European Journal of Anaesthesiology 2018; 35:158-164
Both physicians and nurses have administered anaesthetics in the US, these practices vary in different nations. There are numerous historical factors, as well as global and local contexts which influence the scope of their practice. This article was a review of practice in the Group of 7 Nations (Canada, France, Germany, Italy, Japan, UK, USA)
Anaesthesia in the US is provided by physicians and nurses who have obtained advanced training in anaesthesia. To train, they have a minimum qualification of a bachelor’s degree in nursing, a valid state licence and 1-year experience in critical care nursing. Their length of training is 24-36 months, administering an average of 850 anaesthetics. Since 2006 there is a recertification programme to verify maintenance of standards.
British tradition generally excludes nurses from administration of anaesthesia. Within the anaesthetic team there are another three roles : Physician’s Assistant Anaesthesia PA(A), Operating Department Practitioner (ODP), and Anaesthesia/recovery room nurses. PA (A)s provide GA/RA/LA under direction and supervision of anaesthetist in a 2:1 room model. Their training includes healthcare practitioner degree (nurse/ODP), health science or biomedical science degree (in 2015, 165 PA(A)s in practice in UK).
Since WWII there has been training of non-physician anaesthesia providers, and the first nurse anaesthetists were pioneers in anaesthesia specialty. There is a national examination to become IADE (Infirmier Anesthésiste Diplômé d’État), and they work in supervised role but administer GA and RA.
Anaesthesia became a specialty later than other countries. Surgeons usually controlled anaesthesia and high casualties and shortage of trained medical officers entailed the practice of non-medical anaesthetists. Currently anaesthetics in Germany administered primarily by physicians but there are anaesthesia nurses who form part of peri-operative care team.
Italy and Japan
Anaesthesia is given by physicians and no formal training programme for specialised nurses. Nursing staff assist physicians but there is no mandatory training for this role.
Medical training and working practice is comparable to the UK. A nurse practitioner training in anaesthesia pilot programme was discontinued due to lack of interest
Group of 7 are an informal group of the largest advanced economical nations, but there are stark differences in working practice of healthcare delivery. This is due to historical and geopolitical factors. Anaesthesia has developed as a specialty due to advances in surgical technique, asepsis and a favourable cultural context, but the practitioners involved in its administration have been driven by warfare, gender hierarchies, presumed preference for physicians and other socio-demographic traits. In the future it may be the rise in healthcare costs and the failure to recruit that leads to the widening of practice of nursing staff administering anaesthesia.
Journal Club Discussion
There was discussion regarding the differences in training amongst physician’s assistants and ODPs/anaesthetic nurses, and the importance of critical care training which is mandatory in other countries. There was also discussion regarding the scope of practice relating to the pre-operative assessment and the perceived need for physician-led administration of anaesthesia when things go wrong, especially medico-legally.
Summary by Dr E Morino. Journal Club meeting 15 March 2018.