by | Mar 30, 2013 | Magazine
The need for diversity in the nurse anesthesia profession is a growing concern driven by the U.S. population’s rapidly changing demographics and the low representation of minorities in the nurse anesthesia workforce across the nation. As a result, efforts to increase racial, ethnic, cultural and gender diversity in nurse anesthesia education have taken the forefront at many universities. In recent years, academic institutions such as Florida International University, Georgetown University School of Nursing and Louisiana State University Health Sciences Center (LSUHSC) School of Nursing have implemented programs designed to attract qualified minority students into their anesthesia schools.
Initiatives such as these, coupled with the identification and elimination of barriers—both real and perceived—to recruitment and retention of minority students in anesthesia programs, are pivotal to increasing minority representation in the nurse anesthesia profession. The cultural knowledge and insights minority certified registered nurse anesthetists (CRNAs) bring to the table can impact patient outcomes by providing presence, communication and comfort to an increasingly multicultural patient population. In addition, minority CRNAs bring new perspectives and insights to the anesthesia community and can help other practitioners increase their awareness of cultural issues in anesthesia care.
If you are a minority RN who is contemplating a career in the highly rewarding field of nurse anesthesia, you’re probably well aware that the process of becoming a CRNA is uniquely challenging. Chances are, you are thinking about your own real and perceived barriers to getting admitted into anesthesia school, succeeding in the demanding curriculum and finding a way to pay for it all. As a diverse group of minority nurses who recently graduated from the nurse anesthesia program at LSUHSC, we offer this advice— based on our personal experiences of what worked for us—on how to successfully navigate the journey from applicant to SRNA (student registered nurse anesthetist) to graduate nurse anesthetist (GRNA).
What to Expect
If you are considering nurse anesthesia school you must already have some idea how drastically your life is about to change. Anesthesia school is extremely demanding, timeconsuming and stressful—but also exciting and incredibly rewarding.
Most nurse anesthesia programs range in length from 24 to 33 months. Some programs begin with a didactic course load lasting approximately 12 months, with clinical requirements beginning after the didactic phase is complete. Other anesthesia schools begin with both didactic and clinical phases taken roughly at the same time.
Each phase has its own set of challenges. The didactic phase may be difficult for some students and easy for others. During this phase, the SRNA is taught pathophysiology from an anesthetic perspective. You will learn how anesthetic agents are distributed throughout the body and how body systems respond to anesthetics. Additionally, you will be introduced to the anesthesia machine, airway management techniques and how to properly induce, manage and emerge a patient presenting with an array of co-morbidities.
The first two to three semesters are very difficult because of the rapid pace at which information is provided. You can expect to be tested weekly or biweekly during this phase. In most anesthesia schools, the SRNA must maintain a B (3.0 out of 4.0) grade point average in order to progress and graduate from the program.
If you plan to attend a program in which the didactic and clinical phases overlap, you will have to juggle examinations, care plans, classroom participation, case documentation, clinical participation and your family life all at once. You will be expected to cover day, evening and night shifts during the clinical phase, and some traveling may be required.
The Admissions Process
Always come to the admissions interview well dressed and well prepared. Do not chew gum during the interview or bring coffee/beverages or food into the interview room.
You are likely to be asked clinical questions to assess your knowledge base. Questions regarding medication infusions, critical thinking and ventilator settings are common.
To prepare yourself for the interview, make sure you shadow a CRNA and learn as much as you can about the nurse anesthesia specialty. You should spend the entire day with the CRNA and observe everything that happens, from the preoperative period through the postoperative period. Visit the American Association of Nurse Anesthetists (AANA) Web site at www.aana.com to review information about the CRNA profession. Visit the Web site of the CRNA program(s) you are planning to apply to, and contact a faculty member with any questions you might have about the program.
Belong to a professional association and know why they are important. Find other minority RNs like yourself who are interested in attending CRNA school and make plans to apply together. (Editor’s Note: An excellent way to meet and network with other future minority nurse anesthetists, as well as experienced CRNAs of color who can serve as mentors, is through the Diversity in Nurse Anesthesia Mentorship Program, www.diversitycrna.org.)
If your undergraduate GPA is not very good, do not let that deter you from applying to a CRNA program. Here are some things you can do to improve your chances of getting into a program if your GPA is low:
- Take a few prerequisite graduate courses and get a B or better in them. This shows that you have the ability to complete graduate- level work.
- Take the critical care nursing certification exam (CCRN) and pass. Admissions committees know how difficult this is and it will underscore your dedication to pursuing nurse anesthesia.
Prior to acceptance, you will be required to discuss your intentions to become a nurse anesthetist with either the program’s staff or directors. These personnel are experts at sniffing out individuals who may not be ready for success. Before you contact them, be prepared to explain and justify your intentions, as well as any possible missteps you may have experienced along the way. Remember, you only have one opportunity to make a lasting first impression. Make sure you are representing yourself in a manner which reflects the core values of the institution you plan to attend.
