Legislator’s grandmother, a CRNA, lives life of caring

When state Representative Aaron Bernstine was a boy, he had it better than most.

“Grandmothers are always the best at fixing bumps and bruises,” he said. But Rep. Bernstine’s grandmother, Stella Rybka, was a certified registered nurse anesthetist, so she was able to “fix it a little bit better.”

Mrs. Rybka was born and raised in New Castle, Pa., and began her career as a registered nurse (RN) at Jameson Hospital. When the hospital, in need of anesthetists, offered to train staff members to become nurse anesthetists, she leapt at the opportunity, a response that was very much in character for her.

“She always talked about the importance of continuing education and striving to make yourself better,” Rep. Bernstine recalled. “No matter what you do, it’s about continuing to get better, which I know is a strong focus of PANA. It’s about continued improvement in your vocation.”

The spirit of constant betterment that Mrs. Rybka exemplifies so well is very much alive in the new generation of CRNAs in Pennsylvania. The commonwealth currently is home to more than 3,000 CRNAs and is one of the top states for CRNA students nationwide, with 12 university-level nurse anesthetist programs spread across the state.

Mrs. Rybka developed her interest in anesthesia during her RN training when she was working in an operating room and became “fascinated” by the work being done by the anesthetists. While the intellectual challenges of her craft were important to her, at the end of the day it all came down to one thing: her passion for caring for her patients.

“I just loved all my patients,” she recalled. “And not only because they were all asleep at the time,” she joked. Being able to be there for her patients and console them during difficult times in their lives “gave [her] a sense of fulfillment.”

According to Rep. Bernstine, this dedication to caring for others has extended beyond Mrs. Rybka’s career.

“My aunt has multiple sclerosis and is bedridden,” he said. “To this day, my grandmother provides exceptional care to my aunt, which is why my aunt is in the good health that she is in. I know that her training has been extremely helpful in that regard. Every day I thank God that she had that training and care in her heart to continue treating my aunt.”

Currently, there is no definition for “certified registered nurse anesthetist” under Pennsylvania’s Professional Nursing Law, which means that highly-trained, hardworking, exceptionally dedicated professionals like Mrs. Rybka are not fully recognized for the high level of care that they provide. Pennsylvania is one of only four states that fail to recognize CRNAs in this manner.

Rep. Bernstine has signed on as a co-sponsor of House Bill 719, which will grant professionals like Mrs. Rybka who do what she describes as “the wonderful work of being an anesthetist,” the level of recognition they have earned. A companion measure (S.B. 274) already has passed the Senate and currently is under review by the House Professional Licensure Committee.

“Anytime that we can go out and be supportive of people, like the members of PANA, who are working hard every day and putting food on the table for their families, I’m excited to do that,” Rep. Bernstine said. “We all know that a stronger PANA means a stronger community.”

About Professional Designation Legislation

CRNAs are highly-skilled advance practice nurses who ensure the highest level of care and pain management for patients. As the hands-on providers of anesthesia care, CRNAs practicing 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; and pain management centers.

Yet, Pennsylvania remains one of just four states that do not recognize certified registered nurse anesthetists. Under the state’s Professional Nursing Law, there is no official definition for “certified registered nurse anesthetist,” meaning these professionals are recognized only as registered nurses (RNs). Two companion measures --- S.B. 274 in the Senate and H.B. 719 in the House --- would change that and formally recognize certified registered nurse anesthetists as “CRNAs” under Pennsylvania statute.

Nurse anesthetists like Shirley Gordner forged the way for CRNAs today

Pennsylvania now has more than 3,000 certified registered nurse anesthetists and ranks among the top states for CRNA students nationwide, with 12 university-level nurse anesthetist programs spread across the state. But things were much different when Shirley (Kishbaugh) Gordner graduated in the mid-1950s.

Shirley was among just three student nurse anesthetists who comprised the first class at Williamsport Hospital and, in 1954, successfully completed examinations for membership in the American Association of Nurse Anesthetists (AANA).

It was uncharted territory then. The hospital had only received AANA’s certification for the 16-month nurse anesthetist course the previous year. At the time, Williamsport Hospital in Lycoming County was the only hospital in central Pennsylvania to even host a school for anesthetists. The other options were 90 miles away in Harrisburg or 80 miles north along the New York border in Sayre, distances made all the longer by rural routes.

Today, CRNAs are recognized for their rich history and well-established traditions. But it was trailblazers like Shirley who helped to establish the culture of safe, responsible anesthesia care that continues to this day.

For Shirley, who in 1952 became a registered nurse, a requirement for AANA membership and certification even today, becoming a nurse anesthetist was the next step in a health-care career that would span nearly half a century.

After receiving her certification, she stayed on at Williamsport Hospital for a few months and put her anesthesia training to use for patients there. But professional and personal changes meant a move.

Shirley moved to Berwick in Columbia County, where she would spend most of the next 20-plus years as an operation recovery room nurse and an emergency room nurse and another two decades as the head nurse for a beloved private practice doctor on Berwick’s West End.

Her husband, Carl, an Air Force veteran, worked mornings maintaining HVAC systems at Wise Foods, the makers of Wise Potato Chips. Shirley, still devoted to caring for others, worked for a time at Berwick Hospital on the second shift, from 3 p.m. to 11 p.m., as the couple raised two sons.

Whatever they had to do, they did. Carl worked at the plant for 40 years before retiring. Shirley retired in 1992. She passed away in 2014. Carl survives, as do their two sons.

According to family, although her time as a nurse anesthetist was short, the achievement she felt for being among the first in her class was something she held dearly and spoke of fondly. And that desire to provide the best care possible carried with her throughout her career.

