Alabama patients now have increased access to safe, affordable care with the signing today of HB 268 by Governor Kay Ivey. The law provides that, in addition to physicians and dentists, Certified Registered Nurse Anesthetists (CRNAs) may provide anesthesia care under the direction of or in coordination with a physician, podiatrist, or dentist.
The law further clarifies that the CRNA scope of practice includes ordering of medications and tests before, during, and after analgesia or anesthesia in accordance with the anesthesia plan.
“Removing barriers to CRNA practice will allow Alabama healthcare facilities to maximize their workforce and increase access to safe, affordable care for our patients,” said Wesley Canerday, CRNA, president of Alabama Association of Nurse Anesthetists (ALANA). “By signing this important legislation, Alabama recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification.”
Anesthesia services are provided solely by CRNAs in many of Alabama’s critical access hospitals offering surgical services, and in a majority of its rural hospitals.
The law also specifies that anesthesia care, when an anesthesiologist is not present, is provided by CRNAs “in coordination with” a physician, podiatrist, or dentist, defined as a working relationship in which “each contributes his or her respective expertise in the provision of patient care, which includes the discussion of patient treatment, diagnosis, and consultation.”
“The American Association of Nurse Anesthesiology (AANA) applauds Gov. Ivey for recognizing the important role CRNAs have in delivery of safe anesthesia care to the residents of Alabama,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Increased demand, limited resources, and the rural nature of the state dictate that a system capable of meeting the needs of all Alabama residents be maintained and this law provides that.”
As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup. CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams. Because of their expertise in anesthesia delivery and management of critically ill patients, CRNAs have been a highly sought-after healthcare provider during the COVID-19 pandemic.
During a shift one day in 2018, Dzialo had a Eureka moment when items a nurse anesthetist customarily disposes of after use caught her eye. The drug vial caps she’d been tossing without a thought covered the color spectrum. The caps in the bin ran the gamut from deep, jewel-like blues and purples, to intense reds and yellows… and, wasn’t there something potentially beautiful there? From that day forward the CRNA stopped throwing out those bright plastic caps and instead began pouring them into a unique and meaningful home-based recycling project.
A colleague at Ascension Providence Rochester Hospital, pre-op RN Cheryl Dassow-Chapman, suggested she create a mosaic version of a Monet painting, “but when COVID came and changed the world, it also changed my design plan.”
Dzialo spent hours upon hours in her basement workspace, ultimately piecing together more than 6,000 caps of nearly 400 different colors, sizes, shapes and textures. Using IV tubing and needle covers along with the caps, she created “COVID Time CAPSule,” representing infected cells, blood cells and antibodies. (And if there is Hall of Fame recognition for great puns, she should definitely be a nominee).
“Viruses are smaller than a grain of salt but have an astounding impact on us all — on our health, mental wellness, work, travel, and community and family relationships,” Dzialo said. “The caps shown here, with different colors, shapes, sizes, finishes and all their different potential combinations, make this work as unique as we are.”
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The 8- by 4-foot project earned a coveted spot on display at the downtown JW Marriott hotel during last fall’s ArtPrize, an international art competition held in Grand Rapids, Michigan, since 2009. ArtPrize celebrates artists working in all mediums from anywhere in the world and is open to anyone with artwork to enter and a venue willing to host it.
For three weeks each autumn, art is exhibited throughout the city in parks and museums, in hotels and storefronts, in bars and on bridges, and even in the river that runs through town. Visitors from around the world gather to view the art, engage in meaningful discussions, and vote for their favorite entries, with cash prizes and grants awarded to select artists in the end.
“While displaying this piece at ArtPrize for 21 days, I found that people were really attracted to it,” said Dzialo, who maintains a website to promote her art. “Especially those who had gotten infected or lost a loved one to COVID, and of course all of those with medical backgrounds.”
During conversations about the creative project with ArtPrize attendees, Dzialo was quick to share credit with her support team.
“Health care professionals have been on the front lines during this pandemic, and I would be remiss if I didn’t mention how many nurses, assistants, techs and pharmacists at work helped by saving me caps. Everyone from pre-op to recovery pitched in to get me a certain color I was low on, or a special size and shape I needed more of,” Dzialo said. “Heidi Beverly would save me caps from her other CRNA jobs where they had different manufacturers and suppliers. For two years, our wonderful scrub techs saved any caps I had left behind in operating rooms and made sure I got them! And then my 16-year-old daughter Stephanie sorted everything I brought home by color, shape and size. I’m grateful for the combined support.”
While she happily accepts contributions from clinicians with access to particularly aesthetic vial caps, Dzialo also wants to give back. She hopes to eventually sell her artwork and fund a scholarship at her alma mater, Wayne State University, with the proceeds. To see more of her work, visit the gallery at the top of her personal webpage.
