Rich History Defines CRNAs, America’s Original Anesthesia Experts

By Laura Wiggins, DNP, CRNA

🔹🔹🔹National CRNA Week debuted as an annual commemoration in 2000 as a way to celebrate our nation’s Certified Registered Nurse Anesthetists and nurse anesthesia students. But the history of our profession stretches back generations.

Nurse anesthesiology traces its origins to 1863, when nurses eased the suffering of wounded soldiers in the Civil War. Since then, nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines and remain the primary anesthesia providers in austere combat theaters.

Today, there are nearly 66,000 CRNAs and nurse anesthesia students nationwide, including more than 3,700 in Pennsylvania.

🔹In times of transition and strife, people look to nurses—and, more specifically, highly trained CRNAs—to bridge the gaps of care, offer compassion to those who need help, and ensure the safety of patients during their most vulnerable times. You bring the art and science to the practice of anesthesia, and the work you do to serve our profession so honorably and your patients so faithfully ultimately enhances the patient’s experience.

🚧 In today’s environment, with health-care overhauls, organizational mergers and changes, redesigned care systems, and fluctuating payment models and costs, patients can rely on CRNAs who demonstrate as the foundation of their practice these core values—integrity, accountability, trustworthiness, and community service. You should be proud of what you do.

As we transition through a global economic crunch and continue to emerge from the global pandemic, enhancing our personal emotional intelligence and well-being is becoming an increasingly essential component of our practice. Having self-awareness, self-regulation, empathy, motivation, and empowerment skills, combined with these other core values, will only strengthen our ability to care more compassionately for our patients.

I am confident in the direction of our association and profession. CRNAs are leaders. We have been there from the beginning, as military necessities on the front lines of our nation’s wars, and we continue to build the teams necessary to serve, because we have the backbone, drive, and fortitude to fight, protect, and defend our patients, our communities, and our nation.

🩺 Looking back at the last 160 years, CRNA history is nursing history. It’s women’s history. It’s our nation’s history. So, let’s celebrate our rich past, but let’s not overlook our promising future. With your passion and commitment to our profession, America’s original anesthesia experts will continue to build trust, show compassion, provide stability, and create hope in the health-care system adjusting, adapting, and overcoming with finesse and grace.

😷 Thank you for all you do—and happy CRNA Week, Pa.! PANA would love to join in YOUR celebration of our profession, so if you're on social media, you can tag @panacrna on Instagram, Facebook and Twitter.

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Structural Racism and Its Impact on Nurse Anesthetists

October 2022

PANA is seeking a more inclusive and diverse nurse anesthetist membership and workforce. The National Academies of Sciences, Engineering, and Medicine (2022) generated statements of task based on the Structural Racism and Rigorous Models of Social Inequity: Proceedings of a Workshop symposium conducted in Washington, DC May 16-17, 2022. The three Academies assembled to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions (NAP, 2022). The information gleaned from this symposium has application to the stated goals of PANA 1) Advance Professionalism, 2) Promote Quality of Care, and 3) Advocate and Educate.

Addressing PANA goal number 1: Advance Professionalism, there was information disclosed focusing upon how structural racism and anti-racist practices impact health disparities and health inequities. It comes down to three pivotal areas for PANA’s attention to influence the knowledge of current professionals and to encourage a more robust professional overture in the immediate future of current diversity attention: 1) review the national and state levels for the attention to social inequality as they result in poor health outcomes; 2) review the multidimensional (and varied intersectional) research on impact of health resources on marginalized populations. The Saturday, August 27, 2022, Diversity, Equity, and Inclusion presentation by Dr. Veronica Carey, Assistant Dean for Diversity Equity, and Inclusion for Drexel University addressed 6 (six) various intersections for the PANA Board’s attention: race, ethnicity, culture, diversity, equity, and inclusion. The final application to the first goal is 3) review how minoritized [Pennsylvanians] view the health field and its practices. These may seem lofty, but when chunked can most certainly offer pathways to advancing professionalism of nurse anesthetists in Pennsylvania.

Goal number 2 of Promoting Quality of Care for PANA lends itself to the information gleaned from the symposium as well with respect to the connection of structural racism to social determinants of health. Hedy Lee, professor of sociology at Duke University, reminds us not to be distracted by the shiny and new data but instead structural racism data may be new, but structural racism is not new and has foundation in the United States. Structural racism looks like colonization, genocide and current but overt population health differences (Lee, 2022 personal communication). Cornel West, professor at Harvard University and prolific writer and presenter on diversity, equity and inclusion, speaks about the value gap and weapons of distraction in higher education (AIA, 2020). West (2018) proffers the value gap pertains to the fact that most Americans focus upon the wealth, empathy, and achievement gaps and the false ideal that some persons are valued more than others (value gap). To close the value gap, habits must change at institutions that perpetuate the value gap (unwittingly is an implicit bias). West (2018) continues to share that [PANA] may be susceptible to the weapons of distraction, for example, calling issues a problem when it is a catastrophe or needing to be the ‘smartest’ in the room (majority rule) when the outliers in the crowd may offer other insights (Harper & Davis, 2020). Instead, PANA can achieve the second goal of Promoting Quality of Care by being sensitive to the vulnerable in both the 3,500 memberships in Pennsylvania and the 56,000 memberships nationwide of nurse anesthetists. PANA might shape the Board in a way to illustrate inclusion, be Socratic to the core, and be prepared to defend the decisions to grow the field from an inclusionary posture.

