National CRNA Week

January 24th through January 30th, 2010

Today begins a week long recognition of Nurse Anesthetists. This is the 11th annual such recognition. It's a way to make the general public aware that when ever they have surgery, the person at the head of the bed administering their anesthetic is just as likely to be a nurse anesthetist as it is an M.D. anesthesiologist.

Does that mean that nurses have only been administering anesthetics for eleven years? No. No it doesn't. It means that 11 years ago some individual or group of individuals decide that a public relations effort needed to be instituted to make the public aware that not every deliverer of anesthesia was an anesthesiologist. Nurse anesthetists (CRNAs), in fact, were one of the first Advance Practice Nurses in healthcare. Even that term, APRN (advanced practice nurse) only came to the vernacular in 1965. (the first Nurse Practitioner program was created by a nurse educator, Loretta C. Ford, Ed.D., R.N., P.N.P. and a physician, Henry K. Silver, M.D., in 1965 at the University of Colorado as a non-degree, certificate program training Registered Nurses for advanced roles as Pediatric Nurse Practitioners due to a shortage of primary care physicians.)

Nurse Anesthesia practitioners on the other hand have been administering anesthesia for some 150 years. To digress here for a moment; in researching my genealogy I discovered that one of my great grandfathers (Daniel Story) was a musician/soldier in the Civil War. I further discovered that these musicians also served as the care givers, medics if you will, to the wounded soldiers during Civil War battles, and as such delivered the anesthetics when the physicians did surgery. Musicians, as medical assistants:The non-musical duties of bandsmen were primarily medical. Before battles, bandsmen gathered wood for splints and helped set up field hospitals. During and after the fighting, they carried the wounded to hospitals, helped surgeons perform amputations, and discarded limbs.

I've been a CRNA since 1972 and over the course of that time the two most frequent questions asked of me pertaining to my profession have been:

1. What is a nurse anesthetist? And,

2. What's the difference between a nurse anesthetist and an anesthesiologist?

I'll spare you the quips and jokes that have grown legendary in response to these questions and I'll also spare you the political attestations that abound as to those differences. The simplest and most obvious answers are; a nurse anesthetist is a Registered Nurse who administers anesthetics and an Anesthesiologist is a doctor who administers anesthetics. In a setting, operating room or otherwise, where anesthesia is being given to a patient for any procedure, the person administering the anesthetic, whether doctor or nurse, together or alone, is doing the same thing, have been trained in the same principles and techniques and are equally adept in applying these anesthetics.

That said, within the ranks of anesthesia care givers, nurse or doctor, there are individual differences as to technical skills and overall abilities to deliver anesthesia care unrelated to the letters following their name. In my career I've worked with both CRNAs and anesthesiologists who would serve the world better by doing something other than anesthesia. On the positive side though, most of the anesthesia care givers I've worked with are very well trained and equally competent to bring patients safely through their anesthetic experience.

Just so you know, there is a new participant coming to the head of the table to deliver anesthetics; the AA, anesthesia assistant. Proving that you don't have to have particular initial after your name to give anesthesia, but you do have to have equivalent training.

If you take anything away from this minimalist introduction to the administration of anesthesia, I would ask that you remember this sentence that I tell everyone of my patients:

"I'm going to stay here with you through the entire case, keeping you safe and secure, and making sure you receive just the right amount of anesthesia, and when the surgery is finished, I'll wake you up and take you to the recovery area."

The best person to be at the head of the OR bed is someone trained in anesthesia who cares about your well being above all else, for those precious minutes in you life.

All the rest is political posturing