Structural Racism and Its Impact on Nurse Anesthetists

October 2022

PANA is seeking a more inclusive and diverse nurse anesthetist membership and workforce. The National Academies of Sciences, Engineering, and Medicine (2022) generated statements of task based on the Structural Racism and Rigorous Models of Social Inequity: Proceedings of a Workshop symposium conducted in Washington, DC May 16-17, 2022. The three Academies assembled to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions (NAP, 2022). The information gleaned from this symposium has application to the stated goals of PANA 1) Advance Professionalism, 2) Promote Quality of Care, and 3) Advocate and Educate.

Addressing PANA goal number 1: Advance Professionalism, there was information disclosed focusing upon how structural racism and anti-racist practices impact health disparities and health inequities. It comes down to three pivotal areas for PANA’s attention to influence the knowledge of current professionals and to encourage a more robust professional overture in the immediate future of current diversity attention: 1) review the national and state levels for the attention to social inequality as they result in poor health outcomes; 2) review the multidimensional (and varied intersectional) research on impact of health resources on marginalized populations. The Saturday, August 27, 2022, Diversity, Equity, and Inclusion presentation by Dr. Veronica Carey, Assistant Dean for Diversity Equity, and Inclusion for Drexel University addressed 6 (six) various intersections for the PANA Board’s attention: race, ethnicity, culture, diversity, equity, and inclusion. The final application to the first goal is 3) review how minoritized [Pennsylvanians] view the health field and its practices. These may seem lofty, but when chunked can most certainly offer pathways to advancing professionalism of nurse anesthetists in Pennsylvania.

Goal number 2 of Promoting Quality of Care for PANA lends itself to the information gleaned from the symposium as well with respect to the connection of structural racism to social determinants of health. Hedy Lee, professor of sociology at Duke University, reminds us not to be distracted by the shiny and new data but instead structural racism data may be new, but structural racism is not new and has foundation in the United States. Structural racism looks like colonization, genocide and current but overt population health differences (Lee, 2022 personal communication). Cornel West, professor at Harvard University and prolific writer and presenter on diversity, equity and inclusion, speaks about the value gap and weapons of distraction in higher education (AIA, 2020). West (2018) proffers the value gap pertains to the fact that most Americans focus upon the wealth, empathy, and achievement gaps and the false ideal that some persons are valued more than others (value gap). To close the value gap, habits must change at institutions that perpetuate the value gap (unwittingly is an implicit bias). West (2018) continues to share that [PANA] may be susceptible to the weapons of distraction, for example, calling issues a problem when it is a catastrophe or needing to be the ‘smartest’ in the room (majority rule) when the outliers in the crowd may offer other insights (Harper & Davis, 2020). Instead, PANA can achieve the second goal of Promoting Quality of Care by being sensitive to the vulnerable in both the 3,500 memberships in Pennsylvania and the 56,000 memberships nationwide of nurse anesthetists. PANA might shape the Board in a way to illustrate inclusion, be Socratic to the core, and be prepared to defend the decisions to grow the field from an inclusionary posture.

Advocation and education, goal 3 of PANA, aligns with information addressed at the symposium pertaining to ensuring the work done has the potential both to contribute to well-being, reduce [diversity] disparities, and improve population health (NAP, 2022). PANA’s goal of advocacy would look like thinking about racism only as a form of prejudice makes it impossible to understand the drivers of structural racism; instead, a theoretical understanding of the racialized social system would be beneficial (Glaude, 2018). Education, on the other hand, would resemble addressing current pedagogy, evaluating diversity within curriculum, instating andragogy (Malcome Knowles) as a strategy for including the adult student in the learning process, and reducing the sense of invisibility amongst disenfranchised, marginalized and minoritized faculty, student, and employed alumni of PANA.

References

AIA Resource page for Guides for Equitable Practice (2020). https://www.aia.org/resources/6246433-guides-for-equitable-practice

Eakins, A. & Eakins, S. (2017). African American students at predominately white institutions: A collaborative style cohort recruitment and retention model. Journal of Learning in Higher Education, 13(2), 51-57.

