State asked to allow nurse anesthetists to do more to help in crisis

By Paul J. Gough – Reporter, Pittsburgh Business Times

Apr 7, 2020, 1:47pm EDT Updated Apr 7, 2020, 2:35pm EDT

Pennsylvania's certified registered nurse anesthetists are urging the Pennsylvania Department of Health to waive a supervision requirement to allow them to fully help patients to the level of their training.

Nurse anesthetists are advanced practice nurses that deliver medications including anesthesia during surgery, medical procedures like colonoscopies and dental procedures. They normally work under the supervision of an MD anesthesiologist but have a substantial course of training in their own right: Not just an RN degree but also generally two or three years of advanced practice training beyond it and thousands of clinical hours.

But even though they play a critical role, Pennsylvania's nurse anesthetists aren't given by law what is called a title designation: They can't practice except under the supervision of an anesthesiologist. That, said its trade association the Pennsylvania Association of Nurse Anesthetists, is a critical distinction and an area of opportunity in the commonwealth if health officials allow it.

Pennsylvania is the only state that doesn't allow nurse anesthetists to practice their full scope, which is critically important during the COVID-19 pandemic. New York, the only other state in the country that has the same strictures, last month relaxed them to allow nurse anesthetists to practice to the full level of their training.

That's what Pennsylvania Association of Nurse Anesthetists (PANA) is advocating with the Pennsylvania Department of Health. It's also what the Trump administration, through the Centers for Medicare and Medicaid Services, has done on the national level.

"We are highly educated and trained professionals," said Jess Poole, a Westmoreland County nurse anesthetist and government relations director of PANA. "Our skill sets should be utilized."

That's because in the COVID-19 emergency, some of the skill sets that nurse anesthetists have — the proper intubation and use of ventilators — are really needed. There's already a nationwide shortage of ventilators and more are going to be needed, as well as the skilled medical professionals who know how to use them.

Poole said that it's crucial for nurse anesthetists to be able to help out. Previous attempts to allow it, before a crisis, have not been successful in the Pennsylvania Legislature. But Poole said the Wolf administration has the power to allow them to do it on a temporary, emergency basis.

PANA has requested a waiver from the supervision requirement but it's not yet been granted.

COVID-19 Crisis Doesn’t Dampen Community Spirit

Pennsylvania’s certified registered nurse anesthetists aren’t just frontline workers helping our commonwealth respond to the coronavirus pandemic. Often time these highly skilled professionals have to serve as caretakers for ailing friends and family members, too.

Through it all, whether at work or home, nothing can dampen our community spirit.

Darlene Homa, who previously served as president of the Pennsylvania Association of Nurse Anesthetists and as regional director of the American Association of Nurse Anesthetists, is taking on the challenge of being both a professional and family member during these uncertain times.

Darlene’s husband, Donald, is in the Washington Health System in southwestern Pennsylvania with health issues unrelated to COVID-19. But, because of the coronavirus outbreak, physical contact is limited as a precaution through a “no visitation policy.”

No physical contact? No problem!

Last week, Darlene’s family --- Led by Darlene, her daughter Daria, and Daria’s two children --- coordinated with Washington Health System nurses to make sure Donald received a warm message from the whole Homa clan.

While the family understands the importance of “social distancing” during this pandemic, they also know how important it is to go that extra mile to put a smile on a loved one’s face.

Check out this story from the Washington Observer-Reporter. Or, visit Washington Health System’s Facebook page to see the pictures and share the story.

All of this is typical of Darlene, who still works tirelessly on behalf of PANA and CRNAs in Pennsylvania. Darlene works as a CRNA for BPW Medical Associates at several locations in southwestern Pennsylvania --- and now even serves locally on Donora council’s committee to combat the virus, as this story from the Mon Valley Independent reports.

We’re all in this together. But we’re honored to have CRNAs like Darlene and her family who exemplify what “together” really means.

Important Message to PANA Members

March 25, 2020

Dear PANA Members:

Earlier today, the Pennsylvania Association of Nurse Anesthetists sent a letter to Gov. Tom Wolf and state Health Secretary Dr. Rachel Levine, urging them to formally recognize certified registered nurse anesthetists and to act swiftly to give our professionals the ability to practice to the full extent of our education and training to help Pennsylvania respond to the COVID-19 health-care crisis.

You can read the entire letter here: https://bit.ly/3akUMb0.

As frontline health-care professionals, we play a crucial role in the state’s response to this pandemic. Unfortunately, the full contribution of CRNAs is being limited.

First, in Pennsylvania, education and training for CRNAs is extensive. Yet, there are limits placed on our practice, even though those limits are not based on any data or research, and CRNAs can safely practice beyond these limits. New York, West Virginia, Maine and Arizona already have acted to remove barriers on CRNAs to better utilize all available providers to respond to this health-care crisis without risking patient safety. Pennsylvania should do the same.

Second, Pennsylvania remains one of only two states (New York is the other) that fails to recognize CRNA professional designation in some form, meaning we are recognized only as registered nurses. In times of need, CRNAs are in demand to help with crisis response. But Pennsylvania-based CRNAs cannot be part of response teams in other states that are asking for help --- and so many are --- simply because we lack the formal credentials that nearly every other state recognizes. That needs to change.

Now, we need you to take action, too.

First, send a personal message to Gov. Wolf and urge him to act on the health-care proposals PANA included in its letter. Fill out the form here: https://www.governor.pa.gov/contact/#OnlineForm.

This is all you need to say (there is a 1,000-character limit):

Gov. Wolf: As a certified registered nurse anesthetist (CRNA) in Pennsylvania, I stand ready to help our commonwealth address the health-care crisis caused by the COVID-19 pandemic. Recently, PANA, our statewide association, sent you a letter (which you can access here: https://bit.ly/3akUMb0), urging you to formally recognize CRNAs and allow us to practice to the full extent of our education and training to help Pennsylvania respond in this time of need. Other states already have acted to remove barriers on CRNAs to better utilize all available providers to respond to this health-care crisis without risking patient safety. Pennsylvania should do the same. As frontline health-care professionals, we play a crucial role in the state’s response to this pandemic. Please make these changes so we can help even more. Thank you.

Next, contact your local legislators. Ask them to please contact the governor and secretary and urge them to take fast action on the proposals made by PANA to address this health-care crisis. You can find your lawmakers here: https://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator.

This is all you need to say:

As your constituent, I wanted to be sure you knew that PANA, our statewide association, sent a letter (which you can access here: https://bit.ly/3akUMb0) to Gov. Tom Wolf and state Health Secretary Dr. Rachel Levine, urging them to formally recognize CRNAs and allow us to practice to the full extent of our education and training to help Pennsylvania respond to the COVID-19 health-care crisis. As a certified registered nurse anesthetist (CRNA), we play a crucial role in the state’s response to this pandemic, along with other frontline health-care professionals. Unfortunately, too many barriers are blocking our work. There are limits placed on our practice, even though those limits are not based on any data or research, and the state’s lack of credentialing limits emergency response. Please read our letter and urge the governor and his administration to act swiftly. Other states are acting. It is time for Pennsylvania to do the same. Thank you.

Like the rest of the country, we are watching with deep concern as the COVID-19 pandemic continues to affect a world already brought to a standstill. PANA continues to monitor the situation. But our culture is built on helping people. I hope we can count on you to do your part to advocate for our profession so we can get these changes made and fulfill our mission of keeping residents healthy and safe.