Abstract This paper explains that, because of the lack of physician anesthesiologists in rural areas, the utilization of CRNAs in the rural health care setting is a perfect match. The author points out that the federal government through the Health Care Financing Administration has recently removed the federal requirement that nurse anesthetists be supervised by physicians when caring for Medicare patients. The paper stresses that CRNAs are a wise choice for medically under-served populations because they also can provide services outside of the operating room, such as pain management, obstetrical services, intubations, the initiation of intravenous lines, and lumbar punctures.
From the Paper "In the recent past, the Bureau of Health Professions in the Health Resources and Services division of the US Department of Human Services administered important programs, which were meant to help alleviate the problem of the shortage of trained healthcare professionals in rural America. These programs allowed for the recruiting and retention of qualified health professionals of all disciplines for practice in rural and classically underserved areas. It is therefore unfortunate that funding for the Health Professions acquisitions programs has decreased to the point where the programs were severely under-funded and unable to accomplish goals set in Title VII of the Public Health Services Act. In addition to the woeful under funding of health professions programs, entitlements were made subject to yearly review and justification and the inability of program administrators to adequately forecast funds made each position opened one of uncertainty, causing a lack of long term stability in the provision of quality health care."
Abstract The paper discusses how the modern nurse has developed into a fully-fledged professional with extensive and far-reaching responsibilities and functions. The paper provides a brief history of advanced nursing and nurse anesthetists and examines the situation and status of Certified Registered Nurse Anesthetists (CRNAs). The paper predicts a bright outlook for this professional specialization in the nursing profession.
Outline:
Introduction and Overview
Brief History of Advanced Nursing and Nurse Anesthetists
Situation and Status of CRNAs Licensure and Legal Requirements
Conclusion
From the Paper "If one considers the historical development of nursing and particularly advanced nursing practices, it becomes evident that until fairly recently nursing was considered more as an adjunct to the medical profession and an extension of the healthcare environment than an independent profession. However the concept and reality of the nursing profession has undergone radical change in the last century. In the first instance nursing has become more holistic in nature and has also entered into more technologically orientated areas of medical expertise that were previously reserved for specialists."
Abstract The paper analyzes the article "Preventable Adverse Patient Outcomes", which states that since 1995 Certified Registered Nurse Anesthetists (CRNA) have been doing closed claim analyses on adverse anesthesia outcomes from cases supplied to them by insurance companies. The paper examines how, by doing this analysis, a board of eight certified nurse anesthetists found that of the cases they studied thirty-eight percent of CRNA-related claims involved a respiratory incident as the primary cause of the negative patient outcome. The paper discusses how, by attaining this information, the research assists in ensuring that hospitals, clinics and surgical centers are made safer.
From the Paper "The article also states that errors in clinical judgment and failure to adhere to standards of practice and/or recommended protocols also were identified as patterns in practitioner behavior that contributed to the negative outcomes. Also stated was the importance of identifying patients before the procedure, who might have a higher risk of aspiration."
Abstract This paper examines three articles on nurse anesthetists. The paper first examines an article by Jessica Katz Jameson that articulates the problem of communication and autonomy between certified registered nurse anesthetists (CRNAs) and anesthesiologists. The paper then looks at the article by Amy C. Edmondson, Richard M. Bohmer and Gary P. Pisano that stresses the importance of creating a collective learning process that does not leave some members alienated from change. Lastly, the paper discusses an article by David M., et al. Gaba, (Singer, Sinaiko, Bowen and Ciavarelli) that develops the context of a high-hazard hospital environment and compares it to an equally challenging safety environment of aviation. The paper shows how these articles all stress personal advocacy and the need for greater communication and teamwork to create a more effective learning and caring environment for the development of the autonomy of CRNAs.
From the Paper "The role of the nurse anesthetist, as with many other areas of advanced practice nursing is once again expanding to allow the practitioner a greater amount of autonomy. Legislation to create such changes has developed in most states as a result of the success of other autonomous advanced practice nursing situations, especially with regard to the cost effective nature of the transition. In this new state of autonomy nurse anesthetists still must continue to be rigorous in training and adaptation to new technology in an environment of safety, teamwork and open communication. Anesthesiology is a highly skilled profession that requires extreme attention to detail. The inherent conflicts in this highly skilled care are those associated with a zero margin for error in application of anesthesia as well as a need for simultaneous autonomy and connectivity to the physician anesthesiologists and all other members of the surgical team."
