Professionalism and the
CRNA
Jan Mannino, CRNA, JD

Professional Responsibilities
 Commitment to professional competence

Commitment to honesty with patients
 Commitment to patient confidentiality

Commitment to maintaining appropriate relations with patients
 Commitment to improving quality of care

Commitment to improving access to care
 Commitment to a just distribution of finite resources

Commitment to scientific knowledge
 Commitment to maintaining trust by managing conflicts of interest

Commitment to professional responsibilities

Professional Responsibilities
• Commitment to professional competence
• Commitment to honesty with patients
• Commitment to patient confidentiality
• Commitment to maintaining appropriate relations with patients
• Commitment to improving quality of care
• Commitment to improving access to care
• Commitment to a just distribution of finite resources
• Commitment to scientific knowledge
• Commitment to maintaining trust by managing conflicts of interest
• Commitment to professional responsibilities

Who Defines the CRNA
Profession?

The profession

The Professional Organization (AANA)
 Licensing Boards

Who Does NOT Define
CRNAs

Nursing

Medical anesthesia
 Medical licensure
 CMS
 Insurance companies

Accreditating Agencies

Hospitals and ASC Facilities

Legal Component

Practicing according to the standard of care of of the profession

Held to an anesthesia standard
 One of the few professions that is held to a medical standard

Reimbursement

Getting paid for the value of your education and functions

Do not undervalue administration of anesthesia

Hospital Privileges

How should we be classified?

Allied health?

Mid-level practitoners?

Physician extenders?
Anesthesia PROFESSIONALS (better word than provider)

Anti-trust Actions

Bhan case

Oltz case
 Minnesota case

Future Considerations

Whistleblower Lawsuits

Medicare Fraud and Abuse

OIG ADVISORY

Fee splitting

Company model
 Advantges for CRNA

Contract Negotiations

Critical to be considered a businessperson

Collect facts
 Know your worth
 Understand your opponent
 Set your limits

Perceptions

Nurses are not businesspeople

It is unprofessional to talk about money
 The physician takes all of the responsibility
 Difference between an hourly employee and a professional

Nurses eat their young

Professional Actions

Decorum

Dress
 Ask Smart Questions
 Understanding politics of the operating room
 Patient Advocacy

Final Thoughts

No one is happy for your success except your mother

The AANA is the Power of the Profession
 Get involved
 Always do great patient care

Final Thoughts

We would not be here today, except for:

Strong clinical skills

Basic education and Continuing education

AANA

Committed professionals

References

American Board of Internal Medicine Foundation.
American College of Physicians –American Society of
Internal Medicine Foundation. European Federation of
Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med.
2002;136(3):243 –246.