Day in the Life: CRNAs & COVID-19

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.

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To all the professionals in the field: Happy 2021 National CRNA Week!

CRNA Week Takes on New Meaning Amid COVID

It’s safe to say our 2021 National CRNA Week commemoration really is like no other before it. Because of the global pandemic caused by COVID-19, all of us have had to confront personal and professional challenges we never thought we’d have to face.

Even now, more than 10 months after this health-care crisis began, response and recovery efforts continue.

But one thing is certain in these uncertain times: I’ve never been prouder to be a Certified Registered Nurse Anesthetist (CRNA) than I am today, and I’ve never been more honored to stand by your side as president of the Pennsylvania Association of Nurse Anesthetists (PANA).

In the most ordinary situations, surgery and anesthesia can be intimidating or frightening. CRNAs provide families comfort and reassurance by never leaving their loved one’s side. When this pandemic separated families in crisis, our promise to be there for every heartbeat, every breath took on a whole new meaning.

Because of our advanced education and hands-on training, CRNAs are uniquely qualified to care for critically ill patients who are suffering because of this respiratory pandemic. Many CRNAs have been serving as frontline health-care workers, fulfilling critical roles inside and outside the operating room during this crisis.

In May, when the state granted a temporary waiver to suspend the CRNA supervision requirement, healthcare facilities jumped at the chance to tap into nurse anesthetists’ unique skillset --- and we rose up to meet the challenge.

By allowing CRNAs to practice to the fullest extent of their education and training, not only are more people familiar with what we do, but our work during this crisis has availed more physicians to provide hands-on care, expanded the capacity of both CRNA and physician providers, and augmented the state’s health-care system to continue to meet the growing demands of this pandemic. Our work affects lives.

This crisis still requires an all-hands-on-deck approach. Our health-care systems are still challenged to function above capacity. As long as response and recovery efforts continue, CRNAs will remain a critical part of the solution as “Experts You Trust. Care You Count On,” our theme this week.

On behalf of PANA, I want to extend my heartfelt gratitude to each and every CRNA and student who has stepped up during these difficult times to represent our profession so honorably and serve patients and families so faithfully. If ever there was a time to commemorate what we do, then 2021 National CRNA Week is the time to do it.

Please be safe. And again, thank you for all you do.

Matt McCoy, DNP, CRNA

President

Pennsylvania Assn of Nurse Anesthetists

PANA Members Recount How Patients and Facilities Benefit from Waiver Removing Physician Supervision

Health-care facilities, patients benefit from waiver removing physician supervision during pandemic

We shared with you previously stories from the frontline among certified registered nurse anesthetists who are experiencing firsthand the effects of the state’s temporary blanket waiver removing the physician supervision requirement for CRNAs.

The waiver was included in an executive order that the governor signed to protect health-care practitioners for good-faith actions taken in response to this crisis, and it remains in effect for the duration of the governor’s disaster proclamation.

As you know, Pennsylvania regulations still require physician supervision of CRNAs in a hospital setting. The temporary suspension gives health-care facilities more flexibility to tap into the unique skillset of CRNAs to fulfill critical roles outside the operating room during this crisis. After all, CRNAs possess a skillset uniquely suited to aid during a respiratory pandemic.

Without a doubt, the waiver has made a real difference. Here are some more voices from the frontline. (Please note that the names of the CRNAs and their facilities have been removed to ensure their anonymity and protection in the workplace.)

“My hospital may not financially survive since elective procedures have been canceled. Our anesthesia team staffing had to change to preserve costs and the governor’s order helped us accomplish that.”

“Our role has been authorized for this expansion of function outside the operating room. The plan is to utilize CRNAs to run overflow ICU beds in our PACU and pre-op areas. CRNAs would manage patient care, manage ventilators, order labs, medications and appropriate radiology studies, and insert central and arterial lines as needed.”

“In our facility, CRNAs served in the OR, in labor and delivery, and on the intubation team for the ED and COVID/PUI patients; we also had a portion of our team train to perform supportive roles in our critical care units and also make the PACU into a makeshift ICU if the need arose but that has not been necessary as of this point.”

“Hospital administration along with the support of our MD Anesthesiologist (MDA) counterparts also suspended MDA supervision at the hospital, allowing the CRNAs to practice to the full extent of our knowledge and training. The CRNAs performed advanced practice skills and critical care decisions independent of the anesthesiologists. CRNAs were also the sole advanced practice provider at night during the first two weeks of the COVID crisis. For five weeks, the CRNAs put into practice the skills and knowledge to assist the ICU physicians, nurse practitioners, and nurses. The CRNAs knowingly put themselves literally face to face with COVID patients, intubating and securing the airways, and placing lines to insure vascular access. Our hospital was the hardest hit in central Pennsylvania by the COVID crisis, and had one of the lowest mortality rates. CRNAs were the keystone in the successful treatment and management of these patients.”

This waiver truly has given CRNAs the chance to showcase the value they bring not only to the state’s pandemic response and recovery efforts, but also to the safe, efficient, affordable delivery of quality health care generally. Stories like these and from our earlier post prove why physician supervision should finally be removed permanently in Pennsylvania.