The American Association of Nurse Anesthesiology (AANA) is presenting the Pennsylvania Association of Nurse Anesthetists (PANA) with the Excellence in State Government Relations Advocacy Award at its Mid-Year Assembly in Washington, D.C. this week.
The Excellence in State Government Relations Advocacy Award, established in 2016, is presented annually to a state association based on the quality of its efforts in the state legislative or regulatory arena for the nurse anesthesiology profession. The recipient is chosen by the AANA Government Relations Committee.
In 2021, the PANA successfully lobbied for a law that includes formal title recognition for Certified Registered Nurse Anesthetists (CRNAs) in statute for the first time, clarifies the CRNA relationship with physicians and dentists, and allows for CRNAs to work with podiatrists.
“The pandemic raised awareness of the critical roles that CRNAs play in healthcare settings and how some state policies prevented CRNAs from practicing to the fullest extent of their education and training at precisely the time they were most needed,” PANA President Lew Bennett, DNP, CRNA, said. “We are honored to be recognized by the AANA for our achievements.”
To increase the flexibility of healthcare resources, Pennsylvania Governor Tom Wolf waived physician supervision during the pandemic. PANA used this opportunity to build relationships with legislators to support title recognition legislation.
“The relationships PANA developed with the governor and legislators will benefit CRNAs for years to come,” Bennett said. “Thank you to the many Pennsylvania CRNAs who laid the foundation for this effort, and those who will continue to fight to protect CRNA practice in the future.”
In addition, PANA developed relationships with a coalition of nursing, rural health, and other groups, including Americans for Prosperity, the Pennsylvania Farm Bureau, and the National Guard, all of which validated and reinforced PANA’s message to legislators.
As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup. CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams.
During the COVID-19 pandemic, nurse anesthetists across the country have been essential in addressing the deadliest part of the disease in addition to providing top-of-the-line anesthesia care. They have served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients.
The president of the American Association of Nurse Anesthesiology (AANA) issued the following statement in response to a bill designed to prevent Certified Registered Nurse Anesthetists (CRNAs) from practicing to the full extent of their licensure in the Veterans Health Administration (VHA). AANA President Dina Velocci, DNP, CRNA, APRN, is calling on Congress to reject this “dangerous legislation and support our veterans’ access to the highest quality care.” Full statement:
“Today, allies of the American Society of Anesthesiologists introduced a bill to deny, delay, and disrupt veterans’ access to care in the middle of a public health emergency. In a direct attack on CRNAs, who have been serving on the front lines of the COVID-19 pandemic, the bill would limit the ability of the Veterans Administration (VA) to allow CRNAs to provide care to veterans. The bill would benefit physician anesthesiologists at the expense of our veterans and in denial of all available evidence and data. Reports from the VA Office of the Inspector General have shown dozens of facilities citing shortages of anesthesia staff, and on the ground evidence shows that overly onerous supervision requirements have caused delays and denials of care for veterans.
AANA strongly opposes this misguided legislation that would only serve to hurt veterans’ access to care. All available evidence shows that CRNAs working independently are the most cost-effective method of anesthesia delivery and the safest, which is why CRNAs are able to practice independently in every branch of the military and why 49 states do not require the involvement of physician anesthesiologists in CRNA practice. This is why multiple Veterans Service Organizations (VSOs) supported CRNA full practice authority in 2016 and why several VSOs have testified in support of national standards of practice that would allow CRNAs and other providers to practice to the top of their scope.
The move to eliminate CRNA full practice authority within the VA is being done without the health and wellbeing of our nation’s veterans in mind. While CRNAs provide the most cost-effective and timely access to highest quality care, we do recognize the need to have both physician and nurse anesthesiologists providing anesthesia collaboratively to our veterans, moving away from antiquated delivery models that have one qualified provider overseeing another qualified provider. Any model that unnecessarily restricts CRNA practice will only increase costs, delay care, and adversely affect veterans. At a time when the healthcare system is seeing overwhelming levels of retirements and burnout, stressing the workforce, and limiting care, the ASA and their allies are seeking to further limit care and put veterans at risk for their own benefit.
This is an unconscionable bill meant to slander nurses and hurt veterans.”
More than 1,100 CRNAs currently work in the VA. CRNAs have historically provided much of the anesthesia delivery to active-duty military in combat arenas since World War I and predominate in veterans’ hospitals and the U.S. Armed Services, where they enjoy full practice authority in every branch of the military. CRNAs have been in high demand during the pandemic, due to their skill in ventilator and airway management, as well as anesthesia and pain management. Information on CRNA safety and cost efficiency is available at anesthesiafacts.com/the-research.
