The emergence of advanced nursing practice over the past decades has made the healthcare sectors and governments realize that optimizing the contributions of nurses to the health care by expanding their roles is an ideal strategy that would help improve health services (Klar, 2015). Similarly, dynamics in the global health sector due to population increase, diversification, and rising costs of health care have played a significant role in shaping the health care systems. Advanced nursing practice encompasses a clinical nursing practice at a higher level, which maximizes on the availability of experts, nursing knowledge, and graduate education to meet the health needs of the population (Hsiao, Wu & Chen, 2013). The advanced practice nursing role from South University that the paper will examine is nurse anesthetists.
Nurse anesthetists are registered nurses with post-basic training nursing education in anesthesia and passed a certification exam. Therefore, a certified registered nurse anesthetist (CRNA) refers to a registered nurse who is master’s prepared and competent to provide anesthetics to patients. The role of a nurse anesthetist is to administer anesthesia services to patients in procedures such as diagnostic, surgical, obstetrical, and therapeutic and trauma care (Klar, 2015). Additionally, nurse anesthetists offer pain management and emergency services. For instance, they provide airway management. Nurse anesthetists do not work on their own; however, they provide anesthetics in collaboration with dentists, surgeons, podiatrists, anesthesiologist and other health care professionals (Riddle, Gregoski, Baker, Dumas & Jenkins, 2016).
CRNAs administer anesthesia and related care in the following categories. Anesthetists are involved in pre-anesthetic preparation and evaluation, anesthesia induction and providing post-anesthesia care. Similarly, they participate in peri-anesthetic and clinical support.
Besides, completing a master’s education training in nurse anesthesia and passing a certification exam, one need to complete the following programs and education before becoming an anesthetist. First, a person should hold a bachelor’s degree in nursing and a registered nursing license. Second, one should get a minimum of one year experience. A bachelor’s in nursing students should get their hands on practice towards a cure care. CRNAs get the chance to experience a high degree of autonomy and professional respect. They are of significance in areas that have inadequate medical services. Regarding sub-specialization, some CRNAs have specialized in neurosurgical anesthesia, obstetric, dental and pediatric. Moreover, other anesthetists hold credentials in areas such as respiratory care and critical care nursing.
Nurse anesthetics falls under clinical medical jobs. A clinical role entails providing diagnosis and treatment by a health care professional. A nurse anesthetist takes care of the anesthesia needs of the patient before, during or after surgery by offering the following clinical services. Nurse anesthetics perform a physical assessment of the patient, participate in preoperative teaching, oversee patient recovery from anesthesia and prepare for anesthesia management (Rudner, 2016). Additionally, they administer anesthesia so that the patient can be pain-free and maintain anesthesia intraoperatively. Lastly, nurse anesthetics have the role of following the postoperative course of patients from the time they are in the recovery room to the patient care unit.
According to the NPSGs, nurse anesthetics play a significant role in ensuring the safety of the patient when they are under their care. Trainees such as anesthesiology residents may be part of the surgical setting (Rudner, 2016). In this environment, the education process present challenges in ensuring the safety of the patient. The principle requires careful supervision to all trainees and accorded assistance when participating in surgery. Supervisors and trainees need to be alert and well prepared in advance for the procedures. Moreover, since patient safety relies on the communication among physicians, trainees should be well familiar with terminologies prior to engaging in a surgical procedure.
The source of human error is attributed to excessive stress and fatigue (Rizer, 2015). Inadequate sleep leads to fatigue and reduced level of cognitive performance, and this will increase the risk of accidents when attending to a patient. With sleep deprivation, an anesthetist can cause an error when performing a familiar task thus compromising the safety of the patient (Rizer, 2015). Therefore, NPSGs requires health care facilities to have adequate backup personnel who relieve staffs who detect decreased performance.
Nurse anesthetists can enhance patient safety when administering anesthesia by maintaining a high level of concentration and focus. During surgery, there is always increased tension and confusion (Sobhy, Zamora, Dharmarajah, Arroyo-Manzano, Wilson, Navaratnarajah & Thangaratinam, 2016). In the surgical environment, the surgical team should agree on the protocol regarding administering medication to avoid errors. Concentration and effective communication between the surgical and anesthesia team are essential to avoiding medication error due to misunderstanding and misapplication during the procedure. Lastly, patient involvement is also significant in ensuring their safety. The formal enlistment of patients helps to prevent errors in the operative unit (Sobhy, et al. 2016). It is appropriate to involve patients by providing them with the necessary education. Those with the greatest stake in avoiding errors are the ideal since they will help to ensure errors are avoided.
