What makes CRNA's unique?

ITALY123 · Mar 13, 2010

Ummm.yea nobody can jump straight into CRNA right out of RN school. First , 99 percent of CRNA schools require a BSN. You must obtain above a 3.5 or most will not even consider a person. You have to interview with the board of the school you are wishing to attend post nursing school. Hypothetically, if you get in to CRNA school, it takes about 27 months to complete. Right now, out of every 100 students who apply each year 25 to 30 are accepted. It is a very competitive program, but if you have the drive to handle it then go for it and I am sure you will do well!!!!

allnurses Guide · Mar 13, 2010

CRNA's provide anesthesia, just as an anesthesiologist would. In most states they can practice independently, which means they could be the sole person in charge of the patient's anesthesia. This is a HUGE responsibility, and the reason they require the extra experience and education. Even when they are MDA supervised, they still usually manage their cases start to finish.
CRNA's do not usually work on units or floors providing general nursing care as an RN would. They work in OR's at hospitals or outpatient surgery centers. When it comes down to it, a CRNA does the same thing an anesthesiologist does. You can't say that for many other nursing specialties.

CRNAs can and do practice independently in all states. Billing medicaid and medicare is where the confusion comes in. http://www.aana.com/Advocacy.aspx?id=2573

allnurses Guide · Mar 13, 2010

This is from the AANA.

Clinical Practice

CRNAs practice according to their expertise, state statutes or regulations, and institutional policy.

CRNAs administer anesthesia and anesthesia-related care in four general categories: (1) pre-anesthetic preparation and evaluation; (2) anesthesia induction, maintenance and emergence; (3) post-anesthesia care; and (4) perianesthetic and clinical support functions. The CRNA scope of practice includes, but is not limited to, the following:

(a) Performing and documenting a pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, or administering pre-anesthetic medications and fluids; and obtaining informed consent for anesthesia.

(b) Developing and implementing an anesthetic plan.

© Selecting and initiating the planned anesthetic technique which may include: general, regional, and local anesthesia and intravenous sedation.

(d) Selecting, obtaining, or administering the anesthetics, adjuvant drugs, accessory drugs, and fluids necessary to manage the anesthetic, to maintain the patient's physiologic homeostasis, and to correct abnormal responses to the anesthesia or surgery.

(e) Selecting, applying, or inserting appropriate non-invasive and invasive monitoring modalities for collecting and interpreting patient physiological data.

(f) Managing a patient's airway and pulmonary status using endotracheal intubation, mechanical ventilation, pharmacological support, respiratory therapy, or extubation.

(g) Managing emergence and recovery from anesthesia by selecting, obtaining, ordering, or administering medications, fluids, or ventilatory support in order to maintain homeostasis, to provide relief from pain and anesthesia side effects, or to prevent or manage complications.

(h) Releasing or discharging patients from a post-anesthesia care area, and providing post-anesthesia follow-up evaluation and care related to anesthesia side effects or complications.

(i) Ordering, initiating or modifying pain relief therapy, through the utilization of drugs, regional anesthetic techniques, or other accepted pain relief modalities, including labor epidural analgesia.

(j) Responding to emergency situations by providing airway management, administration of emergency fluids or drugs, or using basic or advanced cardiac life support techniques.

(k) Additional nurse anesthesia responsibilities which are within the expertise of the individual CRNA.

The functions listed above are a summary of CRNA practice and are not intended to be all-inclusive. A more specific list of CRNA functions and practice parameters is detailed in the AANA Scope and Standards for Nurse Anesthesia Practice.

Clinical Support Services Provided Outside of Operating Room

CRNAs also provide clinical support services outside of the operating room. Anesthesia and anesthesia- related services are expanding to other areas, such as MRI units, cardiac catheterization labs and lithotripsy units. Upon request or referral these services include providing consultation and implementation of respiratory and ventilatory care, identifying and managing emergency situations, including initiating or participating in cardiopulmonary resuscitation that involves airway maintenance, ventilation, tracheal intubation, pharmacologic, cardiopulmonary support, and management of blood, fluid, electrolyte and acid-base balance.