Success Strategies for SRNAs
Completing a nurse anesthesia program is an incredibly daunting task, but you can do it. Success during all phases of anesthesia school hinges on the SRNA’s ability to use the following survival strategies.
Identify, minimize or eliminate any stressors BEFORE you apply to anesthesia school. A nurse anesthesia program requires your full attention and focus. Taking an inventory of all aspects of your life to identify possible distractions and sources of stress will allow you to plan accordingly. Examples of possible problem areas include childcare, extended family care, transportation, finances, relationships, etc. Make sure you explore available resources for managing these issues and have plans in place to reduce stress “flare-ups” during your education process.
Manage your time wisely. Time management is vital to success in a nurse anesthesia program. Organization is also important, especially during the early phases of the program. During the first two to three semesters of your curriculum, you will be overwhelmed at some point. Get organized as quickly as possible and create a schedule. Many first-year SRNAs carry daily planners with schedules accounting for months of coursework and clinical time. Once study sessions are scheduled, stick to them. You may not get another opportunity to study again before examination time and your stress level will skyrocket.
Network! Network! Network! Seek out other SRNAs, especially minority students whose experience may be similar to yours. Ask them for advice about how to succeed during the various phases of anesthesia school. Talk to them about interview techniques, test-taking skills, study aids, reference materials and clinical reference sheets. You may find a treasure trove of information and success tips if you just ask. Also, seek out practicing minority CRNAs and ask about professional organizations that you could join. While there may not be a local organization in your area, you may find an online resource where you can communicate with peers from all over the country.
Stockpile as much money as you possibly can. The financial burden of attending anesthesia school can be overwhelming. The average debt accrued by an SRNA is approximately $100,000. And because nurse anesthesia programs are so time-intensive, most students are unable to work while attending CRNA school. Before starting your program, try to reduce or eliminate your current financial debt and save up as much money as you can.
Don’t let debt stand in the way of your dreams. If you have decided that nurse anesthesia is your future, it is possible to enter the program with current debt and still finish. Some SRNAs begin their program carrying student loan debt accumulated during their undergraduate studies but are still able to graduate from anesthesia school without delay. Additionally, you can take advantage of CRNA loan repayment programs currently offered by the armed forces, anesthesia groups and hospitals across the nation. Moreover, some of these employers may even pay your full tuition cost as well as a monthly stipend while you are in school in exchange for a commitment that you will work for them after you graduate. The key is to not allow debt to become a distraction.
Don’t be afraid to ask for help. If an unavoidable “flare-up” rears its ugly head, don’t try to fix things on your own. Utilize your student support group and discuss your situation with your advisors and program directors. Anesthesia programs are often willing to grant time off for students who are having temporary personal difficulties, and in severe cases it is sometimes possible to postpone taking an exam.
Develop coping mechanisms. Take advantage of every opportunity you get to unwind and relieve stress. Anesthesia school will push you to the limit, especially during the first year of your program. Even if you only have one hour for stress relief, take the time to relax and rejuvenate your soul.
Do You Have What It Takes?
You may be asking yourself: “Is nurse anesthesia really for me? Do I have what it takes to succeed in anesthesia school and in this complex advanced practice career?” Our experience has shown that several key qualities are conducive to success as both an SRNA and CRNA.
Critical thinking is a skill that any SRNA candidate must possess. You will be placed in a position that requires you to formulate an anesthetic care plan on the spot and have a good rationale for choosing that particular plan. In some cases, this care plan will have to be formulated and implemented in a matter of minutes, if not seconds. Poor anesthetic care plans can sometimes result in negative patient outcomes, and even death. Your training, supervision and nursing experience will assist you tremendously in accomplishing this task, and you will not be expected to be proficient at it on day one of your training. However, your success as an SRNA and beyond hinges on your ability to think critically and quickly.
Initiative is another important quality to possess, due to the onthe- spot changes that are frequently needed during an anesthetic procedure. After a good anesthetic plan is formulated and implemented, vital sign adjustments are sure to follow. You must adjust your plan as needed and take the initiative in implementing changes. Airway management during a monitored anesthetic provides the perfect example. During this anesthetic technique, patients often lose the ability to maintain their airway, and oxygen saturation will fall quickly. The anesthesia provider must initiate an intervention immediately or risk adverse patient outcomes. Sometimes a simple jaw thrust is all you need, but it must be provided without delay.
Diligence is also important to the SRNA, because your patient has placed his or her life in your hands. You will monitor every beat of his/her heart, oxygen saturation, blood loss, temperature, level of consciousness, pulses, pressure points, positioning, urine output and a host of other patient data. You cannot fail to continually assess both your patient and the effectiveness of your anesthetic plan. Even a temporary lapse in diligence may result in poor patient outcomes.
Patient advocacy is vital, because at times you must speak up for the best interest of your patient. In some cases, you may be the only individual in the room with up-tothe- minute patient data that may have gone unnoticed by others on the team. Or your patient may have been placed in an awkward position that could lead to injury or worse.
