PANA Members Recount How Patients and Facilities Benefit from Waiver Removing Physician Supervision

Health-care facilities, patients benefit from waiver removing physician supervision during pandemic

We shared with you previously stories from the frontline among certified registered nurse anesthetists who are experiencing firsthand the effects of the state’s temporary blanket waiver removing the physician supervision requirement for CRNAs.

The waiver was included in an executive order that the governor signed to protect health-care practitioners for good-faith actions taken in response to this crisis, and it remains in effect for the duration of the governor’s disaster proclamation.

As you know, Pennsylvania regulations still require physician supervision of CRNAs in a hospital setting. The temporary suspension gives health-care facilities more flexibility to tap into the unique skillset of CRNAs to fulfill critical roles outside the operating room during this crisis. After all, CRNAs possess a skillset uniquely suited to aid during a respiratory pandemic.

Without a doubt, the waiver has made a real difference. Here are some more voices from the frontline. (Please note that the names of the CRNAs and their facilities have been removed to ensure their anonymity and protection in the workplace.)

“My hospital may not financially survive since elective procedures have been canceled. Our anesthesia team staffing had to change to preserve costs and the governor’s order helped us accomplish that.”

“Our role has been authorized for this expansion of function outside the operating room. The plan is to utilize CRNAs to run overflow ICU beds in our PACU and pre-op areas. CRNAs would manage patient care, manage ventilators, order labs, medications and appropriate radiology studies, and insert central and arterial lines as needed.”

“In our facility, CRNAs served in the OR, in labor and delivery, and on the intubation team for the ED and COVID/PUI patients; we also had a portion of our team train to perform supportive roles in our critical care units and also make the PACU into a makeshift ICU if the need arose but that has not been necessary as of this point.”

“Hospital administration along with the support of our MD Anesthesiologist (MDA) counterparts also suspended MDA supervision at the hospital, allowing the CRNAs to practice to the full extent of our knowledge and training. The CRNAs performed advanced practice skills and critical care decisions independent of the anesthesiologists. CRNAs were also the sole advanced practice provider at night during the first two weeks of the COVID crisis. For five weeks, the CRNAs put into practice the skills and knowledge to assist the ICU physicians, nurse practitioners, and nurses. The CRNAs knowingly put themselves literally face to face with COVID patients, intubating and securing the airways, and placing lines to insure vascular access. Our hospital was the hardest hit in central Pennsylvania by the COVID crisis, and had one of the lowest mortality rates. CRNAs were the keystone in the successful treatment and management of these patients.”

This waiver truly has given CRNAs the chance to showcase the value they bring not only to the state’s pandemic response and recovery efforts, but also to the safe, efficient, affordable delivery of quality health care generally. Stories like these and from our earlier post prove why physician supervision should finally be removed permanently in Pennsylvania.

CRNA from Pa. Jumps Headfirst into N.J. Hotspot to Fight COVID-19

Denise Skradski photo_2

Denise Skradski photo_1

While most Americans were hunkering down at home and sheltering in place in the face of the global pandemic caused by the novel coronavirus, Denise Skradski of Butler County was doing what she was trained to do by jumping headfirst into a COVID-19 hotspot.

Skradski, a certified registered nurse anesthetist (CRNA) for 14 years since graduating from the University of Pittsburgh in 2006, recently returned home after spending more than two weeks at a hospital in North Bergen, N.J., the epicenter of the viral outbreak in the Garden State.

“I was having a hard time watching the medical providers struggle, and I knew I had a service to offer. I knew my skills could be used best in New York or New Jersey, where the need was so great,” said Skradski, who worked for Allegheny Health Network before recently going into independent practice.

“They needed CRNAs. They needed our skillsets,” she said. “And I was fortunate enough to have the support of my family to be able to go.”

Not that there was much of a family discussion. Skradski’s decision was made. “This is what I do,” said the wife of 25 years to her husband and two sons, 18 and 20, when they asked her why. “I take care of people who need to be taken care of. They know that about me.”

Skradski worked as part of an intubation team, while also placing central lines, arterial lines, triple lumen catheters, intravenous catheters, and more. When a patient was in respiratory or cardiac distress and needed resuscitation, Skradski was part of the team that led other medical professionals in what to do to save them.

New Jersey, unlike Pennsylvania, formally recognizes certified registered nurse anesthetists and allows them to practice to the fullest extent of their education and training.

Pennsylvania is one of just two states that fails to formally recognize CRNAs in some form. Because there is no definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, CRNAs are recognized only as registered nurses, not as CRNAs.

Pennsylvania also requires physician supervision of a CRNA in a hospital setting. During the pandemic, the Centers for Medicare and Medicaid Services removed the national physician supervision requirement and encouraged states to do the same. States like New Jersey, New York, West Virginia, Maine, Michigan, Arizona and others acted to remove barriers.

Both requirements remain in place in Pennsylvania, which is part of the reason why Skradski went to New Jersey --- to put her full skillset to use to help others rather than sitting at home in Pennsylvania were outdated laws limited her ability to fight the virus.

“What I did in New Jersey, well, I have actually been encouraged not to use those skills in the state of Pennsylvania,” Skradksi said.

What she did in New Jersey was work 14 of 17 days from April 8 to April 26, in 12-hour shifts, while staying in isolation during her downtime at a nearby hotel reserved for other medical professionals who came to help from across the country.

