The title "Doctor"

I thought I would share this blog post arguing why DNPs should be called "Doctor"! I totally agree!

http://community.advanceweb.com/blogs/np_7/archive/2014/07/09/doctor-vs-doctor.aspx

What is a CRNA?

I wrote this for a school project, but I thought it might be interesting to someone out there so I'll share....  

Nurse Anesthetists are nurses who have advanced training to deliver anesthesia, providing amnesia, analgesia, and muscle relaxation. Advancements in anesthesia care have allowed for advanced surgical procedures and improved patient outcomes. Anesthesia was among the first areas of advanced practice nurses, and began in crude form as nurses aided doctors during surgery by holding a paper cone soaked in ether during the earliest surgeries. As anesthesia techniques became more sophisticated and technologically-oriented medical doctors began specialized resident training programs in anesthesia as well (Richards, 1993).

Education

            The first formal anesthesia-training program began in 1909, and it was open to physicians, dentists, and nurses. Early nurse anesthetists were active in research and published their findings and techniques as well as established the standards of care for the anesthesia specialty (Harris, n.d). These first anesthesia training programs accredited graduates with a certificate in anesthesia. Currently, the AANA is implementing new guidelines for newly enrolled nurse anesthesia students effective January 1, 2022 (Madsen Gombkoto, 2014). These new standards prepare graduates for public policy, advance standards of care, and to transform the health care system through practice doctoral degrees.

            The curriculum offered in nurse anesthesia programs is regulated by the Council of Accreditation (COA), which is recognized by the US Department of Education and the Council for Higher Education. The basic curriculum requires pharmacology of anesthetic agents and adjuvant drugs including concepts in chemistry and biochemistry (105 contact hours); anatomy, physiology, and pathophysiology (135 contact hours); professional aspects of nurse anesthesia practice (45 contact hours); basic and advanced principles of anesthesia practice including physics, equipment, technology and pain management (105 contact hours); research (30 contact hours); and clinical correlation conferences (45 contact hours) (AANA, nd).

Certification

            Certified Registered Nurse Anesthetists (CRNAs) must pass the national certification exam administered by the National Board of Certification and Recertification of Nurse Anesthetists (NBCRNA) after completion of  an accredited post-baccalaureate program (AANA, nd).

Scope of Practice

The AANA outlines the elements included in the scope of practice of CRNAs that is used by the Council for Accreditation (COA) of Nurse Anesthesia Programs.

• Perform a comprehensive history and physical examination
• Conduct a preanesthesia evaluation
• Obtain informed consent for anesthesia
• Develop and initiate a patient-specific plan of care
• Select, order, prescribe, and administer drugs and controlled substances
• Select and insert invasive and noninvasive monitoring modalities and clinical experience requirements
• Provide acute, chronic, and interventional pain management services
• Provide critical care and resuscitation services
• Order and evaluate diagnostic tests Request consultations Perform point-of-care testing
• Plan and initiate anesthetic techniques, including general, regional, local, and sedation. Anesthetic techniques may include the use of ultrasound fluoroscopy and other technologies for diagnosis and care delivery, and to improve patient safety and comfort
• Respond to emergency situations using airway management and other techniques; facilitate emergence and recovery from anesthesia
• Provide postanesthesia care, including medication management, conducting a postanesthesia evaluation, and discharge from the postanesthesia care area or facility

Specialty Organization(s)

            There are several specialty organizations that CRNAs can belong including American Association of Nurse Anesthetists (AANA), Tennessee/Oklahoma Association of Nurse Anesthetists (TANA/OANA --local branches of AANA), 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 Anesthesi, Society for Obstetrical Anesthesia Perinatology, Society for Ambulatory Anesthesia. Many of these organizations have websites, which outline the criteria for membership and may also sponsor research journals.

References

AANA. nd. Qualifications and Capabilities of the Certified Registered Nurse Anesthetist. Retrieved from http://www.aana.com/ceandeducation/becomeacrna/Pages/Qualifications-and-Capabilities-of-the-Certified-Registered-Nurse-Anesthetist-.aspx

Harris, N. (n.d.) Retrieved from http://www.aahn.org/gravesites/magaw.html on December 1, 2013.

Madsen Gombkoto, R. L., Walker, J. R., Horton, B. J., Martin-Sheridan, D., Yablonky, M. J., & Gerbasi, F. R. (June, 2014). Council on Accreditation of Nurse Anesthesia Educational Programs Adopts Standards for the Practice Doctorate and Post-graduate CRNA Fellowships. AANA Journal, 82, 177-183.