Glaude, E. (2018). Racism is a congenital disease. Retrieved: https://www.youtube.com/watch?v=MfK4jGstcO8

Harper, S.R.& Davis, C.H.F. (2020). Eight actions to reduce racism in college classrooms. American Association of University Professors.

National Academies Press (2022). 26690.pdf

Ohio State University: Kirwan Institute for the Study of Race and Ethnicity: http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/

West, C. (2018). Speaking truth to power: https://www.youtube.com/watch?v=-Bc6TRjptKI

CRNAs in the News: Pittsburgh woman shares hard-earned lessons from the Appalachian Trail

This story was originally published in the Pittsburgh Post-Gazette.

by ABBY MACKEY for the Pittsburgh Post-Gazette OCT 24, 2021 Sarah Robison spent months daydreaming about her last night on the Appalachian Trail.

She imagined lying alone in her tent, reflecting on what she’d seen and pondered while walking all 2,190-ish miles of it. But when she got to the campsite at Maine’s Baxter State Park — the home of Mount Katahdin and the northern end of the AT — those plans were in jeopardy because she had only a handful of Swedish fish candies to sustain her.

But as she came upon a group of ex-thru-hikers who drove to the site for a cookout, she remembered the hiker mantra, “The trail provides.”

They invited Ms. Robison, 40, most recently of Point Breeze, and five others who planned to summit Mount Katahdin the next day to join them for all the turkey burgers and fresh vegetables they could eat, plus more to pack for the next day. After dinner, they sandwiched together in a wooden lean-to shelter for warmth. It wasn’t in her daydream, but it was “perfect.”

Ms. Robison’s journey to and through the AT was paved with serendipity found in moments such as this, which makes her trail name, “Serendipity,” or “Dips” for short, fitting. On Oct. 11, she found herself in rarified air at the peak Mount Katahdin: Of those who begin the AT, only 1.6% of them do so in “purist” fashion: from one end to the other, not missing even a foot of the trail.

She writes about the journey on her website, AndThenIWalked.com. But with the Maine dirt still damp on her boots, she shared some of the most impactful lessons from the trail with the Post-Gazette by phone as she “lives into” the next chapter of her life.

(More) Serendipity

Ms. Robison backpacked for the first time in September 2019. The trip with friends came after a sequence of events that seem preordained, in retrospect.

She broke her foot while training for a marathon. She bought a bike as a way to remain fit and bike from her Bloomfield home to her job as a nurse anesthetist at UPMC Presbyterian Hospital in Oakland. She pedaled through some recreational biking trips, too, including an arduous ride — with several flat tires — on the Great Allegheny Passage and C&O Canal trails.

Though they finished the trip, a friend suggested they exact their revenge on that ill-fated journey by hiking Maryland’s portion of the AT, with its beginner’s terrain and relatively modest 40-mile distance. “I’m going to despise this, but I’ve never backpacked before and I’ll add this to my life’s resume,” Ms. Robison thought.

Sarah Robison standing atop Mount Washington in New Hampshire's White Mountain National Park in September. (📸 Courtesy of Sarah Robison)

After just 100 yards of hiking, she changed forever. She saw a sign that read “Appalachian Trail: foot traffic only.”

She didn’t know where it started or stopped, but it sparked the urge to live differently. “I just became enthralled with the idea that one would put their life on hold, live outside, simplify and get themselves over 2,100 miles.”

Intuition

She backpacked twice more over the next two years, but the trips didn’t satisfy the inner voice gnawing at her since she saw the AT sign in Maryland.

“That gut feeling is our internal alarm system,” she said over the phone from Bangor, Maine. “Leaving a relationship that’s unhealthy, to take a hike, to find shelter because you sense bad weather, it’s always the right answer.”

At the end of 2020, she put all of her belongings in storage, moved out of her Bloomfield rental and lived in a Point Breeze Airbnb as she house hunted.

