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

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.