Updated: Jan 20, 2021
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.