This week, certified registered nurse anesthetists (CRNAs) and the work they do are honored with the annual CRNA Week.
CRNAs are highly trained nurses who have a focused skill set and responsibilities that require close patient interaction. According to the American Association of Nurse Anesthetists (AANA), this year’s celebration coincides with 2020’s historical event few will forget—the World Health Organization’s declaration of a global health emergency because of the COVID-19 pandemic and the discovery of the first case of the virus in the United States.
In the past year, CRNAs have faced challenges they could have never anticipated. An overwhelming caseload of extremely ill patients, uncertainty of how to treat patients with the deadly virus, concerns about their own safety and that of their families, and lack of PPE supplies in some of the most advanced facilities in the world dawned in 2020.
Like other medical staff, some CRNAs have described conditions over the past year as “a war zone” and their heroic efforts to help and care for patients was evident. As a CRNA, these nurses are with patients before, during, and after procedures where anesthesia is necessary. The typical cadence of procedures changed in 2020, with big dips in elective surgery during COVID-19 surges and increased emergency situations for patients who were desperately ill. CRNAs needed to use their critical thinking and fast adaptation skills constantly.
Beginning in 2025, the requirements for this career path will change. At that point, nurses who want to hold this position will need to obtain a doctorate degree to become a CRNA. The current CRNA master’s degree programs will fold into these degree programs. If you’re already a CRNA by then, you won’t need to return to school for the additional degree.
Above all else, CRNAs find their daily job gives them plenty of opportunities to use all their nursing skills—from complicated math to compassionate direct patient interaction. And having a positive impact where they focus on improving the outcomes of surgeries and procedures for the patient and for the larger medical team is something for which all CRNAs strive.
Certified Registered Nurse Anesthetists (CRNAs) provide important anesthesia care for many different types of surgeries and services. However, as they gain more and more autonomy, their risk for facing malpractice lawsuits increases as well.
“CRNAs practice with a high degree of autonomy, and they play a critical role in patient outcomes,” says Georgia Reiner, Risk Specialist, Nurses Service Organization (NSO). “This also makes them more vulnerable to a malpractice lawsuit if anything goes wrong.”
According to Reiner, although most states still require that CRNAs work under physicians’ supervision, some states—and the number is growing—are allowing them to practice independently. The good news is that, as Reiner says, CRNAs have been able to provide a lot more anesthesia care in more rural areas of the U.S. that otherwise wouldn’t be able to—such as including obstetric, surgical, and trauma services. “CRNAs are also trained and qualified to treat pain patients. With the ongoing opioid epidemic in the U.S., and with millions of patients still suffering from chronic pain at the same time, the services CRNAs provide are essential to promoting safe and effective pain management,” explains Reiner.
As for the top risks that CRNAs face, Reiner says, “According to claim metrics from NSO’s underwriter, CNA, some of the top allegations made against CRNAs in malpractice lawsuits involve improper treatment or intervention during a procedure, medication errors, inadequacies in the anesthesia plan, and failure to monitor the patient’s condition. CRNAs encounter these liability risks on a daily basis, so it is important for them to identify and manage these risks to protect their career and livelihood while also improving outcomes for their patients.”
The NSO recently reviewed two case studies and then identified six ways that CRNAs can manage risks. They are as follows:
1. Maintain competencies (including experience, training, and skills).
Competencies should be consistent and up-to-date with the scope of authority granted by state law, the needs of the CRNA’s assigned patients, patient care unit, and equipment.
2. Obtain and document informed consent for any planned anesthetic intervention.
Patients or the patients’ legal guardian must be informed of the potential risks, benefits, and alternatives to the planned anesthetic intervention and surgical procedure(s). CRNAs should verify that informed consent was obtained by a qualified member of the patient’s health care team and documented in the patient’s health care record prior to any intervention.
3. Document pertinent anesthesia-related information in the patient’s record.
Review the patient’s clinical history, including relevant social and family history; evaluate the patient and determine if they are appropriate for anesthesia and the proper method of anesthesia. CRNAs should document this process, including their rationale, and any discussions with the patient.