Organization is a must, not only in your studies but also in the operating room and beyond. While in the clinical setting, you will be performing many tasks, such as documenting data, administering medications and transferring patients from pre-op holding to the OR and then to recovery. Organize your OR workspace prior to patient arrival. Have everything you will possibly need ready to go before your patient rolls into the room. After the patient leaves the OR, set up whatever you can for the next case. Organize your paperwork and complete as much as you can before your patient is brought in. Stay ahead of the game!
Determination will be important— before, during and after your anesthesia education. If you are serious about your intentions to become a nurse anesthetist, pursue your goal with a high level of intensity. If you can find a reason why you shouldn’t apply to anesthesia school, maybe this career choice is not for you. Once you decide and commit to an anesthesia program, this key quality may be a major reason why you are successful. Many SRNAs simply decide that this career path is not for them and quit the program. If you don’t have the determination to stay focused and see it through, you may miss out on the opportunity of a lifetime.
In conclusion, nurse anesthesia is an extremely exciting and fulfilling career choice for any nurse who is willing and able to accept the challenge. We invite you to investigate all that this career has to offer, and make the decision to join a community of professionals dedicated to providing the best possible anesthetic care to each and every patient. Consider the suggestions and personal testimonials offered in this article, and network with practicing minority nurse anesthetists who can offer further guidance. A life-changing career filled with challenges and rewards is well within your reach. If we could do it, so can you.
Yes We Did: Overcoming Barriers
As part of a capstone project completed during the authors’ final year of anesthesia school at Louisiana State University Health Sciences Center (LSUHSC) School of Nursing in New Orleans, we examined the issue of potential barriers to minority participation in nurse anesthesia programs. Our goal was to identify the most common barriers to success, both real and perceived, and examine possible solutions for increasing enrollment, inclusion and acceptance of minority students in anesthesia programs.
We began by making lists of the barriers each of us had personally faced as minority nurses pursuing a career in nurse anesthesia. By sharing some of these personal testimonials, as well as the strategies that helped us overcome or work around some of the biggest barriers, we hope to inspire other future minority nurse anesthesia candidates to develop your own blueprints for success.
Kendell Andrus, GRNA, MN
Biggest Barriers: Finances, Age, Isolation
Kendell is a single, 27-year-old African American who was one of only five minority SRNAs in a class of 43 anesthesia students. After a brief stint in the Army as a combat medic, Kendell decided to pursue a career as a registered nurse. He was initially apprehensive about his career choice, because of his perception that nursing was not a typical career for African American men. But realizing that nursing is a profession that offers excellent opportunities and income potential, he decided to move forward with his decision and has never looked back.
One of Kendell’s perceived barriers to success in anesthesia school was the fact that he had been accepted into the LSUHSC program at a relatively young age. Because all the other minority SRNAs in his class were older and married with children, he felt a certain amount of disconnect from them. “It would have been nice to have another younger minority student like me to relate to and connect with,” he recalls. “I found myself [feeling] almost alone [even though I was] surrounded by a larger than average number of minorities at LSU.”
Finances were at the top of Kendell’s list of real barriers. His nurse anesthesia education was an expensive journey, especially since he had limited financial support. Fortunately, his time in the military provided an excellent opportunity to stockpile financial resources that may not have been available to him otherwise. Benefits such as the GI Bill, coupled with student loans, allowed Kendell to pursue his dream.
“I took advantage of student loan opportunities to buffer my financial situation,” he says. “I wasn’t going to let money stand in the way of my anesthesia career.”
Linda Nguyen, GRNA, MN
Biggest Barriers: Finances, Self-Doubt, Limited Awareness of Nurse Anesthesia as a Career Option
Linda is a single, 31-year-old Vietnamese American. She is the first individual of Vietnamese descent to attend the LSUHSC nurse anesthesia program. She is also the first person in her family to attend college.
Some of the top areas of contention for Linda were finances and self-confidence. Most importantly, financial barriers were of the utmost concern. “In order to be considered for acceptance into most CRNA programs, a baccalaureate degree in nursing is required,” she says. “[Paying for your undergraduate program is hard enough.] Once [you are accepted into anesthesia school], another 33 months of education inevitably leads to a mountain of debt.”
Another barrier on Linda’s list was lack of knowledge about the nurse anesthesia profession. She did not become aware of this career option until after she had finished her undergraduate coursework. “If I had gained exposure to nurse anesthesia prior to graduation,” she says, “I could have adjusted my finances accordingly and possibly have been accepted into anesthesia school sooner.” While she was easily accepted by her fellow SRNAs, Linda says she would have enjoyed the company of other Asian American students. “Having a support system is definitely a key to success in the program, and I was fortunate enough to have a great support system outside of anesthesia school,” she notes. “[I had] moments of self-doubt both before and after I was accepted into the program. But I just knew that anesthesia was my future and I continued to work hard. After [spending a lot of time in] the operating room and applying the knowledge I learned in the classroom, my confidence level rose exponentially. I am excited about my future. ”
Efrem Greely, GRNA, MN
Biggest Barriers: Finances, Entrance Exams, Racial and Cultural Barriers
Efrem is a 39-year-old African American who is married and has two children. After acquiring 14 years of nursing experience in the emergency room and advancing to the level of nurse manager in that department, he decided to further his education and pursue a career in nurse anesthesia. Like Kendell and Linda, Efrem listed finances as his leading barrier. He also cited other real and perceived barriers, such as limited anesthesia school slots available for minority students, the length of time required to complete the program while being unable to work, and cultural barriers to passing graduate school entrance exams, such as the GRE (Graduate Record Examination) and MAT (Miller Analogies Test).