Richards, E. (1993). The Problem of Certified Registered Nurse Anesthetists. http://biotech.law.lsu.edu/Books/lbb/x943.htm

Union Research Symposium

Today, we had the opportunity to present our research to the scholarship symposium at Union University. We had a very positive response to our work, and all of our anxieties were unwarranted! We enjoyed educating our anesthesia faculty on our new knowledge of malignant hyperthermia. The symposium was open to all areas of study and we even had questions from non-medical researchers. This was fun but challenging! Here are some pictures from our day!

My husband thought "Symposium" was a funny title so I had to share this picture with him

Our final mounted poster. It really turned out great

Our research group 3 - DNP - Anesthesia Students and 1- MSN - Education Student

The three anesthesia girls and my regular study buddies!

Anesthesia Machine Check

Well, After 9 month of talking about anesthesia we are finally getting to start putting our hands on some anesthesia equipment! YAY!! Okay, I know I am a nerd, but I am seriously EXCITED to start doing anesthesia! So, today was our first day in the simulation lab and we learned our "pre-flight" checklist. As a pilot's wife I can really appreciate this important first step to a successful day! Here are some pictures from our first day in "the sim." Much like flying, medicine has developed a similar education tool to help develop and perfect technique and emergency procedures. In anesthesia, "the simulator" is a mannequin that is very life like and has vital signs (HR, RR, BP, etc...). Our instructors can control the sim and allow him to respond to our actions. We also have actual anesthesia machines that we use to deliver our anesthetic to the sim. REALLY COOL technology!

Here I am.. Excited to get started doing anesthesia

My classmates (and the only other "Okie") in my class

My trusty sim partner

They think I am nerd ;)

Easter

One of the things I love about Union University is the core-values - Christ Centered, People Focused, Excellence Driven, and Future Directed. Each step of our education at Union focuses on these values. Our current technology course focuses on the future direction of health care and prepares us for the increasing importance of technology in our field. Union does an excels in all of these areas, but one of the things that sets us a part is being Christ-Centered. We have an amazing group of Godly professors at Union who are not only experts in their field but mentors in their faith. With the season of Easter upon and our last class period before breaking for Easter, we received an unexpected anatomy/pathology lesson. Our course instructor is a veterinary by trade but a skilled anatomist and has spent numerous hours in the cadaver lab perfecting various techniques to aid his teaching. After finishing our lecture on the pathology of the respiratory system, Dr. Wamble shared with us the physiology of the crucifixion. This lecture truly prepared my heart for the real reason for Easter and helped me to focus on the amazing grace of God! One of my classmates happened to be recording the lecture, and I think it is too awesome not to share! Enjoy & Happy Easter!

 

How thankful I am for His mercy! What an awesome season! After class I was able to travel home to Oklahoma again, and enjoy a wonderful Easter celebration with family.

Research

We are currently taking Advanced Research/Evidence-Based Practice. In this course, we are learning basic principles necessary to review literature, determine credibility, and compile a literature review. Throughout the course, we have had reading assignments which prepare us to complete a literature review of a topic of our choosing with a group. Our group consisted of three DNP anesthesia students and DNP education student who is an OR nurse. One of our nurses is a trauma nurse at The MED and we found the incidence of malignant hyperthermia in trauma patients to be a particularly interesting topic. We are looking forward to presenting our research at the scholarship symposium on April 29th at Union University.

OANA Meeting

I had a fabulous educational conference in Oklahoma! I enjoyed meeting the great group of anesthetists located in the state, and I am excited to join the ranks of the highly skilled group of professionals I met there, and I learned a lot about the politics of anesthesia and the job market in Oklahoma. The conference had a great day crammed pack of great lectures! Although, my lack of practical anesthesia knowledge left be a little lost in some of them! Overall, it was a great day and well worth my time and trip to Oklahoma!

And, Grandma did not complain too much! This is what the kiddos did while Mommy was learning!

OANA Meeting

With Spring Break fast approaching, I am looking forward to attending the professional meeting of my future home state (HOPEFULLY)! My husband and I both grew up in Oklahoma City, and as our children get older we desperately long to return home to family. I am trying to educate myself as much as possible regarding the job market, practice guidelines, and legislative issues of my home state. Although, I realize is still early to begin the job hunt, I figure it is never to early to begin educating myself on the issues I will soon be facing! I also hope to gain information from the OANA and get on their mailing list! 

