Among the earlier formal programs for nurse anesthesia were those established at Johns Hopkins Hospital in Baltimore, the University Hospital of the University of Michigan in Ann Arbor, Charity Hospital in New Orleans, Barnes Hospital in St. Louis, and Presbyterian Hospital in Chicago. (History of Nurse Anesthesia Practice) Another important historical event which shows the acceptance and advancement of nurse anesthetists was the invitation of Alice Hunt, a nurse anesthetist, to join the Yale Medical School faculty as an instructor of anesthesia in 1922.
The American Association of Nurse Anesthetists was founded in 1931 and today is a professional organization which represents more than 35,000 Certified Registered Nurse Anesthetists (CRNAs) and student nurse anesthetists. (AANA Overview)
Furthermore the AANA, promulgates education, and practice standards and guidelines, and affords consultation to both private and governmental entities regarding nurse anesthetists and their practice. The AANA Foundation supports the profession through award of education and research grants to students, faculty, and practicing CRNAs."
History of Nurse Anesthesia Practice)
Another import at aspect of this Association is that it furthers the profession in terms of certification of CRNA credentials and these credential are today recognized and accepted by the medical community.
However, in closing this section it should also be noted that there are still instances within the medical profession of prejudice against the nurse anesthetist.
Opposition to the training and clinical practice of nurse midwives and nurse anesthetists continues to be an issue... The nurse midwifery and nurse anesthetist conflicts have resulted in underutilization and inappropriate use of these highly skilled nurse specialists. Debate and ambivalence regarding their role continues to confuse the American public. (Donahue, 1996, p. 431)
Despite this, the employment nurse anesthetists are widespread and accepted and many hospitals "...employ nurse anesthetists in addition to regular anesthesiologists..." (Postotnik, 1984) in fact, as will be referred to in the following section, there is a shortage of these professionals in many areas.
3. Situation and status of CRNAs
There are many reports which indicate that there is a shortage of CRNAs in many parts of the country. As the president of the AANA, Deborah Chambers has stated: "The shortage of nurse anesthetists is delaying surgeries and making healthcare less accessible to Americans," (America's Nurse Anesthetists Commend Bush Administration...)
Chambers has also reiterated the importance of these nursing professionals. She states that "Certified Registered Nurse Anesthetists (CRNAs) provide two-thirds of all anesthetics given in the United States each year, and are the predominant anesthesia providers to rural America and the military, said Chambers." She also notes that the certification requirements are extremely stringent.
The shortage of these nursing professional is also acutely experienced in New Mexico. There are numerous reports which describe the effects of this shortage. For example; "A lack of nurses has caused 72% of hospitals to reduce services, 38% of home care agencies to refuse referrals, and 15% of long-term care facilities to refuse admissions; and public health offices are cutting vital services." (Is There a Nurse Available? The Nursing Shortage in New Mexico)
The same report also states that many emergency room patients have been turned away at New Mexico hosptals. Furthermore,."..clinic hours have been shortened, and some intensive care units have closed... "(Is There a Nurse Available? The Nursing Shortage in New Mexico)
It is also generally reported that New Mexico has "... major problems in the supply and distribution of its health care workforce. "(Reports: The Health Care Workforce in Eight States: Education, Practice & Policy: New Mexico) the general situation is described as follows.
The ratio of National Health Service Corps personnel per 10,000 population living in HPSAs is over twice the U.S. average. New Mexico's overall ratios of physicians, nurses, dentists and pharmacists per 100,000 population each are significantly below the national average. The state has one medical school and one pharmacy school, and no dental school. There are just 15 schools of nursing in New Mexico.
Reports: The Health Care Workforce in Eight States: Education, Practice & Policy: New Mexico)
These figures also relate to the situation with regard to CRNAs. The number of active CRNAs in New Mexico was ascertained at 120 in 1997. New Mexico has 5.9 nurse anesthetists per 100,000 population, which is lower than the national rate of 9.3. (Nursing Jobs in New Mexico) This situation is exacerbated by the fact that "...nurse anesthetists are the sole anesthesia providers in more than half of New Mexico hospitals..." (47TH LEGISLATURE - STATE of NEW MEXICO - SECOND SESSION)
4. Licensure and legal requirements.
The following basic requirements are needed according to the New Mexico Board of Nursing website.
1. Current RN license.
2. Graduate of a Nurse Anesthetist education program accredited by the American Association of Nurse Anesthetists' Council on Accreditation.
CRNAs who are initially licensed by the board or a board in another jurisdiction after January 1, 2001, and must be educated in a nurse anesthetist program at a master's level or higher level.
