The Norwegian Association of Nurse Anesthetists
In Norway, two occupational groups have anesthesia education – anesthesiologists and Nurse Anesthetists. The formal educations of the two groups differ, but they overlap and complement each other in everyday work. Norwegian general anesthesia standards (Standard for anestesi i Norge) are recommended guidelines for anesthesia practice, jointly developed by the Norwegian Association og Anesthesiologists (Norsk Anestesiologisk Forening) and The Norwegian Association of Nurse Anesthetists.
Guidelines for the Practice of Anesthesia in Norway
Check out the Norwegian Standard for the Safe Practice of Anaesthesia by clicking the link below.
ASA - physical status classification system
Patients are assessed preoperatively and placed in one of five categories irrespective of the type of surgery planned. However, the patient’s surgical needs and any relevant acute medical problems are taken into account.
ASA 1: «Normal healthy patient». No systemic, physiological or psychiatric disorders. The disorder to be treated is localised and there is no general systemic disease. Smokes less than 5 cigarettes per day. Under 80 years of age.
Example: Healthy 50 year-old non-smoker, planned operation for varicose veins.
ASA 2: Patients with mild systemic disease causing no functional limitations, but possibly requiring special measures with regard to anesthesia. The disease may be caused by the condition to be treated or by some other pathological process.
Over 80 years old or under 3 months old. Smokes more than 5 cigarettes per day.
Examples: Mild heart disease; diabetes without systemic effects (types I and II); controlled hypertension.
ASA 3: Patient with severe systemic disease causing some functional limitations.
Examples: Diabetes with organ dysfunction; invalidising heart disease; moderate to severe lung disease; angina pectoris; heart attack (more than 6 months ago).
ASA 4: Patient with severe life-threatening systemic disease, which may or may not be related to the reason for surgery.
Examples: Malign hypertension; recent heart attack (less than 6 months ago); severe systemic dysfunction of the liver, kidneys, lungs or endocrine system; severe heart failure; unstable angina pectoris; SAB (patient awake or drowsy).
ASA 5: A moribund patient who is not expected to survive the next 24 hours, with or without surgery.
Examples: Patient in shock with an aortic aneurysm. Deeply comatose patient with intracranial bleeding.
Regarding nurse anesthetists with foreign qualifications
THE NANA EDUCATION COMMITTEE - Drawn up January 2007
Note that this document contains links to other documents such as the National Curriculum and relevant laws such as the Health Personnel Act. Some of these referenced documents may not be translated to English.
The Norwegian Association of Nurse Anesthetists (NANA) regularly receives enquiries on this subject from employers throughout the country, and has therefore prepared the following information regarding the current situation.
There are currently no official guidelines for evaluating the expertise of nurse anesthetists with qualifications from countries outside Norway. It is therefore up to individual employers to evaluate the nurse anesthetist’s expertise. The question is whether employers have any real chance of being able to carry out an evaluation of a foreign qualification, and to what extent this is quality assured.
NANA would like to see a system for this, and hopes that the planned specialist authorisation for nurse anesthetists may provide both employers and inspection authorities with the necessary tools. A government approved specialist authorisation with specific criteria will provide a basis for evaluating the competence of nurse anesthetists with foreign qualifications.
Increasingly free movement of health care workers across borders and the fact that specialisation programmes vary considerably in content and length between countries, bring with them a need for an overview of and alignment between education systems.
The Standing Committee of Nurses in the European Union is an informal network of national professional organisations and specialist groups within Europe. By means of cooperation with other Scandinavian and international organisations, NANA has acquired an overview of the education systems in a number of countries. We find significant variations in both the specialist training for nurse anesthetists and their professional expertise. As a consequence, the title Nurse Anesthetist is not clearly defined and covers wide variations in both content and professional expertise.
A central question is therefore; do the specialist training programmes vary so much in content and length that employing nurse anesthetists from other countries could be regarded as irresponsible.
NANA would like to see local and national health authorities take a more critical approach when employing nurse anesthetists with foreign qualifications in Norway, in order to ensure high standards of professional expertise.