Informatics in Anesthesia

As a doctorate level provider, we are expected to provide research and change practice. Computers and information systems have become an integral part of the health care system especially over the last 10 years. In my short nursing career, I remember the chaos when our hospital "went live" with its new electronic medical record (EMR). This system converted the nursing staff over to electronic charting, while the providers continued using paper order entry. Recently, they have opted for a newer system which streamlines the EMR, and all levels of staff will use the same system (including anesthesia)! In the past, the OR and the ER are the last to adopt these changes (which seems kind of backwards to me), So, this hospital is one of our clinical sites so I am looking forward to the opportunity to utilize computer charting in the OR (I believe there are only a couple of hospitals in West TN that have computerize charting in the OR).

I believe computers and technology have so much to offer when properly utilized. My hope is that through this course and through continuing education, as technology changes, I will be able to provide the best possible patient care!

DNP Project Ideas

I am interested in a pain management speciality as I have seen so many struggle with chronic back pain and the subsequent battle with opiates. It is my desire to help relieve chronic pain with minimal usage of narcotics. I believe that the use of pain blocks as well as a holistic approach may offer relief for patients suffering chronic pain. I would like to incorporate this interest into my DNP project.

Another area of interest is education. As many of you know, I served as a high school science teacher and coach before beginning my nursing career. Although, I believe bedside anesthesia is definitely my calling, I believe the God may still have plans for my passion for teaching. I am not sure where that will lead, but this was definitely a factor in choosing the DNP anesthesia program. With that said, I am exploring research literature on regional anesthesia training using cadavers.

I mean... How can coming to work to this not put a smile on your face!!

The path to becoming a CRNA

After being asked, What is a CRNA? The next question I often hear is okay, so how do you become a CRNA? The answer is not that simple as there are many pathways to becoming a CRNA and the requirements and schooling has change drastically over the years. All CRNAs share their RN roots and critical care background. As critical care nurses, we become good at managing vital signs, dealing with specialty equipment like ventilators, and critical thinking and decision making. This background serves us well as we enter the OR!

 

In early years of nurse anesthetists, nurses were trained on the job to provide as safe anesthetics and later evolved into diploma programs, then master's program, and now doctoral programs. Many health care organizations are embracing the push to train advanced practice nurses on the doctoral level including AANA (The American Association of Nurse Anesthetists).

 

So here are some steps:

1) Become a RN

2) Complete Requirements for Admission to CRNA school: Usually 1-2 years of critical care experience, ACLS (Advanced Cardiac Life Support Certification), PALS (Pediatric Advanced Life Support), CCRN (Critical Care Registered Nurse), & Completion of a Bachelor's Degree. These are some of the most common requirements, but anesthesia programs have become quite competitive and often require some level of leadership experience (charge nurse/preceptor/MRT/etc)

3) Complete CRNA school: many programs are now doctorate programs and require approximately 3 years of additional training (both clinical and didactic)

4) Pass Anesthesia board certification exam

Here is a look at the courses I will be taking over the next three years -- We are currently in Spring I!

Notice the hour requirements for some courses -- These are hours we will spend in the hospitals supervised by certified CRNAs and MD-Anesthesiologists learning anesthesia on real people!

What is an anesthetist?

Well, as many of you already know, I decided to back to school AGAIN (for the LAST time)! This fall I began studying anesthesia in Jackson, TN at Union University. The program I chose is a 36-month doctorate in nursing practice (DNP) program with an anesthesia specialty. Upon completion of the program, I will take "boards", which is an exam, that accredits nurse anesthetists or CRNAs, certified registered nurse anesthetists

So, You Ask, What is a Anesthetist, Nurse Anesthetist, or CRNA?

An anesthetist specializes in the delivery of anesthesia and management of both acute and chronic pain. There are several pathways to becoming an anesthetist including graduate anesthesia assistant programs (AA), medical school residencies (MD/DO), and graduate nurse anesthesia programs (CRNA).

Here is a funny video about what people think we do! I promise it is really a LOT more complicated!

Nurses were the first anesthesia providers and assisted surgeons with providing pain relief and anesthesia services during procedures. The scope of practice of CRNA is determined by the individual state the anesthetist is practicing, however, CRNAs offer the only anesthesia services in many rural counties across the country. Chances are if you have required anesthesia services of some type (epidural for childbirth, anesthesia for a tonsillectomy, or even a coronary bypass surgery) you have experienced the skill and expertise of a nurse anesthetist!

This blog is being created for a school project so it will contain lots of educational information, but feel free to follow my 36-month journey to becoming a nurse anesthetist!