Day in the Life: CRNAs & COVID-19

By Sonya Brown, BS, MS, CRNA

In celebration of 2021 National CRNA Week, this article provides a brief history of the certified registered nurse anesthetist (CRNA) profession, describes what it’s like to be a CRNA today during the COVID-19 pandemic, and details the ongoing importance of the state’s recent waiver of supervision requirements for CRNAs.

Historical Perspective: Can you believe that nurse anesthetists have been providing anesthesia services in the United State for more than 150 years? During the Civil War, nurses provided anesthesia services to wounded soldiers on the battlefield, and they soon became the predominant anesthesia provider for those on the frontline. Later, in 1956, CRNA credentialing came into existence. Today, CRNAs safely administer more than 49 million anesthetics each year in the United States. CRNAs also serve as the primary anesthesia provider in the vast majority of many rural and underserved communities. Peer-reviewed studies show that anesthesia care is nearly 50 times safer now than in was in the 1980s, and that there is no difference in the quality of anesthesia care provided between a CRNA and a physician-trained counterpart. CRNAs practice with a high degree of autonomy and carry great responsibility due to their extensive education, training, and licensure. It is estimated that by 2026, there will be a 31 percent increase in need for advanced practice nurses such as CRNAs. There already is a 60 percent shortage of CRNAs across the United States.

CRNAs & COVID-19: With the surge caused by COVID-19, CRNAs stepped up, masked up, and were given the opportunity to practice to their full extent and capabilities. With more patients in need, there simply were not enough skilled and trained providers to care for all these sick individuals. CRNAs were able to jump in immediately to care for these patients. Because of their training in critical care and airway management, CRNAs were able to offer support in intubations and airway management outside of the typical operating room setting. This included covering the emergency room, intensive care unit, and other critical care areas. In addition, CRNAs have played a vital role in invasive line insertion, managing sedation, monitoring labs and blood gases, as well as other diagnostic tests. They also continued to manage their patient’s anesthetic needs within the operating room. Because of all of this, CRNAs have been and continue to be one of the most important team members in the management of COVID-19 patients, while continuing their primary role of administering safe anesthesia for their patients.

State Waiver: Because there were and continues to be an increasing number of patients afflicted by COVID-19, Pennsylvania Gov. Tom Wolf temporarily waived CRNA supervision requirements, allowing CRNAs to utilize their unique skillset to help care for these sick individuals. (The waiver remains in effect as part of the governor’s ongoing disaster declaration.) This waiver allows CRNAs to play a critical role in the care of these patients and to be able to respond appropriately. The governor’s action also has made a huge impact in that more CRNAs are able to respond to this health-care crisis. As of right now, Pennsylvania remains one of only a few states where CRNAs are not recognized as advanced practice providers, something our association is fighting to change. CRNAs play a vital role in providing lifesaving airway and critical care management of those patients impacted by COVID-19. There are 33 states with no CRNA supervision in state law. Removing CRNA supervision permanently in Pennsylvania should be a top priority. We need to work with our associations and advocate for our profession at the state and federal levels. This would allow us to provide anesthetic services to our patients within our full scope of practice and to the best of our ability. Please support and advocate for CRNAs in Pennsylvania.

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To all the professionals in the field: Happy 2021 National CRNA Week!

CRNA Week Takes on New Meaning Amid COVID

It’s safe to say our 2021 National CRNA Week commemoration really is like no other before it. Because of the global pandemic caused by COVID-19, all of us have had to confront personal and professional challenges we never thought we’d have to face.

Even now, more than 10 months after this health-care crisis began, response and recovery efforts continue.

But one thing is certain in these uncertain times: I’ve never been prouder to be a Certified Registered Nurse Anesthetist (CRNA) than I am today, and I’ve never been more honored to stand by your side as president of the Pennsylvania Association of Nurse Anesthetists (PANA).

In the most ordinary situations, surgery and anesthesia can be intimidating or frightening. CRNAs provide families comfort and reassurance by never leaving their loved one’s side. When this pandemic separated families in crisis, our promise to be there for every heartbeat, every breath took on a whole new meaning.

Because of our advanced education and hands-on training, CRNAs are uniquely qualified to care for critically ill patients who are suffering because of this respiratory pandemic. Many CRNAs have been serving as frontline health-care workers, fulfilling critical roles inside and outside the operating room during this crisis.

In May, when the state granted a temporary waiver to suspend the CRNA supervision requirement, healthcare facilities jumped at the chance to tap into nurse anesthetists’ unique skillset --- and we rose up to meet the challenge.