As a tribute to his mother, her youngest son, state Sen. John R. Gordner (R-Columbia), has introduced legislation (S.B. 274) that would formally recognize nurse anesthetists as “CRNAs” under Pennsylvania statute. He grew up experiencing her love for the profession.

“She really enjoyed spending time with patients, listening to them, getting to know them,” Sen. Gordner said. “For as long as she worked, she was always an old-school nurse. There were no 10-minute appointments. She used to say that you can learn a lot more about a patient by listening than by being just diagnostic. She was very personable, and that came out in how she did her job.”

Because of his mother’s work, Sen. Gordner has been a long-time champion of nurse anesthetists. He was a featured speaker at the Pennsylvania Association of Nurse Anesthetists’ spring symposium in Hershey in May 2015, when he was awarded PANA’s prestigious Leadership Award.

“I probably wouldn’t be a state legislator today without my mother having all the connections she had and being so beloved in the community,” Sen. Gordner said.

Now, as Senate Majority Whip, one of the highest-ranking positions in the state Senate, Sen. Gordner is set to help finish something his mother started by making sure more people are aware of nurse anesthetists and the work they do.

Currently, there is no definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, meaning these professionals are recognized only as registered nurses. Pennsylvania remains one of just four states that do not recognize CRNAs in this manner.

Sen. Gordner’s professional designation bill would remedy that and formally recognize CRNAs for the advanced training and education they undergo and the skills they administer to help patients — skills that Shirley (Kishbaugh) Gordner spent a lifetime perfecting.

This piece was originally posted on Medium.com.

Without CRNA designation in Pa., nurse anesthetists face challenges

Lt. Col. Laura Wiggins, a critical care nurse and reservist in the U.S. Air Force, was the only anesthesia provider on her base when she was deployed to Kyrgyzstan in 2006. That’s not uncommon. CRNAs usually are the primary anesthesia providers in austere combat theaters, and often the only anesthesia providers in the military’s forward surgical teams.

A native of Johnstown, Pa., Wiggins received her bachelor’s degree in 1994 from Penn State University and graduated in 2003 from the Bethesda, Md.-based Uniformed Services University of the Health Sciences, one of the top-ranked schools in the country for CRNAs. Wiggins currently is enrolled in the Doctorate of Nursing Practice Program at the University of Pittsburgh.

While deployed and on active duty, she was able to practice to the fullest extent of her education and training, putting her skills to work as an advanced practice registered nurse credentialed provider. At home, it was an entirely different story.

CRNA Designation in Pa.

Pennsylvania, where Wiggins took her state board exams, is one of only four states that fail to recognize the CRNA designation in some form. There is no definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, meaning Wiggins and other professionals like her are recognized only as registered nurses (RNs), not CRNAs.

Without that designation from Pennsylvania, Wiggins, a reservist who is approaching 20 years of military service, needs other state credentials to continue her work on behalf of the USAF Nurse Corps to serve as a credentialed provider while ensuring that military members and veterans have access to care. She currently is an RN in Ohio with a Certificate of Authority to practice as a CRNA, and as an RN in Virginia, where she is licensed as an Advanced Practice Nurse, which covers CRNAs.

The inability to be recognized as a CRNA in her home state brings many challenges --- logistically and financially.

Not only are the costs of licensing going up in each state each year, but new continuing education requirements also keep popping up. That means more out-of-pocket expenses to renew the license, finding conferences that offer the appropriate CEUs that are required, and paying more to travel out of state to obtain the CEUs, background checks and other legal requirements she needs to stay licensed and credentialed as a CRNA in the military. Getting the time off to maintain all of these requirements is an added expense.

This isn’t a problem unique to just Wiggins and other veterans, either. Pennsylvania CRNAs on humanitarian missions find it harder to get credentialed when offering their services overseas.

Legislative Fix Essential

The state legislature wrapped up its two-year 2015-16 legislative session without fully addressing the issue of CRNA designation. The Senate Consumer Protection and Professional Licensure Committee unanimously approved legislation (S.B. 481) in June to officially recognize CRNAs under Pennsylvania statute. But the measure never made it to the full Senate for consideration. A companion bill (H.B. 764) died in the House without a vote. Both measures must be reintroduced in the 2017-18 legislative session, which begins in January.

“The burden is on us,” Wiggins said. “It’s a nurse fix. I’m fixing [the designation issues] on my end as I’m waiting for the legislature to fix it on their end. And it’s getting more and more expensive to fix. Each year it’s worse.”

Wiggins, who lives in Cheswick, located along the Allegheny River about 15 miles northeast of Pittsburgh, works for UPMC and Anesthesiology Services Network. While she works mostly in Pennsylvania, she also practices in Ohio, picking up shifts or covering for vacations to stay licensed there. She also keeps her certification in Virginia to maintain her scope of practice for military service.

CRNAs are trained for procedures such as epidurals and spinals for orthopedic and obstetrical anesthesia; central venous catheter placement for complicated surgeries that require the possibility of transfusions and closer monitoring; and peripheral nerve blocks that are excellent pain management techniques for the wounded warrior. Wiggins expertly administered those procedures without any complications when she was the only anesthesia provider on base. Stateside in Pennsylvania, she can’t perform those same tasks without a supervising physician.

“If this state would just recognize what we do already,” Wiggins said. “Nurse Anesthetists have been administering anesthesia on the battlefield since the Civil War. Pennsylvania is over 150 years behind the times in recognizing our profession.”

Defining CRNA in Pennsylvania law is the first step. The act would carry across borders and finally give CRNAs the recognition they deserve in Pennsylvania.

Learn more about CRNAs in Pennsylvania at www.PANAforQualityCare.com. Additional details are available via Twitter at @PANACRNA and on Facebook at www.facebook.com/PANACRNA.