A certified nurse anesthetist at work (Photo via University of Wisconsin-Oshkosh/Flickr Commons)
By Jessica Poole
As the COVID-19 pandemic continues to increase exponentially in Pennsylvania, certified registered nurse anesthetists (CRNAs) are uniquely prepared to provide care for the surge of critically ill patients. Unfortunately, the full contribution of CRNAs is being limited.
There are approximately 3,700 CRNAs and students in Pennsylvania, making us one of the largest contingencies of CRNAs in the nation.
In fact, anyone having a surgery or procedure requiring anesthesia was likely under the direct care of a CRNA. However, due to widespread cancellations of elective surgery throughout Pennsylvania, many CRNAs are off the job, creating an untapped resource for fulfilling critical roles outside of the operating room during this crisis.
CRNAs possess a skillset uniquely suited to aid in management of this crisis. Most have cared for patients as sick as, or even more acutely ill than, the COVID-19 patient. In the operating room, the nurse anesthetist serves as the frontline, critical care intensivist; surveilling, assessing and implementing appropriate interventions.
Much has been said about the importance of ventilators during this crisis, and CRNAs not only routinely use them, but they tailor their complex settings to each patient. Due to a nurse anesthetist’s science-based education and clinical experience, CRNAs understand the why and how of their equipment, allowing them to manage complex patients.
The CRNA possesses hands-on skills extending far beyond their already vast critical care experiences. CRNAs perform rapid physical assessments, airway and ventilatory management, volume resuscitation and hemodynamic management, patient triage, emergency preparedness, and procedural skills that include central and arterial invasive line placement.
Furthermore, a skill unique to the nurse anesthetist is our ability to lead and manage the care of a critical patient. Health care is experiential, and CRNAs have the experience of critical care nursing with further graduate level education in the application of medical skills beyond that of a critical care nurse. This level of expertise places the CRNA in a position of leadership and management extending beyond the operating room.
As frontline health-care professionals, we play a crucial role in the state’s response to this pandemic, especially one related specifically to respiratory failures. Facing unprecedented challenges in our medical communities, health-care systems must prepare to fully utilize the unique skill set of CRNAs.
Pennsylvania remains a state that still requires supervision of a CRNA by a physician. However, under the directive of President Donald Trump, the Centers for Medicare and Medicaid Services removed the national physician supervision requirement for CRNAs and encouraged states to allow CRNAs to practice to the fullest extent of their education and training to best care for patients during this crisis.
States like New York, West Virginia, Maine, Michigan, New Jersey and Arizona have already acted to remove barriers, allowing them to better utilize all available health-care providers without risking patient safety. It is imperative for Pennsylvania to do the same.
Gov. Tom Wolf and his administration should lift the requirement that Pennsylvania CRNAs be supervised by a physician to ensure that CRNAs can respond immediately to the COVID-19 health-care crisis using their advanced education and training to provide expert anesthesia and emergency airway management.
In Pennsylvania, education and clinical training for CRNAs is extensive. Unlike physicians, national board certification is required for CRNAs to practice. In total, CRNAs complete approximately 9,000 clinical hours.
Numerous scientific research studies have shown no statistical difference in patient outcomes when a CRNA provides anesthesia care compared to a physician anesthesiologist, even for rare and difficult procedures. In fact, the Federal Trade Commission cautioned states against policies that restrict the scope of advanced practice nurses. Direction from the President supports this.
More importantly, this crisis requires an all-hands-on-deck approach, and removing the supervision requirement of CRNAs in Pennsylvania will avail more physicians to provide hands-on care, expand the capacity of both CRNA and physician providers, and augment our system to meet the growing demands of this pandemic.
Our health-care systems are challenged to function above capacity, and untethering Pennsylvania CRNAs from unnecessary statutory and regulatory requirements will allow CRNAs to contribute more efficiently to the rapid response needed.
Wolf and his administration should follow the lead of our federal government and several other states by finally permitting CRNAs to serve to the full capacity of their education and training. CRNAs are prepared and eager to help keep Pennsylvania residents healthy and safe.
Jessica Poole is the director of State Government Affairs for the Pennsylvania Association of Nurse Anesthetists.
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