Updated: May 26, 2022
By Sonya Brown, BS, MS, CRNA
In celebration of 2021 National CRNA Week, this article provides a brief history of the certified registered nurse anesthetist (CRNA) profession, describes what it’s like to be a CRNA today during the COVID-19 pandemic, and details the ongoing importance of the state’s recent waiver of supervision requirements for CRNAs.
Historical Perspective: Can you believe that nurse anesthetists have been providing anesthesia services in the United State for more than 150 years? During the Civil War, nurses provided anesthesia services to wounded soldiers on the battlefield, and they soon became the predominant anesthesia provider for those on the frontline. Later, in 1956, CRNA credentialing came into existence. Today, CRNAs safely administer more than 49 million anesthetics each year in the United States. CRNAs also serve as the primary anesthesia provider in the vast majority of many rural and underserved communities. Peer-reviewed studies show that anesthesia care is nearly 50 times safer now than in was in the 1980s, and that there is no difference in the quality of anesthesia care provided between a CRNA and a physician-trained counterpart. CRNAs practice with a high degree of autonomy and carry great responsibility due to their extensive education, training, and licensure. It is estimated that by 2026, there will be a 31 percent increase in need for advanced practice nurses such as CRNAs. There already is a 60 percent shortage of CRNAs across the United States.
CRNAs & COVID-19: With the surge caused by COVID-19, CRNAs stepped up, masked up, and were given the opportunity to practice to their full extent and capabilities. With more patients in need, there simply were not enough skilled and trained providers to care for all these sick individuals. CRNAs were able to jump in immediately to care for these patients. Because of their training in critical care and airway management, CRNAs were able to offer support in intubations and airway management outside of the typical operating room setting. This included covering the emergency room, intensive care unit, and other critical care areas. In addition, CRNAs have played a vital role in invasive line insertion, managing sedation, monitoring labs and blood gases, as well as other diagnostic tests. They also continued to manage their patient’s anesthetic needs within the operating room. Because of all of this, CRNAs have been and continue to be one of the most important team members in the management of COVID-19 patients, while continuing their primary role of administering safe anesthesia for their patients.
State Waiver: Because there were and continues to be an increasing number of patients afflicted by COVID-19, Pennsylvania Gov. Tom Wolf temporarily waived CRNA supervision requirements, allowing CRNAs to utilize their unique skillset to help care for these sick individuals. (The waiver remains in effect as part of the governor’s ongoing disaster declaration.) This waiver allows CRNAs to play a critical role in the care of these patients and to be able to respond appropriately. The governor’s action also has made a huge impact in that more CRNAs are able to respond to this health-care crisis. As of right now, Pennsylvania remains one of only a few states where CRNAs are not recognized as advanced practice providers, something our association is fighting to change. CRNAs play a vital role in providing lifesaving airway and critical care management of those patients impacted by COVID-19. There are 33 states with no CRNA supervision in state law. Removing CRNA supervision permanently in Pennsylvania should be a top priority. We need to work with our associations and advocate for our profession at the state and federal levels. This would allow us to provide anesthetic services to our patients within our full scope of practice and to the best of our ability. Please support and advocate for CRNAs in Pennsylvania.
To all the professionals in the field: Happy 2021 National CRNA Week!