Nurse Anesthetist Panel Discussion is the topic of this episode as we look at CRNAs this month on Nursing Notes Live. In this episode of the Nursing Notes Live podcast, I got the chance to sit down and chat with our panel of nurse anesthetists including Sharon Pearce, president of the American Association of Nurse Anesthetists and CRNA at Carolina Anesthesia and Associates in Greensboro/Winston-Salem, N.C. and John M. O’Donnell, professor and chair of the Department of Nurse Anesthesia and director of the Nurse Anesthesia Program at the University of Pittsburgh in Pittsburgh, Pa. Here’s that discussion.
Jamie Davis: Sharon and John, it’s great to have you both here on the show and talking about nurse anesthetists today. I’ll start out with my first question for Sharon and that is tell us a little bit about why you wanted to become a nurse?
Sharon: Well, Jamie, when I was younger I had congenital deformities of my feet which required extensive surgical procedures. I was in second grade. I will never forget the nurse that took care of me. I kind of wish I knew who she was now but I was going through a lot of pain and she had to give me an IM injection and she talked me through it. And to me, she was an angel. I can remember being, what seven years old and looking at her and I said, “One day I’m going to be a nurse just like you.” I had no idea who that lady was. But she made such a profound impact on me at such a tender young age.
Jamie: It’s amazing the way that nurses impact each of us and so many nurses become nurses because of that nursing touch at some point in their lives.
Sharon: Absolutely. I totally agree. My grandmother always thought I was going to be a teacher so she was one who was ultimately surprised that I became a nurse but it absolutely goes back to that event.
Jamie: John, how about you?
John: Well, I have to say my pathway is a little bit different. I grew up in the Western Pennsylvania steel mill country and I think the expectation was that I would become a carpenter or perhaps work in a steel mill like my dad did but I was also exposed to nursing. I had an aunt who was the director of Pennsylvania Easter Seals and they run a camping and recreation program in summer for physically and mentally challenged individuals and so I got the chance to work as a camp counselor. That was the first time I really encountered on a day-to-day basis the work that a nurse did. So every camp had a nurse there because of all the medications and physical and sometimes mental needs of these campers. I just became fascinated by her interaction with them. Got to know her a bit better. Found out what the career trajectory was and then went home and told my steelworker dad that I plan to become a nurse.
Jamie: How did that go?
John: [Laughter] Well, it didn’t go perfectly smoothly because it was really pretty far outside of his comfort range but when it became clear that I was truly serious about it and got into a college for that - and especially when I graduated and then my career started taking off - he became proud of me and so it ended up as something we kind of laughed about later.
Jamie: As a fellow male nurse I know that sometimes you get that raised eyebrow from people you know when you announce that that’s your career decision. So I’m curious how that went.
John: I mean this is back in 1979 as well. It’s a whole different world.
Jamie: It is. So tell me a little bit about how your career progressed. What drew you to become a nurse anesthetist?
John: Well, I was working as a nurse, I took my first job at Magee-Women’s Hospital in Pittsburgh and I was working with oncology patients and became a chemotherapy nurse. That I found out to be really rewarding pathway and I also kind of rotated to other units within the facility. No one of the places I really enjoyed working was in the post-anesthesia care unit and that’s where I first encountered nurse anesthetists. Really it wasn’t something we talked all about in my nursing program and I wasn’t very familiar with them. I got to see how autonomous they were and how they manage patients all the way up through the postoperative period. I started talking to those CRNAs and they encouraged me to consider the career. I didn’t do it immediately because at the time the local programs didn’t accept post-anesthesia care unit experience so I eventually transitioned. Started working in ICUs and a couple years later I applied to my nursing anesthesia program and then went on to graduate. With the first Master’s cohort here at the University of Pittsburgh, took a position within the health center and at the same time I was a reservist in the U.S. Army. I would rotate out and work in the Army hospitals - Madigan Army Medical Center, Walter Reed Army Medical Center hospitals – for two to four weeks a year. So I got that experience. I also had an additional job where I work privately as a traveling anesthetist. At the same time, my academic career started taking off and by 1995 I was working pretty much full-time in the nurse anesthesia program here at the University of Pittsburgh. So there’s about a four window where I got lots and lots of clinical experience and then started working more in academics in the mid-90s and went on to finish my doctorate in epidemiology in 2009. Now I sit as a full professor, epidemiologist and the director of the anesthesia program here at Pitt.
Jamie: That’s awesome. That’s a fantastic progression there and again thank you for your service to our country as well.
John: You’re very welcome.
Jamie: Sharon, how about you? Was your path similarly trajectory straight up towards nurse anesthetist or did you move around the different fields?
