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A 17-year-old boy went into full cardiac arrest 27
years ago in the emergency room of a rural hospital
in Missouri. Respiratory therapist Sally Bass Witkowski
was on duty that evening, and the incident would change
her life.
"In 1975, my career goal was to teach respiratory
therapy at the college level. I was working full time
and close to graduating with a BS in respiratory therapy
when this kid arrested.
"The on-call nurse anesthetist was called. She
walked in the room, started his IV, intubated him and
saved his life. She did it all effortlessly and quietly.
I could tell it was no big deal to her. When I saw her
do that, I knew that was what I wanted to do, what I
wanted to be.
"She was a quiet, well-trained country woman.
Her name was Margaret Ryan. I've wanted to tell her
many times how much I admired her, how she changed my
life, but that was 27 years ago."
Witkowski became a certified registered nurse anesthetist
18 years ago and has worked as a staff anesthetist for
an anesthesia group in Austin, Texas, since 1984. "Our
anesthesia group covers several hospitals, and we do
every kind of surgery imaginable, from total hip to
neonatal open heart."
Witkowski described the mechanics of her job. "We
[CRNAs] interview patients, review charts and physical
history, do preoperative teaching and develop an anesthesia
plan in collaboration with the anesthesiologist. While
the patients are in surgery, we assure their safety
and comfort by administering anesthesia while at the
same time monitoring vital signs, anesthesia depth,
blood loss, body temperature and positioning. We assure
that the patient gets from surgery to the recovery room
or ICU stable and comfortable.
"Patient safety is the No.1 priority for nurse
anesthetists. We minister to the patient's physical
and emotional needs, offer reassurance and comfort,
and stay right by the patient's side throughout the
surgery."
National shortage of anesthesia providers
Despite the critical need for CRNAs, a national protracted
shortfall of anesthesia providers threatens to limit
the growth of surgical activity. CRNAs practice in every
setting in which anesthesia is delivered, including
traditional hospital surgical suites, obstetrical delivery
rooms, physicians' offices, ambulatory surgical centers
and the military, said Ira Gunn, MLN, CRNA, FAAN. "We
have so decentralized where we perform that people are
spread out all over. Those who work in outpatient surgery
centers reduce the number of nurse anesthetists available
to take call and work round-the-clock. We just can't
cover it all."
Another factor contributing to the shortage is an aging
population, as elderly patients have an inpatient procedure
rate about three times that of the general population.
The burgeoning field of pain management, as well as
advances in diagnostic and operative procedures, have
grown out of proportion to the supply of active anesthesia
providers, and the proportion of nurse anesthetists
nearing retirement age is increasing.
Educational capacity is a problem. "We need more
accredited nurse anesthesia programs in this country.
There aren't enough student slots, and faculty are difficult
to recruit. For our entering class of August, we had
312 applicants for 85 slots," said Kay Sanders,
MHS, CRNA, director of the graduate program of nurse
anesthesia at Texas Wesleyan University, the largest
nurse anesthesia program in the United States.
On the positive side, the shortage has resulted in
higher pay for CRNAs. In 1999, the national average
salary of CRNAs was about $102,000, finally jumping
the six-figure hurdle, according to the American Association
of Nurse Anesthetists.
"Besides comfortable pay, nurse anesthesia is satisfying
work," Gunn said. "Most CRNAs were critical
care nurses first. With nurse anesthesia, you have far
more control over your work. And the one-on-one focus
with your patient is priceless."
How to become a CRNA
To become a CRNA, a licensed registered nurse must
complete an accredited nurse anesthesia program (earn
a master's degree), then pass a certification exam.
Requirements for admission are a bachelor's of science
of nursing or another appropriate baccalaureate degree
and a minimum of one year of acute care nursing experience.
"The average length of work experience for CRNA
school candidates is four to five years, although a
fair number have had quite a few years of experience.
Critical care experience is what's needed, preferably
adult intensive care or emergency nursing," said
Gunn, who has practiced anesthesia for nearly 50 years
and has worked extensively with state legislatures,
Congress and administrative bodies regulating the nurse
anesthesia profession.
"Most nurse anesthetist programs are located within
schools of nursing, and the average program length is
24 to 36 months. Texas Wesleyan is 27.5 months,"
Sanders said. "The first year is classroom with
graduate-level classes in the basic sciences, advanced
anatomy and physiology taught by Ph.D. physiologists,
pharmacology, pathophysiology-many of the same classes
you'd find in medical schools. The second year consists
of clinical residencies where a student is assigned
to a hospital with hands-on general and regional anesthesia,
and acute and chronic pain management."
CRNAs have provided anesthesia care for more than 100
years and legally administer 65 percent of the 26 million
anesthetics delivered in the United States each year,
according to the AANA. They are the sole anesthesia
providers in 65 percent of rural hospitals. For more
information about this subject or in becoming a CRNA,
visit the association's Web site at www.aana.com.
Contact
Tony Inglis at tinglis@austin.rr.com.
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