“Traditionally, nursing specialty areas have been difficult to break into for minorities,” Efrem explains. “Some specialties, such as critical care, require additional skills training, like ACLS and PALS, which require time and money to acquire. Add to that the fact that minorities traditionally score lower on many standardized entrance examinations and it’s not hard to see the disparities minority students face in trying to successfully complete advanced education.
“I was fortunate in that I scored what was needed on the entrance exam after very little preparation,” he continues. “With the many years of ER nursing experience I had acquired, I felt confident in my abilities and prospects as an SRNA. I also had a sound support system in my wife, who is an obstetrician, and extended family and friends.”
Sedric Williams, GRNA, MN
Biggest Barriers: Finances, Limited Awareness of Nurse Anesthesia as a Career Option, Self-Doubt, Entrance Exams
Sedric is a married 43-year-old African American and a father of three. He was one of only two African Americans accepted into the 2009 CRNA class at LSUHSC who were actually born and raised in the city of New Orleans. In some ways, Sedric was the sole representative of the 61% majority African American community that literally surrounds the campus at LSU. While there were four other African American GRNAs in the 2009 graduating class, none of them were born and raised in New Orleans. Like Kendell, Sedric had served in the armed forces before becoming a nurse and was able to take advantage of opportunities for educational assistance through programs offered by the military. But one of his earliest barriers was a perceived gender bias that delayed his choice to even consider nursing as a career. He believed that nursing was a female-dominated field and he was apprehensive about what his family and friends would think of his career choice.
“My wife, who is also a nurse, attempted to persuade me to [go into nursing] long before my military career began,” he says. “I never imagined that nursing could be a legitimate career choice for men until I met other men who were interested in the profession.”
He also echoes Linda’s comments about not being aware of the nurse anesthesia profession early enough to plan for it. “After earning a degree in English literature, I chose only to acquire an associate’s degree in nursing, thinking that would be the extent of my nursing career,” he recalls. “Had I known about nurse anesthesia, I would have pursued a BSN degree first, [with an eye toward continuing on into a CRNA program]—possibly saving money as well as time.”
Not surprisingly, Sedric cited finances as the biggest perceived barrier to enrolling in anesthesia school. “I grew up in New Orleans, where the average annual income per family is about $32,000,” he explains. “If I hadn’t joined the military, obtaining a BSN may have been beyond my reach.”
Some of his other perceived barriers included low representation of African American men amongst the CRNA ranks and anxiety about passing the GRE. “The GRE was difficult for me,” Sedric says. “In fact, without the aid of a prep course, I may not have achieved the required score for acceptance. I really didn’t allow the low [minority male] representation to prevent me from applying, but it did fuel some self-doubt. So I focused more on my studies and my duties as a future CRNA and worked as hard as possible to see my dreams come true.”
by | Mar 30, 2013 | Black and African-American Nurses, Faculty Nurses, Magazine, Nursing Mentorship
Dear Deans of Nursing:
A sense of urgency is upon us. Now, certainly not later, is the time to seriously consider starting a nurse anesthesia education program at your institution. Consider this fact: Of the 106 nurse anesthesia master’s degree programs in the U.S. and Puerto Rico that are currently accredited by the American Association of Nurse Anesthetists (AANA) Council on Accreditation (COA), not one is located at a historically black college or university (HBCU). This means that any BSN graduates from your fine institutions who are seriously interested in pursuing a rewarding advanced practice career in nurse anesthesia will have to apply elsewhere.
Why now rather than later? The COA has drafted a position stating that it will not consider accrediting any new master’s degree nurse anesthesia programs after 2015. This is because all accredited nurse anesthesia programs will be converted into doctoral programs by 2025.
Here’s another fact to consider: There are currently 37,000 certified registered nurse anesthetists (CRNAs) in the United States—yet there is less than 6% minority representation in the nurse anesthesia profession. How are we going to properly introduce and prepare racially and culturally diverse nursing students to enter the nurse anesthesia field? When will the minority nurse leaders who serve as administrators and educators in HBCU nursing schools sit down to have a serious dialogue about how adding a nurse anesthesia program can benefit both their students and their institutions?