Sharon: No, actually it was pretty straightforward. When I first started nursing school, I was in an associate degree program. And back in that era, patients were admitted the day before so that they can be pre-op by anesthesia for their surgical experience on the next day. I was up on the floor. I was a junior nursing student, first year nursing student. The anesthesiologist, believe it or not, was out there pre-opping patients for the next day. They didn’t tell us in my associate degree program that nurses give anesthesia. And the anesthesiologist was there. He said, “Have you ever thought about going to nurse anesthesia?” And I said, “Well, I didn’t know nurses could give anesthesia.” He said, “I heard you’re very sharp. I think you need to look into it.” So I did and whenever I did my rotation through the operating room, I, like John, was absolutely fascinated watching the CRNA and what they did and the autonomy they had. And so those are the two things that kind of gotten me in my past. Interestingly enough, I will not name the anesthesiologist who encouraged me to go, who now will be the president of our national Association of Nurse Anesthetists. Those anesthesiologists might not be too happy with the one who started me on this career path. [Laughter] But it’s been the best decision I ever made.
Jamie: Excellent. Sharon, while we’re talking about nurse anesthesiology, why don’t we talk a little bit about the history of the nurse anesthetist. The first nurses started giving anesthesia all the way back in the American Civil War. It’s really a very old and revered nursing specialty.
Sharon: Absolutely. I tell people all the time that we have been giving anesthesia since the Civil War. It wasn’t me, I promise you, during the Civil War that was giving anesthesia. We were the first advance practice nurses. If you go on just a little bit more to the history of nurse anesthesia back, they really started at the Mayo Clinic. And what had happened, these two anesthesia was given by surgical residents and their first interests was watching the surgical procedure. Well, they weren’t paying attention to the patient. A lot of patients died just from the anesthetic. And so they decided to look around and just look at who would actually monitor the patient. So they went to a nunnery, of course, found nurses that were nuns and that’s how some of the original nurse anesthesia programs began and the original nurse anesthetists. So we have a very long and rich history. Like I said, we were the first advanced practice nurses segment that there was.
Jamie: John, you educate nurse anesthetists at this time, what are some of the things you’re seeing as far as the people coming through the programs right now, new students in nurse anesthesiology? Are they looking different than they were maybe five or 10 years ago?
John: Well, I have to say they look a lot younger.
Sharon: [Laughter] I agree. You feel like you got older.
John: I would say as far as the applicants that we see, the biggest differences are that there are so many ways that applicants now can come into nurse anesthesia programs. For the 20-some years that I’ve been involved in education, there has been a trajectory which has always been Bachelors of Science in Nursing or Bachelors of Science degree. But the way that you could now get a Bachelor of Science in Nursing really varies dramatically across the United States. There are online capabilities. There are accelerated programs. There are upper division programs which students get kind of their baseline sciences and social sciences courses in their first years and then they go on to a junior and senior year, which is the nursing program. So that’s been a really big difference. Other differences that I would tell you is that I’m amazed at the quality and the preparation of applicants relative to what we used to see. I think Sharon and I kind of conveyed you it was kind of a profession which was not as well known even within nursing circles and now our undergraduate students are very well aware that nurse anesthesia is a possibility. They’re very interested in it from the standpoint of the technical aspect, the ability to work in high acuity situations as well as the idea that there’s a lot of respect and autonomy that goes with the role. So that the applicants we see now, I would say, are more qualified every year. It’s exciting to me because I know that the profession will be in great hands when I leave.
Jamie: Sharon, anything to add?
Sharon: Oh, I absolutely agree with John. Sometimes I see some of the young kids coming into the program and I think, “Oh, my goodness, I’m not too sure if I could get in now standing up next to some of the credentials that they have putting into the program.” So I absolutely agree with you, John.
Jamie: So Sharon, as president of the organization for Nurse Anesthetists, you actually have a programmer or an initiative out there the future of anesthesia care today and so I want to ask you little bit about where you see the future of nurse anesthetists? Where is the specialty in nursing going down the road?
Sharon: Well, I like to say the future is so bright you have to wear shades. Healthcare is changing right now and it is changing in leaps and bounds. I believe that medical system if finding out that – not to demean the patriarchal medical model - but that’s what we have had for many years and it’s just not a sustainable system. However, advanced practice nurses have a role in this healthcare system that’s really breaking and we can provide the same or superior level of care and save the healthcare system real dollars and cents. So not only our CRNAs vital to this healthcare system, the other advanced practice nurses: Nurse Practitioners, Clinical Nurse Specialists, Nurse Midwife – we all play a role in this upcoming healthcare system and we are a solution to many of the healthcare problems that we are now facing. Would you not agree, John?
