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. “We have so decentralized where we perform that people are spread out all over,” said Ira Gunn, MLN, CRNA, FAAN. “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.
Austin, Texas