Administrative and Other Professional Roles

Many CRNAs perform administrative functions for departments of anesthesia. The services provided by these department directors and managers are extremely important to the overall functioning of an anesthesia department and directly affect the efficiency and quality of service provided. These functions include personnel and resource management, financial management, quality assurance, risk management and continuing education.

CRNAs serve on a variety of institutional committees and participate as instructors in staff development and continuing education programs for both professional and non-professional staff members.

CRNAs hold staff and committee appointments with state and federal governmental agencies such as state boards of nursing and the U.S. Food and Drug Administration. CRNAs are also actively involved in professional and standard-setting organizations such as the National Fire Protection Association and the American Society for Testing and Materials.

Research

Nurse anesthetists have been involved as investigators, collaborators, consultants, assistants, interpreters and users of research findings since the beginning of the 20th century. Movement of nurse anesthesia educational programs into graduate educational frameworks has allowed students to graduate with basic skills for undertaking research. In addition, there is a growing number of CRNA faculty, credentialed at the graduate level, who regularly sponsor and consult in research endeavors and act as project directors or principal investigator for funded research in university settings. The AANA Foundation as a non-profit organization, promotes and facilitates research. The foundation established the Doctoral Mentorship Program to encourage seasoned researchers and novice researchers to share ideas and help each other. The group includes CRNAs with doctoral degrees as well those in doctoral programs.

At the AANA Annual Meeting, educational sessions are conducted in research methodology and grantsmanship. To respond to the current health care environment, the AANA has focused on quality and outcome-based research. The AANA, in cooperation with the AANA Foundation, provide venues for communicating research findings.

Additionally, CRNAs have presented their research at a variety of national and international meetings, including those sponsored by nurses, physicians, physiologists and pharmacologists. Research by CRNAs has been funded by private and governmental grants, as well as from the AANA Education and Research Foundation.

The AANA's research component has grown and is supported by the AANA Foundation. The AANA Foundation approves and funds small grants for CRNAs and nurse anesthesia students. In 1998, the Research Scholar award was the first large grant awarding up to $25,000. The award was initiated to encourage CRNAs to conduct research of greater magnitude.

Publications

CRNAs have authored numerous books, chapters in books, monographs and articles on clinical, educational and research subjects in a variety of refereed professional publications such as the AANA Journal, CRNA: The Clinical Forum for Nurse Anesthetists, Nurse Anesthesia, Anesthesiology, Anesthesia and Analgesia, Journal of the American Society of Regional Anesthesia, Journal of the American Medical Association, Nursing Research and Hospitals.

Subspecialization

Some CRNAs have chosen to specialize in pediatric, obstetric, cardiovascular, plastic, dental or neurosurgical anesthesia. Others also hold credentials in fields such as critical care nursing and respiratory care. In addition to their membership in the AANA, many CRNAs also belong to in a variety of anesthesia and subspecialty organizations, including the following:

International Anesthesia Research Society

American Society of Regional Anesthesia

American Association of Critical Care Nurses

American Society of Perianesthesia Nurses

Association of PeriOperative Room Nurses

American Association of Respiratory Care

American Pain Society

Society of Office Based Anesthesia

Society for Obstetrical Anesthesia Perinatology

Society for Ambulatory Anesthesia

Otessa, BSN, RN · Mar 13, 2010

What is it about their role and position that makes them so unique? I guess I'm just wondering why it's "more risk".

People are being anesthetized-can't protect their airways-there is a fine line between the 'dreamy sleep' of surgery and no longer breathing....the risk of death- you are there to provide assistance with breathing during surgery/procedures and making sure they wake up again after surgery.....

a CRNA put my epidural in for my c-section-I want someone highly skilled when they are poking in my spinal area......

allnurses Guide · Mar 13, 2010

What is it about their role and position that makes them so unique? I guess I'm just wondering why it's "more risk".