Today’s historically black schools of nursing have moved proudly into the new millennium, adding state-of-the-art buildings, “smart rooms,” simulation labs and other educational innovations. Many of you are currently in the process of adding graduate degree programs, or expanding existing graduate-level offerings. What better time to embark on adding a nurse anesthesia program as a viable option for your BSN graduates, as well as other talented students from across the country who are interested in this growing specialty? Which HBCU school of nursing will one day be recognized as one of the nation’s premier nurse anesthesia programs, widely respected as a leading source of scholars, practitioners and innovators in the CRNA profession?
The time is now and the decision is yours.
by Linda Childers | Mar 30, 2013 | Magazine
Although it happened over 30 years ago, Henry Talley V, PhD, CRNA, MSN, vividly remembers the day he first met Goldie Brangman, CRNA, MEd, MBA, founder and director of New York City’s Harlem Hospital Center School of Anesthesia for Nurses.
“I was working as a nurse at Harlem Hospital and had met some of Goldie’s students from the anesthesia program,” he says. “I was so impressed with the work they were doing and the way they carried themselves that I immediately went to Goldie’s office to introduce myself and find out how I could enroll in her program.”
Talley remembers Brangman looking at him over the top of her glasses and asking if he understood the responsibilities of a nurse anesthetist. “Goldie is only 5 foot 2 but she always seemed larger than life,” he says. “When I told her I didn’t know much about nurse anesthetists, she told me not to come back until I did. The Internet didn’t exist [back then] so I did research at the library and read everything I could on the topic.”
After Talley completed his re-search, he returned to Brangman’s office. “I must have made an impression on Goldie, because she took the time to speak with me about how I could begin a career in nurse anesthesia,” he says. “I was a real inner city kid from the Bronx. That chance encounter with Goldie helped to save my life and proved to be the beginning of a career that I love.”
Today, Talley is the director of the nurse anesthesia program at Michigan State University College of Nursing and founder of Minority Anesthetists Gathered to Network, Educate and Train (M.A.G.N.E.T.). He is one of many minority CRNAs who credit Brangman with being not only their mentor but a pioneer who blazed new trails of opportunity for nurses of color and men in the field of nurse anesthesia.
An Inspiring Educator
In addition to her many contributions to the nurse anesthesia profession as an educator, author and clinician, Brangman was the first—and so far, only— African American president of the American Association of Nurse Anesthetists (AANA), serving from 1973 to 1974. Today, at age 92, she lives on the Hawaiian island of Oahu, where she remains active as a volunteer with the American Red Cross. She still attends the AANA’s Annual Meeting and keeps in touch with many of her former students, including Talley.
“Goldie is the greatest mentor any nurse could ever have,” he says. “She instilled confidence and pride in her students and taught us how important it was to become [actively] involved in our profession if we wanted to see change. With Goldie, failure was never an option.”
Talley took his teacher’s words to heart and went on to become the first African American to serve as director of a university nurse anesthesia program. He also plans to run for a national leadership position on the AANA board of directors.
“There are still not a lot of minority nurse anesthetists and I believe that’s due to a lack of awareness about the field,” Talley says. “Goldie encouraged her students to serve as role models. I’ve tried to follow in her footsteps and give back to a profession that’s been very good to me.”
Bobby Turner, a retired CRNA from Louisville, Ky., was one of Brangman’s students in the 1960s. He, too, continues to keep in touch with his former mentor. Turner says he was able to take many of the lessons learned in Brangman’s classroom and apply them in his own career.
“Goldie expected a lot from her students but she was also very supportive of us,” he adds. “She taught us that we needed to make pre-op rounds in addition to the anesthesiologist. Working in pediatrics, I found that introducing myself to children before surgery and talking to them about the procedure helped to ease their fears.”
Brangman also impressed upon her students the importance of becoming involved in the AANA. “I remember Goldie taking her students to the AANA national conference,” Turner says. “Now, even though I’m retired, I continue to attend the conferences every year.”
Finding Her Calling
Goldie Brangman graduated from Harlem Hospital Center’s nursing program in 1943 and went on to accept a nursing job at the hospital. But ironically, she was almost ready to give up on nursing as a career before finding her true calling as a nurse anesthetist.
Goldie Brangman (seated, center) with the 1974 graduating class of Harlem Hospital Center School of Anesthesia for Nurses. She founded the program in 1951 and directed it for 34 years.
“Right before World War II began, I had made the decision to leave the nursing profession,” she remembers. “I hated bedside nursing with a passion. At the time, black nurses were asked to do tasks that a white nurse would never have been asked to do.”
When the U.S. entered the war, many of Harlem Hospital’s phys-ician anesthetists were recruited for active duty. To fill the gap, the hospital began seeking volunteers to train as nurse anesthetists.
“The residents and surgeons trained us in all aspects of anesthesia,” Brangman says. “I really enjoyed the work. Unlike many nursing jobs, [in nurse anesthesia] you have a beginning and an end—you put the patients to sleep and you later have the satisfaction of seeing them wake up and begin the recovery process.”
When Harlem Hospital decided to establish a school for nurse anesthetists in 1951, the administration asked her if she would be interested in leading the program. Brangman welcomed the opportunity to open one of the first nurse anesthesia education programs in the country that boasted a diverse student body.