The days were anything but typical. There were three or four CRNAs on every 12-hour shift, with at least eight intubations a day. She responded to eight to 10 codes per day, putting in anywhere from three to 10 central lines, in addition to consulting with ventilation management

Before she left, unfortunately, 70 percent of her patient encounters had died, and that number may rise still because Skradski only worked with the sickest and most acute individuals, many of whom remained in the hospital as she prepared to end her shift to come home.

“The hardest part, honestly, was that people were passing away and that their families weren’t able to be with them,” she said. “Most of the patients were either taken to the hospital by ambulance or dropped off at the ER, and they never saw their families again. It’s hard to think about.”

The hospital had restrictions on visitation to prevent community spread.

Skradski is at home with her family, self-quarantining for two weeks. She has not been tested for COVID-19 but remains without any symptoms.

Since being home, the conversation has shifted about how thankful she and her family are to live in an area outside Freeport, Pa., that didn’t experience the same devastation as other locations.

“They’re thankful that I went, and I satisfied something I needed to do,” she said.

Skradski hasn’t ruled out going back, if the need remains great and staff support is needed. But her real hope is that Pennsylvania will finally learn from the native daughter who had to travel to another state to put her full skillsets to use.

“Pennsylvania should look at this situation and recognize how valuable and cost-effective CRNAs are in terms of patient care and health and safety,” she said. “I’d love for the politics to be put aside and for people to look at who’s actually doing the job here and respect us for what we do.”

Two-thirds of Pa. Voters Support Professional Designation for CRNAs

Pennsylvania Association of Nurse Anesthetists

FOR IMMEDIATE RELEASE

CONTACT: Kurt Knaus; P: 717-724-2866; E: kurt@ceislermedia.com

Two-thirds of Pa. Voters Support Professional Designation for CRNAs

Pennsylvania is one of just two states that fails to recognize nurse anesthetists in some form

HARRISBURG (April 20, 2020) --- Two-thirds (67%) of Pennsylvania voters support professional designation for certified registered nurse anesthetists (CRNAs), including those who identify as Republican (59%), Democrat (75%) and Independent (62%), according to results of a statewide public opinion poll conducted by G. Terry Madonna Opinion Research.

Pennsylvania is one of just two states that fails to recognize CRNAs in some form. Because there is no definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, CRNAs are recognized only as registered nurses, not as CRNAs. That brings logistical and financial burdens, and it continues to inhibit our full response to this health-care pandemic.

In response to COVID-19, many CRNAs want to contribute more in the facilities where they work but can’t. Likewise, hospitals and other health-care institutions want to use CRNAs to their fullest capacity but can’t. Many of these facilities feel restricted by the way the state licenses CRNAs and will not allow nurse anesthetists to provide advanced, critical care services, even though it is within their education, training, clinical experience and scope of practice --- meaning this valuable health-care resource remains untapped during a time of crisis.

There are other challenges as well. Pennsylvania nurse anesthetists who serve in the military must secure designation in another state to provide anesthesia in the armed services. They cannot assist on rapid response teams in states affected by natural disasters because they lack formal credentials. And, after receiving training in Pennsylvania, many nurse anesthetists relocate to states with full credentialing, contributing to the state’s “brain drain.”

Bipartisan measures have been introduced in both chambers to recognize nurse anesthetists as “CRNAs” under Pennsylvania statute, with one bill (S.B. 325), sponsored by Sen. John R. Gordner (R-Columbia), receiving Senate approval last year. The legislation remains under consideration in the House Professional Licensure Committee.

“Broad support like this should give lawmakers the confidence they need to advance this measure and finally provide CRNAs with the professional designation they deserve,” said Angelarosa G. DiDonato, DNP, CRNA, president of the Pennsylvania Association of Nurse Anesthetists (PANA), which represents more than 3,700 CRNAs and students in the state.

CRNAs are the hands-on providers of anesthesia care, operating safely in every setting where anesthesia is administered, including: hospital operating and delivery rooms; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons; pain management centers and more.

Pennsylvania is recognized as a leader in anesthesia education and training, with 13 university-led programs. Yet, without an official CRNA designation in the state, many students leave the state. Some graduating students have to wait as long as six months to get credentialed in out-of-state facilities, as state boards must verify that the students meet the requirements necessary to be classified appropriately there.

According to the poll findings, respondents agree (47% agree to 28% disagree) that students who graduate from one of Pennsylvania’s education and training programs ultimately may leave the state because of issues with designation, going to a state that fully recognizes their profession. In the same respect, respondents agree (51% to 23%) that having professional designation would help to attract and retain these professionals.

According to the poll, respondents agree (45% to 40%) that there is no difference in patient outcomes when a CRNA provides treatment compared to an anesthesiologist. Numerous medical studies back them up. In fact, studies by nationally recognized health-care policy and research organizations prove that outcomes are nearly identical in these cases and that CRNAs provide high-quality care, even for rare and difficult procedures.

Not only are CRNAs critical to patient care, but they also help to reduce the cost of health care. Respondents also agree (46% to 40%) that CRNAs help to keep down health-care costs.

That is especially true in rural areas, where CRNAs are the main providers of anesthesia care, delivering essential health care and preventing gaps in services. CRNAs are far less costly for hospitals to employ, so rural hospitals, for example, are able to staff emergency services with in-house CRNAs 24 hours a day, 7 days a week, so that every Pennsylvania resident has access to these needed services.

The poll, conducted by ProBusinessConnection, interviewed 650 registered voters in the state and includes both landline and cellular households. The margin of error is +/-4.8 percent.

For more information about certified registered nurse anesthetists in Pennsylvania, visit www.PANAforQualityCare.com or follow along on social media via Twitter at @PANACRNA or on Facebook at www.facebook.com/PANACRNA.

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