Dream a Little Dream: A Certified Registered Nurse Anesthetist Is By Your Side Sierra Gower, CRNA, MS
Anesthesia in the United States In the USA anesthesia care is provided by three specialty groups, nurse anesthetists, anesthesiologists and anesthesia assistants. Certified registered nurse anesthetists (CRNAs) are licensed professional nurses (RNs) who have completed a graduate education with extensive training in anesthesia. They complete a national certification exam after graduation from an accredited masters level education.
Anesthesia in the United States CRNAs can be licensed and practice in all fifty states Anesthesiologist are physicians which after medical school (medicine or osteopathy), complete one year internship and three year residency in anesthesia. (change in 1986 to a three year from a two year residency) Anesthesiologists have the option of becoming board certified Anesthesiologist Assistants complete a four year undergraduate college degree and have satisfactorily completed an anesthesiologist assistant education program
Medicines Best Kept Secret The nurse anesthesia profession has been the silent profession. Physician anesthesiologists mostly practice in developed and modern countries, leaving many underdeveloped nations to rely on nurse anesthetists. The International Federation of Nurse Anesthetists is the authoritative voice for nurse anesthetist worldwide
Medicines Best Kept Secret Studies on worldwide anesthesia care find this a nursing function. Researchers identified 107 countries where nurse anesthetist train and practice and 9 countries where nurses assist in the administration of anesthesia. Nurse anesthetist participate in 80% of anesthesia worldwide and are the sole providers in 60% of anesthesia worldwide.
History of Nurse Anesthetists The first official nurse anesthetist recognized is Sister Mary Bernard, a Catholic nun who practiced in 1878 at St. Vincent s Hospital in Erie, Pennsylvania The first school of nurse anesthesia formed in 1909 at St. Vincent Hospital, Portland, Oregon Established by Agnes McGee, the course was 6 months in length. These included programs at Mayo Clinic, John Hopkins Hospital, Barnes Hospital, New York Post Graduate Hospital, Presbyterian Hospital in Chicago
History of Nurse Anesthetists Physicians residences in anesthesia did not exist at this point so doctors attended these programs to learn anesthesia. Noted programs included Agatha Hodgins program established in 1915 at Lakeside Hospital School of Anesthesia in Cleveland, Ohio. (6 months and $50.00) Under Dr. George W. Crile Ms. Hodgins administered 575 anesthetics. They perfected the nitrous oxide anesthetic feeling ether or chloroform lead to surgical shock.
History of Nurse Anesthetists Research: 1906 Alice Magaw published a report on the use of ether anesthesia by drop method 14,000 times without a death Alice Magaw was the anesthetist for Drs. William J. and Charles H. Mayo, founder of the Mayo Clinic in Rochester, Minnesota She is the Mother of Anesthesia
History of Nurse Anesthetists During World War I America s nurse anesthetist were the major providers of care to the troops in France. They trained the French and British nurses and physicians in anesthesia care. This was also the first time the U.S. Military started training nurse anesthetist for service Agatha Hodgins serve in France from 1914-1915, two years prior to America entering the war
History of Nurse Anesthetists 1931 the American Association of Nurse Anesthetist (AANA) held their first meeting Main objectives ware to establish a national qualifying exam and establish an accreditation program for nurse anesthesia schools The first national certification exam was held in 1945 In 1952 a program for the accreditation of nurse anesthesia schools went into effect
History of Nurse Anesthetists In 1942 there was 17 nurse anesthetist for every one anesthesiologist. In 1972 48.5% of anesthesia was given by CRNAs, while 38.34% was provided by American Society of Anesthesiology members. The 1970 s brought about advances in surgical services yet operations became more complex and anesthesia more difficult and dangerous
Program Requirements Nurse anesthesia programs are 24-36 months in length (average 28) Requirements are to be a licensed registered nurse, have a four year college degree in science or nursing (BSN), and at least one year of acute care nursing experience before entry into a program Other requirements GRE, GPA, required coursework)
Certification Requirements Graduation with a master s degree from an accredited nurse anesthesia educational program. As of February 2008, there were 109 nurse anesthesia programs with more than 1,800 affiliated clinical sites in the United States. Pass a national certification examination following graduation
Nurse Anesthetists CEU In order to become recertified, 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.
Scope of Practice When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way. CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities. CRNAs will work in collaboration with surgeons, dentist or podiatrist, or an anesthesia care team with an anesthesiologist to provide anesthesia care
Scope of Practice 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. According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.
Scope of Practice Laws governing the degree of physician collaboration or supervision will vary state to state CRNAs can administer anesthesia in all types of surgical cases, applying all the accepted anesthetic techniques-general, regional, local or sedation
Military Role of CRNAs In the military CRNAs provide a critical peacetime and wartime skill. In peacetime they provide the majority of anesthesia services for the retired service member, active duty military and their dependents. CRNAs function as the only licensed independent anesthesia practitioner at many military treatment facilities.
Military Role of CRNAs They are also the leading provider of anesthesia for the VA and Public Health Service. During wartime they are usually the primary anesthesia provider at forward positioned medical treatment facilities and they play a key role in the education and training of nurses and technicians in the care of trauma patients. In addition CRNAs have provided the majority of anesthesia services in every US war during the 20 th century.
Membership There are over 40,000 members in the American Association of Nurse Anesthetists including certified, recertified and student members The American Society of Anesthesiologist boast a membership of 42,330. However in the membership breakdown in 2007 26,093 were active practicing members and the others were made up of honorary, researchers, residents and medical students, retired members
Membership Approximately 44 percent of the nation s 40,000 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.
Why choose nurse anesthesia? Diana M. Chiles, M.Ed., MRE, CCLS Community Educator (& Bernard's Mommy) Le Bonheur Children's Medical Center Memphis, Tennessee
References American Association of Nurse Anesthetists. http://www.aana.com/ Thomas J. Evans, CRNA, MS (2008). What is a CRNA. Retrieved August 1, 2009 at http://www.anesthesianursing.com/wina.html