3. Certified by the American Association of Nurse Anesthetist's Council on Certification.
REQUIREMENTS and INSTRUCTIONS for CRNA LICENSURE)
Furthermore the legal requirements include that fact that "...Certified Registered Nurse Anesthetist with lapsed AANA certification are not eligible for a permit to practice." (REQUIREMENTS and INSTRUCTIONS for CRNA LICENSURE) it is also emphasized that any failure of the applicant to write the scheduled qualifying examination or if the exam, will "render the applicant
Ineligible to practice anesthesia in NM and the employer must immediately return the permit-to-practice to the board..." (REQUIREMENTS and INSTRUCTIONS for CRNA LICENSURE)
The New Mexico statutory authority also states that;
certified registered nurse anesthetist may provide pre-operative, intra-operative and post-operative anesthesia care and related services, including ordering of diagnostic tests, in accordance with the current American association of nurse anesthetists' guidelines for nurse anesthesia practice.
And certified registered nurse anesthetist who has met the requirements for prescriptive authority in the area of anesthesia practice is authorized to prescribe and administer therapeutic measures, including dangerous drugs and controlled substances included in Schedules II through V of the Controlled Substances Act [30-31-1 NMSA 1978] within the emergency procedures, perioperative care or perinatal care environments.
Health Care Practitioner Scope of Practice Guide)
There is by all accounts a bright outlook for this professional specialization in the nursing profession. As one article states: "Faster-than-average growth is expected for anesthesia nurses through 2012 as the American population ages, according to the U.S. Bureau of Labor Statistics. While anesthesia nursing is certainly nothing new to surgery and patient care, it continues to be a promising, challenging career for those who heed its call." (Hyman G. 2006)
The situation in New Mexico as discussed above certainly warrants a greater number of nurse anesthetists. There is also little doubt, given the relatively long history of this specialization in nursing, that this is an area where nurses can excel and contribute to the health care environment. The changing status of nurses and their greater acceptance as professionals in hospitals and other medical institutions is also a positive sign for the advancement of nurse anesthetists.
47TH LEGISLATURE - STATE of NEW MEXICO - SECOND SESSION. Retrieved Jan 13, 2007, at http://legis.state.nm.us/Sessions/06%20Regular/memorials/house/HM033.pdf.
AANA Overview. Retrieved Jan 13, 2007, at http://www.aana.com/aboutaana.aspx?ucNavMenu_TSMenuTargetID=15&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=100
America's Nurse Anesthetists Commend Bush Administration for Tripling Nurse Anesthetist Traineeship Funding Today. Retrieved Jan 13, 2006, at http://www.aana.com/news.aspx?ucNavMenu_TSMenuTargetID=171&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1615&terms=CRNA+shortage&searchtype=1&fragment=True www.questia.com/PM.qst?a=o&d=104802739
Donahue, M.P. (1996). Nursing, the Finest Art: An Illustrated History. St. Louis, MO: Mosby.
Engebretson, Joan. (2002)
Hands-on: The persistent metaphor in nursing Holistic Nursing Practice, 16, 4, pp. 20-35 www.questia.com/PM.qst?a=o&d=5000843053
Goodwin, K. (2002, October/November). States Tackle the Nursing Shortage: The Lack of Qualified Nurses Is Reaching Epidemic Proportions. States, Universities and Hospitals All Are Trying to Do Something about it. State Legislatures, 28, 20+.
Hauser S. (2003) "Backbone of the institution" Nursing Management, 34, 10. p.26.
Health Care Practitioner Scope of Practice Guide. Retrieved January 13, 2007 at http://www.state.nm.us/pharmacy/healthguidelines.html
History of Nurse Anesthesia Practice. Retrieved January 13, 2007 from the Michigan Association of Nurse Anesthetists, http://www.miana.org/history/history.html
Hyman G. (2006) Are You Ready for Anesthesia Nursing School? Retrieved January 13, 2007 at http://www.healthcare-programs.com/articles/are-you-ready-for-anesthesia-nursing-school.php
Nursing Jobs in New Mexico. Retrieved January 13, 2007 at http://www.nursejobshop.com/new-mexico-nursing-jobs/
Is There a Nurse Available? The Nursing Shortage in New Mexico. Retrieved January 13, 2007 at http://www.nmwoman.com/Archive05/May_05.html#shortage www.questia.com/PM.qst?a=o&d=5002112683
Postotnik, P. (1984, June). Anesthesia: A Long Way from Biting Bullets. FDA Consumer, 18, 24+. Retrieved January 15, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002112683
Reports: The Health Care Workforce in Eight States: Education, Practice & Policy: New Mexico. (HSRA) Retrieved Jan 13, 2007, at http://bhpr.hrsa.gov/healthworkforce/reports/states02/newmexico.htm
REQUIREMENTS and INSTRUCTIONS for CRNA LICENSURE. Retrieved Jan 13, 2007, at http://www.bon.state.nm.us/forms/CRNAapp.pdf
The Role of Collective Bargaining and Unions in Advancing the Profession of Nursing. Retrieved Jan 13, 2007, at http://www.nursingworld.org/readroom/nti/9802nti.htm