Letter: Villanova University Urges Support for CRNA Designation, S.B. 325

SUPPORTING DESIGNATION LEGISLATION IN PENNSYLVANIA

Re: CRNA Professional Designation Legislation: S.B. 325 (Gordner)

October 1, 2019

Dear Senator/Representative:

Pennsylvania has more nurse anesthesia graduate programs than any other state in the U.S., attracting students from across the country to study in Pennsylvania to become certified registered nurse anesthetists (CRNAs). Many choose the highly competitive Villanova University Nurse Anesthesia Program, which is administered in partnership with the Crozer Chester Medical Center.

Pennsylvania remains one of just two states that fail to formally recognize CRNAs in statute or provide licensure as a CRNA. There is no definition for “Certified Registered Nurse Anesthetist” under the state’s Professional Nursing Law, and there is no title designation for CRNAs and they are recognized only as registered nurses, not as CRNAs. This ignores the lengthy advanced education and training, required to become a CRNA.

Fortunately, in the final days of legislative session before the General Assembly adjourned for summer 2019, the state Senate approved a measure (S.B. 325) introduced by Sen. John Gordner that would formally recognize CRNAs under PA state law. This is the second consecutive legislative session that the measure passed the Senate. We are urging the House to do the same, immediately.

Nurse anesthetist programs like Villanova’s have seen firsthand the challenges our students and graduates face without title recognition in Pennsylvania. Many graduates opt to relocate to other states where CRNAs can practice to their full scope of their education and training. Without formal designation as a CRNA, our graduates who relocate to other states can wait as long as six months to become credentialed. In the absence of title recognition or CRNA license reciprocity, other state boards must verify that the graduates have met their state requirements to be licensed appropriately, which delays our graduates’ ability to work. Retention of these advanced professionals in Pennsylvania should be a priority for our commonwealth because of the outstanding health services that they provide thus improving the health and welfare of PA residents.

Nurse anesthetists must graduate with a minimum of a master’s degree from a nurse anesthesia accredited program, complete greater than 2,000 hours of clinical experience in anesthesia practice and pass a national certification exam in order to practice. The average nurse anesthetist completes 9,000 clinical hours of clinical training, including the clinical ICU experience as an RN required to enter CRNA training, the clinical experience obtained in an undergraduate nursing curriculum, and the clinical anesthesia training in a nurse anesthesia program. CRNAs are required to be nationally certified and must be recertified every four years, meeting strict continuing education standards.

Lack of title recognition in PA presents significant barriers for CRNAs in Pennsylvania who are active military personnel or who volunteer in emergency response teams. Pennsylvania CRNAs who are active military have to secure CRNA licensure in another state to serve as a CRNA in an active duty role of the armed forces. This is unacceptable because it adds additional fees and continuing education requirements to maintain licensure in another state to be eligible serve in our military. Nurse anesthetists have been the primary providers of anesthesia care to U.S. military personnel on the front lines since World War I, and remain the primary anesthesia providers in austere combat theaters. Yet, Pennsylvania’s battle-tested CRNAs are at a distinct disadvantage without CRNA licensure in Pennsylvania. Pennsylvania CRNAs cannot assist as part of emergency response teams in other states because they lack CRNA title designation in Pennsylvania, which diminishes the role our commonwealth can play in aiding states affected by hurricanes, floods or other natural disasters.

The CRNA graduates from Villanova University / CCMC Nurse Anesthesia Program are highly-qualified clinicians who are recruited across the country. CRNAs have been providing superior anesthesia care for more than 150 years and empirical evidence demonstrates there is no difference in the quality of anesthesia care when provided by CRNAs or physicians, independently, or together in a team model.

The CRNAs in Pennsylvania need title recognition and we urge you to both support S.B. 325 and urge immediate action by the House of Representatives.

Sincerely,

Donna S. Havens, PhD, RN, FAAN

Connelly Endowed Dean and Professor

Villanova University

M. Louise Fitzpatrick College of Nursing

PANA Member Part of National Team Updating Anesthesia Practice Standards

PANA represents more than 3,700 certified registered nurse anesthetists and students in Pennsylvania, making it one of the largest state associations for CRNAs in the country. Many of PANA’s board members also play a role at the national level with the American Association of Nurse Anesthetists, meaning members here have enhanced representation.