Charles Edward Fisher and his wife, Rosa Lee Fisher, had five children—two sons and three daughters. Theirs was an African-American family in the community of Freemanville, near Atmore, Alabama, in the mid-20th century. Given the times, they were aware of racial barriers to their children’s opportunities. However, that did not prevent the Fishers from having high expectations for their children and encouraging them to be the best they could be. Those expectations included that their children would graduate from high school and then pursue higher education. In their parents, the Fisher children had role models for working hard. Their dad worked as a janitor and later in production in a chemical plant. Their mom raised flowers for a plant-and-flower nursery.
Parental encouragement paid off. Four of the five Fisher children became college graduates and the fifth a trade school graduate.
For the Fisher daughters—Sarah, Cynthia and Eleanor—seeds also were planted for pursuing a nursing career. Their mom, Rosa, had wanted to become a nurse. But, as eldest daughter Sarah put it, “time and opportunity were not on our mother’s side.”
All three Fisher daughters would become nurses and would earn a nursing education grounded at the University of Alabama at Birmingham. As time went on, Rosa Lee Fisher would smile and say, “with all three of my daughters in nursing, if I get sick and need a nurse, I should be covered on all three shifts!”
Sarah Louise Fisher, Ph.D, MSN, RN
Sarah Louise Fisher, PhD, MSN, RN
In September 1965, Sarah Louise Fisher entered the baccalaureate program at what today is known as the UAB School of Nursing. The School then was based in Tuscaloosa, Ala., and, midway through Sarah’s studies, moved to its current Birmingham home as part of what would come to be UAB. Sarah was the first African-American student to be accepted to the School and, in 1969, the School’s first African-American graduate.
She later earned her master’s in nursing, an education specialist certificate and a PhD. All were from Wayne State University in Detroit, Michigan, a city where she and her husband, Joe Giles, lived and reared their family. One of their three children, their son, is a nurse.
For Dr. Sarah Fisher Giles, innovation became a way of life. She was among the first nursing faculty at Wayne County Community College in Detroit and was innovative with curricula to educate nursing students. After retiring from a long career there, she became the founding director of a nursing education department for South University in Novi, Michigan. She also was in the Army Reserves and became a full colonel. In 2001, she was in the first group of distinguished nurses inducted into the Alabama Nursing Hall of Fame.
“I am pleased that I was able to achieve my goals,” she said. “My baccalaureate nursing education from the UAB School of Nursing provided me with a strong foundation.”
She now lives in Georgia and spends her time volunteering to care for people in her church and in the community.
Cynthia Fisher Frazier, BSN, MSN, RN, MS Ed.
Cynthia Fisher Frazier, BSN, MSN, RN, MS Ed.
Cynthia Fisher Frazier is the middle of the Fisher daughters. Like her sisters, she has a life strongly grounded in nursing. She holds three degrees from UAB—a bachelor’s in nursing, a master’s in nursing, and a master’s in occupational education.
For more than 30 years, she worked at the Birmingham Veterans Affairs (VA) Medical Center and rose to positions of leadership. She worked as a nurse manager for four areas—dialysis, IV therapy/phlebotomy, medical specialty clinics and chemotherapy. Her nursing leadership has attracted accolades, including an Excellence in Nursing Award from B-Metro Magazine. The impact of her role modeling is apparent in her own family; one of her two daughters is a nurse.
Cynthia Fisher Frazier recalled being exposed to nursing ideals of high-quality care while she was a UAB baccalaureate and master’s nursing student.
“As a student at the UAB School of Nursing, I saw that the School’s standards were high and that the School did not compromise on those standards.”
Nursing ideals she came to know at UAB continue to guide her today.
“In regard to patient care, through the years I have believed in not compromising values and principles, and in maintaining that expected standard of care in whatever area of nursing you are delivering for patients,” she said. “For me, I believe that understanding and adhering to a high standard of care go back to what I learned at the UAB School of Nursing.”
That dedication to care for patients continued into retirement. When the need arose during the COVID-19 pandemic, she decided to go back to work to help administer vaccines to veterans.
Eleanor Fisher, BSN, MSN, RN, CRNA
Eleanor Fisher, BSN, MSN, RN, CRNA.
The youngest Fisher sister, Eleanor Fisher, pursued an education that led her to a rewarding career in nurse anesthesia.
Typical of the Fisher siblings’ quest for higher education, Eleanor built a strong educational base. She earned baccalaureate and master’s degrees from the UAB School of Nursing. From the UAB School of Health Professions, where the program was formerly housed, she received education in nurse anesthesia.
Eleanor Fisher makes her home in the Birmingham area. But, for this retired contract nurse anesthetist, her work took her into hospital operating rooms in towns and cities outside the area.
She speaks of lessons learned in nursing school. “As a student at the UAB School of Nursing, I learned from the strong emphasis on delivering quality care and being an advocate for your patients. I took those lessons with me.”
