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.

End of session is just the beginning of AA legislative fight

Only a few session days remain—six in the Senate, three in the House of Representatives—before Pennsylvania’s 2021-22 legislative session ends.

Any bill that hasn’t made it entirely through both chambers of the state General Assembly to get to the governor’s desk for his signature and enactment must be reintroduced and work itself through the whole legislative process again when the new two-year session starts in January 2023.

The end of session is good news when it comes to bad policy like House Bill 1956 and Senate Bill 1258, two companion measures that would license anesthesiologist assistants (AAs) for the first time in Pennsylvania.

Neither bill received consideration and no votes are pending in these waning days of session. But that doesn’t mean the issue is finished—far from it.

The Pennsylvania Association of Nurse Anesthetists (PANA) successfully pushed back against the legislation this year, but we fully expect the measures to be reintroduced in the 2023-24 session.

We’ll be ready, too. We have to be, because we’ve already seen some of tactics proponents will use to advance their bills. Consider the lengths they’ll go:

• Certified Registered Nurse Anesthetists (CRNAs) and SRNAs heard rumors that the legislation passed. Nope. Never happened. In fact, on April 25, PANA testified against the legislation during a House Professional Licensure Committee hearing. The measure never received a vote.

• In an unprecedented attempt to circumvent the legislative process, AAs began reaching out directly to both physician-owned and CRNA-owned anesthesia companies with notice that they are authorized to work in Pennsylvania under delegatory authority. The Pennsylvania Department of Health has made clear that anesthesiologist assistants are not recognized as an anesthesia provider in the state and therefore cannot operate as such in the commonwealth.

• Working with their state and national organizations, anesthesiology assistants also have been claiming publicly that AAs and CRNAs can be used interchangeably, alleging an anesthesia shortage, as part of an attempt to move AAs into facilities where CRNAs are already working. Nonsense. AAs are limited by their training to only provide support as a technical assistant to a physician anesthesiologist and cannot provide anesthesia care apart from their direct supervision. Any scenario that has an AA working apart from a physician anesthesiologist is in direct violation of federal law.

So, while this legislative session is ending, it’s really just the beginning of the fight against a misguided policy that will NOT improve patient safety or enhance care; will NOT reduce health-care costs, but instead contribute to costlier care models; and will NOT improve access to anesthesia services.

Learn more at www.PANAforQualityCare.com.