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A Certified Registered Nurse Anesthetist’s (CRNA) day begins with an inspection of the OR he or she is assigned to, with priority over the OR table and anesthesia equipment. Immediately before seeing the patient, a CRNA reviews the patient’s chart for any red flags, including information the patient may not willingly divulge. Examples of red flags include: a previous surgery, current medications (particularly cardiac medication and narcotics), and BMI. All of these factors can significantly impact how the patient will respond to anesthesia and surgery.

When meeting the patient, both a conversation and a physical exam ensue, as this is the final opportunity to determine what the CRNA can reasonably expect hemodynamically from the patient during the case.  While inspecting the patient’s anatomy, a CRNA may ask how many stairs they can climb before getting winded, or how many pillows they use to sleep comfortably at night. All of this information combined will inform the American Society of Anesthesiology (ASA) score assigned the patient, which is a scale from one to five, one being a healthy patient and five being a moribund patient.  This will be announced during the surgical time out.

In New York and Pennsylvania, CRNAs do not have APN status. In New York, this means that CRNAs work under the supervision of an anesthesiologist or the operating physician. This anesthesiologist is expected to be present for induction, intubation, emergence, and extubation, as well as frequent check-ins throughout the case. By contrast, CRNAs in Pennsylvania work in cooperation with a surgeon or dentist and the CRNA’s performance shall be under the overall direction of the chief or director of anesthesia services.

In all other states where CRNAs do have APN status, they perform collaborative care, which involves much less oversight. Nurse anesthetists practice under supervision of the surgeon with no physician anesthesiologist requirement in 49 states and completely independent of a physician in 17 states.

What every CRNA must carry over from days as a critical care nurse is nursing intuition, strong assessment skills, and a sense of resilience. It is not a position for shrinking violets; your voice as the patient’s advocate is more important than ever. A patient may be deemed unfit for general anesthesia based on assessment. The CRNA who cancels a surgery will find it is almost never received well by the patient, nor the surgical team or the nursing team who prepared for surgery. A significant portion of any CRNA’s day may be making decisions on the patient’s behalf that are unpopular.

On any given day, depending on what type of surgeries are being done in a given OR, a CRNA may see one patient or twelve during a twelve-hour shift.  While doing a series of quick hysteroscopies on young women may mean your patients are healthier, the challenge is to keep pace and to do so without sacrificing thoroughness. Having every patient’s life essentially in your hands is nothing to take lightly, no matter how clean their health record may be. After each case, the CRNA has to make sure every patient is stable in recovery before leaving them with the PACU team.  It’s then on to the next patient to do it all over again.

In order to become a Certified Registered Nurse Anesthetist, you must graduate with a minimum of a master’s degree from an accredited nurse anesthesia program and pass the national certification exam, which is administered by the National Board of Certification and Recertification for Nurse Anesthetists.

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Nancy Swezey, BSN, RN, CNOR

Nancy Swezey received her BSN from Columbia University. She now practices in New York City in the operating room where she has worked as a staff nurse, and currently as a care coordinator specializing in head and neck surgery. Nancy is also pursuing her advanced practice degree at CUNY Hunter where she assists the faculty as a research assistant, focusing on nurse education and module development.
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