ever that simple. Let's look at the evidence of anesthesia delivery models, some of the challenges and barriers, and then explore some possible solutions.