Certified Registered Nurse Anesthetists - Research Paper Example

INTRODUCTION Certified Registered Nurse Anesthetists (CRNAs) are professional nurse who are involved in advanced practice. They are responsible for providing anesthetists before and during operations and more significantly, they play the role of monitoring patients throughout an operation. The role of the CRNA is specialized and it involves various processes and activities that makes it a distinct and unit in the healthcare industry. Certified Registered Nurse Anesthetists (CRNAs) have distinct professional standards and challenges. These issues and matters come together to define the terrain of CRNA practice and how practitioners relate to other members of the health community. This paper analyzes the background and core philosophies and ideologies of the Certified Registered Nurse Anesthetists. It will critically evaluate the core practice concerns and identify the main ethics and controls that are in place to deal with all these matters and issues. BACKGROUND OF CRNA The CRNA is a registered nurse who is regulated and authorized to provide anesthetists in medical facilities. The primary responsibility of the CRNA is to undertake anesthetists and inform patients about the anesthetic process of the operation and the risks that comes with it (Hirth and Hatch, 2012). Thus, in most practical cases, the primary role of the CRNA is to meet patient and family, seek consent of the patient and undertake preliminary procedures. Nurse anesthetists have existed in the United States for almost 150 years (Matsusaki and Sakai, 2011). It has its history that dates back to the late 1800s and nurses came together to form associations to regulate and guide the practice of nurse anesthetists. Specialization began in 1899 at the St. Marys hospital where Alice McGaw and Dr. Mayo built techniques for administering anesthesia (Zaccagnini, and White, 2010). The partnership led to a system through which doctors and nurses began to understand each other and partner to provide less painful surgeries that were more humane. Thus, many medical facilities around the world sent representatives to St. Marys hospital to evaluate and analyze the methods used by the hospital in providing anesthetics. During the First World War, the use of nurse anesthetics began and the military of USA, France and a few nations sought to use nurse anesthetists (Zaccagnini and White, 2010). However, due to the risks and the essence of this service, there was a need to structure the profession (Lundy and James, 2009). This meant that there was the need for the creation of a professional association and this association sought to train, regulate and control the affairs of anesthetists (Lundy and James, 2009). Today, the responsibilities and duties of the nurse anesthetist is regulated by Federal Law. To this end, a person can become a CRNA if and only if s/he is a nurse who has attained advanced specialized education, acquired experience and follows relevant ethics (Office of Federal Register, 2012). To ensure that all practitioners meet these basic standards and expectations, a CRNA will have to be licensed and registered with the state within which s/he practices (Office of Federal Register, 2012). For a nurse to become a CRNA, s/he must meet all licensing requirements for anesthetics that is expected of a non-physician anesthetist. That individual must also have graduated from a recognized anesthetist institution (Office of Federal Register, 2012). This involves a 24-month graduate program that provides the basic theoretical training and tuition for practice. Finally, a person must pass all certification examinations conducted by the Council on Certification of Nurse Anesthetist Council (Office of Federal Register, 2012). There must be other training and practical requirements that a person must attain and achieve in order to become a CRNA. This is important because it enables a candidate to familiarize herself or himself with actual practice and this is integrated into the licensing program and the training program. ISSUES AND CHALLENGES There are several issues and matters that a CRNA needs to be sensitive to. As a professional, a CRNA will have to look out for certain issues and try to deal with them before they get out of hand and lead to various complications. The main professional issue involved in the work of the CRNA is recording and keeping a close eye on the status and situations the patient is in before, during and after the surgery (Hamric et al, 2013). Due to this, there is the primary professional challenge of watching, monitoring and keeping a close view on the patient as the operation goes on. The primary challenge is to ensure that the patient is in a stable condition throughout the procedure. And in this case, the CRNA will ensure that he plays a significant role in analyzing the condition of the patient whilst the physician or surgeon and his/her team carry out the operations and technical procedures. Thus, the foremost challenge of the CRNA is to ensure that the patient is stable and alive throughout an operation or medical procedure. Another important matter and issue that a CRNA needs to be sensitive to is the case of infection control (Ford, 2012). The anesthetist is fundamentally responsible for ensuring that there is no disease or infection spread whilst the patient is going through the procedures. This is because during operations and other medical procedures, patients are at their most vulnerable and they are exposed to a lot of diseases and sicknesses. Therefore, there is the need for the CRNA to ensure that there is a clear evaluation and analysis of the operating environment and care is taken to ensure that the patient remains safe throughout the process. The third professional issue that is most significant is the management of the anesthetist team and equipment (Ford, 2012). This is because the anesthetics are administered by a team and they must all be operating and working according to the standard and expectation required of it. Through this, the facility will be able to conduct procedures and affairs in such a way and manner that is fitting for the agreed operation. This will include amongst other things, the management of waste gases and other things. Also, there will be the need for the team members to be organized for effective work. Thus, the