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CRNAs Staffing ICUs?

Disasters   (1,187 Views | 12 Replies)

adventure_rn is a BSN and specializes in NICU, PICU.

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I know this is a controversial proposition, so please, don't @ me...

Given that so many elective and non-urgent procedures have been cancelled, bringing surgical cases to an all-time low....

...And that CRNAs have both a) several years of ICU nursing experience and b) an expert understanding of airways, pressors, paralytics, etc...

...Has there been any push to recruit CRNAs to come staff ICUs (either as bedside nurses or to assist intensivists)?

I read a few NYT articles claiming that there are New York hospitals where OB-GYNs, dermatologists, ortho surgeons and radiologists are rounding on ED and ICU patients; surely CRNAs would be better qualified. I don't have any idea how that would work in terms of scope of practice limitations as a provider, but I'm guessing that a CRNA could still legally work as a bedside RN (even if that may put them into a murky situation).

For reference, here's one of the NYT articles stating that physicians of all specialties have been given the ultimatum to either staff for acute COVID patients or go without pay:

https://www.nytimes.com/2020/04/03/nyregion/new-york-coronavirus-doctors.html

It's common knowledge that CRNAs are very well paid, but I'm sure that their revenue streams have all but dried up due to the moratorium on non-urgent procedures. Given the huge crises pay bonuses being offered to travelers (and the very lax recruitment requirements), I wonder if there are any CRNAs out there considering doing temporary COVID work.

Edited by adventure_rn

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OUxPhys has 4 years experience as a BSN, RN and specializes in Cardiology.

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If I am being forced to learn critical care via a crash course and shadowing (with no prior ICU experience) then CRNA's should certainly be allowed to care for critically ill pts in the ICU.

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Rose_Queen has 15 years experience as a BSN, MSN, RN and specializes in OR, education.

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In my hospital they will be assisting in staffing a surge ICU area and managing vents.

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CampyCamp has 18 years experience as a RN.

247 Posts; 1,173 Profile Views

From what I know, in the hospital where I worked OR, many are staffing bedside in the units. They would certainly be able to fill in many of the tasks of CC NPs as well, and I'd have them tube my crumpy patient before anyone else!

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by CVVH Member

25 Posts; 1,345 Profile Views

Yes, in my NYC hospital CRNAs are staffing our surge OR-ICUs. They function in the same manner as an ICU resident/NP/PA (and are interchangeable with them as they all are part of the OR-ICU provider team).

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

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American Association of Nurse Anesthetists: AANA Position Statement:

CRNAs Asked to Assume Critical Care Responsibilities During the COVID-19 Pandemic
https://www.aana.com/docs/default-source/practice-aana-com-web-documents(all/crnas_asked_to_assume_critical_care_responsibilities_during_the_covid_19_pandemic.pdf?sfvrsn=ea3630e7_6

Quote

...As healthcare facilities escalate their response to the COVID-19 pandemic, CRNAs may also be asked to assume responsibilities that are different from their traditional anesthesia roles. Many facilities, for example, are asking CRNAs to assume responsibilities typically met by critical care registered nurses (RNs) (e.g., manage patients on ventilators in intensive care units, provide critical care in operating or emergency rooms). Given the extraordinary nature of the COVID-19 pandemic and the fact that CRNAs are licensed as RNs, CRNAs must carefully evaluate several factors, including, without limitation: current competencies, skillsets, and privileges; government directives or guidance, including any emergency management declarations or measures; compliance with state or applicable regulatory requirements for the specific role; and malpractice insurance coverage.1 AANA recognizes the expertise that CRNAs can provide during this time of crisis. The AANA does not endorse the use of CRNAs in RN roles. Ultimately, the decision to assume new responsibilities is based on an array of considerations unique to the individual CRNA, facility, and state....

However, in the event that a CRNA decides to take on RN responsibilities, they may practice as an RN if the role is within their comfort level and within the scope of RN practice in the given facility and state, if the CRNA and facility can meet all regulatory and accreditation requirements for that role, and if the CRNA has completed all of the current competencies for the specific RN role. CRNAs, however, may be held to a higher standard of care and practice than RNs, consistent with the scope of practice for CRNAs in a given state. CRNAs cannot separate themselves from their advanced practice background and their highest level of education and training....

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CCU BSN RN has 7 years experience and specializes in CICU, Telemetry.

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Our CRNAs were basically told they could get laid off or have their hours seriously reduced, or they could come work as ICU RNs for the remainder of the shenanigans.

They've mostly chosen not to work as ICU RNs, and I get it, but we're seriously short staffed, so I'd obviously rather they come work with me.

You would think with all the urgent intubations throughout the hospital that we would need more anesthesia providers, but they're allowing ICU fellows/attendings to intubate their COVID+ or suspected COVID patients to minimize exposure to other staff in the hospital, especially during aerosolizing procedures.

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HappilyME has 12 years experience.

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Depending on how dire the shortage is, I can envision this as long as they were getting the same pay. The training would be minimal as well which is a good thing.

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MarieBF has 9 years experience and specializes in ER, ICU.

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I’ve asked this too. My facility shut down elective procedures and most clinic appointments and are giving OR RNs and preop crash courses. To me it makes more sense to ask a family practice NP to staff the ICU because they have advanced pathophys and advanced pharm. I have honestly wondered what the death toll is from people being treated by medical professionals treating outside their specialty

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MsJenn_The_RN has 2 years experience and specializes in Critical Care (MICU).

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That’s what’s happening at my hospital. A lot of the CRNA’s don’t have as much work available since the number of procedures has been cut so drastically. We’ve been crash-course re-orienting them to ICU and they’re working bedside on the critical COVID floor.

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MarieBF has 9 years experience and specializes in ER, ICU.

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Why do they need a crash course? Maybe in your states and facilities it’s different, but in my state and the surrounding states nurses have to have a minimum of two years ICU experience in order to be admitted into CRNA school, there are CRNAS is in my state that practice on their own so they are the ones running the drips in the OR

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by TXRN New Nurse Retired

TXRN specializes in Perioperative, peds ,floor nurse,scl nurse.

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We are in crisis mode. Every pair of hands are needed !

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