Editor’s Letter
Do You Like To Write?
We would like to publish your short story about your life as a nurse - a professional glance at your daily activities or a spectacular event that ocurred in an emergency room or operating table or a vacation you'd like to tell us about. This will be the Nurses On The Go feature of our newsletter. But we need you to write the stories. The best story for each quarter as determined by our editor will receive a $50 VISA gift card.
All submittals should be between 500 and 800 words.
To submit a story, send an email with the subject line Nurses On The Go story submission to info@nurse-recruiter.com
Enjoy, and see you next month!
Nurse Anesthetists: the Often-Overlooked CRNA
By Norma Walsh
Most people outside the medical field - and a good deal of those within it - are not sure exactly what a nurse anesthetist does; some may have never even heard of it, or think of them as "assistants" to anesthesiologists. Nurse anesthetists have a long and storied history spanning over 150 years, and today perform an important and increasing role in patient care.
The first nurse to provide anesthesia was Catherine S. Lawrence, who administered anesthesia for Civil War surgeons circa 1861 to 1865. However, anesthesia was used infrequently, because it was considered too dangerous.The first "official" nurse recognized as a nurse anesthetist was Sister Mary Bernard, a Catholic nun who practiced in the 1870s at St. Vincent's Hospital in Erie, Pennsylvania. The first school of nurse anesthesia formed in 1909 at St. Vincent Hospital, Portland, Oregon. The course of study was 6 months long, and included classes on anatomy and physiology, pharmacology, and administration of common anesthetic agents. Soon, many schools offering similar programs were formed. Between 1912 and 1920, approximately 19 schools opened in the United States. All consisted of post-graduate anesthesia training for nurses, and were about 6 months in length. These included programs at Mayo Clinic, Johns Hopkins Hospital, Barnes Hospital, New York Post-Graduate Hospital and Presbyterian Hospital in Chicago.
At the time, physician residences in anesthesia did not exist, so doctors attended these programs to learn anesthesia. The nurse anesthesia specialty was formally organized on June 17, 1931, when the American Association of Nurse Anesthetists (AANA) held its first meeting. The new organization had two main objectives: establish a national qualifying exam, and establish an accreditation program for nurse anesthesia schools. The first national certification exam was held on June 4, 1945, with 92 candidates sitting for the exam.
Prior to World War II, anesthesia was considered more a nursing specialty. In 1942, there were 17 nurse anesthetists for every one anesthesiologist. Even as late as 1971, 48.5% of anesthesia was given by certified registered nurse anesthetists (CRNAs), while 38.34% was provided by American Society of Anesthesiology members. The numbers of physicians in this specialty did not greatly expand until the late 1960s and 1970s, which parallels a time in surgical history when operations became much more complex.
After many years of preparation, on January 19, 1952, a program for the accreditation of nurse anesthesia schools went into effect. The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer approximately 30 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists' (AANA) 2007 Practice Profile Survey.
Nurse anesthetist programs are offered by 109 educational institutions in the United States today. The programs are between 24 to 36 months in length (average 28) and provided on a Masters degree level. All programs include clinical training in university-based or large community hospitals. In addition, there are Doctorate programs (Nursing Doctorate or Doctor of Nursing Practice) at several universities in the United States. All programs require you to be a registered nurse, and have a four year college degree in science or nursing (BSN), and at least one year of acute care nursing experience before entry. Acute care is usually defined as intensive care, coronary care, emergency/trauma, etc. In addition, applicants must meet the qualifications of the graduate school (GRE, GPA, required course work). Because most programs have far more qualified applicants than available spaces, successful candidates usually have several years of experience in nursing in addition to specialized education in nursing or other health disciplines. Graduate college requirements may include a minimum score on GRE exams (e.g. 1000+), and possibly a 400 or graduate level statistics course. Anesthesia school requirements usually include recent college level math, physics, chemistry and anatomy.
There is a varied scope of practice for nurse anesthetists. They can work for a hospital, outpatient surgery center (surgery, dental, podiatrist), in a group practice or they can practice independently. CRNAs will work in collaboration with surgeons, dentists or podiatrists, or on an anesthesia team with an anesthesiologist, to provide anesthesia care. Laws governing the degree of physician collaboration or supervision will vary state to state. Most often, the patient can expect to receive their anesthetic from an anesthesia care team, with the CRNA and anesthesiologist working together. CRNAs can administer anesthesia in all types of surgical cases, applying all the accepted anesthetic techniques - general, regional, local, or sedation. The exception is "pain medicine," which is usually practiced by anesthesiologists. Others become clinical instructors, school directors, or department supervisors. Working hours vary according to practice, but in many cases, exceed 40 hours per week. Salaries exceed most nursing specialties, depending on location and experience.
CRNAs are the primary anesthesia providers in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals. Nurse anesthetists have been the main providers of anesthesia care to U.S. military men and women on the front lines since WWI, including the current conflicts in Iraq and Afghanistan.
Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. Approximately 44 percent of the nation's 39,000 nurse anesthetists and student nurse anesthetists are men, compared with less than 10 percent in the nursing profession as a whole. More than 90 percent of U.S. nurse anesthetists are members of the AANA.
As advanced practice nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly. There is also a stringent recertification/continuing education requirement, as CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.
They Might be Angels
By Norma Walsh
In the last few years of my mother's life, when she was suffering from myriad chronic conditions that had greatly decreased her mobility, my entire family - but especially my mother, the patient - was thankful for the convenience and reassurance of having a weekly visit from an Registered Nurse, Annie. After my father passed away and my mother was home alone all day, it was especially nice to know that someone whose company she truly enjoyed and appreciated, who had knowledge of her "ailments," as she called them, would be evaluating her regularly for those small changes that can signal major problems in the elderly. It was, in fact, Annie who called my brother at work in alarm one frigid February morning, quite concerned that she had arrived at my mother's house to find the door locked and no one answering the phone. Annie offered to call 911 and wait at the house until emergency services and my brother arrived. Sadly, my mother had passed away in her sleep a few hours earlier. But it seemed fitting and comforting to my brother and me that Annie, whom she trusted and, I'm certain, loved, had been there to cushion the fall for us.
Visiting nurses have been providing home health care and more to patients for over 100 years through various agencies and organizations. The Visiting Nurse Associations of America (VNAA) was established in 1983 as the official national association for non-profit, community-based Visiting Nurse Agencies, who care for and treat approximately four million patients each year. The nation's network of more than 400 Visiting Nurse Associations share a nonprofit mission to provide cost-effective and compassionate home healthcare to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. The VNAA offers a wide range of resources about home healthcare and questions to ask when considering home healthcare.
Visiting Nurse Associations (VNAs) care for patients of all ages, from infants to the elderly, offering comprehensive services such as post-partum and infant wellness programs to hospice care. Patients can receive skilled nursing care, rehabilitation therapy, social services/counseling and other professional attention as needed. Many VNAs also offer help with housekeeping, transportation, personal care and delivery and set-up of medical equipment. And in addition to individualized, at-home care, VNAs play an important role in the community, organizing immunization clinics and support groups and running wellness programs in schools and senior centers.
Both in their involvement with patients at home and their work with the public, Visiting Nurses play a role in improving quality of life for everyone with whom they interact. Annie told me about the bond she felt not only with my mother, but with all the patients she works with and cares for, short-term or long-term, recovering from minor surgery or terminally ill. She truly made a difference to my family and visiting nurses make a difference in society.
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