But the “chirping” voice didn’t quit. She was “petrified” of leaving her job of 15 years and hiking 14 states alone.

But paradoxically, while trying to “set down roots,” with no lease and her belongings in storage, she was also set up perfectly to leave everything behind.

In January 2021, she formally decided to follow her intuition.

Thru-hikers sometimes spend years preparing, studying the perfect packs, sleeping pads and lanterns as they balance weight with cost and durability. But Ms. Robison had only two months for those decisions, plus other final boxes to check such as doctors appointments, a haircut and obtaining health insurance.

It taught her that just beginning was a definition of success.

Sarah Robison's "tramily" -- trail family -- walked along the Appalachian Trail together from Georgia to Shenandoah National Park. (📸 Courtesy of Sarah Robison)

“Starting it means you faced whatever you were afraid of to make the changes in your life to get there,” she said. “It’s getting to the starting line but also being honest with yourself and not worrying about what other people think. I didn’t finish it for anyone, and I didn’t not finish it for anyone.”

Find your ‘tramily’

Ms. Robison’s aunt and uncle drove her to Springer Mountain, Ga. and on March 18 she took her first steps on the AT. A friend hiked the first three days with her. She was fully prepared to hike the rest alone, but, about halfway through Georgia, she met her “tramily” — a hiker’s trail family.

The eight of them started and finished their days together, although they naturally separated during hiking hours. Every four or five days, they’d get off the trail together at a hostel or small town to resupply and maybe spend the night in a real bed.

Although Ms. Robison tends to live by this credo anyway, the tramily hammered home a lesson: “The trail knows no age, socioeconomic status, gender, color, anything because you’re with a group of people who all have the same goal.”

For a variety of reasons, the group amiably separated at Shenandoah National Park in Virginia after 800 miles together, but “Dips” stuck with “Wallflower,” a 20-year-old guy from Florida who quickly became her best friend.

Although they stayed near each other, there were many days spent apart, which led to what she calls the “most vulnerable” post on her website. “I always needed people,” she said. “I used them to prevent myself from feeling lonely. That’s why I chose to do the Shenandoahs alone. I’d never walked 100 miles by myself, but it was time to go there. It served me extremely well.”

Ripples

Friends and family couldn’t help but to spread around Ms. Robison’s story of bucking societal norms, and her website did the same, which created a ripple effect of courage.

At each hostel along the trail, she read a few dozen emails from friends and people she’d never met who were inspired by her trek. “I started a weight-loss program,” one said. “I got my paint-by-number set out of the basement,” read another.

Kelly Minney, a longtime acquaintance of Ms. Robison’s from Oakdale, was one of them. “When she started off, I wanted to make better, healthy choices for myself,” she said. “If she’s going to walk 20 or 30 miles per day, gosh, there’s no reason I can’t get on the treadmill and walk at least 2 miles!”

“I decided to make my journey public, not as a self-fulfilling prophecy, not for attention, not for a look-at-me,” Ms. Robison said. “Truly, if I can do it, anyone can do it.”

But it certainly wasn’t easy. She spent time alone on foggy nights, searching for her next sure step in the pitch black. She wrote about preparing herself to crouch when her knees felt like they held shards of glass. But because of the emails and care packages sent by strangers, kindergarten acquaintances and friends of friends — some of whom purchased AT maps and moved pins along it as she progressed — she wouldn’t allow herself to quit.

“Despite being off the grid and completely far away with no comforts of home, I am closer to everyone at home through this,” she said. “I’ve never felt more loved.”

Reaching the top

Although Ms. Robison views starting as her “first success,” summiting Mount Katahdin is certainly the second, but it felt nothing like she imagined.

In her 207 days on the trail, she took 29 days off. While many hikers played cards and relaxed, she tucked herself into corners of small towns and wrote about her experience for followers of her blog to read. But over the last seven states of the trail, she took only three days off, which “created a very stressful finish.”