CRNA will have to play a central role in ensuring that all workers and all professionals on an operation team are doing what is assigned to them and the patient is monitored and given corrective action where necessary. PHILOSOPHY OF NURSING AND CRNA The central idea and central position of CRNAs is to provide quality service and seek the advancement of the profession (Nagelhout and Plaus, 2012). This implies that the CRNA must provide a service that is of a quality expected of the association. This means that there are some important targets and important expectations that are defined by the industry and its standards. Through these targets, a CRNA is required to provide a high quality service that will enable him to serve patients and provide top-class services. There is an issue of spirituality and the quest for G-d and the practice of CRNA. In the broad sense, CRNA is meant to be a scientific system of enquiry and analysis of sedations, anesthetics and others. It is based on empiricism rather than spirituality and metaphysics. However, the practiting CRNA could have some personal beliefs but this must be kept away from practice and used only to help patients in subjective matters and personal issues where the circumstances are right. But it must not extend to professional practice. However, other authorities tend to advocate for the need to integrate elements and aspects of spirituality in anesthetist care. To this end, Griffin (2009) defines spirituality as a unique human experience of transcending self and finding purpose and meaning in life through connecting with others, self, nature and/or a higher being. Thus, the CRNA is expected to view a patient as a holistic being that has all these elements and features that determine his or her circumstances. This can be done by the review of the patients history, and assessment of the patient in preoperative circumstances (Griffin, 2009) The third philosophical position of the CRNA’s expected process is to focus on a client-oriented process through the provision of scientific-based services and activities (Neft and Greenier, 2013). This implies that the CRNA will have to examine the client’s needs and utilize important processes and activities that are meant to analyze things and issues empirically and provide solutions based on empirical facts. This is in contrast with the use of metaphysical or “ought-to-be facts” which provide chaos and confusion in the field of health. Rather, the core philosophy of CRNAs and most nurses revolves around the need to use scientific and well established an well grounded concepts to analyze issues and provide solutions (Neft and Greenier, 2013). Another philosophical underlining of the CRNA is that it seeks to use a holistic approach. In other words, it seeks to become a unique and distinct method and approach through which patients are to be treated so that their minds, body, emotions and other elements of their lives work together for the best. Thus, the CRNA is meant to work as a unique and distinct element and process of the firm. This involves the creation of a practice and a system that uses all techniques and tools to ensure that the patient goes through the surgery appropriately and recovers properly in all aspects and components of his or her life. CARING The concept of caring is important and vital in the work and processes of CRNAs. As an advanced professional nursing practice, the CRNAs are required to live according to some completely different standards of caring. An advance professional practice of nursing is defined as “the application of an expended range of practical, theoretical and research-based competencies to phenomenon experienced by patients within a specialized clinical area of the larger description of nursing” (Andrist et al, 2010: p375). This implies that an advanced practice of nursing like CRNA has different theoretical and practical aspects and elements that set it apart from other branches of nursing. Hamric et al, (2013) identify that CRNAs adopt principles of evidence based practice and teaching advocated by the Institute of Medicine. This means that they use the same standard of medical practices and principles to deal with their issues and matters in order to resolve problems and provide care to different patients. This is done by a patient centered care system which advocates for an interdisciplinary role where they CRNA play a crucial and critical role in the attainment of high quality care during anesthetists and operation sessions. The main care that is provided by the CRNA is the pre-anesthetic evaluation of the patient to analyze his or her psychological profile and provide the best possible advice and seek the patient’s consent as per legal requirements and expectations (Suillivan-Marx et al, 2011). This form of care is central and vital as it prepares the patient psychologically for the process at hand. During anesthetics, the CRNA provides various forms of care and maintenance in the provision of his services (Huston, 2013). This involves the caring for the body temperature during the process (Iyer, 2010). This includes the analysis of changes in the body temperature of patients under a wide range of treatment conditions and processes. This includes the analysis of the body functions including the neuro-muscular function and nerve simulations. There is the need for anesthetist equipment to be sterilized and other safety equipment tested to ensure that they are right and the patient will be safe throughout the process (Iyer, 2010). There is the need for an anesthetist to also undertake continuous observance of the patient throughout the process (Nagelhout and Plaus, 2012). This includes the documentation of the different conditions and states that the patient goes throughout in the surgery or operation. This data must be analyzed and reviewed critically by the CRNA in order to interpret them and provide important findings and processes that can be used for the betterment and improvement of the surgery process. There is also post-anesthesia care and this involve the peri-anesthetic clinical support function which involves the analysis of the patient’s circumstances after the process (Huston, 2013). This is about care to relieve symptoms after procedures and this involves care and attention (Blankenship, 2012). This revolves around recovery care and attention after the process (Wicker and O’Neill, 2012). ETHICAL ISSUES The fundamental ethical issue revolves around the standards of the Association of American Nurse Anesthetist (AANA) and this involves the principles and rules for care and procedures (Iyer, 2010). The process involves the standards and processes that are permitted and those that are not permitted. Since CRNA is an advance practice category, there are numerous processes and systems that a practitioner is expected to apply. One of the central process and systems involve the use of integrity, accountability, competence and accountability to carry out their activities (Nagelhout and Plaus, 2012). This implies that there is the need for CRNA processes and procedures to be carried out with a high degree of professionalism in order to deliver the best processes. For integrity, a CRNA has to be truthful and carry out activities in all sincerity and according to all necessary standards and expectations. Also, a CRNA must adhere to all competency standards and targets and turn down work that is above his or her competency. One of the fundamental ethics of CRNA practice is the need to ensure that patient autonomy and individual autonomy of patients are respected in all times and in all circumstances (Nagelhout and Plaus, 2012). This implies that CRNA staff will have to ensure that they seek documented consent of patients before they carry out various processes (Stanley, 2010) There are ethical challenges and issues that are faced by CRNAs. However, there are supervisory systems and methods that are invoked and utilized to ensure that CRNAs do things according to the appropriate standards and practice requirements. One of these checks is the National Practitioner Data Bank (NPDB) which allows state licensing boards, hospitals and registered healthcare entities to gain the ability to monitory practitioners (Jordan et al, 2013). The data warehouse allows relevant stakeholders to analyze and evaluate different individual CRNAs and this enables them to find ways and means of dealing with matters and issues in order to evaluate different CRNAs. This database serves as a deterrent in the area of ethics because where a CRNA fails to live according to expectation, that situation becomes a record that different stakeholders can access at different points in time. In the work environment, inasmuch as practitioners are expected to operate according to high standards, there are some elements in the business environment that also carry out various amoral and inappropriate actions that come up with various issues to the practitioners. This includes various processes and practical matters like verbal abuse, sexual harassment, physical abuse and racial abuse (Elisha and Rutledge, 2011). These problems and matters cause the CRNAs to face some kinds of challenges that stand in the way of processing their activities and meeting work objectives. LEGAL IMPLICATIONS CRNA’s have consented to high legal standards (Huston, 2013). By virtue of their legal position, they are independent and accountable for their practice. What this means is that they are holding themselves to a high standard of care. In other words, they are professionals recognized by the wider society. As such, they are expected to do things according to the high ethics they have consented to. Thus, in cases of tort and negligent claims, the CRNA is held to a very high legal standard. This can be found in the case of Commonwealth V Porn [1907] where a nurse midwife was convicted for practicing medicine without a license this indicated that there was the need for standards to be set and categorization of nursing practices. Based on this, advanced nursing practices like CRNA was set apart from other forms of nursing practice to create a skill set and professional standards that was necessary to help these nurse anesthetists to come up with solutions and processes for dealing with problems and issues. In cases where a CRNA comes up with a process and practice that is negligent, an injured or affected client can sue the practitioner. This will involve a claim for damages due to the fact that the practitioner failed to meet the expectations and standards of practice. In such a case, the injured party will need to show proof that indeed there was negligence on the part of the CRNA practitioner. Also, in other situations where a practitioner fails to meet objectives and standards, that individual could be held liable by the practice authority. This will mean the authority will have to come up with a system of holding the practitioner accountable. Groups like the AANA have the constitutional backing under Federal law to regulate and control the practice of CRNAs. CULTURAL COMPETENCE Culture can be seen as a set of relatively stable norms and values that are observed by a group of people (Stanley, 2010). Most nations were monolithic in their cultural systems. The United States was originally built on the basis of an Anglo-Saxon cultural system. Thus, people in the United States needed to modify their ways to fit into the normal cultural trend and systems. However, in the 21st century, most nations have moved towards a system of multiculturalism and diversity, where people from minority groups are to be respected and honored. There are different approaches in the area of cultural sensitivity that are relevant to CRNAs. First of all, there is the communication aspect of CRNAs’ practice. In other words, the CRNAs will need to find ways of communicating appropriately with different people with sensitivity towards their cultural trends and processes (Rostant and Cady, 2009). This is often straightforward in dealing with the majority. However, in cases where one needs to deal with people of minority origins, a CRNA needs to have all the relevant techniques and systems for conveying messages. To this end, the methods of communication and its religious and social dimensions must be known by a CRNA. Rostant and Cady identify that some of the main areas of this involve the areas of breaking news to patients as well as how to phrase sentences and present them in a way and manner that is acceptable to different groups in our diverse society of today. Culture also affects the area of “informed consent” which is central towards the attainment of CRNAs’ processes and procedures (Karlet, 2012). This is because consent must be sought for all patients