By Melissa Wirkus Hagstrom, contributor Jun 24, 2020
As we continue to see an
uptick in the number of confirmed cases of COVID-19 across the United States,
healthcare leaders are seeking to ensure facilities have the right clinicians
in place should the pandemic continue to worsen in the next few months.
One type of clinician that can leverage
his or her skills during a time of crisis is the certified registered nurse anesthetist
(CRNA). According to the American Association of Nurse Anesthetists (AANA),
facilities can optimize their healthcare workforce during COVID-19 outbreaks by
utilizing CRNAs in their role as advanced practice registered nurses (APRNs).
These advanced practitioners can also provide other types of support, depending
on the needs of the patient population and healthcare facility.
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“CRNAs can play an important role in providing
life-saving critical care management for patients impacted by the COVID-19
virus in their APRN role. CRNAs are prepared to practice autonomously and
are qualified to make independent judgments based on their education, licensure
and certification,” said Brett Morgan, DNP, CRNA,
senior director of AANA’s education and practice division.
CRNAs
comprise over 50 percent of the U.S. anesthesia workforce, administering more
than 49 million anesthetics each year. They are master’s- or doctorate-prepared
clinicians with highly specialized skills. These skills can be very helpful
with the complexity of issues that affect a hospitalized coronavirus patient.
Skills such
as airway management, ventilator support and advanced patient assessment are
all included in CRNA training, and can be leveraged during the pandemic to help
treat an influx of patients with respiratory issues.
The AANA
notes that CRNA candidates begin their educational program averaging 2.9 years
of acute care nursing experience, with at least one year of critical care
nursing required. This experience, along with their training and expertise in anesthesiology,
positions them to help in many different areas.
In
addition to their training with airways and ventilators, CRNAs can also assist
with placement of invasive lines and monitors (including central lines,
peripherally inserted central catheters, or PICCs, and arterial lines),
advanced hemodynamic monitoring, and assessing patients who require alternative
positions, paralytic medications or deep levels of sedation that are not
normally managed in the ICU setting.
In a
recent position
statement, however, the AANA cautioned CRNAs to carefully evaluate
several factors before taking on responsibilities outside their normal experience
and skillset, advising them to have a frank discussion with facility leaders.
The continuing need for CRNAs in the
COVID-19 response
According to data from the Centers for Disease Control and Prevention (CDC) and
National Healthcare Safety Network in mid-June 2020, there are nine states that
currently have over 70 percent of their inpatient beds occupied. And the Johns
Hopkins Center for Health Security identified a potential need for 200,000
additional intensive care unit (ICU) beds during a moderate pandemic scenario.
Elective
procedures and nonemergency surgeries are also making a comeback, after weeks of deferment, leading to more
work for anesthesia professionals and other providers. With beds filling up,
hospitals throughout the country may be faced with bed capacity issues as well
as a shortage of qualified clinicians.
“To best
respond to this unprecedented crisis, CRNAs should be given full authority to
practice to their highest level of education and training. They should be
integrated fully into the critical care team, and their roles should reflect
their high degree of clinical skill and expertise,” Morgan said.
“New roles
that may not currently exist in health systems are needed in this complex and
challenging environment,” he continued. “These could include direct patient
care of high acuity patients as well as directing the care of multiple
critically-ill patients. CRNAs are the answer to rapidly, safely and
effectively extending the critical care resources that facilities need to care
for the patients being affected by the COVID-19 pandemic.”
Morgan also
advocates for expanded roles for nurse anesthetists in the future.
“Employers
and facilities should include CRNAs in leadership and executive roles, include
in planning discussions, policy development, have CRNAs be active members of
the medical staff and support CRNAs to work to their full education, training
and skills.”
Sources:
Using
CRNAs’ Unique Skill Set During COVID-19 Crisis – AANA
CRNA
Fact Sheet – AANA
CRNAs
Asked to Assume Critical Care Responsibilities During the COVID-19 Pandemic – AANA position statement
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