Examines the historical background, as well as the ethical and moral dilemmas, of the death sentence, especially those faced by the health care sector.
Abstract This paper provides an analysis of the use of capital punishment in the U.S., with an emphasis on its historical background and ethical/moral issues surrounding the topic that the health care system and providers are faced with. The paper presents a detailed introduction and constitutional justifications with case citations, as well as organization/group justifications of capital punishment.
From the Paper "The International Council of Nurses (ICN) is a federation representing 120 national nurses association around the world (International, 1998), including ANA. The ICN position statement (1988) titled "Torture, Death, Penalty and Participation by Nurses in Executions," declares "the death penalty to be the ultimate form of inhumanity." ICN also adopted the position (1998) which includes the statement that the rights of every person "...includes the right to die with dignity" (p.1). It is extremely clear that the ICN opposes any involvement with capital punishment (Mason, 1997). A nurse might challenged the fact the ending a patient life might be possible if the nurse accepts that the justice system has imposed the death penalty on the person, not the nurse. In addition, the nurse understands that the condemned person will be put to death one way or another, with or without the nurse. However, a common concern voiced by several nurses' colleagues is that "it [ending a life] goes against what nursing stands for."
Abstract In this article, the writer points out that in the U.S.A., anesthesiology or anesthesia care is generally provided by two specialized groups of people: certified registered nurse anesthetists, or CRNA, and anesthesiologists, or physicians. The writer then discusses the issue of Medicare reimbursement for student nurse anesthetists and anesthesiology residents. The writer mentions that one of the foremost problems is the failure to fund health care adequately, and the fact that Medicare and Medicaid have not kept up with the escalating costs and the rate of inflation. The writer concludes that no one knows today what the future direction of the Medicare or Medicaid Reimbursement Difference Bill for student nurse anesthetists vs. anesthesiology residents will take, and one can only hope that it does not exacerbate and aggravate the already existing nursing shortage in the country.
From the Paper "It is not surprising, said Hinchey, that there is a nursing shortage in the United States. New York would have a shortage of 12,640 RNs within a period of two years, and by the year 2010, according to the U.S. Bureau of Labor Statistics the nursing shortage would most probably grow to one million nurses in the United States of America. One of the foremost problems is the failure to adequately fund health care, and the fact that Medicare and Medicaid have not kept up with the escalating costs, and the rate of inflation. For example, when statistics reveal that the costs of providing health care has increased by about 22.4 percent over the past few years, the Medicare reimbursements for nurses at one hospital had only increased by 7.2%, and this gap has serious consequences indeed for the nursing community. It must be stated that the health care system, therefore, needs an increased funding for Medicare and Medicaid from Washington, but the Republican leadership in Congress has not made any efforts to implement this."
Abstract This paper explains that, in the early years, until the use of certified specialty nurse anesthetists, many patients died or had severe complications during and after surgery because the person administering the anesthesia had little training and the physician had to divide his attention between the anesthesia and the actual surgery. The author points out that Agatha Hodgins did much more than teach nurses how to administer anesthesia under combat conditions because she also looked to the future of the profession and where it could go. The paper relates that, in 1939, Agatha Hodgins established the American Association of Nurse Anesthetists, which lead to the first national certification exam in 1945 and continues today as Certified Registered Nurse Anesthetists (CRNA), professional licensed nurses who have extensive training in nurse anesthesia required after obtaining a Registered Nurse (RN) degree.
From the Paper "During World War I, Agatha Hodgins served in France from 1914 to 1915. It was during this time that she helped train physicians and nurses from France and England in the administration of anesthesia. At this time the United States had not yet entered the war. Thank to the efforts of Agatha Hodgins and those she trained, nurse anesthetists have been the primary anesthesia administrators in combat areas. This has been the case in every war the United States has fought since World War I."