When she was involved in putting a patient under sedation for a procedure, Eleanor said she viewed herself as an advocate for making sure the patient receives the best quality of anesthesia services. She approaches her patients with nurturing akin to what she herself received from her own parents and in turn gives to her son.
“I treat each patient as an individual,” she said. “For example, if my patient is a baby, I want that baby’s parents to know that I will treat their baby as though it was my own being put to sleep for surgery.”
Like her sister, she also jumped at the opportunity to do her part during the pandemic. She helps in the process of administering COVID vaccines for children and adults.
By the time an assassin’s bullet killed Dr. Martin Luther King on April 4, 1968, the much-loved – and much-hated – SCLC leader had long become inured to the likelihood that he would not see his daughters grow up. Once he entered the spotlight during the 1955-56 Montgomery, Alabama bus boycotts, King and his family lived through his remaining years like a city under siege, constantly calculating acceptable risks and trying to anticipate the next threat.
King was a target for violence throughout his non-violent crusade for civil rights, and 10 years prior to his assassination, he had a very close brush with death. That he lived to carry on his work for another decade was in part due to the skills of Goldie Brangman, CRNA, MEd, the nurse anesthesiologist who treated him in 1958. Brangman worked at Harlem Hospital for 45 years and directed its nurse anesthesia educational program for some three decades, and in 1973 became the first (and to date, only*) Black president of the American Association of Nurse Anesthetists (AANA). In the December 2015 issue of the AANA Journal, she shared her recollections** of that September 20, 1958 day when King was rushed to Harlem Hospital.
In 1958, King’s would-be killer was not a white supremacist, but a mentally ill 42-year-old Black woman stirred by the conspiracy theories, anxiety, justifiable paranoia, and mistrust that spread through terrorized Afro-American communities during the “long, hot summer” era of the mid-1960s. Convinced that the civil rights leader was a “communist” and a “flimflam artist who pimped the community,” she armed herself with a pearl-handled letter opener and attended the book signing. When she neared King, she aimed right for his heart and managed to drive her makeshift knife six centimeters into his chest.
King was rushed to nearby Harlem Hospital, with the letter opener still in his chest. His treatment was initially delayed when a bizarre political debate erupted. New York Governor Harriman – anxious over his reelection chances – initially urged hospital staff to transfer Dr. King to Columbia-Presbyterian or Mount Sinai Hospital. The governor was worried, as the AANA article put it, “that Harlem Hospital was not fit to treat Dr. King, but he also wanted to show respect for the black community by endorsing Harlem Hospital and its staff.” The vacillating politician was finally persuaded that the future Nobel Peace Prize winner was in good hands.
By 1958, King was already a widely recognized public figure at the center of the increasingly heated debates over segregation and racial injustice. Brangman recalled that their patient was engulfed by a crowd even as he was rushed into surgery. “To this day,” she said, “I don’t understand why they allowed so many people in the OR.” The team examined his wound and found that the weapon had penetrated King’s sternum. Brangman said the tip of the letter opener was tightly lodged between Dr. King’s innominate artery and aorta. Her team was on edge, knowing that “Every breath would move the blade.” She is confident that “The time saved by [performing the surgery] then and there at Harlem Hospital really did save King’s life.”
The AANA article reminded readers that the danger of the situation was exacerbated by the fact that CRNAs had little technological assistance in the 1950s, so thoracic surgery did not necessarily include mechanical ventilation or paralysis. As Brangman recalled, “You bagged them in those days; you could sense [respiratory] changes like compliance that way.” They used manual blood pressure determinations and monitored their patients by “listening, looking, and feeling. You had your hand on the patient the entire time.”
Once Brangman and anesthesiologist Dr. Helene Meyer placed King under anesthesia, surgeons worked for over two hours to remove the letter opener. The surgery left King with a scar, a constant reminder and warning that he could be taken at any moment. As he told a friend, “Each morning as I brush my teeth and wash my face, I am reminded by the cross-shaped scar on my chest that each and any day could be my last day on this earth.”
Thanks to Harlem Hospital’s team, King survived his first major brush with death for ten crucial, history-making years, and millions of Americans breathed a sigh of relief. A white admirer from White Plains, New York was moved to cheer the minister’s recovery in a letter that became famous:
“I read in the paper of your misfortune, and of your suffering. And I read that if you had sneezed, you would have died. And I’m simply writing to say that I’m so happy that you didn’t sneeze.”
The earnest missive so delighted King that shared it with various audiences over the next decade. In fact, during his final speech in Memphis, Tennessee, he read it aloud once more and added, “I want to say tonight that I, too, am happy that I didn’t sneeze.” While King himself may have been unaware that in 1958 his CRNA’s skilled “listening, looking, and feeling” helped preserve his life, nurse anesthetists can take pride in knowing that one of their own played a key walk-on role in history.
* “I was the first woman of color in a leadership position in the AANA, and as a result, I had to run for every AANA office at least twice”.