“There weren’t too many schools at the time that admitted blacks, men or students from foreign countries,” she explains. “We would hold dinners each weekend and try different foods representing one of our students’ diverse ethnic backgrounds.”
Because she believes anesthesia is a specialty that can’t be learned solely from a textbook, Brangman encouraged her students to gain real-world experience. “Working in the clinical field isn’t something my students would do only at the completion of the program,” she says. “I stressed the importance of learning how to take the pulse of a real person and of making pre-op rounds where they could introduce themselves to their patients [and get to know them].”
Integrating the AANA
In addition to her many achievements as director of the Harlem Hospital Center School of Anesthesia for Nurses (where she also held the positions of director of continuing education for the departments of anesthesia and respiratory therapy), Brangman was the first African American CRNA to break through barriers of prejudice to become a nationally recognized leader in her field. She was elected president of the New York Association of Nurse Anesthetists in 1959 and later served on AANA’s national board of directors—first as treasurer from 1967 to 1969, then as president in 1973-74.
“I was the first woman of color in a leadership position in the AANA, and as a result I had to run for every AANA office at least twice,” Brangman says.
She was also the first AANA president to give a theme to her presidential year, calling it the “Year of Communication.” During her term, she strived to achieve more open and effective communication between the AANA and its members, the public, legislators and other health care organizations. She also brought about some much-needed changes in the association’s organizational structure and management.
“Before my term as president, the AANA had been more [like] a social club,” Brangman says. “I accomplished my goal of making it more of a business.”
She remembers walking into the AANA offices at the beginning of her term and seeing membership dues sitting unopened in a basket. “One of the first things I did was hire a full-time bookkeeper.”
Despite the passage of the Civil Rights Act in 1964, Brangman says issues of racial inequality continued to exist in the nursing profession in the 1970s. “There were many times I would look around at the Annual Meeting and see only a sea of white faces. We were able to dramatically increase the number of male anesthetists in the AANA, but racial integration took much longer.
“We had a black CRNA [member] who lived in the South but was only allowed to attend national meetings, not those offered in her state,” Brangman continues. “I remember being asked to speak at a meeting in Alabama in the 1970s. When I walked in the front door of the hotel, almost everyone [just about] had a heart attack. Despite being the only black nurse at many meetings, I was determined to be there.”
Passing the Torch
After completing her presidential term, Brangman continued to provide innovative leadership to AANA in her capacity as past president. She introduced workshops on quality assurance and helped write the first AANA Quality Assurance Manual. In addition, she initiated the introduction of workshops on regional anesthesia (local anesthesia administered to a specific part of a patient’s body) at the AANA Annual Meeting and was one of the first educators to teach regional anesthesia techniques, both in her Harlem Hospital Center anesthesia program and at many state and national AANA meetings.
Today she sees a continued need for more minority nurse anesthetists to follow in her footsteps by taking on leadership roles within the AANA, serving as mentors and encouraging more nurses from underrepresented populations to pursue careers in anesthesia.
“The AANA hasn’t had another president of color since I served,” Brangman points out. “More minority [nurse anesthetists] need to run for leadership positions.”
Fortunately, Brangman’s inspiring presence is motivating a new generation of nurse anesthetists to follow her example of being a visible mentor and giving back to the profession. Nowadays, minority CRNAs such as Talley and Wallena Gould, CRNA, MSN, founder and chair of the Diversity in Nurse Anesthesia Mentorship Program, are carrying on her tradition.
Gould first met Brangman at an AANA meeting in 2003 and now considers her a mentor. “Until I met Goldie I didn’t know the AANA had once had a minority president,” she says. “She’s a true trailblazer and I can’t imagine everything she had to overcome to achieve all of the milestones in her career.
I was a single mom working as an operating room nurse when I first met a black nurse anesthetist and learned about the profession,” Gould continues. “Several nurse anesthetists of color, including Goldie, had a great impact on my career. I believe it’s important to empower and mentor future minority nursing students through programs such as the Diversity in Nurse Anesthesia Mentorship Program.”
Coming Full Circle
Brangman’s lifelong commitment to increasing opportunities for nurse anesthetists has earned her some of the profession’s highest honors. In 1983 she received the AANA’s Helen Lamb Outstanding Educator Award. The association honored her again in 1995, presenting her with the Agatha Hodgins Award for Outstanding Accomplishment. The award, which bears the name of the AANA’s founder and first president, recognizes individuals “whose foremost dedication to excellence has furthered the art and science of nurse anesthesia.”
Although Brangman left her position as director of the Harlem Hospital Center School of Anesthesia in 1985 and moved to Hawaii to retire, she is still making a difference in people’s lives. Four days each week, she volunteers for eight hours a day as a health consultant to the Hawaii State Chapter of the American Red Cross. In many ways, her life has come full circle.