John: Absolutely. I think we would be remiss if we didn’t also talk about the fact that the new wave of graduates from our advanced practice programs are going to be doctoral-prepared folks. So they’re going to have a whole new array of skill sets in the areas of technology use and systems management and understanding of organizational processes. So that I think they will be really positioned to help do many of the things that Sharon has already argued that we do well and perhaps enhance that or move us even further into the future of what promises to be a very different healthcare model.
Jamie: I really like to hear that, John, because I think really for healthcare reform, as we are going through the process right now, to succeed it really requires that nurses assume leadership roles in the healthcare process. It sounds like the nurse anesthetist students are being well prepared to assume those types of leadership situations.
John: Well, I do not want to speak for our president of our association. I’m very humbled to even be on a call with her. She does such a great job. But she mentioned that we are leaders as the first advanced practice nursing group. We were the first group of nurses to get third-party reimbursement for our services. We are the first group to not require supervision in some states for the purpose of getting reimbursement from Medicare. We’re the very first advanced practice group to say, “Look are entry credentials is going to be at the doctoral level.” We as a profession conveys that statement and the deadline for that is 2025. Many of the programs have already moved in that direction. Our program is moving there. We have our application is being prepared right now and our plan is January 2017 that all of our students will begin a doctoral program.
Jamie: That’s fantastic. Sharon, what advice do you give to that nursing student or that existing nurse who says to you, “I think I want to become a nurse anesthetist, what kind of skill sets do I need to be developing along the way as I gain experience? Do I need to be in the critical care setting or are there other places that I can get that experience?”?
Sharon: Absolutely. You do have to have critical care variant and it varies by school which John can probably speak to some of that just a little bit better than myself. But the biggest thing that I tell nurses who want to go into anesthesia is to make good grades, standout, be a leader, be ready for critical situations because that’s exactly what nurse anesthetists do every single day. We are the leaders in critical situations whenever we’re in the operating room. We take the top gun basically, the top 1% of nurse. The best of the best is who we recruit into our field because it is such a critical field as it is. So just do make great grades. I’ll never forget the first day I walked into my anesthesia program. You think you’re going in for an orientation and the director lectures for eight hours. And the first thing she said was, “You will make straight A’s in this program or you’re out because nobody who makes a B is putting me to sleep,” and I have never forgotten that statement. So it should be at the top of your game and to do very well in nursing school so that you will stand out. The competition is high to get into our field. For instance, when I went to school, which has been a number of years ago, that we were seeing about 1,200 applications which were ultimately pared down to 10 spots. I only interviewed about 100 people and then narrowed that down to 10 slots. So it’s very competitive. I imagine it still is. I can’t remember the ratio for every one person that is accepted into the program, I forgot, I think we have about eight to 10 applications now nationwide is what it boils down to. So just be the best that you can be.
Jamie: John, how about you?
John: Well, I couldn’t say it much better than that. Now I would say that I never lecture for eight hours in a row. [Laughter] But just because I know that the attention span of most students is about 15 minutes. I definitely agree…
Sharon: They didn’t have cellphones then.
John: That’s another huge difference in today’s students. We as educators have to be nimble and come up with new educational techniques that are shorter, bursts of information, that have more technology applications associated and that meet the needs of today’s learners. But I always say that students party less and study more if you want to go to anesthesia school because we have an undergraduate program here. We have many of our honor students who want to come into nurse anesthesia. So we allow them to take an honors course with us and get into the OR and really see firsthand what it looks like to be a CRNA. The other thing that I think is really important, and Sharon touched on it, the environment in an operating room is very complicated. You have to work with a lot of different people not just the anesthesiologist or the surgeon but there are many other people who were involved - the surgical tech, the circulating nurse, the technicians who help with anesthesia services, the administrators who are there - and so I think it’s a key skill to start developing, which is your communication skills and their ability to work effectively in a team. Medical schools now are considering making that a key component of their process as well which is, do people have the personality and baseline skills to be good team members? Because that’s really what happens in a complex environment especially an operating room or a critical care environment. You really have to be a good team member. So individual skills and skill sets that students are going to get in ICUs are really important, but also important is the ability to be a good team member and to understand the complexities of what goes on.
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Make sure you check out the entire July 2015 issue of Nursing Notes where we take a look at the nursing career of nurse anesthetists. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our Get to Know nurse Kenneth Wofford, assistant professor in the graduate school of nursing and nurse anesthesia program at the Uniformed Services University of the Health Sciences in Bethesda, Md. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes as well as our new podcast player on DiscoverNursing.com!