1. James Dougery, MSN, ARNP, CRNA
CRNAs and Anesthesia
James Dougery, MSN, ARNP, CRNA

2. How did I become a CRNA (Certified Registered Nurse Anesthetist)?
BSN – University of Miami, 1995
Florida Board of Nursing Licensure Exam – RN 5/1995
6 years as an Emergency Department RN
6 years as an Emergency Department Director
Approximately 1-1 ½ years as a Cardiac Intensive Care RN – means to an end
2 ½ years of Graduate School at Florida International University
Graduated with MSN 12/2009
CRNA Certification Exam 2/2010
Began working as a CRNA 3/2010

3. Some Facts About CRNAs
History: Providing anesthesia care to patients in the United States for more than 150 years. The CRNA (Certified Registered Nurse Anesthetist) credential in The oldest nursing specialty.
Prolific Providers: CRNAs safely administer approximately 43 million anesthetics to patients each year in the United States, American Association of Nurse Anesthetists (AANA) Practice Profile Survey.
Rural America: Primary providers of anesthesia care in rural America, and in some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.

4. More Facts…
Anesthesia Safety: According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcome studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.
Practice of Anesthesia: CRNAs provide anesthesia in collaboration with all surgical specialties, anesthesiologists, Obstetricians, Gastroenterologists, Pulmonologists, dentists, podiatrists, and other qualified healthcare professionals. Whether CRNA or MDA all anesthesia professionals give anesthesia the same way.
Autonomy and Responsibility: CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.

5. Still More Facts…
Practice Settings: CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.
Military Presence: Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI. Nurses first provided anesthesia to wounded soldiers during the Civil War.
Cost-Efficiency: Managed care plans recognize CRNAs for providing high- quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs. 

6. When Will This End???
Supervision Opt-Out: In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers). To date, 17 states have opted out of the federal physician supervision requirement, most recently Kentucky (April 2012). Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so.
Malpractice Premiums: Nationally, the average 2016 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (65 percent lower when adjusted for inflation).
Direct Reimbursement: Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.

7. We should have skipped some of these!!!
AANA Membership: More than 50,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or, 90 percent of all U.S. nurse anesthetists). More than 40 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole.
Education Requirements: The minimum education and experience required to become a CRNA include*:
A baccalaureate or graduate degree in nursing or other appropriate major.
An unencumbered license as a registered professional nurse and/or ARNP in the United States or its territories.
A minimum of one year full-time work experience, or its part-time equivalent, as a registered nurse in a critical care setting.
Graduation with a minimum of a master’s degree from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. As of August 2016, there were 115 accredited nurse anesthesia programs in the United States; 46 nurse are approved to award doctoral degrees for entry into practice. Nurse anesthesia programs range from months, depending on university requirements. Programs include clinical settings and experiences.
Pass the National Certification Examination following graduation. 

8. Last of the boring stuff, I promise!
Recertification: CRNAs who certified or recertified in 2016 are now part of the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) Continued Professional Certification (CPC) Program. The CPC Program consists of eight-year periods, with each period comprised of two four-year cycles. In addition to practice and licensure requirements, the program requires CRNAs to attain a minimum of 100 continuing education credits per 4 year cycle; complete educational modules in four content areas, including airway management technique, applied clinical pharmacology, human physiology and pathophysiology, and anesthesia equipment and technology; and pass a comprehensive examination every eight years.

9. So what do I really do?
“…and this is James, your Anesthetist.”

10. Anesthesia, what is it, and how can I get some?
Insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before and during surgical operations.
General Anesthesia
Regional Anesthesia
Epidural
Spinal
Nerve Blocks
Sedation
Local Anesthesia

11. Barbaric to Bearable

12. Passing gas….yup…that’s what it is.
Ether (Not any more!!!)
Sevoflurane
Desflurane

13. Passing gas is so much better now!

14. Intubation

15. Epidurals and Spinals: What’s the difference, and who cares?

16. Caesarian Sections are much more pleasant.

17. Other types of regional anesthetics

18. Everything from sedation to induction! The magic of PROPOFOL!

19. Any questions?

20. Thank you!

21. I knew someone would ask that…