Logistics and survival pushed her race to the finish. Access to Mount Katahdin closes sometime in mid-October based on snowfall. The closure isn’t meant to protect hikers, but rather to prevent the trampling of endangered mountain flora. Frigid nighttime temperatures were the other pressure, as 30-some-degree nights were already common in early October.

To finish in time, she hiked from 4:30 a.m. to 8 p.m. for the last several states. She was physically and emotionally exhausted. She imagined her finish at the Mt. Katahdin sign in Maine and assumed she’d feel accomplished but minimally emotional.

She was incredibly mistaken.

The day she and “Wallflower” summited, they caught a glimpse of the sign from about 200 yards away. A lump grew in her throat until she could hardly catch her breath.

Traditionally, thru-hikers will stand behind the sign with their arms up in victory and pose for a picture. She did that eventually. But first, in a tidal wave of unencumbered emotion, she knelt atop her pack and laid her body against the sign, wailing.

“In that, I saw my evolution of self over the past 10 years,” she said. “It was proof that I have faced fears and pushed myself and was the person I didn’t think possible.

“I actually do not like to hike. It wasn’t the activity. It was the willingness to fearfully and courageously write our own story and not subscribe to this manual people read that says, at 40, you can’t quit your job.”

Ms. Robison was married and divorced about 10 years ago. She doesn’t have kids or a white picket fence to protect them. But she has her car — because a friend drove it from Pittsburgh to Maine — and she plans to drive around New England for a few weeks before returning to Pittsburgh.

She’ll spend time with friends and family, because she lives nowhere in particular with no job demanding her time. But she “has a lot to say,” which she’ll put to words on her website and, hopefully, publish on a more formal platform.

The next chapter of her life is intentionally blank because “Serendipity” knows her trail will provide.

“I’m going to live with the ambiguity I lived with on the trail,” she said. “I’m going to do the next right thing.” Read more about Ms. Robison on her website: https://www.andtheniwalked.com.

Abby Mackey: amackey@post-gazette.com, Twitter @AnthroAbbyRN and IG @abbymackeywrites.

Sarah Robison leaned against the Mount Katahdin sign in Maine's Baxter State Park as she finished all over 2,100 miles of the trail. (📸 Courtesy of Sarah Robison)

CRNAs Looking for Opportunities to Help Pa. with Vaccination Program

Pennsylvania’s certified registered nurse anesthetists (CRNAs) possess unique skillsets that have made our professionals critical to the state’s response to the health-care crisis caused by COVID-19. So many of you have worked long and hard to meet the growing demands of this pandemic.

Because of your commitment to patient health, many of you want to do even more.

CRNAs have been reaching out to the Pennsylvania Association of Nurse Anesthetists (PANA) to examine ways our profession may be able to help the state implement and potentially expand its vaccination program by offering to support clinics or providing volunteers. With our high level of education and training, CRNAs are perfectly suited for the task at hand.

PANA has had discussions with the commonwealth during this critical juncture to offer our services and make sure they know about our willingness to take on a bigger role.

Unfortunately, at this early stage of the vaccine rollout and based on available supplies, the first phases of the program are locked in place. We will continue to work with the state on future opportunities as vaccinations progress in the weeks and months ahead.

If you want to make sure the state knows you are available to help, the Department of Health is encouraging individuals to register on Pennsylvania’s online registry for medical and non-medical volunteers: https://www.serv.pa.gov/.

If you want to stay on top of the work PANA is doing to offer its assistant, and any future opportunities that may arise from our work with the state, please visit https://www.pana.org/page/vaccineprovidercommitment.

Please note that these are two separate databases, and by signing up via the PANA site you are not adding yourself to a pool of volunteers. More information will be shared at a later date when it becomes available.

All of us at PANA are so proud of the work being done by CRNAs and SRNAs around the state, and we are so grateful that so many of you reached out to the association about your ideas on ways to help with the vaccination program. We have the same shared goals and will do all we can to help you so you can fulfill your mission to help others.