Advocation and education, goal 3 of PANA, aligns with information addressed at the symposium pertaining to ensuring the work done has the potential both to contribute to well-being, reduce [diversity] disparities, and improve population health (NAP, 2022). PANA’s goal of advocacy would look like thinking about racism only as a form of prejudice makes it impossible to understand the drivers of structural racism; instead, a theoretical understanding of the racialized social system would be beneficial (Glaude, 2018). Education, on the other hand, would resemble addressing current pedagogy, evaluating diversity within curriculum, instating andragogy (Malcome Knowles) as a strategy for including the adult student in the learning process, and reducing the sense of invisibility amongst disenfranchised, marginalized and minoritized faculty, student, and employed alumni of PANA.

References

AIA Resource page for Guides for Equitable Practice (2020). https://www.aia.org/resources/6246433-guides-for-equitable-practice

Eakins, A. & Eakins, S. (2017). African American students at predominately white institutions: A collaborative style cohort recruitment and retention model. Journal of Learning in Higher Education, 13(2), 51-57.

Glaude, E. (2018). Racism is a congenital disease. Retrieved: https://www.youtube.com/watch?v=MfK4jGstcO8

Harper, S.R.& Davis, C.H.F. (2020). Eight actions to reduce racism in college classrooms. American Association of University Professors.

National Academies Press (2022). 26690.pdf

Ohio State University: Kirwan Institute for the Study of Race and Ethnicity: http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/

West, C. (2018). Speaking truth to power: https://www.youtube.com/watch?v=-Bc6TRjptKI

PANA PRESIDENT: Enhanced Leadership, Increased Engagement, Mentorship Key to Growing Profession

PRESIDENT’S MESSAGE:

Laura Wiggins, DNP, CRNA

Lt. Col. (R), U.S. Air Force

It is a pleasure and honor to be assuming the role of President of the Pennsylvania Association of Nurse Anesthetists (PANA). I am looking forward to serving the membership in the upcoming year. There certainly is no shortage of work to do.

Our Government Relations Team and Government Relations Director, Jessica Poole, are confronting several issues in Harrisburg. I attended a meeting there Oct. 27 with the Department of State and the Bureau of Professional and Occupational Affairs on behalf of PANA and our members. During this meeting, they discussed the antiquated PALS system and license renewals within the state of Pennsylvania. PANA is trying to determine how our new title designation will be processed through this system, or any other system the state develops. We learned several things at this meeting, but the most important thing is not to delay renewing any licenses. Get them done as soon as you receive notification because there will be obvious growing pains in activating a new system and removing the old PALS system.

As your new PANA President, I am setting the following goals for our association:

• Enhance the leadership of the board of directors;

• Increase member engagement; and

• Mentor our future leaders

I think as CRNAs we are experts at patient care and clinical competence. I feel that we are sometimes lacking in the leadership realm. I hope to improve on this within our board by encouraging participation in the AANA Leadership Summit and offering other leadership training throughout the year. Advocacy continues to be one of our main priorities, especially during an election year. We need to be out in front, meeting with our legislators and forming long-lasting relationships with legislative aides, legislators and lobbyists to solidify our position on various health-care issues that will present themselves within the coming year. Leadership in this area is a priority and necessity. We are fully expecting legislation to be re-introduced in the next session, which begins in January 2023, to license anesthesiologist assistants (AAs) for the first time in Pennsylvania. The connections and relationships we form now with lawmakers will be extremely important in helping us maintain our position and will help us with gains in propelling the profession forward.

I also hope to increase member engagement by communicating with members directly on issues that affect our profession. PANA’s Communications Director, Sarah Trau, will help facilitate this huge undertaking. She will be working with the team at Ceisler Media & Issue Advocacy to make sure our members are in the know and kept informed. My hope is that as we increase engagement, more members will participate in district events and other educational activities and political action committee (PAC) events.

Finally, mentoring our future leaders is extremely important in ensuring the ongoing success and trajectory of the profession. Please encourage student involvement at every level of participation! I am motivated and encouraged by the excitement and enthusiasm of the SRNAs we have on the PANA board. Hopefully, their enthusiasm is contagious and will be felt by all of the members in the coming months.

I remain committed to helping this profession succeed in this time of uncertainty. With change there is always room for opportunity. Advancing our profession is worth the fight. If you have any ideas or suggestions for upcoming PANA events or want to know how to contact your legislators, please don’t hesitate to contact me. I am looking forward to working with all of you and serving this association.