“As a student nurse in the 1940s, I was sent out with a tin can to collect donations for the Red Cross on the streets of New York,” Brangman says. “[When I moved to Hawaii I had planned on just being retired], but instead I was talked into volunteering. I’ve worked with the Red Cross in a number of different capacities for the past 69 years.”
by | Mar 30, 2013 | Magazine
As a Certified Registered Nurse Anesthetist (CRNA), I have to interface and plan anesthetics for this diverse group of patients. Not only must CRNAs take into consideration age, weight, assessment of health issues, airway and anesthetic plan but also the linguistic and cultural issues that influence each patient’s directed care management.
Removing Language Barriers
After checking the anesthesia machine and preparing emergency and anesthetic drugs, nurse anesthetists or nurse anesthesia students must conduct an interview and assessment of their patients before moving them to the operating room. During the interview, they may find there is a language barrier. There will be patients where English is a second language and/or patients with limited English proficiency. It is imperative that each patient, regardless of the language barrier, is fully informed regarding his or her anesthesia.
Nurse anesthetists should always avoid using patients’ bilingual children, family members and friends as translators. Using these familiar people as interpreters seems like a quick fix, but they dilute the interaction at best or misinterpret in the worse case scenario. Patient privacy should be foremost in securing anesthesia consent.
The best form of communication with a patient with limited English proficiency is the Language Line Service that can be found in most hospitals. After completing the necessary preparations for anesthetizing the patient, nurse anesthesia providers should locate the nearest Language Line telephone.
Not every patient room has this special telephone, and it is important to physically move it from the nursing station into the room if necessary. For example, when I was the Chief Nurse Anesthetist at South Jersey Healthcare System, if a Mexican immigrant patient with no English capability was in labor, I would ask the charge nurse for the Language Line telephone, which was retrieved from the nurse’s station and taken into the patient’s room.
This special telephone has two receivers. Only the anesthesia provider and the patient are on the telephone, simultaneously speaking with a trained interpreter. The anesthesia provider gives the operator the account number and requests the preferred language from the patient. The Language Line translates over 180 languages.
When interviewing patients via the Language Line telephone, it is best to ask short questions in terms of allergies, last meal, previous surgeries and anesthesia, health issues and the preferred anesthetic plan. Nurse anesthetists should make sure that the last question they ask their patient via translator is “Do you have any questions regarding your anesthesia?”
The Language Line operator identifies his or herself as a number, not by his or her own name. It is important to capture the identifier number on the anesthesia consent form to ensure that the Language Line was the best form of communication used prior to scheduled or emergency surgery.
The anesthesia consent at South Jersey Healthcare System had an English and Spanish version. The patient would sign the Spanish side, where the Language Line operator’s number was clearly written, along with the anesthesia provider’s name, the signature of a witness like a registered nurse and the date and time.
Cultural Issues
I have observed several cultural trends in my years as a nurse anesthetist. For example, the Hispanic/Latino patient typically has a great deal of supportive family members who will come to visit or accompany the patient. This does not necessarily affect my work; however, some culture-specific customs do.
One cultural issue I have encountered concerns the Asian patient population, particularly aged patients. A cultural norm that needs to be acknowledged by anesthesia providers is the “coining” of Southeast Asian patients. This practice involves applying hot oil to the back and torso, then rubbing a coin or the edge of a spoon on the skin until circular or linear marks are embedded. Anesthesia providers typically auscultate patients’ lungs and/or perform regional anesthesia. CRNAs may see these marks on a patient’s back when giving spinal epidurals and not know what they are. It is important to recognize this practice before administering anesthesia and not misinterpret it as elder abuse or any other form of abuse.
Another cultural issue for nurse anesthetists is taking care of Muslim and Orthodox Jewish patients, especially women. These groups are similar in their treatment of married women, and couples tend to be concerned with female patients’ exposure to males in the operating room. Muslim and Orthodox Jewish patients may insist on wearing the hijab or a simple scarf or wig while in public. They will often ask for only female providers in the operating room, if staffing permits. It is important to relay to these patients and their husbands that their modesty as a patient will remain intact as much as possible, including covering windows in the operating room. CRNAs must communicate with male surgeons not to enter the room until the patient has been properly identified, put to sleep by a female CRNA and draped by the OR technician. Only after the surgeon exits should window coverings be removed. The patient should be covered with blankets as she is transferred to the PACU.
Lastly, another cultural group of patients that should be acknowledged are women from Africa, the Middle East and other regions practicing female genital mutilation (FGM). According to the World Health Organization, 100–140 million girls and women have undergone the cultural indoctrination of FGM. Typically, girls age 7–10 will go through this process, where the external genitalia are partially or totally removed, often with crude instruments (not sterilized) and under no anesthesia. The repercussions are wide, from infection to vaginal birthing issues to psychological problems as adults. Women from these cultures who reside in the United States will require anesthesia services for cesarean sections and major genital reconstructive surgery. Nurse anesthetists should be aware of this practice and how it will impact their work.
