Nurse Anesthetists in Action

Abstract

A nurse anesthetist is an advanced practice nurse who has the knowledge, skills, and competencies to provide individualized care in anesthesia, pain management, and related anesthesia services to patients across the life span, whose health status may range from healthy through all levels of acuity, including immediate, severe, or life-threatening illnesses or injury (ICN, Thatcher. History of nurse anesthesia with emphasis on nurse specialist. Lippincott: Philadelphia, 1953).

Appendices

Appendix 1: Nurse Anesthetists’ Scope of Practice, ICN Advanced Practice Nursing Guidelines: Nurse Anesthetist (2021) reprinted with permission [8] (pgs. 443–444)

Nurse anesthetists are advanced practice nurses who plan and deliver anesthesia and anesthesia-related services to patients of all ages and conditions. Nurse anesthetists collaborate with the patient and a variety of healthcare professionals in order to provide patient-centered high-quality, holistic, evidence-based cost-effective care. Nurse anesthetists accept responsibility and accountability for practice and engage in continuous professional development.

Preoperative/Before the Procedure

• Ensure a safe working environment.

• Provide patient education and counselling.

• Perform a comprehensive history and physical examination, assessment, and evaluation.

• Conduct a pre-anesthesia assessment and evaluation.

• Develop a comprehensive patient-specific plan for anesthesia, analgesia, multimodal pain management, and recovery.

• Obtain informed consent for anesthesia and pain management.

• Select, order, prescribe, and administer medications, including controlled substances.

• Identify potential complications, and plan and execute individualized interventions to prevent their occurrence.

• Maintain comprehensive and accurate healthcare records.

Intraoperative/During the Procedure

• Implement a patient-specific plan of care, which may involve anesthetic techniques, such as general, regional, and local anesthesia, sedation, and multimodal pain management.

• Select, order, prescribe, and administer medications, including controlled substances, adjuvant drugs, accessory drugs, fluids, and blood products.

• Select, insert, manage, and analyze invasive and noninvasive monitoring modalities.

• Recognize and appropriately manage complications that occur during the provision of anesthesia services.

• Maintain comprehensive and accurate healthcare records.

Postoperative/After the Procedure

• Facilitate emergence and recovery from anesthesia.

• Assess, analyze, and evaluate the adequacy of the patient’s condition before transferring care.

• Provide a comprehensive report regarding the perioperative period to personnel in charge of the next level of care.

• Select, order, prescribe, and administer postanesthetic medications, including controlled substances.

• Conduct postanesthesia evaluation.

• Educate the patient related to recovery, regional analgesia, and continued multimodal pain management.

• Discharge from the postanesthesia care area or facility.

Pain Management

• Provide comprehensive patient-centered pain management to optimize recovery.

• Provide acute pain services, including multimodal pain management and opioid-sparing techniques.

• Provide anesthesia and analgesia using regional techniques for obstetric and other acute pain management.

• Provide advanced pain management, including acute, chronic, and interventional pain management.

Other Services

• Serve as leaders, clinicians, researchers, educators, mentors, advocates, and administrators.

• Respect human rights, values, customs, and beliefs of patients and their families.

• Prescribe medications, including controlled substances.

• Provide emergency, critical care, and resuscitation services.

• Perform advanced airway management.

• Serve as a resource for airway and ventilatory management.

• Perform point-of-care testing.

• Order, evaluate, and interpret diagnostic laboratory and radiological studies.

• Use ultrasound, fluoroscopy, and other technologies for diagnosis and care delivery.

• Provide sedation and pain management for palliative care.

• Order consults, treatments, or services related to the patient’s care.

Appendix 2: Examples of Nurse Anesthetists’ Contributions to Healthcare Services ICN Advanced Practice Nursing Guidelines: Nurse Anesthetist (2021) reprinted with permission [8] (p. 450)

• Nurse anesthetists increase access to surgery, obstetrical care, diagnostic procedures, and pain management in all types of healthcare settings that are located in urban, underserved, rural, and remote areas (Vreede et al. 2019; Blair 2019).

• Healthcare facilities in medically underserved areas are able to offer obstetrical, surgical, pain management, and trauma stabilization services that would otherwise be impossible without nurse anesthesia services (Lipnick et al. 2017).

• Nurse anesthetists provide anesthesia care to military personnel on front lines, navy ships, and aircraft evacuation teams around the globe (AANA 2020a; Gunn 2015; Lockertstein & Fause 2018).

• Nurse anesthetists help reduce needless death and disability in low- and middle-income countries where nine out of ten people have no access to basic surgery (Barash & Newton 2018; Umutesi et al. 2019; Vreede et al. 2019).

• Anesthesia that is required to meet an urgent need for surgical care in the world’s poorest regions can be provided by nurse anesthetists in an affordable and timely manner that ensures good outcomes, as reported in Rwanda and Sierra Leone (Needleman and Minnick 2009; [20]).

• Appropriately educated nurse anesthetists can serve as resources and consultants to colleagues, teachers, and communities based on their nursing background and expanded competencies, as has been reported in Kenya ([20]; Umutesi et al. 2019).

• The training of nurses to provide anesthesia care has tremendously improved the health status of women and decreased maternal and infant mortality in some low-income regions, as reported in Sierra Leone (Sobhy et al. 2016; [20]).

• A nurse anesthetist school in Kenya has produced sufficient graduates to meet local needs and has now expanded the training program to nurses from other African countries. This serves as a role model for other countries to increase the anesthesia manpower necessary for patients needing surgery (Umutesi et al. 2019).

• Nurse anesthetists contribute to the safety of patients under their care. Anesthesia care given by nurse anesthetists or physician anesthesiologists is nearly 50 times safer in high-income countries than it was in the early 1980s (IOM 2000; Pine et al. 2006; Umutesi et al. 2019).

• Nurse anesthetists have contributed to the development of emergency preparedness programs and provided care during mass casualties based on their anesthesia education and expertise (AANA 2020d).

• Because of their knowledge in rapid assessment, airway management, management of vital cardiac and respiratory functions, and a nursing background in critical care units, some nurse anesthetists have assumed critical care responsibilities as licensed nurses during the COVID-19 pandemic (AANA 2020e).