Monday, March 30, 2015
First and foremost, the role of the CRNA is dictated if not defined by its essence as an advanced practice specialty. Overall, the CRNA’s all encompassing aim is to ensure the safety and comfort of patients of all ages, those who are facing every conceivable form of surgery and procedures, in an equally diverse array of set ups. Simultaneously, and particularly in terms of the CRNA’s specialty, the CRNA, while a member of a multidisciplinary team, enjoys a high level of autonomy in their profession, that is, they are qualified to deliver anesthesia sans physician direction. While the CRNA functions largely independently, they so still maintain clear communication with anesthesiologists. In the OR, teamwork is not only expected by indispensible, with each member being dependent upon the other. There is a distinct intensity in the OR, with each team member focusing on their role. The CRNA’s relationship to the surgical team is more defined than with the RNs, particularly the CRNA to surgeon and technologist. This is due to the fact that the surgeon is reliant upon the CRNA’s expertise with the pharmacology, particularly if a patient must be stabilized, at which point the CRNA is in fact in a lead role. Unlike physicians, the CRNA does not refer patients to other providers, but instead receives referrals; the CRNA’s patients are in most cases under the care of a surgeon. CRNAs are not meant to have a patient caseload, unless they are aiding patients in need of pain management. Instead, CRNAs primarily function via consultations, which make up the bulk of their daily work. The consultations are essential for a number of reasons stemming from a patient’s care plan, not the least of which are legal and clinical reasons. Moreover, surgeons recognize and rely on the CRNA’s proficiency in anesthesiology, turning to them to understand completely any risks involved in an upcoming surgery. This is not to say that the CRNA never sees a patient directly or the patient’s family. Indeed, the CRNA must be able to quickly establish a rapport and trust with patients and their families. What makes the role of the CRNA truly exclusive, and adds to their autonomy is that their specialty commands a great deal of authority across healthcare teams. The CRNA is called upon to help in assessing patients, but also to inform and bolster the efforts of residents, and CRNA students. They teach via demonstration, not only in terms of clinical acumen, but particularly in terms of professionalism, competence and as a role model for others. The CRNA has the capability of affecting change in perioperative and perianesthesia care by not only personifying aptitude, but also by imparting their expertise clinically and not just academics. Conversely, though, many CRNAs do in fact teach and train upcoming CRNA students. The CRNA is an integral part of the surgical team, and must maintain strong ties with perioperative team members, from the surgeons to the RNs, technologists and anesthesiologists. This also means that the CRNA is a part of a different administration, separate from other clinical staff. Despite these differences, though, the CRNA is essential in terms of supporting the efforts of all nursing staff, advancing healthcare, ensuring patient safety and an overall exceptional healthcare experience for patients.