CRNAs in the News: Prolung Ngin Taking on Diverse Patient Challenges in the APP Field

Advanced Practice Provider Spotlight: Certified registered nurse anesthetist shares perspective on caring for diverse patients

Advanced practice providers (APPs) play an integral role in meeting the needs of Penn State Health’s increasingly diverse patient populations. With their advanced training and credentials, these professionals expand access to high-quality care, build trust with patients and are a valuable aspect of patients’ overall experience.

Posted April 11, 2023 by Penn State Health News

Prolung Ngin, a certified registered nurse anesthetist (CRNA) at Penn State Health Milton S. Hershey Medical Center, said she was inspired to become a health care practitioner at a young age when she was her mother’s interpreter during her doctor’s visits and hospitalizations. Her family had fled Cambodia as political refugees and settled in the United States, where Ngin said she admired the doctors and nurses who cared for her mother. That motivated her to learn to care for her mother and others as well.

Ngin studied to become a nurse at Villanova University near Philadelphia and planned to become a pediatric critical care nurse practitioner. Part of her pediatric critical care transport training involved performing advanced airway management in the operating room. Her interactions with other CRNAs piqued her interest in pursuing certification in the field, which she said were a natural fit with her experience in pediatric critical care and transport.

A CRNA specialty, Ngin added, “allows a marriage of advanced critical care skills, the technical skills, advanced knowledge and skill sets required to take of care of patients in a variety of settings.”

After graduating from the nurse anesthesia program in 2010, Ngin began working at Hershey Medical Center, where she said she enjoys providing care to its diverse patient population.

ADDRESSING DIVERSITY CHALLENGES IN THE FIELD

Diversity in the nurse anesthetist field was challenging when she was enrolled in the anesthesia program at Villanova, Ngin said. At that time 85% of the students were white, 14% were Asian and there was no Black or Latino representation in the program. She compared those statistics to the current composition of CRNAs at Penn State Health, which is predominantly white, with 6% Asian and 8% Black CRNAs but no Latino representation.

Reflecting on the impact of diversity in her field, Ngin shared that she feels socially isolated from time to time and “invisible” as a minority female. Because English is her second language, she experiences occasional microaggressions, she said.

While there is always room for improvement, “I think it’s been very positive that there is a systemwide push for inclusion and diversity at Penn State Health,” Ngin said. “By doing this, we are meeting the need of our growing diverse patient population. I think we are moving in a good direction.”

One way Penn State Health is helping to meet the needs of its diverse patients is by being flexible with its medical processes, allowing families to be a part of their child’s care in the hospital. She also noted the health system’s effort to address language barrier challenges through certified interpreters, appreciating different cultural beliefs and traditions and providing equitable care to all, no matter their socioeconomic background.

The best approach to addressing diversity issues, Ngin said, is by “leaders and educators continuing to promote a culture of acceptance, understanding and empathy toward diverse individuals, staff and patients.”

HOW TO BECOME A CRNA

After CRNAs earn a bachelor’s degree, become a registered nurse and gain experience in critical care, they must also earn either a doctorate in nursing practice or in nurse anesthesia practice and pass a national board certification exam before obtaining a license to practice in their state.

PATIENT CARE RESPONSIBILITIES

CRNA patient care responsibilities include:

• Administering anesthesia before, during and after surgery

• Monitoring a patient’s response to anesthesia

• Educate patients before and after they receive anesthesia

The advance practice providers at Penn State Health include certified registered nurse practitioners, physician assistants, certified registered nurse anesthetists, certified nurse midwives and clinical nurse specialists. Rigorously trained and credentialed, APPs work collaboratively with other health care providers to offer patients the highest level of care possible. This is the second feature in our APP Spotlight series. See the March APP Spotlight feature on nurse practitioners.

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BLACK HISTORY MONTH: Dawn Bent’s hard work helped her overcome challenges to be a mentor for many

Dawn Bent, DNP, MSN, CRNA, didn’t choose to be a nurse anesthetist as much as the profession chose her.