Let's use the example of placing an epidural and some of what you need to know to manage an epidural as an anesthesia provider.

1. An epidural on a laboring patient is a blind technique ie. except for landmarks on your back I am doing your epidural totally by feel/loss of resistance with blunt curved tip 18g needle that is about 4" long. How many other providers blindly stick an 18g blunt needle up to 4 inches ( or longer if my patient is especially fluffy) based soley on landmarks, and still have approx. a 90% success rate the 1st time (national average not mine).

2. Also, I know that if my local anesthetic gets to high while dosing up my epidural I can cause the patient to stop breathing, become profoundly bradycardic, or go into asystole. You maybe saying we just push some meds and tube the patient right? Well I can push some medicines to help with the bradycardia, but that doesn't mean the patient won't be refractory to that medicine. Tubing a pregnant patient sounds easy but do you know that during labor that the cardiac output increases significantly and that the pregnant lady's airway swells and placement of endotracheal tube can be all but impossible..

3. Now let us say I get the local anesthetic in the intravascular compartment, and I don't realize it. The patient will probably arrest and there will be nothing you can do that was taught to you in ACLS that will probably help. The only thing that will probably save the patient at this time is bolus of intralipids.

Another example is just a routine induction for general anesthesia and the medications we often give. A normal adult patient I might give 2-5mg of Versed up front, 2-3mcg/kg of fentanyl (which is about 100x as potent as morphine, and at this dose is usually enough to make most individuals severely slow down their breathing or stop breathing all together especially when mixed with versed), next I would normally give about 15-20ml of propofol (almost certainly stopping their breathing and usually dropping their BP, if the patient is dehydrated or has poor cardiac output you can easily bottom out their BP and kill the patient if you aren't being observant), next I give the patient a non-depolarizing paralytic (which I know is the #1 cause of allergic reactions in the OR, and can kill the patient if not sufficiently worn off at the end of surgery or improperly reversed). Now these are just some of the medications I might give in the 1st five minutes of surgery.

These are just a couple of small things to think about.

tvccrn, ASN, RN · Mar 13, 2010

Funny this should come up now. My father just emailed me and said that one of his friends was dating a CRNA and that he thought I was one also.

No way!! I admired CRNA's, but I wouldn't want that responsiblity.

dudette10, MSN, RN · Mar 13, 2010

Let's use the example of placing an epidural and some of what you need to know to manage an epidural as an anesthesia provider.
1. An epidural on a laboring patient is a blind technique ie. except for landmarks on your back I am doing your epidural totally by feel/loss of resistance with blunt curved tip 18g needle that is about 4" long. How many other providers blindly stick an 18g blunt needle up to 4 inches ( or longer if my patient is especially fluffy) based soley on landmarks, and still have approx. a 90% success rate the 1st time (national average not mine).

And, on top of that, dealing with scarring in the same area if it is the woman's second epidural. That's what happened to me when I was in labor, and you could have drawn a line down my midline from my umbilical...I was numb on one side and not the other! I understood the issue the anesthetist was dealing with so I just worked through (half) the pain...now, take a woman who doesn't understand and is screaming at you that "IT DIDN'T WORK!!!" :lol2: :lol2: :lol2:

allnurses Guide · Mar 13, 2010

And, on top of that, dealing with scarring in the same area if it is the woman's second epidural. That's what happened to me when I was in labor, and you could have drawn a line down my midline from my umbilical...I was numb on one side and not the other! I understood the issue the anesthetist was dealing with so I just worked through (half) the pain...now, take a woman who doesn't understand and is screaming at you that "IT DIDN'T WORK!!!" :lol2:

That is what a combined spinal epidural is for. My daughter had a true one sided epidural with my grandson, and it is the only perfect one sided epidural I have seen so far. It happens and it sucks about the only thing you can do is add spinal dosing with the epidural or pull the epidural and go to another level.

allnurses Guide · Mar 13, 2010

Closed for staff review

allnurses Guide · Mar 13, 2010

Thread re-opened.

Please keep on topic and do not insult other members

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