CRNA - Certified Registered Nurse Anesthetist Anesthesia Roles Exam 1

CRNA - Certified Registered Nurse Anesthetist Anesthesia Roles Exam 1 Certified Registered Nurse Anesthetist Anesthesia Roles Exam 1 Catherine S. Lawrence and other nurses provided anesthesia for surgeons operating on the wounded during the Civil War 1842 Crawford long used diethyl ether for cyst removal 1846 Anesthesia was developed in the US. Ether dome in Boston William Morton: dentist discovered ether 19th century Demonstrated efficacy of ether at Mass Gen. 1877 Sister Mary Bernard at St. Vincent's Hospital in Erie, Pennsylvania becomes the first nurse to specialize in anesthesia 1893 *Alice Magaw begins as nurse anesthetist for Dr. Mayo at St. Mary's Hospital, who would later bestow upon Magaw the title "Mother of Anesthesia" for her mastery of open drop ether 1899 Magaw published the first paper by a nurse anesthetist in the Northwestern Lancet 1906 Mayo Brothers 1909 Magaw's successor, Florence Henderson, continued in her mentor's pioneering footsteps with a paper she published. Agatha Hodgins, who later would found the National Association of Nurse Anesthetists (NANA), provided a commentary on Henderson's paper. 1911 first legal battle, cinnicinati physicians McMechan vs Crile. McMechan claimed anesthesia was only for physicians not nurses. Shut down Crile's anesthesia program at lakeside for a bit. 1917 able to teach again/ anesthesia is for nursing too. Sophie Winton, provided anesthesia for casualties during World War I Agatha Hodgins also provided anesthesia for casualties during World War I 1917 In Frank v South, the Kentucky Court of Appeals ruled that nurse anesthetist Margaret Hatfield was not engaged in the practice of medicine when she administered anesthesia for surgeon Louis Frank’s cases 1931 Agatha Hodgins, together with 47 nurse anesthetists, founded the National Association for Nurse Anesthetists (NANA) 1933 First annual NANA/AANA meeting in Milwaukee 120 attendees. Agatha Hodgins elected as president 1934 In Chalmers-Francis v Nelson, the California Supreme Court affirmed the Superior Court finding for nurse anesthetists Dagmar Nelson in a ruling that confirmed the legality of nurse anesthesia practice (AANA files its first amicus brief for the case.) 1939 NANA became the American Association of Nurse Anesthetists (AANA) 1941 The AANA seal "the watchful care fo the sleeper by the light of the lamp of learning" is adopted (1963) Second Lieutenant Mildred Clark, who would later become the first nurse anesthetist to serve as Chief of the Army Nurse Corps, and many other nurse anesthetists provide anesthesia for the wounded in World War II 1945 -AANA administered its first qualifying (certification) examination [90 women in 39 hospitals in 38 states] -AANA hires Florence McQuillen, a highly respected CRNA from the Mayo Clinic, to manage the association. McQuillen served as Executive Director until 1970. -Jack Neary- pioneer in pain management education and practice 1947 The first issue of the AANA News Bulletin is published 1952 AANA implemented its program for accrediting nurse anesthesia schools. (now COA- counsel of accreditation) Helen Lamb had been a proponent of the accreditation idea since the 1930s. 1953 Virginia Thatcher's History of Anesthesia with Emphasis on the Nurse Specialist is published. Through the efforts of the AANA History & Archives Society, the AANA Archives recently made this first history of nurse anesthesia available on the AANA website 1956 AANA members adopt the credential Certified Registered Nurse Anesthetist (CRNA) 1963 COL Mildred Irene Clark CRNA becomes first nurse anesthetist to serve as Chief of the Army Nurse Corps 1969 AANA members approved a voluntary continuing education for CRNAs 1974 Board of Directors adopts Standards for Nurse Anesthesia Practice 1975 The Council of Certification of Nurse Anesthetists (CCNA), the Council on Accreditation (COA) of Nurse Anesthesia Educational Programs, and the Council for Public Interest in Anesthesia were formed. Ira P. Gunn was the architect of the Council structure. Big influence on anesthesia education. -The Agatha Hodgins award for Outstanding Accomplishment is first presented to Ruth Satterfield, CRNA. 1977 AANA members approved mandatory continuing education for CRNAs 1978 The Council on Recertification of Nurse Anesthetists was established. Now called NBCRNA. (National board) Focus is on certification and recertification. 