In the research article, A Pilot Study on Student Nurse Anesthetists’ Views on CRNA Role Transition, Andy Tracy performed a study to understand views of students nurse anesthetists on the CRNA role transition. According to Tracy (2015), the transition from RN to CRNA is challenging and stressful to the health care sector. The author conducted three focus groups that consisted of 17 nurse anesthesia students. Participants were selected from schools in Chicago that offer anesthesia programs. The sampling method based on students’ level of completion. Obtaining informed consent from all participants was necessary. During the focus group, data was collected via audio recording. Each focus group lasted for a proximately 2 hours. The thematic analysis approach was used to analyze the collected data.
Findings of the research indicated that students perceived preceptors and mentors as the greatest influence on their role transition. According to Tracy (2015), the definition provided by nurse anesthesia students on role transition entails the ability to work independently with minimal assistance while ensuring patients are safe. Other themes that influence a successful role transition included training variety, reflection and role models. Tracy (2015) concluded that the level of training offered in anesthesia programs determine perceptions of student registered nurse anesthetics on which factors influence the role transition from RN to CRNA. Students who are about to complete their training have a better knowledge of factors that influence their transition (Tracy, 2015).
In the research article, Learning Curves of Macintosh Laryngoscope in Nurse Anesthetist Trainees Using Cumulative Sum Method, Rujirojindakul, McNeil, Rueangchira-urai, and Siripunt (2014), conducted research to determine nurse anesthetist trainees’ studying ability when performing orotracheal intubation with Macintosh laryngoscope. According to Rujirojindakul, McNeil, Rueangchira-urai, and Siripunt (2014), a failed intubation causes morbidity. All medical personnel must master intubation with Macintosh laryngoscope. The research involved eleven nurse anesthetic trainees. Prior to the study, a formal lecture on endotracheal intubation was necessary for all trainees. Trainees were required to perform with a manikin under the supervision of the instructor until they performed a successful orotracheal intubation with Macintosh laryngoscope. Cumulative summation methods were used to construct learning curve for each trainee.
Rujirojindakul, McNeil, Rueangchira-urai, and Siripunt (2014) stated that 388 patients were used by trainees for tracheal intubation. On the first attempt, tracheal intubation was successful in 360 patients. Analysis shows that ten trainees managed to cross the acceptable failure rate mark, which was 20%. In conclusion, with a success rate of 80%, the least procedures required was 22 in the case of non-experienced trainees.
Steve L. Alves in his article, Nurse anesthetists, save on health care costs, argues that the health care system should take advantage of advanced practice nurses who have experience, skilled and extensive education. Although nurse anesthetists and nurse practitioners play a significant role in the health care sector, they face regulatory challenges that are costly and outdated. For instance, in Massachusetts, nurse anesthetists experience frustrating and unnecessary physician supervision. According to Alves (2014), sometimes anesthetists can be stopped from getting test results. Alves (2014) argues that nurse anesthetists should not replace a physician anesthesiologist; however, the nurse professionals should be given a chance to work as extenders of care. They should provide patients with medical services at lower cost. Alves (2014), today, nurse anesthetists administer anesthesia in the operating room and in others they are not. The solution to the problem according to Alves (2014) is to have legislation that would give nurse anesthetists the right to have full control and work according to their educational level.
Alves, S. (2014, April 12). Steve Alves: Nurse anesthetists save on health care cost. The Patriot Ledger. Retrieved from http://www.patriotledger.com/article/20140412/OPINION/140418739
Hsiao, J. L., Wu, W. C., & Chen, R. F. (2013). Factors of accepting pain management decision support systems by nurse anesthetists. BMC medical informatics and decision making, 13(1), 1-13.
Klar, G. (2015). The Role of Anesthesiology in Global Health: A Comprehensive Guide. Canadian Journal of Anesthesia, 62(8), 941-941.
Riddle, D., Gregoski, M., Baker, K., Dumas, B., & Jenkins, C. H. (2016). Impressions of pharmacogenomics testing among Certified Registered Nurse Anesthetists: a mixed-method study. Pharmacogenomics, 17(6), 593-602.
Rizer, C. (2015). Documenting competence: Evidence of excellence in nurse anesthesia practice. European Scientific Journal, ESJ, 11(10), 26-30.
Rudner, L. N. (2016). Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue. Online journal of issues in nursing, 21(2), 6.
Rujirojindakul, P., McNeil, E., Rueangchira-urai, R., & Siripunt, N. (2014). Learning curves of Macintosh laryngoscope in nurse anesthetist trainees using cumulative sum method. Anesthesiology research and practice, 2014. 1-6.
Sobhy, S., Zamora, J., Dharmarajah, K., Arroyo-Manzano, D., Wilson, M., Navaratnarajah, R., & Thangaratinam, S. (2016). Anesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Global Health, 4(5), e320-e327.
Tracey, A. (2015). Student Nurse Anesthetists’ Views on CRNA Role Transition. Anesthesia eJournal, 3(1), 1-4.
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