B.C. Health Minister Mike de Jong says he's dead serious about introducing nurse anesthetists into the B.C. health care system and not just using it as a political strong-arm tactic in the heated dispute with anesthesiologists.
"This is a matter which has engaged my attention for many months now," de Jong said in an interview, "and I will tell you candidly that, confronted by the threat of withdrawal by anesthesiologists, combined with the under-utilization of nurse practitioners, it provoked additional research on my part.
"As a consequence, I am serious about pursuing this," he said, referring to exploring an expanded role for specialized nurses.
De Jong first brought up the idea a few weeks ago when he told a media scrum at the legislature that the government was "prepared and preparing" to give nurses an expanded scope of practice to act as anesthetists.
In the United States, there are as many certified registered nurse anesthetists (CRNAs) - 40,000 - as there are physician anesthesiologists. De Jong concedes that giving nurses such an expanded role would require legislative change and a special training program, but he is prepared for both.
"We are in the process of developing a contingency plan and an option that would see a whole other group of professionals acquire the skills that they have in the U.S. to provide, not all of these services, to be sure, but a good chunk of the anesthesiology services that are required," de Jong said, just days before B.C. anesthesiologists were set to withdraw elective services. The government subsequently got an interim court injunction stopping the job action; another B.C. Supreme Court hearing is set for April 18 to 20.
Anesthesiologists are hoping to avoid a court case by getting standing before a conciliator who is working with government and the B.C. Medical Association on a new contract.
The health minister's revelation was a surprise, even to nurses. The last time the College of Registered Nurses - which regulates the profession - had discussions with government about nurse anesthetists was before the 2010 Winter Olympics, when emergency planning was an issue.
B.C. would become the first jurisdiction in Canada to use nurse anesthetists.
Asked why nursing leaders and organizations wouldn't have known about de Jong's intentions before now, given the government's enthusiasm, Ministry of Health spokesman Ryan Jabs said:
"Well, it's true it hasn't reached the consultation stage, but it's not an intimidation tactic. Government has been exploring the feasibility of this for some time."
Dr. Jeff Rains, head of the BC Anesthesiologists Society, has said he isn't opposed to nurse anesthetists, but the timing of de Jong's musings on hiring them suggests it is an intimidation tactic. "It's unfortunate one would use a threat like that to bully and intimidate physicians," he said.
Cynthia Johansen, CEO/registrar of the College of Registered Nurses of BC (CRNBC), said she couldn't comment on the matter until the government decides what to do.
"We're aware of the ministry's interest in the possible introduction of nurse anesthetists. As regulators, we would become involved should this profession come into fruition."
There are about 200 Nurse Practitioners (NPs) in B.C. Although they have advanced postgraduate education, they are not trained in providing anesthesia services.
In the U.S., there are 112 nurse anesthesia programs. It takes six or seven years of undergraduate and graduate degree education and practical experience to become a CRNA - one or two years less than doctors who practise anesthesiology. In the U.S., nurse anesthetists are paid an average of about $150,000 and doctor anesthesiologists are paid, on average, about twice that.
Two oft-cited U.S. studies have shown that there is no significant difference in the quality and safety of care when nurses provide anesthesia instead of doctors. But doctors have medical degrees before taking residency training in anesthesiology, so contend they're better able to handle complex cases and react to unexpected, rare emergencies in the operating room.
American CRNAs can either be independent or provide care with doctor oversight, providing either "medically directed" or "supervised" anesthesia services, depending on what model hospitals use. The medical direction model usually means one anesthesiologist directing up to four CRNAs, while the supervisory model means one anesthesiologist directing more than four CRNAs.
The B.C. government does not yet have a plan for how it might use nurse anesthetists. De Jong said without a training program, it's possible B.C. could save the trouble and cost of training and invite foreign-educated nurse anesthetists to apply for jobs here. Their credentials would, however, have to be checked by the CRNBC.
The BC Nurse Practitioner Association (BCNPA) said it has not engaged in discussions with government on the matter and it doesn't want to get embroiled in the dispute between government, the BC Medical Association and hundreds of anesthesiologists over fees and staffing levels.
It appears NPs are not even relishing the prospect of taking on anesthesia since the association already has its plate full just getting NPs integrated into primary health care settings.
"Nurse anesthetists are used in other jurisdictions, but are not a priority in B.C. Nurse Practitioners are underemployed and with approximately 250,000 British Columbians with no primary health care provider, NPs can provide a valuable service to patients," the BCNPA says in a statement.
According to the association's annual report, about seven per cent of NPs in B.C. are unemployed.