1981 The AANA Education and Research Foundation aka AANA Foundation is created. 1986 *-- Congress passed legislation providing CRNAs direct reimbursement under Medicare Part B (1st nurse specialty group able to be reimbursed) -- Board of Directors endorsed Harvard Patient Monitoring Standards 1989 -Direct reimbursement for CRNAs under Medicare Part B was implemented -Guidelines for Obstetrical Epidural Anesthesia Services were implemented -Marianne Bankert's Watchful Care: A History of America's Nurse Anesthetists is published. Bankert is presenting the first copy to Sandra Maree, now Sandra Ouellette, who served as AANA's president during this eventful year (Dr. Coker graduated this year) 1990 AANA Federal Government Affairs office open is Washington D.C. 1992 Park Ridge Illinois location of AANA office. 1996 CCNA administered the certification examination for the first time using computerized adaptive testing (paper test prior to this) The 1st AANA website is launched 1997 Guidelines for Office-Based Anesthesia for CRNAs were implemented (now increased need for anesthesia outside of the OR) 1998 The U.S. Department of Health & Human Services' Health Care Financing Administration (HCFA) published a proposed rule to defer to the states on physician supervision of CRNAs for Medicare cases (discussion started in 1988) 1999 AANA’s Standards for Office Based Practice for CRNAs were adopted 2000 HCFA announced it would finalize the rule to defer to the states on physician supervision of CRNAs for Medicare cases 2001 -- HCFA published the final rule to defer to the states on physician supervision of CRNAs for Medicare cases on the last working day of the Clinton administration HCFA announced it would finalize the rule to defer to the states on physician supervision of CRNAs for Medicare cases -- After two implementation delays, the Center for Medicare and Medicaid Services (CMS, formerly, HCFA) of the Bush administration published a proposed rule significantly different from the spirit of the Clinton physician supervision of CRNAs for Medicare cases rule -State governors can opt out of the federal physician supervision for CRNAs is they determine: it is consistent with state law, in the best interest of citizens, and a consult is made with board of medicine/nursing about the access to and quality of anesthesia. o Iowa becomes the first state to opt out of the federal physician supervision requirement for nurse anesthetists -John Garde, who served as AANA's Executive Director for more than 17 years, retired -John Garde and Jeff Beutler completed the near-seamless transfer of power during the fall and early winter 2007 NBCRNA came into existence 2012 Kentucky becomes the 17th state to opt out of the Federal Supervision Requirement 2016 AANA membership reaches the 50,000 member milestone 2022 All CRNA programs should be DNP Name the 17 opt out states? 1.Iowa December 2001 2.Nebraska February 2002 3.Idaho March 2002 4.Minnesota April 2002 5.New Hampshire June 2002 6.New Mexico November 2002 7.Kansas April 2003 8.North Dakota October 2003 9.Washington October 2003 10.Alaska October 2003 11.Oregon December 2003 12.Montana January 2004 13.South Dakota March 2005 14.Wisconsin June 2005 15.California June 2009 16.Colorado September 2010 17. Kentucky April 2012 What is a CRNA? A licensed RN who is educationally prepared at the graduate level & certified as competent to engage in the practice of anesthesiology, which is defined as the art & science of rendering a patient insensible to pain by the administration of anesthetic agents and related drugs CRNAs are licensed in all 50 states The practice of CRNAs is a recognized role within the profession of nursing & is NOT a medically delegated act. About how many CRNAs are there? Demographics? 53,000. 60% women and 40% men How many CRNA schools existed in August of 2017 There were 120 accredited nurse anesthesia programs in the United States utilizing more than 2,200 active clinical sites How many nurse anesthesia programs are approved to award doctoral degrees for entry into practice? 