By allowing CRNAs to practice to the fullest extent of their education and training, not only are more people familiar with what we do, but our work during this crisis has availed more physicians to provide hands-on care, expanded the capacity of both CRNA and physician providers, and augmented the state’s health-care system to continue to meet the growing demands of this pandemic. Our work affects lives.

This crisis still requires an all-hands-on-deck approach. Our health-care systems are still challenged to function above capacity. As long as response and recovery efforts continue, CRNAs will remain a critical part of the solution as “Experts You Trust. Care You Count On,” our theme this week.

On behalf of PANA, I want to extend my heartfelt gratitude to each and every CRNA and student who has stepped up during these difficult times to represent our profession so honorably and serve patients and families so faithfully. If ever there was a time to commemorate what we do, then 2021 National CRNA Week is the time to do it.

Please be safe. And again, thank you for all you do.

Matt McCoy, DNP, CRNA

President

Pennsylvania Assn of Nurse Anesthetists

Guest column: Eliminate barriers to crisis-ready health care

An emergency is no time to trifle with bureaucratic red tape. At the outset of the COVID-19 crisis, many feared a surge of patients would overwhelm hospital capacity. Health officials sounded the alarm and identified policy changes that would enable them to meet the coronavirus challenge. And, in many cases, government responded.

In March, Gov. Tom Wolf issued executive orders designed to expand the state’s health care capacity, including temporarily suspending regulations that restricted where and how nurses and other health care professionals could practice.

For those aiming to ensure our health care system is always prepared, this raises an important question: If we cut the red tape during times of crisis, why not cut it permanently?

The fact is, before these regulations were suspended, our health system was suffering serious consequences. In April, PennLive reported that thousands of medical professionals across the country were getting furloughed or laid off. Though postponed elective procedures were partially responsible, another major factor was licensing requirements that made it difficult for medical staff to transition from their previous roles to help care for those suffering due to COVID-19.

Jess Poole, who previously worked out of Greensburg, is one such medical professional. Despite being a licensed nurse anesthetist with the training to intubate and manage patients, Pennsylvania wouldn’t recognize her specialty. Licensing restrictions made it impossible for her to contribute.

Health care heroes like Jess were forced to sit on the sidelines just when they were needed most. Thankfully, some state lawmakers are determined to keep this from happening again.

State Rep. Christopher Quinn (R-Delaware County) recently introduced legislation, HB 2779, that everyone concerned about conquering the virus should care about. Rep. Quinn’s bill would extend the suspension of certain bureaucratic regulations holding back our health system for one year — and establish a panel to determine which of those counterproductive regulations should be done away with for good.

Telehealth, or remote medical appointments often conducted via video calls, is a great example of a health care innovation that would have been limited under prior overly-restrictive regulations. The contagious nature of COVID-19 made telehealth an essential service in 2020, and utilization skyrocketed by 50 to 175 percent. This expanded use was made possible because Pennsylvania took steps to guarantee provider reimbursements by insurance companies and relaxed licensing restrictions that prevented providers from serving patients across state lines.

Even after the crisis subsides, telehealth promises increased access to care and reduced patient costs. For example, a Vermont Veterans Association saved almost $19,000 a year from reduced travel costs after offering telehealth options. A 2017 study found that patients experienced a cost savings of $156 per consultation due to reduced time and travel burden.

The removal of antiquated barriers to telehealth and the lifting other unnecessary regulations should be made permanent to expand access to care. For example, maintaining newly-increased practice flexibility for Advanced Practice Registered Nurse Practitioners would empower over 7,000 nurse practitioners in Pennsylvania to care for more patients.

Rep. Quinn isn’t alone in seeing an opportunity to improve health care access and reduce cost for all Pennsylvanians. Senate Bill 25 and HB 100, together sponsored by over 70 lawmakers, create a path for nurse practitioners to practice independently after a minimum of 3 years and 3,600 hours under the supervision of a physician. Empowering them to provide primary care could bring down the patient load per primary care provider from almost 1,000 patients per provider to 667 patients per provider.

Two other proposals, HB 1997 and HB 1998, would give doctors more flexibility over how to work with physician assistants. The result? Greater access by patients to customized care.

Another bill would allow pharmacists to offer flu shots to individuals 9 years of age or older, creating an additional 9,000 access points for flu vaccinations across the state. Empowering pharmacists to provide vaccinations to a wider age range can free up physicians to focus on their most urgent cases.

It is impossible to predict what the future holds for COVID-19. But by repealing unneeded health care regulations that are barriers to patient care, lawmakers can ensure Pennsylvania’s health system is always prepared for crisis.

Stephen Bloom is vice president for the CommonwealthFoundation, Pennsylvania’s free market think tank.

Published in The Pottstown Mercury