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Nursing Board Signs Off On ‘Anesthesiologist’ Title

Lying atop a mobile gurney, a patient was being prepped and coached just prior to the subsequent medical procedure that was about to take place in this hospital setting. The nurse was wearing her requisite blue colored hospital scrubs, and had draped a st
T. Grace Emori / CDC
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

John McDonough, an advanced practice registered nurse, has for years identified as a “nurse anesthesiologist,” and he tells his patients the same. 

Now he can do it with the blessing of the Florida Board of Nursing, which at a meeting last week in Fort Myers unanimously agreed to allow McDonough, a certified registered nurse anesthetist, to officially use the anesthesiologist title.

Although the board’s ruling only applies to McDonough --- also a professor and director of the nurse anesthesiology program at the University of North Florida --- doctors fear that more certified registered nurse anesthetists will follow suit.

Chris Nuland, a Jacksonville attorney and lobbyist who represents the Florida Society of Anesthesiologists, didn’t mince words when it came to where the society --- comprised solely of medical and osteopathic physicians --- stands on the issue.

“The FSA firmly believes that, although this declaratory statement only applies to this one individual, this sets a dangerous precedent that could confuse patients,” Nuland told The News Service of Florida.

The Board of Nursing’s unanimous decision is the latest wrinkle in a bumpy relationship between advanced practice registered nurses and physicians in Florida. The Florida Association of Nurse Anesthetists, for example, last week blasted physician groups for questioning the logistics of how a new law meant to help abate opioid abuse will work.

McDonough’s move to be called a nurse anesthesiologist also comes at a time when other health care professionals are finding new ways to describe their roles.

Anesthesiologist assistants have recently started describing themselves as “anesthetists,” a term that has long been associated with advanced practice nurses who specialize in the administration of anesthesia. The American Academy of Anesthesiologist Assistants refers to the providers as “anesthetists” in its 2019 mission statement.

There are 383 active registered anesthesiology assistants in Florida, according to the latest available data on the Department of Health website. Anesthesiology assistants must work under the direct supervision of an anesthesiologist.

A certified registered nurse anesthetist is authorized by law to administer anesthesia but must work under the supervision of a physician. Salaries for nurse anesthetists also are higher than for anesthesiology assistants.

“I am not a technician. I am not a physician extender. I am not a mid-level provider,” McDonough said. “I am, in fact, a scientific expert on the art and science of anesthesia. So I think anesthesiologist is a perfectly acceptable term, especially since the term anesthetist has been hijacked from my profession. “

Moreover, he argues that dentists, who are not medical doctors, have been identifying themselves as dental anesthesiologists.  Some anesthesiologists, he said, now identify themselves as physician anesthesiologists.

It’s logical, he said, for advanced practice nurses to also distinguish themselves.

“It doesn’t make any sense, to me, why we have nurses who are equally well trained in the specialty and licensed to practice it who are not called nurse anesthesiologists,” McDonough said.

The Florida Board of Nursing isn’t the only licensing board to sign off on the term. According to McDonough’s petition, the New Hampshire Board of Nursing has done the same.

The Florida Association of Nurse Anesthetists' chief lobbyist Lori Killinger, an attorney with the Lewis, Longham & Walker law firm, said the nurse's group would be watching the issue and “monitoring with interest.”

Meanwhile the nursing board’s decision came on the heels of a legislative session where lawmakers considered proposals to allow advanced practice registered nurses to practice independently from physicians.

The measure had the blessing of House Speaker Jose Oliva, a Miami Lakes Republican who has championed greater autonomy of nurses.

But Gov. Ron DeSantis didn’t support this year’s measure (HB 821), noting that he would “have to really be convinced that kind of expanding scope of practice would be good. “

While the Board of Nursing granted McDonough’s request, he doesn’t expect it to change how he practices. That’s because McDonough has for “years” been identifying himself to his patients as a nurse anesthesiologist.

“Truth to tell, I have been referring to myself as that for a very long time,” McDonough said. “Someone said to me in the clinical area you may want to be careful about that, somebody may file a complaint against you.”