4. Communicate in a timely and accurate manner initial and ongoing findings regarding the patient’s status and response to treatment.
It is essential for CRNAs to report changes in the patient’s condition, any new symptoms displayed by the patient, or any patient concerns to the practitioner in charge of the patient’s care in a timely manner. Document patient responses to treatment, whether positive or negative.
5. Provide and document the practitioner notification of changes.
In addition to communicating any change in the patient’s condition or symptoms, or any patient concerns, CRNAs also need to document the practitioner’s response and/or orders in the patient’s health care record.
6. Report any patient incident, injury, or adverse outcome.
CRNAs should report any patient incident, injury, or adverse outcome, and the subsequent treatment and patient response to their organization’s risk management or legal department. If CRNAs carry their own professional liability insurance, they should alert their insurance carrier to any potential claims, as timely reporting ensures that an incident, if it develops into a covered claim and is not excluded for other reasons, will be covered.
“Facing a malpractice suit can be stressful and overwhelming because it is a long, unpredictable, and costly process. One step I recommend for CRNAs to take is maintaining their own professional liability insurance to help protect their careers,” says Reiner.
With more than 52,000 nurse anesthetists and student nurse anesthetists, the career is thriving and attractive for several reasons. Many nurse anesthetists say the patient interaction they have is unsurpassed. They are with patients before, during, and after surgery, so there’s a necessary trust that is quickly established with the skill and care of the nurse.
Why is the AANA particularly aware of the health and wellness among student nurses looking to enter or actively studying in this field?
Student nurses are the future of the profession, and it is important to cultivate and prepare for a long and healthy career. Students who aspire to enter into nurse anesthesia programs must be healthy mentally and physically. They must have healthy outlets for stress relief, and healthy lifestyle habits that will support them throughout our educational programs.
Nurse anesthesia education programs are required by their accreditation standards to provide education content on wellness and substance use disorder. The AANA actively encourages members, students, as well as educational programs to engage whenever possible in healthy behaviors, whether that includes physical activity or simply reducing stress by encouraging individuals to take time for their loved ones or to engage in an activity they love.
The AANA is committed to providing resources and information about ways to become involved in establishing a healthy lifestyle and even offers fun runs, wellness tutorials and a massage therapy area at many of their conferences.
How does establishing good health and wellness practices now help a student nurse become better? And how will taking care of oneself now carry over once they graduate and are several years into a CRNA career?
Nursing has unique stressors like dealing with patient care situations that require critical thinking, fast decision making, and autonomy is tough. If the student nurse does not have the ability to cope with these situations autonomously, it is very difficult to care for patients. Maintaining both mental and physical health and wellness are at the foundation of successful practice.
Developing healthy lifestyle habits early, helps students handle stress more effectively, set clear goals, and develop a clear plan to achieve them. They also assist students with discipline, good study habits, prepare for clinical experiences properly, and self-evaluate objectively. It also helps to establish diet and exercise plans that can be adjusted as one transitions to practice, to avoid elimination of healthy habits out of inconvenience.
Maintaining a school-life balance is also important to develop a support system and find time for small, pleasant breaks to gives a fresh perspective and recharge. Establishing healthy behaviors and habits early is vital to long-term health, wellness, and maintenance of a successful career.
Do you have any advice for student nurses about considering this field and being aware of any challenges unique to this branch of nursing?
For student nurses considering the field of nurse anesthesia, awareness about the depth and breadth of study is valuable, but is important to be well, so that an individual will have the endurance to graduate. A strong support system and personal discipline are necessary to allow for healthy stress relief and appropriate professional conduct. Anesthesia remains the field with the highest incidence of drug abuse and unhealthy coping behaviors, due to high stress and access.
Think about what you do when stressed. Review your lifestyle habits: exercise, eating, alcohol use, and other substance use. Some prospective students may want to employ a lifestyle coach who can look at a person individually and help one to develop positive lifestyle habits that will set one up for success in graduate school and a stressful career. Good study habits, a healthy respect for one’s self and career, use of study resources, and strong, supportive relationships will be required to succeed and thrive in this field.
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