Nurse Anaesthetists at a Glance:
1. Nurse Anaesthetists have been providing anaesthesia care in Jamaica for over 50 years.
2. These dedicated professionals are advanced practice nurses who administer 65% anaesthetics given to patients each year in Government hospitals in Jamaica.
3. Nurse anaesthetists are sole provider of anaesthesia in many hospitals, affording these medical facilities, obstetrical, surgical and trauma stabilization.
4. Nurse anaesthetists provide anaesthetics to patients in collaboration with surgeons, anaesthesiologists and other qualified health care professionals.
5. As Advanced Practice Nurses, nurse anaesthetists practice with a high degree of autonomy and professionalism.
6. These nurse anaesthetists practices in every setting in which anaesthesia is delivered and provide accessible cost-effective safe anaesthesia care to the underserved and others requiring care. Nurse anaesthetists await legislation that will afford them prescription rights and direct reimbursement rights for private cases done in governmentís hospitals. Legislation will also pave the way for greater utilization of the expertise and skills of nurse anaesthetists.
Education and Experience Required to Become a Nurse Anaesthetist:
. Hold a current license as a registered nurse
At least three to five years experience in an acute care setting
. Hold a current license as a registered midwife
. Graduate from an approved school of nurse anaesthesia educational programme from 24 to 36 months
. Complete continuing education and recertification programme every two years.
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Education of Nurse Anaesthetists in Jamaica:
Nurses in Jamaica have been practicing in the field of anaesthesia since the early 1900s. These nurses had no formal knowledge or training in anaesthesia but relied on their basic nursing knowledge and skills and instruction by the operating surgeon.
It was Dr. Leo Freeman, Senior Medical Officer at the Spanish Town Hospital, who on one of his visits to the USA in the 1950s observed nurse anaesthetists trained in the specialty of anaesthesia, competently administering general anaesthesia. He lobbied the government to send nurses for training in the USA.
Mrs. Nurielda Ernandez Newman, an operating room nurse at the Spanish Town Hospital, paid her fare to the Graduate Hospital of the University of Pennsylvania, Philadelphia for training, in September 1956 and returned to work at same hospital in 1957. Her performance was impressive, surgical load improved coupled with marked improvement in patient care and safety. As a result the Ministry of Health sent a total of twelve nurses for training in the USA between the periods 1958 to 1962.
In the fall of 1969 the HOPE Survey Team spent several weeks in Jamaica, planning for the arrival of the SS HOPE Ship, during which time Dr. Robert Dripps, the then Professor and Chairman of the Department of Anaesthesia, University of Pennsylvania, and his team conducted a survey and reported that of the 22 anaesthesiologists in the island only three worked in the rural hospitals and only five of the 38 nurses administering anaesthesia in 20 of the rural hospitals had formal training in the USA. Most of the others were largely trained on the job by the surgeons. He recommended that a training programme for nurses be started so this would ensure better anaesthesia and postoperative care, which would improve anaesthesia care in the rural hospitals and reduce referral of patients to Kingston.
Thus the first local nurse anaesthesia training programme was started, organized by Project HOPE, MOH, UHWI, Mrs. Dorothy Denny was prepared as tutor to work with the Director for subsequent classes. Paediatric anaesthesia experience was gained under the supervision of Dr. Hazel Chung-Knight, Head of Anaesthesia Department, Bustamante Hospital for Children. A total of 17 nurse anaesthetists were trained from 1970 Ė 1976. The programme ended when the support from Project HOPE was discontinued.
In 1980, on one of Fidel Castroís visits to Jamaica, he offered technical assistance in the form of nurse anaesthesia training. Five (5) registered nurses were sent to Cuba for training. They returned a year later to join the cadre of trained nurse anaesthetists. Dr. Hazel Chung-Knight felt Jamaica had the expertise and resources to train nurse anaesthetists, and so the local team; ANEU, UHWI and Mrs. Dorothy Denny, Dr. Hazel Chung-Knight, Dr. Beverley Grant-Lewis and Dr. W. Hanna (UHWI) from the Ministry of Health commenced planning.
The team was assisted by a Consultant, Sister Mary Arthur Schramm, CRNA, PhD (Physiology) and Programme Director. She was sponsored by Project HOPE, who also provided teaching aids, books and equipment. In 1981 the Jamaica School of Nurse Anaesthesia commenced training of six (6) registered nurses from Jamaica. Two years later Caribbean students were admitted for training. The training programme comprised 24 months, and later extended to 32 months. The curriculum included anatomy, physiology, pathophysiology, chemistry, physics, pharmacology, and research methodology. The clinical component provides experience in a variety of anaesthesia techniques and procedures for all types of surgeries. To date 88 nurse anaesthetists have been trained, 51 Jamaicans and 37 from the Caribbean.
In 1989 the BSc degree (Nurse Anaesthesia) commenced at the University of Technology; 23% of nurse anaesthetists in Jamaica now have a BSc degree. The school in collaboration with JANA plans continuing education sessions, seminars, workshops and annual conferences for the graduates from Jamaica and the Caribbean. Plans are in high gear to transfer the programme to UTech and to upgrade it to a Masters degree. Sister Mary Arthur Schramm continues as a consultant as she guides faculty through the transfer process.
