As we continue our series highlighting concerns Ohio APRNs including CNPs, CNMs, CNSs, and CRNAs, experience each day, which can be resolved with the simple passing of HB 216, we are eager to share Bill’s story.

Bill Swartley, CRNA, MS, currently practices in NW Ohio.  He is an Advanced Registered Nurse Practitioner who moved to Ohio several years ago from his home state of Kansas, where he practiced in a variety of settings. This is Bill’s story.

Several weeks ago a Certified Registered Nurse Anesthetist (CRNA) colleague brought a patient to the post anesthesia care area (PACU) of the hospital. The patient was emerging from anesthesia but upon arrival sustained a cardiac arrest. There was no physician in immediate attendance. The CRNA began to take steps to resuscitate the patient. Following established protocol, she assisted the patient’s breathing and asked the PACU nurses to assist her. Since the patient’s heart rate was very slow the CRNA, who was managing the airway and assisting the patient’s respirations, asked a nurse in attendance to administer the drug Atropine to increase the heart rate. The nurse advised the CRNA that she was unable to administer any medication or treatment on the behalf of the CRNA. There was a significant delay in resuscitating the patient while a physician was located who could order the same drug in the same dose as the CRNA had requested. Thankfully, the patient recovered without sequelae.

Not long ago a CRNA in our hospital transported a patient to the ICU of our hospital following an extensive and critical surgical procedure. Due to the condition of the patient and the seriousness of surgery, the anesthetist elected to use breathing tube to assist the patient’s breathing. Upon arrival in the ICU, nursing staff began to monitor the patient and prepared a ventilator to assist the patient’s breathing. The CRNA, who had spent over four hours caring for the patient in the OR, administering medications, controlling blood pressure, breathing, and depth of anesthesia, was not permitted (by Ohio State Law) to set the ventilator to continue ventilating the patient. However, a respiratory therapist, who did not know the patient or understand her condition arbitrarily, volunteered ventilator settings for the patient. Again, several minutes passed while a physician was located to order the same settings as the CRNA had suggested.

These are only two examples of the danger patients face in hospital settings when qualified, highly trained advanced practice nurses are prohibited from practicing to the full extent of their training and qualifications. Ohio is one of the few states with such restrictive practices. Having personally practiced in a state (Kansas) for over 30 years where CRNAs are considered to be “independent practitioners,” moving to the very restrictive practice of Ohio was shocking and frustrating. CRNAs are especially well trained to provide anesthesia services and personally provide over 50 percent of anesthesia care nationwide. In rural areas, CRNAs provide a much higher percentage of anesthesia care. In states where practice is more independent, CRNAs provide care within the scope of their training and qualifications without the supervision of anesthesiologists or physicians. Multiple studies have demonstrated repeatedly that independent care is safe and on par with the care provided by anesthesiologists. Indeed, many surgeons who are accustomed to working with CRNAs in independent practice prefer the outstanding and cautious care provided by these qualified providers. Ohio would be wise to remove the barriers to practice in our state and advance the quality of care for our citizens.

Share your story in a brief, hand-written note to your state representative in support of this legislation and be sure to contact OAAPN Communications Chair Cathy Hoffman by emailing