The latest example is Jessica Poole, DNAP, MSN, CRNA. Jessica heads PANA’s Governance Committee, which is the association’s top post for engaging members and lawmakers on issues important to CRNAs, and for helping to coordinate efforts with other health-care partners.

Besides her work with PANA, Jessica also holds committee posts with AANA, where she is chair of the AANA Practice Committee, which comprises eight nurse anesthetists who work to ensure practice standards support the delivery of patient-centered, consistent, high-quality, and safe anesthesia care.

Jessica and her committee recently worked to release an updated version of the “Standards for Nurse Anesthesia Practice.” Revising the practice standards is a multi-year endeavor involving extensive reviews and several comment periods for stakeholder feedback. The comprehensive document sets standards that apply in all settings.

It’s an incredible undertaking --- and one more way both PANA and AANA are working to serve CRNAs in Pennsylvania and across the country.

Learn more about Jessica’s leadership and the updated standards by reading the full release below.

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Anesthesia Practice Standards Updated, Published by American Association of Nurse Anesthetists March 20, 2019

Park Ridge, Illinois—To ensure that patients continue receiving the highest quality anesthesia care possible, the American Association of Nurse Anesthetists (AANA) has published a comprehensive update to its Standards for Nurse Anesthesia Practice, the foundation of Certified Registered Nurse Anesthetist (CRNA) care delivery. The standards can be accessed at https://www.aana.com/standards.

As anesthesia experts with a 150+ year history, CRNAs are the hands-on providers of more than 45 million anesthetics each year in the United States, according to the AANA’s website (www.aana.com/crnafacts). The association represents approximately 53,000 CRNAs and student registered nurse anesthetists.

“The AANA’s practice standards support the delivery of patient-centered, consistent, high-quality, and safe anesthesia care and assist the public in understanding the CRNA’s role in patient care,” said Jessica Poole, DNAP, CRNA, chair of the AANA Practice Committee which is comprised of eight nurse anesthetists and supported by AANA staff. “The association routinely reviews and updates our profession’s practice standards, guidelines, and other critical documents based on the latest research to support CRNAs practicing at the peak of their knowledge and skills.”

This adherence to keeping current is one reason for CRNAs’ stellar safety record, according to AANA President Garry Brydges, DNP, MBA, CRNA. “No fewer than 10 major anesthesia safety studies published since 2000 have confirmed that CRNAs are the safest, most cost-effective anesthesia professionals in the United States,” he said.

With 7-8½ years of education and more than 9,000 hours of clinical training resulting in a graduate degree in their specialty, CRNAs are qualified to deliver anesthesia care for surgical, obstetrical, and emergency procedures, as well as provide chronic pain management services. They are the predominant anesthesia providers in rural and medically underserved areas of the country, to new moms in labor, and to U.S. military personnel around the world, especially on the front lines.

Poole said that “revising the practice standards was a multi-year endeavor involving an extensive literature review, multiple focus sessions, legal review, and a public comment period to obtain feedback from stakeholders across all practice settings.” The final document delineates each standard and includes links to more detailed resource documents containing the latest research to support the implementation of the standard.

“The standards apply in all practice settings, including operating rooms, nonoperating room anesthetizing areas, ambulatory surgical centers, and office-based practices,” Poole said. “As anesthesia care delivery continues to evolve at a rapid pace, the AANA and its members will continue to evolve right along with it. Our patients and employers expect nothing less.”

The essential elements of the standards include:

• Patients’ rights, which are prioritized as Standard 1 in the revised document;

• Preanesthesia patient assessment and evaluation;

• The anesthesia care plan;

• Informed consent;

• Documentation;

• Equipment;

• Anesthesia plan implementation and management;

• Monitoring and alarms;

• Infection control and prevention; and

• Transfer of care.

The revision also includes the addition of new standards on wellness and culture of safety.

“Patients can rest assured that when they receive their anesthesia from a Certified Registered Nurse Anesthetist they are in the care of a well-prepared, highly qualified provider whose sole focus is on their comfort and safety,” said Poole.