Advance Practice Nurse: A Case Study

Defining the true meaning of nursing is not a simple task; people often struggle to identify what nurses do or what they are. American Nurses Association defines nursing as, “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2016). Throughout the years, the role of nursing has evolved into much more complex profession. Advance Practice Nurse (APN) has taken the meaning, the duty and the responsibilities of a regular nurse into the next level. APNs are primary healthcare providers who are educated at Masters or Post-Masters level.
There are four types of APNs: Nurse Practitioner (NP), Nurse Midwives (NM), Certified Registered Nurse Anesthetist (CRNA) and Clinical Nurse Specialist (CNS) (Kansas Board of Nursing, 2012). Although people believe that nursing should be a supervised profession, certain types of nursing such as CRNA has exceeded educational levels, clinical experience and state board discussion to be qualified as an individual practice without the supervision of an anesthesiologist. Though the certification came about in the year of 1956, CRNA has been giving quality care to patients for at least 150 years or during the US Civil War when they treated the wounded soldiers (Bankert, 2010). CRNA is a type of APN who works in collaboration with surgeons, physicians or anesthesiologist with providing the right amount of anesthesia for medical or surgical procedures. One of the main explanations why CRNA struggle for independence from anesthesiologist supervision is because doctors and general public believe that they do not attain proper educational level for a complex duty which could result in patient fatality. However, in order to become a CRNA, a Registered Nurse (RN) must receive a master’s or a doctoral accreditation from a nurse anesthesia educational program and the candidate must pass the National Certification Examination (NCE) (Wickenhagen, 2015). In comparison to RNs, who is supervised at a bachelor’s level, CRNAs should not have supervision due to a higher degree of education. In addition, there are several similarities of educational requirements between CRNAs and anesthesiologists. For example, both professions are expected to complete a higher education than a bachelor’s degree. While anesthesiologists are mandated to receive a bachelor’s degree in a Pre-Medicine track, such as Biology, and CRNAs are required to receive a bachelor’s degree in Nursing, multiple licensure examination must be taken for both professions. In addition, CRNAs and anesthesiologist must have several years of clinical experience with the intention of continuing to a doctorate degree. With this in mind, it easy to understand how CRNAs have exceeded educational levels to be considered an individual practice profession. x CRNA are more than qualified to perform local, regional and general anesthesia service for all ages and for different medical or surgical procedures.
The clinical experiences of a CRNA begin before entering a masters or a doctorate degree and through such processes, they hope to recognize the three stages in learning: seeking of the basic information, continued practice and development of confidence, comfort and finesse (Wren, 2005). To become an outstanding CRNA one must begin with the basic information which is finding the physiological, pathological and pharmacological explanation about the patient. In this stage, organization is critical for easier retrieval. Similarly, understanding the principle is preferred more than memorizing the “do’s” and “dont’s” when caring for a patient. Continued practice is commonly defined as hands on learning. Though it is essential for a CRNA to understand procedures, performing it is a better alternative of learning. Experience can transform a CRNA into a much intuitive nurse who can sense that something is not right without conducting a test. The last stage is development of confidence, comfort and finesse; this is considered to make CRNAs quick, efficient and comfortable in most situations. New knowledge is use to enhance existing practice and be able to recognize complications of patient faster than before. This stage is best achieved when a CRNA is comfortable with oneself and the tool, anesthesia, being
use. The issue regarding whether or not CRNAs are qualified to practice without the supervision of an anesthesiologist has been around for several years.
The problem cannot reach a conclusion; therefore, it is now in the hands of every state to make that decision. It is their obligation to determine if CRNA, in their state, should be allowed to practice alone. A case study that was tested in Washington states, “Laws governing CRNA practice vary widely across the nation. In 39 of the 50 United States, the laws regulating CRNA practice of not require CRNAs to be supervised by physicians” (Kaplan, 2007). In the year of 2003, Washington made the decision to opt-out from the issue, but, rather, licensed all Washington CRNAs as Advance Registered Nurse Practitioner and accredited them to practice independently. In the state of Oregon, similar situation has altered the States decision. Oregon and Colorado claim that they are confident and trusting CRNAs to perform a safe practice similar to or better than an anesthesiologist (Wickenhagen, 2015).
x In spite of what people believe about CRNA, they has surpassed the educational levels, clinical expectation/ experience and the state board discussion to be considered as an unsupervised practice. CRNA are required to receive post-masters or a doctoral degree from an accredited nurse anesthetist program. In addition, through seeking of the basic information, continued practice and development of confidence, comfort and finesse, a CRNA can master the key to clinical expertise. Lastly, more than half of the fifty states, such as Oregon, Colorado, Illinoi, etc., support the idea of CRNA practicing alone.