Minn. Doctors Question Nurses Giving Spinal Pain Injections

Updated: 04/21/2014 10:50 PM
Created: 04/21/2014 4:47 PM
By: Maarja Anderson

A subsection of a large bill going through the Minnesota legislature is causing quite the stir in the health care industry.

The bill (HF 435/SF 511) defines the duties and regulation of advanced practice registered nurses (APRNs). APRNs include nurse midwives, nurse practitioners, clinical nurse specialist, and nurse anesthetists. Supporters of the bill say it removes barriers for APRNs by allowing them to do certain work without a collaborative agreement with a physician.

But it's a section regarding registered nurse anesthetists that has doctors in the field of interventional pain medicine worried.

"Not everything in the state capitol is a matter of life or death, but this qualifies," said Dr. Louis Saeger, the president of the Minnesota Society of Interventional Pain Physicians.

Leaders in the field are traveling the state with a skeleton and needles. They're trying to show lawmakers just how dangerous their work can be.

"The thing about interventional pain management is that if an injection or procedure is done even one millimeter off target it can be the difference between pain relief, serious injury or death," said Dr. Andrew Will, the president of the Minnesota of Physical Medicine and Rehabilitation Physicians.

The subsection would allow registered nurse anesthetists (CRNAs) to deliver nonsurgical treatments for chronic pain.

Saeger said nurses aren't trained to do the procedures.

"We do not need to lower the standards for a highly complex medical sub-specialty that involves but not limited to highly technical, potentially dangerous procedures," said Saeger.

The Minnesota Association of Nurse Anesthetists (MANA) is a statewide professional organization of CRNAs. They support the legislation, saying the bill would allow for greater access to health care in rural areas.

Julie Hendricks, a CRNA in Duluth and on the association's board, said they aren't looking to expand their work. The group just wants to keep doing what they are doing.

"The CRNAs that are doing the simpler pain procedures right now don't want to harm their patients, but they want to be able to continue to provide the service to their patients that they've developed relationships with," she said.

Hendricks said CRNAs often administer labor epidurals, but a few specially trained in her field do administer pain injections, such as steroid injections.

The same bill died in the capitol four years because of the conflict around chronic pain medication.

The doctors in opposition to the subsection would like to do an informational audit with the Department of Health to get a better idea of what CRNAs do in Minnesota before they come up with an amendment.

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