Again, with the changing demographics of the United States, our patient population will dictate new ways of approaching their anesthetic plan. We must treat each person regardless of ethnicity, language barrier or imposed societal cultural norm in the same manner as we do with our family members, neighbors and friends… with the utmost respect and dedication to our anesthetic practice.
by | Mar 30, 2013 | Magazine
One of the most critical components in surgery is anesthesia, and Certified Registered Nurse Anesthetists continue to play a pivotal role in its practice. And because of the autonomy, one-on-one patient care, and critical-thinking skills required, becoming a CRNA can lead to many exciting career paths.
While CRNAs administer more than 32 million anesthetics annually to patients, many people are unaware of the myriad of professional options available to them. Wherever anesthesia is delivered, nurse anesthetists practice: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs health care facilities. Many CRNAs are often amazed at the twists and turns their career paths take after becoming a nurse anesthetist, but for the anesthesia professionals here, they would not have it any other way.
Where anesthesia can lead
According to the American Association of Nurse Anesthetists (AANA) 2009 Practice Profile Survey, most CRNAs derive their income from a group practice (33%) or a hospital (35.3%). In addition, 96% of full-time CRNAs reported working primarily in one of the aforementioned practice settings. The remaining CRNAs are evenly split between management, administration, and education, and an overwhelming number of nurse anesthetists find their career choice fulfilling. The survey also revealed that 37% of full-time CRNAs have been practicing for more than 20 years.
Six years after Elizabeth Ann Thompson, C.R.N.A., became a registered nurse, she began looking for a position that was more challenging but allowed her to stay in the clinical area. On the advice of two nurse anesthetists, I considered becoming a CRNA. I was a little reluctant at first; however, the more I found out about the profession, the more it intrigued me,” she says. Thompson finds it surprising that much of the public and health care professionals alike still do not realize that there are nurses who administer anesthesia. “Although I work in a hospital care team setting, I like the fact that many nurse anesthetists are the primary providers of anesthesia in rural America. I provide anesthesia for a great deal of orthopedic and eye surgeries,” she says. “Thirty-two years later, I still really enjoy what I do.”
Less than two years into his career as a nurse anesthetist, Nelson Aquino, C.R.N.A., M.S., recognized his passion for working with younger populations and wanted to elevate the level of care he was able to offer his pediatric patients. “I decided to enter anesthesia school in 2006…to allow myself to have more one-on-one patient care with the children facing surgery,” he says. “It is a great feeling to be able to help a child and his or her family during one of their most vulnerable moments. Knowing that I am able to ease their worries and comfort them is the best part of my job.”
Education
In order to advance the profession of nurse anesthesia, dedicated educators are needed to teach future nurse anesthetists how to provide the quality care that has been the hallmark of the profession for nearly 150 years. CRNAs can become clinical and didactic educators, as well as program directors. A CRNA since 1997, Juan Quintana, C.R.N.A., M.H.S., D.N.P., had worked in the ICU for 10 years before deciding to become a nurse anesthetist. Quintana practices anesthesia and works as a clinical coordinator for nursing schools in Texas. Among other things, coordinators do the clinical scheduling between college or university nurse anesthesia programs and teaching hospitals. CRNAs can also supervise during clinicals, providing students with hands-on experience administering anesthesia and allowing them to put into practice what they’ve learned in the didactic setting. “If you enjoy health care and autonomy, if you fi nd yourself wishing you could do more for patients, if you love helping patients feel better and handle stressful situations in their lives, then this is a great job for you,” Quintana says.
Military service
The commitment and sacrifice of CRNAs in the military has contributed much to the rich history of nurse anesthesia in the United States. Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East. Nurses first provided anesthesia to soldiers on the battlefields of the Civil War. It was the military that started Derrick Glymph, C.R.N.A., D.N.A.P., down the path to a career in nursing. “I initially became a licensed practical nurse through the military. After completing that program, a nursing mentor encouraged me to complete my [Bachelor of Science in Nursing] degree,” he says. “After learning about nurse anesthesia, I realized it fi t my needs and desire for more autonomy.” An Army reservist for 19 years, Glymph holds the rank of major. Since graduating from nurse anesthesia school in 2004, he was deployed to Afghanistan with a Forward Surgical Team as the sole anesthesia provider, then mobilized to the Walter Reed Medical Center in Washington, D.C. In 2008, Glymph returned to school to earn his Doctor of Nursing Practice, which he completed this year. “A terminal degree in my field did not exist when I entered nurse anesthesia school, and now it’s a reality for me,” Glymph says. “Obtaining this degree has allowed me to encourage other minority nurses to also pursue one.”
Leadership
One of the most highly regarded nursing specialties, nurse anesthetists have been leaders in the nursing and health care community for decades. As advanced practice registered nurses, CRNAs carry a heavy load of responsibility and are compensated accordingly. “Throughout my time in the military and since becoming a nurse anesthetist, opportunities for leadership and education continue to come my way,” Glymph says. And the field continues to grow and evolve. Even before the turn of this century, anesthesia care was nearly 50 times safer than in the early 1980s, according to a report from the Institute of Medicine. “You have the knowledge and experience,” Quintana says. “You must take control of the situation and take action.”