62 What is the NBCRNA criteria for recertification? Based on eight-year periods comprised of two four-year cycles •Have four other main component areas: 1.60 Class A CE credits (traditional CEC) 2.40 Class B credits or professional development activities 3.Completion of Core Modules in four content areas, including airway management, applied clinical pharmacology, human physiology & pathophysiology, and anesthesia equipment and technology (recommended) 4.Pass a comprehensive examination every eight years. According to the 2016 AANA Practice Profile Survey how many anesthetics do CRNAs administer annually? 43 million List areas where CRNAs can practice. •Traditional hospital OR suites •OB delivery rooms •Critical access hospitals •Ambulatory surgical centers •Offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists •US military*, Public Health Services, & Departments of Veterans Affairs healthcare facilities -*Rural America Define the CRNA Profession An occupational group who, in time, gained the recognition and trust of the public for services that were highly valued by society. What is the Moral Code of Nurse Anesthetist in the USA? (5 statements) Patient care values must be honored. Nurse anesthetists must be honest. Admit mistakes Be able to say, “I don’t know.” Accept personal responsibility for actions Tell the truth at all times Nurse anesthetists are loyal. Allegiance to a larger group of nurse anesthetists Supportive of individual colleagues in a crisis Supportive of accomplishments of colleagues Nurse anesthetists believe in equal opportunities for individuals. Equality for gender and sexual orientation Equality for race and religion Nurse anesthetists do not anesthetize family members except in an emergency. What are abuses of the CRNA profession? Abuses are usually attributable to a decreasing sensitivity of providers to public need, resistance to change in the public interest, commercialization, unaffordable cost for fewer and lower-quality services, and projection of professional interests (especially financial) over those of the public. What does professional socialization look like for the CRNA? •Describes how nurses are "molded" into their new roles as nurse anesthetist by developing knowledge, skills, behavior, and career commitment appropriate to the profession. •Process that one must follow to belong to a professional society •Process leading to the point where one identifies as a CRNA _____% of SRNAs think of themselves as nurse anesthetists within the first ___ months. 67% 6 months •By ___ to ___ months, ___% of SRNAs identify completely as nurse anesthetists 24 to 30 months ___% What are the two most common categories for CRNA employment? •Nearly 80% of all CRNAs in the US are employed by healthcare facilities or physician groups •Contracted professionals in solo or group practice -Usually wages are higher b/c they assume no claim to benefits as employees do. They are mobile in practice and are immediately available. -CRNAs who enter into contracted services should consider retaining the services of a professional accountant and attorney to ensure their rights and protection. List other emerging professional roles that CRNAs can be involved in. •Assume roles in pharmaceutical or manufacturing companies •Assume educational positions •Assume marketing or sales positions with companies that sell anesthesia equipment, devices, and pharmaceutical agents •Assumed positions with public and private agencies such as the Food & Drug Administration •Creating & managing entrepreneurial enterprises; e.g., CRNA-owned practices •Providers of educational conferences or seminars What is the AANA? •The AANA is the single professional organization in the United States that represents the interests of Certified Registered Nurse Anesthetists (CRNAs). Its mission is to promote the full scope of practice for CRNAs and promote healthcare policy that supports nurse anesthesia practice. (90% of CRNAs are members) What two main factors influence CRNAs today? 