The Norwegian specialisation in anesthesia nursing aims to guarantee that anyone who has completed the training has the knowledge, skills and attitudes required by the authorities. The National Curriculum for the specialist training of nurse anesthetists drawn up by the Ministry of Education, Research and Church Affairs in November 1999 and revised in 2005, defines a national standard for Norway. The National Curriculum can be found at: https://lovdata.no/dokument/SF/forskrift/2005-12-01-1388
The “Health Personnel Act” also emphasizes that health personnel have a duty to ensure that patients are cared for by qualified personnel. The act underlines the requirement that educational programmes are approved by relevant authorities, and that specialisation programmes are of an adequate standard. The relevant laws and regulations can be found at: https://lovdata.no/dokument/NL/lov/1999-07-02-64/KAPITTEL_9
NANA has worked for the past 20 years towards achieving a legally defined status for nurse anesthetists. In addition, it has collaborated with The Norwegian Society of Anesthesiology (NAF) in establishing “Guidelines for the practice of anesthesia in Norway”. The guidelines can be found at: Norsk standard for anestesi
Registration as a nurse entitles the person to use the professional title nurse. Any person who is not registered or licensed as a nurse has no right to use this title, nor any title which might convey the impression that the person is a registered nurse. See helsepersonellovens § 74. The main purpose of nurse registration is to ensure the safety of patients, high health care standards and, as a consequence, confidence in the health service. See helsepersonellovens § 1.
Registration carries with it the responsibility of professional behaviour. All health care professionals have a duty to maintain a high level of expertise, and to refrain from providing help on matters in which they are not competent. In such circumstances, they should refer the patient to someone with the necessary expertise, see helsepersonellovens § 4. Whereas the Norwegian Registration Authority for Health Personnel (SAFH) is responsible for authorising nurses, there is no official body for authorising specialisation programmes in nursing.
There are currently 27 professional groups in the Norwegian Health service that are regulated by law and granted professional authorisation by SAFH *, see helsepersonellovens § 48 (first subsection). In order to practice one of these professions it is necessary to be authorised (or licensed). Authorisation to practice professionally is only granted to persons who can demonstrate the necessary ability (professional knowledge and skills) and suitability (personal characteristics needed to work in the health service). See https://www.sak.no/
Professional authorisation differs from academic recognition. Academic recognition is granted to foreign educational programmes either in order to incorporate the qualification in the Norwegian Education Authority’s degree structure (general academic recognition), or to allow the recognition of foreign qualifications by Norwegian educational institutions, thus enabling entry to a course of study (specific academic recognition). General academic recognition is granted by the Norwegian Agency for Quality Assurance in Education (NOKUT). NOKUT is an independent public agency responsible for carrying out external quality assurance of higher education and tertiary vocational education in Norway. NOKUT also grants general recognition of foreign higher educational programmes. Specific academic recognition is applied for at the Norwegian educational institution at which a student wishes to enrol.
When employing staff, an employer is responsible for ensuring an acceptably high standard of professional practice. This presupposes that the employer has secured documentation of the employee’s formal and practical expertise. The employee must therefore be able to provide evidence of the following:
- Basic nursing training and registration *
- Specialist training in anesthesia nursing Theoretical studies: Course literature should include in-depth studies in nursing, anesthesia nursing, social science subjects, scientific theory and methods, medical, technological and natural science subjects. Methods of assessment should show knowledge of the different areas of study. Practical training: The candidate must be able to provide evidence of supervised practical anesthesia training in the areas of general surgery (e.g. gastrointestinal, cardiovascular/thoracic, urology), orthopaedics, gynaecology, ear/nose/throat surgery, obstetrics and postoperative monitoring as well as supervised training in pre-hospital emergency care. Documented experience of providing anesthesia to children is also required. See Nasjonal Rammeplan.
- Certificate / academic transcript stating the number of weeks of practical training and areas covered by the programme, the candidate’s progress as shown in written evaluations and whether the candidate passed the practical training.
- Anesthesia-related practical experience after completed training
- The number of weeks of supervised practical experience after completed training
- The ability to read, write and understand Norwegian – be prepared to take a language test.
- The candidate has passed the national exam in anaesthesiology (not currently a requirement)
If a nurse anesthetist with foreign qualifications does not have or is unable to provide evidence that they fulfil the high professional standards of expertise required by both the National Curriculum and the Guidelines for the practice of anesthesia in Norway, then the employer must arrange for the foreign nurse anesthetist to be able to meet the same requirements that apply to Norwegian nurse anesthetists. We urge employers to vet relevant documentation to ensure it meets requirements for both formal and practical expertise. NANA can supply information about nurse anesthetist specialisation programmes in other countries.