Department of Labor's 2006-07 Occupational Outlook Handbook published by the Bureau of Labor Statistics, job opportunities for registered nurses in all specialties are expected to be 'excellent' in the next few years, with employment rates growing much faster than the average for all occupations through 2014. The Handbook also predicts that advanced practice nurses, including CRNAs, will be in high demand, particularly in medically underserved areas such as inner cities and rural areas" (Beattie, 2014)
Successfully enacting this change affects deeply engrained status relationships in the or team, as the surgeon's role shifts from that of an order giver to a team member in the more interdependent process. (Edmondson, Bohmer & Pisano, 2001, p
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. "Health care institutions strive to be HROs, [highly-reliable organizations] providing technically challenging and intrinsically hazardous modalities of medical care to patients efficiently and safely (Gaba, 2001)
Yet members of both groups express desires to improve their communication and create a collaborative relationship. (Jameson, 2004, p
This method involves administering drops of a liquid anesthetic to a gauze mask or cone, worn over the mouth and nose of the patient, so that the patient inhales the anesthetic at a rate sufficient to keep them sedated. Not only was Magraw an accomplished nurse but she made significant contributions to her field through publication including the documentation of 14,000 anesthetics procedures achieved without complication (Magraw, 1906)
In the late 1800's the high rate of morbidity due to poor anesthetic practices increased the demand for clinicians who specialized in anesthesiology. Prior to the formal development of this field, little training was given to the person administering the anesthesia, who was more or less an extra pair of hands for the physician whose attention was thus divided between the care of the patient and the surgery at hand (Postotnik, 1984)
Vincent Hospital, Portland, Oregon in 1909 by Agnes McGee. The school consisted of a six-month course incorporating pharmacology, anatomy and physiology, and the administration of common anesthetic agents (Thatcher, 1953)
There is also a greater need for anesthesia in non-surgical settings which can more feasibly be provided by a CRNA. "People are living longer with co-morbidities and require more interventions, monitored anesthesia care or pain management" (Beattie 2007)
Not all states have fully embraced the critical role that nurse anesthetists have been playing in many areas of the country. For example, in California, the California Society of Anesthesiologists (CSA) and the California Medical Association (CMA) filed a lawsuit alleging it was illegal to allow CRNAs to anesthetize Medicare patients in hospitals or work in ambulatory surgical centers without physician supervision (Lyttle 2010)
Clearly, the resultant medication shortage has threatened patient safety more than violation of regulation, which led to closing of manufacturing units. Industry consolidation, reduced profitability, variable demand and reduced manufacturing capacity have all played a role in causing specific shortage (Campbell, n
Drug-hoarding before a predicted shortage might deplete available inventory and aggravate the shortage issue, by diverting supplies from other needy patients and facilities. Drug-stockpiling may also prove to be costly, and can leave a medical facility with excessive inventory, which isn't only costly, but may also not be absorbed in case the shortage gets averted or is less severe than predicted (Fox et al
Drug-hoarding before a predicted shortage might deplete available inventory and aggravate the shortage issue, by diverting supplies from other needy patients and facilities. Drug-stockpiling may also prove to be costly, and can leave a medical facility with excessive inventory, which isn't only costly, but may also not be absorbed in case the shortage gets averted or is less severe than predicted (Fox et al
How drug shortage challenges "non-maleficent" and "beneficent" health care delivery With regard to non-maleficence and beneficence, compelling evidence now exists of the fact that health systems, individual patients, and whole populations may suffer harm on account of drug shortages. A patient may be harmed when no equally effectual alternative drug can be found for his/her care, leading to compromised, precluded, or delayed care (Lipworth & Kerridge, 2013)
These shortages affect anesthesiologists, in particular. According to the GAO (Government Accountability Office), central nervous system (CNS) drugs and anesthetics constitute 17% of total shortages; they also come under the categories of drugs regularly experiencing highest shortage frequency (Orlovich & Kelly, 2015)
Besides causing harm to individual patients, a shortage of drugs threatens public health. In fact, some regard this to be a public health emergency, as it threatens society's ability of preventing and treating acute as well as chronic illnesses (Singleton et al
, an order is only partially filled, a particular strength of medication can't be obtained, or a majority of manufacturers lack stock. Medication-purchasing agents who aren't pharmacists must collaborate with members of pharmacies (Ventola, 2011)
The sole anesthesia providers are CRNAs in virtually every rural hospital for some states. Bearing in mind these professionals' history of guaranteeing superior-quality, safe anesthesia delivery, and being the nation's most economical anesthetists, their contribution in America's healthcare system valued (Hogan, Seifert, Moore, & Simonson, 2010)
Crile's leading nurse anesthetist, Agatha Hodgins, who held the post since 1908, founded the National Association of Nurse Anesthetists, which later went on to become AANA (American Association of Nurse Anesthetists). In this time, there were other lawsuits and sanctions against individuals who trained or employed nurse anesthetists in the states of California, Kentucky, Pennsylvania, and New York (Malina & Izlar, 2014)