History of CRNA’s

For over 150 years Certified Registered Nurse Anesthetists (CRNA’s) have been putting people to sleep in the United States. The Anesthesia care in the U.S. was mainly provided by trained nurses supervised by surgeons until anesthesiology was developed as a medical specialty.

 Nurses first gave anesthesia in the Civil War while they were caring for wounded soldiers. Surgeons sought out nurses to give anesthesia due to the high morbidity and mortality rates they were experiencing during surgery. In 1877, Sister Mary Bernard became the first nurse to specialize in anesthesia at St. Vincent’s Hospital in Erie Pennsylvania.

The first CRNA known as “the mother of anesthesia” was Alice Magaw in 1893. The title was given to her by Dr. Charles Mayo due to Mary’s magnificent mastery of “open drop ether.” She founded the first CRNA program 1909 by  at St Vincent’s hospital in Portland Oregon. Originally, it was a course consisting of 6 months that focused on relevant anatomy, physiology and anesthetics.

Since World War I, nurses were the principal providers of anesthesia during surgical procedures. CRNAs have been wounded in military combat, have been prisoners of war and died for their country. There are even 2 names of CRNA’s engraved on the Vietnam War Memorial 1^st Lts. Kenneth R. Shoemaker, Jr., and Jerome Olmstead. Several CRNA’s also served as chiefs in the Nurse Army Corp during the Vietnam War.

 Agatha Hodgins founded the National Association of Nurse Anesthetists on 1931 in Cleveland Ohio. The first certification exam for CRNA’s was administered in 1945.

Safety stats

CRNAS were found to be the most cost effective sole anesthesia provider in the model of anesthesia delivery with no measurable difference in the quality of care per a study in the Journal of Nursing Economics. There are many studies that have also found no difference in care between nurse anesthetists and physician anesthesiologists according to a literature review by the Cochrane Collaboration. A recent study in Medical Care (June 2016) noted there was no measurable impact in anesthesia complications exhibited by CRNAs scope of practice or practice restrictions.

Reimbursement rights

It wasn’t until 1986 that CRNAs became the first nursing specialty granted direct reimbursement rights from Medicare. U.S. Congress passed a legislation in 2020 that prohibits health plans from discrimination against qualified licensed healthcare professionals which include CRNAs and other non-physician healthcare providers.

Supervision Opt-Out

The federal physician supervision rule for CRNAs was changed in 2001 by CMS. State governors are allowed to opt-out of the facility reimbursement requirement used by surgery centers and ambulatory surgery centers by meeting the following criteria

1. Consult the state boards of medicine and nursing about issues related to access to and quality of anesthesia services in the states.
2. Determine that opting out is consistent with state law
3. Determine that opting out ids in the best interest of the state’s citizens.

Which states have opted-out?

Approximately 19 states including Guam have opted-out of the federal physician supervision  requirement. These states include Arizona, Oklahoma, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, and Kentucky. However, due to the COVID-19 crisis in 2020, CMS suspended the supervision of CRNA’s in order to further increase the U.S. healthcare delivery system. A January 2021 CMS reports from the COVID-19 crisis stated that CRNAs were among the top 20 specialties that served the most beneficiaries in non-telehealth care between March 2020 and June 2020.

What does it take to be a CRNA?

Today all 50 states in the U.S. utilize CRNAs. CRNA programs take into account the complex matter of providing anesthesia care and the curriculum that is necessary for nurse anesthetists. In order to practice, CRNAs must hold a master’s degree in nursing, but more employers are preferring those who hold a doctorate of nursing practice (DNP) degree with national certification. On average, registered nurses entering nurse anesthesia programs have been in practice for approximately 2.9 years.

On average, graduates of nurse anesthesia programs complete 9369 hours of clinical experience which included 733 hours during the baccalaureate nursing program, 6032 hours as a critical care registered nurse, and 2604 hours during their nurse anesthesia program. Various CRNAs pursue a fellowship program specializing in pain management

Average CRNA salary

Between 2019 and 2029 the Bureau of Labor Statistics (BLS) projects a 45 percent job growth for CRNA’s. CRNAs are the highest nursing profession with an average mean salary of $189, 190.00 per year.

Employ a CRNA today

CRNAs can be considered one of the most trusted professions per Gallup poll results. Places like rural America benefit from CRNAs due to their cost savings and reimbursements as compared to employing an anesthesiologist. Many locum Tenens employ CRNAs to work in various areas around the U.S. and offer the benefits of work travel opportunities.

If you are a CRNA looking for Locum Tenens opportunities or a healthcare facility looking to employ a CRNA please contact a recruiter at Medcare Staffing.

The post Who’s Putting You To Sleep? The Value Of Certified Nurse Anesthetists (CRNAs) In Clinical Practice. appeared first on Medcare Staffing.

-Albert Einstein

Tax season is here. It can be an overwhelming time for many healthcare providers. Especially if you are a private contracted employee.

Taxes are the biggest expense of your life

At one point in time, almost every healthcare provider in the United States has worked under a W2 status. Your employer took care of all your tax deductions and those included: state income tax, federal income tax, and social security tax. On pay day, you’d see a huge portion of your wages going to the taxman and you were left with some scraps.

Healthcare providers employed by a locum tenens agency are usually characterized as ‘independent contractors’ and will file their taxes under a 1099 status. Basically, no taxes are deducted from your paycheck by your employer. But that doesn’t mean you get to hit your favorite shoe store or casino on pay day. You still gotta pay Uncle Sam!

The Power of the 1099 status

Lowering your tax bill as much as possible ‘legally’ is the name of the game when it comes to filing your taxes as a 1099 status. Once you categorize yourself as an independent contractor under a 1099 status, you are still responsible for paying taxes at the end of the year. If you don’t plan accordingly, your tax bill at the end of the year can be a total shocker.