1.First and foremost the quality of anesthesia services provided by CRNAs 2.The strength of the professional association of CRNAs, the AANA What is the AANA vision statement? AANA will be a preeminent professional association for healthcare and patient safety. What is the AANA mission statement? AANA advances patient safety, practice excellence, and its members' profession. What are the 6 core values of the AANA? •Quality •Professionalism •Compassion •Collaboration •Wellness •Diversity What is the AANA motto? Safe and Effective Anesthesia Care for Every Patient What AANA Region is TN in? How many total regions are there? TN-2 Total: 7 Who is the Current President of the AANA? Kathryn Jansky Who is the Current Present Elect of the AANA? Steven Sertich Who is the current Vice President of the AANA? Heather Rankin Who is the current Treasurer of the AANA? Maribeth Massie Who is the Director of Region 2 (TN) for the AANA? Angela Mund True or False: UTHSC's DNP CRNA Program is recognized by the International federation of nurse anesthetists. True Who is Jack Neary? Pioneer in pain management education and practice. Fought for nurse anesthetists practice rights throughout his career and worked with AANA on policy and regulatory issues surrounding pain management. Awards received: Alice Magaw outstanding clinical practice, Agatha Hodgins outstanding accomplishment, and New Hampshire NP of the year award. Who is Francis Hoeffer McMechan? 1911- McMechan claimed anesthesia is only for Doctors. Temporarily shut down Crile's anesthesia school. 1917 Crile convinced board to lift the ban. Now trained nurses able to administer anesthesia under physician supervision. Who is George Crile? Physician who protected CRNA practice. Involved in McMechan legal battle. Agatha Hodgins practiced under him. Lakeside hospital Cleveland OH. Who is Louis Frank? Louisville Surgeon. Margartet Hatfield studied under him. Legal battle against KY Medical society (Frank vs. South). KY stated expulsion of physicians using nurse anesthetists. Ruling- Hatfield was not practicing medicine during anesthesia, rather nursing. AANA 1st Educational Committee Chair- Helen Lamb (Agatha Hodgins honorary president) 1st meeting- 1931 Work: accreditation, educational standards, 1945 first standardized credentialing test. What are the failures associated with Nitrous oxide? Horace Wells: failed public demonstration of nitrous oxide in 1844. Committed suicide in jail. Crawford Long: 1842 used ether in practice. Didnt publish results until 1846 after Morton. Because of this he lost the honor he might have received Charles Jackson: Consulted with Wells and Long on ether and nitrous oxide. Obsessed with it and spent end of his life in insane hospital. What is the date of the 1st qualifying exam? June 4, 1945 92 candidates What are the dominant rules of behavior associated with nurse anesthetists? (15 total) o Able to control and manage stressful clinical situations o Makes independent judgements quickly o Accepts a high degree of responsibility o Belongs to a professional organization (AANA) o Committed to lifelong learning o Demonstrates self-confidence o Effective in using assertiveness to facilitate role as a patient advocate o Engages in political activities o Short-term patient care o Functions effectively in life and death situations o Organized and pays meticulous attention to details o Intelligence and knowledge o Technically skilled, efficient and competent o Upholds patient care values o Willing to work hard and dedicate long hours to job How did nurses giving anesthesia progress via the multiple military branches? Civil War ()- CRNAs at forefront/in the fields. 1st opportunity for nurses to assume duties of anesthetist. WWI ()- Nitrous oxide being used, not enough nurse anesthetists to use it. Agatha Hodgins served in this war, after came up with plan of study to train more nurses. WWII ()- 1947 official training program for nurse anesthetists through US Army Nursing Corps. High demand, short schooling, "extraordinary complication for AANA" Military required nurses to pass AANA certification exam, civilian hospitals followed suit. Korean War ( - accreditation of all nurse anesthesia programs Vietnam War ()- 1st professional nurses drafted for military service (prior only volunteers) Only males drafted at this time. What two people studied the properties of nitrous oxide and diethyl ether? Joseph Priestly and Humphrey Davy Experimented on themselves and partied with it in the late 1700s. (40 years before it was used in surgery. Davy speculated it could be useful with surgery. Priestly studied/discovered nitrous oxide in 1772. Davy called it "laughing gas" and prepared/named it. In August 2017 how many accredited program existed? How many doctoral? 120 accredited nurse anesthesia programs. 62 were doctoral