PANA Members Discuss What Blanket Waiver During Pandemic Really Means

Blanket waiver removing physician supervision requirement benefits health-care facilities, patients during pandemic

The Pennsylvania Association of Nurse Anesthetists achieved a significant victory for the profession in May when Gov. Tom Wolf announced a temporary blanket waiver removing the physician supervision requirement for certified registered nurse anesthetists (CRNAs).

The waiver has been hugely important as part of the state’s response to the health-care crisis caused by COVID-19. Advanced practice nurses like CRNAs can finally practice to the fullest extent of their education and training.

That avails more physicians to provide hands-on care. It expands the capacity of both CRNAs and physician providers. It augments the state’s health-care system to continue to meet growing demands during this pandemic. And it ensures patients get the best care.

But what has this waiver really meant for CRNAs, health-care facilities and the patients we serve? Here are some firsthand accounts from CRNAs on 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.)

“I work in a critical access hospital and since the governor removed the supervision requirement, the anesthesiologists are now running their own room and I’m working in another room with my surgeon --- which means we are able to provide two times the services!”

“We at our local Hospital started a COVID response team in conjunction with the ER and ICU. We responded to all COVID intubations, put in an arterial line, a central line, and intubated the patients. We also helped manage vent settings/unstable patients as needed.”

“My hospital told our anesthesiologists that they will be taking their own assignment and that the CRNAs will work alone until we get caught up on elective surgeries. Many of our anesthesiologists resigned because they don’t want to give anesthesia.”

“Yes, we have provided a CRNA from our department for 24-hour coverage of the COVID units to act as an NP to help assess patients, place lines, and act as extenders for the critical care intensivists in our county. The chief in my group was able to use the supervision waiver for us to work outside of the OR and in the OR without supervising anesthesiologists.”

“The orthopedic surgeons at my hospital have always wanted an ologist available. That has all changed. The CRNAs are working alone and our ologist was given the option of working in a room or taking time off unpaid.”

It’s clear: Gov. Wolf’s decision to issue that temporary blanket waiver and remove the physician supervision requirement for certified registered nurse anesthetists is making a real difference.

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, which gives him broad powers to manage this public health emergency.

The proclamation was renewed for 90 days in early June. Lawmakers challenged the extension. But state judges sided with the governor. That means the proclamation remains in place for at least two more months. As long as the governor’s disaster proclamation remains in place, so does his blanket waiver removing the physician supervision requirement for CRNAs.

Stories like these from our CRNAs prove that this policy shouldn’t just be implemented during a pandemic, but instead be permanent to ensure patient health and safely and to give greater options to health-care facilities to provide the best care to those in need.

Military CRNAs Lead the Fight against COVID-19

Certified registered nurse anesthetists (CRNAs) are battle-tested providers, joining all our military’s medical personnel deployed in the fight against COVID-19.

Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since World War I, and remain the primary anesthesia providers in austere combat theaters. In fact, CRNAs most commonly are the only anesthesia providers in the military’s forward surgical teams.

It is no wonder then that CRNAs are back on the frontline and on active duty fighting against the global COVID-19 pandemic. CRNAs provide high-quality, safe care, even in the most stressful and emergent situations.

In America’s epicenter of the viral infection, the anesthesia department at the Javits New York Medical Station (JNYMS) consisted of 27 CRNAs who worked with medical providers from the U.S. Army, Navy and Air Force, addressing the health-care crisis striking New York City.

Among those at JNYMS was U.S. Navy Cmdr. Joe K. Blair, CRNA, MS, NC. Blair is a 2005 graduate of the Allegheny School of Anesthesia/La Roche College School of Nurse Anesthesia in Pittsburgh, and was featured in a video showcasing the military operations of CRNAs working at the medical station:

“It has been noted frequently what a difference the CRNAs have made in the care the patients have received in the ICU,” Blair said. “Our vast ICU experience with our current anesthesia training made us supremely adapted to function in the capacity that we took on in this situation.”

The Pennsylvania Association of Nurse Anesthetists and all of our CRNAs and students salute Cmdr. Joe K. Blair and the military medical professionals like him from all of the uniformed services who are bravely and proudly serving our country in its national response to COVID-19.

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Jamaica-native, U.S. Army Reserve Capt., supports Temple University Health health care workers​

PHILADELPHIA, PA, UNITED STATES

04.29.2020

Video by Master Sgt. George Roach

Defense Department Support to FEMA COVID-19

U.S. Army Reserve Capt. Yakeba Allison, certified registered nurse anesthetist (CRNA), attached to Urban Augmentation Medical Task Force 352-1, is supporting Temple University Health health care workers in the fight against COVID-19 in Philadelphia, Pa., April 29, 2020. UAMTF 352-1 is augmenting civilian medical staff at six Philadelphia-area medical facilities in support of the Department of Defense COVID-19 response. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army video by Staff Sgt. Adrian Patoka, 22nd Mobile Public Affairs Detachment)

For more information on this story, please contact 1st Lt. Kara Crennan at kara.crennan.1@us.af.mil

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.”