She was working as an ICU nurse for eight years when one of the anesthesiologists that she worked with told her: “I think you would be a great nurse anesthetist.” She didn’t know what that was, and so he took her over to the operating room and let her see the profession in action. She still wasn’t convinced, but she didn’t forget. About a year or two later, she explored the profession again and decided to pursue the career path.

“I don’t know if I ever told him, but to this day I thank Dr. Stayer for introducing me to the profession,” said Bent, who works at the University of Pennsylvania and St. Christopher’s Hospital for Children.

Dawn Bent, DNP, MSN, CRNA

Today, Bent is a program director, a role she takes seriously for a number of reasons.

“There are so many challenges from an educational standpoint,” Bent says. “It is even more challenging as a director of color. I say that because we have such a diverse cohort of students on every level that giving them exactly what they ‘need and want’ can pose difficulty.

"I want to be an example to every student regardless of their background, but I know that students of color look up to me in a very different way. I want to make sure that I am being a great example to all of my students.”

Some of the students featured during PANA’s Black History Month commemoration have named Bent as their mentor. And, Bent has her own list of mentors, too. “It’s almost like, 'where do I begin here,'” she says.

The late Art Zwerling touched her education and clinical life so deeply. He was one of the best in the OR and she wanted to follow his lead at all times. She also can’t say enough for Maria Van Pelt (nee Magro), who is not only her friend but definitely always a text or phone call away. “She is so graceful in her approach and has the best poker face out there.” Bent says she learned so much from her.

With all this support, Bent’s greatest achievement thus far is her program director role and working with her associate director. This was not a role that she sought out and she was not even sure she would do it any justice, but they put together not only a team between the two of them, but also with their students and program administrator.

“The value of partnering with our students gives me such hope that in the future they will look at students as their partners so we can actively break the cycle of needing our students to be resilient,” Bent says. “Anesthesia education requires resiliency, but it also needs an environment of gentleness and tolerance to a degree. We were all students at one point.”

As a first generation Jamaican American, Bent’s family always stressed the importance of hard work, but she also recognizes that some from diverse backgrounds may work hard but are still not afforded opportunities. Her focus is continuing to be the face of hard work, mentorship and caring. There are a lot of talented Black Americans out there and some just need the platform in order to shine, she says.

As for what’s next? Bent hopes to continue to make a difference in the lives of students and grow the profession. Being a program director of color, she understands that students from diverse backgrounds — all of them — need an advocate and a mentor.

“I have had students reach out to me that do not go to my program and ask me lots of questions and ask me to mentor them,” she says. “I can’t help but say yes because there were people who invested in me when they really didn’t have to. Giving back means a lot. Working in partnerships with others who have the same heart for students is what I am looking to do.”

Shapiro addresses lag times in licensing

Gov. Josh Shapiro has announced plans to cut red tape and make it easier to work in Pennsylvania by creating a “money-back” guarantee for industries that require different professional licenses, certificates and permits --- and that includes nursing licenses.

In February 2021, PANA joined with the Pennsylvania State Nurses Association (PSNA) and the Pennsylvania Coalition of Nurse Practitioners (PCNP) to push the Pennsylvania State Board of Nursing (SBON) to do more to address urgent concerns and challenges regarding licensing.

At the time, members reported difficulties related to initial licensure and/or renewal application processes. There were numerous examples where an employer has suspended a nurse due to a lag in new or renewal applications. Problems still persist, today.

Under the executive order Shapiro signed on Jan. 31, the governor is directing state agencies to catalog all the licenses, certificates and permits they issue, the rules outlining how long agencies should take to process applications, and the fees that are charged. Agencies have 90 days to comply.

Shapiro also made the pledge that if it takes too long to get a professional license, applicants should get their money back.

In 2021, NPR reported that Pennsylvania had some of the longest wait times in the country to issue nursing licenses, a critical need during the height of the Covid-19 pandemic.

But it's not just nurses. More than one million workers need a license from Pennsylvania to do their jobs, ranging from doctors and hair stylists to accountants and real estate agents, according to a 2018 report by the Department of State.

Shapiro is directing state agencies to review existing digital services used to apply for licenses, certificates and permits, and then work to modernize them.

More details are forthcoming as agencies prepare their reports in the next 90 days.