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."

Tags:anesthesiologists, communication, teamwork, advocacy

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."

Tags:nursing, benefits, health, care

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 undeserved 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."

Tags:underserved, utilization, requirement, services, quality

Abstract
This paper explains that some surgeons have suggested that cardio pulmonary bypass surgery in and of itself activates an inflammatory response that results in a stress reaction. The author points out that the role of the anesthesiologist in cardiac surgery is, as much as possible, to reduce the stress response that results form cardiac surgery. The paper relates that the stress response can be mitigated by a variety of anesthetic techniques, including use of opioids and epidural anesthesia.

Table of Contents
Introduction
Synopsis
Stages of Anesthesia for Cardiac Patients
Implications for Practice

From the Paper
"The job of an anesthesiologist during a CBS procedure includes minimizing the autoimmune and stress response. Studies have shown that "greater fear or distress prior to surgery" is typically associated with slower and more complex and complicated post-operative recovery (Glaser, et. al, 1998). Stress response in fact delays healings. The body naturally perceives surgery as a "threatening" experience, and thus a variety of stress factors are involved in the surgical process (Glaser, et. al, 1998). Among these stress concerns include worries related to survival and recovery, as well as separation from family (Glaser, et. al, 1998); these factors are especially prevalent among cardiovascular patients, who face at bets long postoperative periods and "delicate" recovery prognosis."

Tags:inflammatory, anesthesiologist, reduction, psychological, opiods

Abstract
In the paper, the writer examines the growing demand by patients suffering from chronic pain for pain management and relief treatments that will improve the quality of their lives. The writer contends that America's rapidly growing population of Seniors, coupled with increased longevity is the reason for this demand and examines some of the solutions that doctors are able to provide. The author then examines the growth of specialized care in pain management and the current system for subspecialty certification for physicians, before making his final conclusions and recommendations.

Outline:
Introduction
Specialized Pain Management Growth
Increased Opportunity For Care
Current Opportunity for Specialization in Pain Management/Proposed AA System
Conclusion
References

From the Paper
"The current system for subspecialty certification for physicians, in pain medicine comes in the form of an annual exam offered by the ABPM. The organization certifies about 2200 physicians per year in this specialty through the successful completion of the exam, which has about an 80% pass rate. (ABPM, 2008, NP) It would be conducive to structure the AA system in a similar manner with the inclusion of preparatory post grad fellowship continuing education opportunities. Individual AA's who took the seminar style two semester prep classes, and who were signed off by a governing anesthesiologist or their work institution as working within this field successfully for greater than one year would be eligible to sit for the exam and would then be certified in the subspecialty of pain medicine if success was achieved on the exam. All preparation would also qualify the individual for continuing education credits, toward their general licensure and facility requirements. Some legislation for a broadening of services offered might also be needed to alter the current state of allowable practical functions of an AA. The development of such legislative changes would likely be welcomed, as cost reduction seems to be the rule of the day with regard to medical care and spending, and this would likely improve the availability and reduce the cost of procedures significantly."

Tags:physicians, medicine, insurers, anesthesiologist, hospital, chronic, epidural, medication, healthcare