with a sound mind. However, there is the objective and subjective element of this ethical requirement (Karlet, 2012). The subjective aspect is about the way through which a patient accepts and decodes the message presented by the CRNA. There is therefore the need for a CRNA to understand the main components and elements of different patients’ views of matters and situations. Through this, a practitioner can provide information and consent can be said to have been sought in good faith, rather than in an induced manner which could lead to various legal consequences for the practitioner and health facility. The need to analyze and understand a person is steeped in understanding that individual’s personality. Personality involves the cultural and individual make-up of an individual (Stanley, 2010). The failure to understand another person’s personality and cultural traits always leads to stress and confusion at the workplace. In a study conducted on 800 CRNAs, it was discovered that where a CRNA identified that s/he was right in a given situation or matter, that individual stood his grounds and this often led to discord in the workplace and this caused so much confusion and distress (Radzvin, 2011). These persons stood their grounds when they believed they were morally right and they engaged in conflicts that were generally destructive to their cause. Thus, there is the need to eliminate various levels of cultural stress and cultural disagreements and this will go a long-way to prevent arguments and disagreements. HEALTHCARE DELIVERY CRNAs belong to the category of autonomous healthcare service deliverers (Black, 2010). This is because they are held to a high level of care and hence, they are allowed to provide their services in a much more independent way and manner. Most of these practitioners are part of the mainstream healthcare delivery system and they provide their services for wages. There have been very serious debates about whether they can practice independently or not. This has been a conflict between CRNAs and physician anesthetists who practice their service independently and uniquely (Matsusaki and Sakai, 2011). This is a conflict that seem to continue into the future and that is mainly because some practitioners believe that nurses must not be allowed to practice independently. In the framework of affordable healthcare under the current US universal healthcare systems, there is likely to be a fall in the bargaining power of AANA. This is because there are over 114 CRNA institutions in the United States and this turns in at least 1000 CRNAs each year. The implication is that the demand for these practitioners will go up and more and more people will be practicing as CRNA. This could affect the wage rate and the amounts facilities are likely to pay to CRNAs. However, with strong bargaining and increases in professionalism, CRNAs are likely to become more productive and improved in delivering their services to the members of the public. This will increase their worth and contribution and help them to maintain a stable and sufficiently high rate even in the face of modified economic conditions. PROFESSIONAL GOALS A person who signs up to become a nurse comes with the basic desire and need to help humanity and improve the quality of life amongst members of the society like Florence Nightingale. At the same time, a nurse also needs to be sensitive to the rules and regulations of the practice in order to attain all the right results expected of a nurse. In signing up for the BSN program, I seek to improve my technical skills and competency by learning more about anesthetists in order to provide a more specialized service to serve my generation. The taught-course and the practical aspects will prepare me for what I believe will be relevant in helping me to achieve my fundamental goal. Through this, I can monitor and help patients and do my best to save lives and improve the quality of life amongst people. The BSN will also enable me to acquire more knowledge in social aspects of life. It will enable me to learn more about the anatomy of the human being and give me the chance to exercise better judgment. Through this, I hope to become a better individual and become more productive to society and humanity. In terms of my life as an individual, it is my hope that the BSN will enable me to improve my prospects in life and in the society. This could potentially be necessary for other forms of occupational mobility and enable me to achieve my life goals and expectations. CONCLUSION The report identifies that CRNA is an advanced and specialized program. It is steeped in the need to train and create a specialized field of nursing that will enable practitioners operate independently. It involves actual care and specialist services to help patients to go through various forms of surgery and operations. CRNA seeks to imbibe high professional standards and ethics and get practitioners to attain the best results in the industry. CRNA requires various levels of care and competency to enable practitioners to attain high standards. These ethical standards are respected and monitored by authorities in the field and in the industry. To this end, it is necessary for practitioners to know them as there are legal consequences for failure to attain all these results and ends. CRNA requires cultural competency in this era of diversity. This is because it enables practitioners to become good and productive members of the society and deliver services according to dominant social and national trends. CRNA is a field that has some conflicts with physician anesthetist. However, it seem to be one that will survive through the impending changes in the healthcare system. The writer of this article has goals of improving his skills and competency in order to help her generation and the BSN will help in this. The writer also seeks to improve her overall skills and capabilities and achieve various kinds of results in the profession. REFERENCES Adrist, L. L., Nicholas, P. K. and Wolf, K. A. (2010) A History of Nursing Ideas London: Jones and Bartlett. Association of Surgical Technoloigists (2010) Surgical Technology for Surgical Technologists Mason, OH: Cengage Black, B. P. (2010) Professional Nursing: Concepts and Challenges London: Elsevier Health Science. Blackenship, M. F. 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