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Nurse Anesthesia Makes a Comeback

New incentives for CRNAs are meant to attract others like Jennifer Penzell to Johns Hopkins.

As a patient lays in suspended animation on the operating table, Jennifer Penzell keeps a close eye on his essentials: heart rate and rhythms, breathing, blood pressure and oxygen saturation.

Before the surgery began, Penzell brought the man into unconsciousness using a complex machine that monitors his life functions, controls his breathing and administers the right amount of anesthetic gas. Yet Penzell is not an anesthesiologist. She’s a certified registered nurse anesthetist. A small team of CRNAs are currently practicing at Johns Hopkins, but with new incentives in the works, their ranks are expected to swell.

CRNAs are trained at the master’s level in the delivery and management of anesthesia in operating rooms, labor and delivery, outpatient surgical centers and doctor’s offices. Like anesthesiologists, they’re well versed in applying a wide variety of general, regional and local anesthetics, from inhaled gasses to injected liquids. At Hopkins, they participate in procedures ranging from pediatric brain surgeries to kidney transplants to routine wrist repairs. A collaborative team approach allows their anesthesiologist colleagues to focus on teaching and research, which in turn affords the nurse anesthetist a considerable amount of autonomy and access to the latest advances.

John Ulatowski, who became chairman of the Department of Anesthesiology and Critical Care Medicine last year, feels so strongly about the importance of the CRNA role that he established a nurse anesthesia division within the department and is hoping to recruit more CRNAs.

As part of that effort, the department has set up a competitive tuition-scholarship fund for Hopkins employees who enroll in the full-time CRNA program at the University of Maryland or other regional institutions. Up to two scholarships per year will be offered to successful applicants to cover their in-state tuition costs. Though the Johns Hopkins University closed its own CRNA program in 1985, Hopkins Hospital is once again a clinical site for student nurse anesthetists. Each semester, students from several regional CRNA programs will rotate through.

Penzell, who began as an intensive care nurse, completed her advanced CRNA training just two years ago. Already she’s administered anesthesia for surgeries in nearly every specialty. A typical day, she says, may involve up to three cases in the general operating rooms (some as long as 12 hours) or as many as six in the Outpatient Center.

Well before the physician specialty of anesthesiology was born, nurses were advancing the art. In fact, it was nurse Olive Berger who manned the ether during Alfred Blalock’s first “blue baby” surgery in 1944. Today, there are dozens of types of anesthesia, and patients’ individual chemistries and morbidities—smoking, age, compounding medical conditions—can affect their bodies’ reactions in infinite ways. “It takes a lot of quick and critical thinking,” says Penzell. “You really have to be on your toes to correct any imbalances that may arise.”

Though the patient-to-nurse ratio is a coveted one-to-one—unlike unit nursing, which typically places as many as eight patients under one nurse’s care—establishing bedside rapport proves challenging. “I try to spend time with patients the night before their surgeries,” says Penzell. “They need to know that while they’re in such a vulnerable state, they can trust you with their lives.”

Lindsay Roylance




Johns Hopkins Medicine

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