How can I lower what owe Uncle Sam every year?

Pure and simple, register yourself as a Limited Liability Company (LLC) and have your checks made out to your LLC instead of to you directly. An LLC is a business structure whereby the business owners are not personally liable for the company’s debts or liabilities. LLC’s are hybrid entities that combine the characteristics of a corporation with those of a partnership or a sole proprietorship.

LLC’s are incredibly popular. They provide the same liability as a corporation but are easier and much more cost efficient to run. Your LLC business is responsible for covering all expenses for running it.

 What can you deduct as an LLC?

• Rental space or home office: a portion of your home mortgage can be deducted.
• Charitable giving
• Professional liability insurance
• Tangible property: property purchased for the LLC’s use
• Professional expenses: this includes professional licenses, engaging in professional development such as professional journals
• Meals and entertainment: half of the cost of meals and entertainment related to prospective business with customers. Meals with employees are deducted in full.
• Independent contractors: can be deducted in full.
• Automobile expenses, gas and mileage
• Travel for business
• Interest: if you use a credit card for your business expenses and purchases, the interest acquired can be deducted.
• Equipment
• Taxes incurred in business operations
• Advertising and promotion
• Office supplies
• Parking and meters
• Postage
• Education: this includes CE’s, CME’s and conferences.

How to start an LLC

There are several different ways to start an LLC. You can pay a third party like Legal zoom to do it for you. There are also various online companies that can offer you this service. It’s a simple process, you choose a name and pay a fee.

You can also start an LLC on your own. Go to your home states secretary of state’s website, create and account and fill out the allotted forms. Articles or organization can be provided to you with in 24-48 hours

The Pros of filing as a 1099 and starting your own LLC

An article published on the website EliteNP states “ a self-directed IRA or a 401k paid for by your company can result in significant retirement savings. The maximum contribution to a self-directed 401k is $56,000 a year compared to $18,500 for the W2 employee. This lowers your

taxable income.” 

The Cons of starting an LLC

Profits are subject to social security and Medicare taxes. In some cases, the owner of an LLC may pay an increased amount of taxed than owners of a corporation. Salaries and profits of an LLC are subject to self-employment taxes which are equal to 15.3 percent.

Putting money aside for tax time

Ideally, if you are a 1099 private contractor and starting an LLC, you will want to put money aside to that when tax day rolls around, you are adequately prepared. Approximately 30 to 40 percent of your income should be set aside.

Side gigs will help

Providing another service under your LLC will help you get the most benefits. For example, you can provide consulting services, be a freelance writer, or open up a travel business and see a few clients per month. You are more than just a private contractor; you are a legitimate business.

Perhaps Benjamin Franklin said it best, “nothing is certain in this world except death and taxes.” Understanding what your tax benefits when working as a healthcare provider and categorized as private contractor who is filing your taxes under a 1099 status is key to success. The savings benefits of starting your own LLC with the addition of side businesses in the end will prove to be satisfactory.

The post Tax Season, 1099 Status and Starting An LLC, What All Healthcare Providers Need To Know appeared first on Medcare Staffing.

Is going back to the bedside as an RN a wise decision?

Personally, I’ve volleyed back and forth from the NP role to the RN role in various different positions. That’s the beauty of nursing, you have lots of opportunities. Each time I went back to the RN role, I learned something valuable that I would not have learned in the NP role. At the time, I chose to make these shifts in my career, I was looking for a break from being an NP. Sometimes, I was looking for greater compensation and a better work life balance.

One of the biggest problems with rebounding your career is your ego. Your career should not define who you are. Instead, a healthy work life balance should dictate how you maneuver your life.

COVID-19 pandemic brought many opportunities.

Nurse Practitioners took advantage of the COVID-19 pandemic crisis opportunity to go back to the RN role on the frontlines. One NP reported “It was a nice break. It felt good getting overtime pay again.” Another NP stated, “I’m thankful for the opportunity to go back to bedside nursing as an RN during this COVID crisis. Although, I would not want to leave my NP hospitalist position to be an RN full time again.”

The CARES Act signed into law a 2 trillion-dollar economic relief and public healthcare package which also increased the need for more nurses at the bedside. Hospitals and staffing companies recruited nurses to work on the frontlines paired with robust salaries and accommodations. Petitions were even being circulated so that AANP (American Academy Of Nurse Practitioners) should strengthen the bedside numbers by having Nurse Practitioner’s act as bedside nurses during this crisis. Hospitals are now offering higher pay to recruit nurses due to overproduction of NP’s and RN’s leaving the bedside to pursue an NP degree.

Transitions Can Be Difficult

The transition from the RN role to the NP role can be a difficult one.  Responsibilities are greater in the Nurse Practitioner role. In some cases, you may be the main provider in your practice setting.

Changes in schedule, going from 12-hour shifts, 3 days a week to 8 hours 5 days a week may also cause conflict. Charting at home, working longer than 40 hours and not getting paid overtime are common complaints from new Nurse Practitioners. One NP in a Facebook group stated she had to take out several loans to pay for her college tuition and NP program. She further stated she felt the pay from NP to RN was the same in her state of residence. She was also having difficulty finding a job as an NP and regrated leaving the bedside.

Carpe Diem (Seize The Day)

COVID-19 brought with it a flurry of new RN positions. Some of these may include PCR testing, vaccine administration, and public health educator. The demand for ICU nurses is increasing day by day. If you find yourself furloughed, out of an NP job, or just wanting to take a break from the NP role, it’s best to call a locum Tenens recruiter and see what options are available for you.

The post NP To RN: Should You Rebound Your Career? appeared first on Medcare Staffing.