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Cost-effectiveness of Nurse Anaesthetist Practice:
. Nurse anaesthetists provide high quality, cost-effective anaesthesia care.
. Study done by the AANA showed that at least ten CRNA could be educationally prepared for the cost of preparing only one anaesthesiologist.
. These CRNA will have entered the work force and cumulatively provide anaesthesia services for a number of years by the time that one anaesthesiologist is ready to practice.
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Qualifications and Capabilities of the Registered Nurse Anaesthetist (RNA):
The practice of anaesthesia is a recognized specialty within the profession of nursing. As one of the first nursing specialty groups, nurse anaesthetists have a longstanding commitment to high standards in a demanding field and are responsible and accountable for their practice. Nurse anaesthetists administer anaesthesia for all types of surgical cases from the simple to the complex and work in every setting which anaesthetist is delivered. In order to be a Registered Nurse Anaesthetist (RNA), on must:
1. Graduate from an approved school of nursing and hold a current licensure as a registered nurse
2. Graduate from an approved midwifery educational programme
3. Graduate from an approved nurse anaesthesia educational programme
4. Comply with criteria for biennial re-certification.
These criteria include evidence of:
(a) current licensure as a registered nurse
(b) active practice as a nurse anaesthetist
(c) appropriate continuing education, and
(d) verification of the absence of mental, physical or other problems which could interfere with the practice of anaesthesia.
Education of Nurse Anaesthetist:
The JSNA educational programme is 32 months inclusive of six months internship. Students are given the opportunity to integrate classroom content with direct application of techniques in the provision of anaesthesia care to all populations in all risk categories. The education of RNAs also includes experiences in management of respiratory care and emergency resuscitation of patients in intensive care units; post-anaesthesia care units and other acute care areas.
Academic Curriculum required for Registered Nurse Anaesthetist Programme includes:
1. Professional aspects of nurse anaesthesia practice
2. Advanced anatomy, physiology and pathophysiology
3. Chemistry and physics related to anaesthesia
4. Advanced pharmacology
5. Principles of anaesthesia practice
6. Research methodology
7. Clinical anaesthesia practicum:
The clinical component mandates that each student administer a minimum of 600 anaesthetics to patients, representing 1200 hours of anaesthesia time. Students provide these services under the supervision of qualified clinical instructors, which include registered nurse anaesthetists or anaesthesiologists. The clinical experiences are as follows:
(i) Use of major techniques and monitoring modalities in current use.
(ii) Patients of all ages from birth through to old age.
(iii) Patients whose concomitant medical conditions with ________ ___________ impact on anaesthesia care.
1. Graduation from an approved school of nursing
2. Current licensure as a registered nurse
3. A minimum of three to five years professional nursing experience in an acute care setting
4. Graduation from an approved school of midwifery
Admission to the programme is very competitive. Intake of students is every two years and the number of space available is limited.
Faculty of nurse anaesthesia educational programmes are multidisciplinary and are composed of registered nurse anaesthetists, anaesthesiologists, graduate nursing faculty, specialty physicians and other graduate faculty in basic medical and social sciences. The registered nurse anaesthesia programme director and tutors have a masterís degree.
The registered nurse anaesthesia programme is accredited by the accrediting body of JANA, Nursing Council of Jamaica, UHWI and UTech.
Recertification of Nurse Anaesthetists:
Mandatory recertification is required every two years for which 30 contact hours of approved continuing education must be obtained and presented to the Council.
RNAs practice according to their expertise, government regulations and institutional policy. They administer anaesthesia and anaesthesia related care in four general categories:
(i) Pre-anaesthetic preparation and evaluation
(ii) Anaesthesia induction, maintenance and emergence
(iii) Post-anaesthesia care
(iv) Peri-anaesthetic and clinical support functions
The RNA scope of practice includes but is not limited to:
a) Performing and documenting a pre-anaesthetic assessment and evaluation of the patient, including requesting, consultations and diagnostic studies; selecting, obtaining, ordering, or administering pre-anaesthetic medications and fluids; and obtaining informed consent for anaesthesia.
b) Developing and implementing an anaesthetic plan.
c) Selecting and initiating the planned anaesthetic technique which may include general intravenous sedation.
d) Selecting, obtaining or administering the anaesthetics, adjuvant drugs, accessory drugs, and fluids necessary to manage the anaesthetic, to maintain the patientís physiologic homeostasis, and to correct abnormal responses to the anaesthesia or surgery.
e) Selecting, applying and monitoring modalities for collecting and interpreting patient physiological data.
f) Managing a patientís airway and pulmonary status using endotracheal intubation, mechanical ventilation, pharmacological support, respiratory therapy, or extubation.
g) Managing emergence and recovery from anaesthesia by selecting, obtaining, ordering, or administering medications, fluids or ventilatory support in order to maintain homeostasis, to provide relief from pain and anaesthesia side effects, or to prevent or manage complications.
h) Releasing or discharge patients from post anaesthesia care area, and providing post anaesthesia follow-up evaluation and care related to anaesthesia side effects or complications.
i) Responding to emergency situations by providing airway management, administration of emergency fluids or drugs, or using basic or advanced cardiac life support techniques.
j) Additional responsibilities which are within the expertise of the individual registered nurse anaesthetist.
The functions listed above are a summary of registered nurse anaesthetist practice and are not intended to be all-inclusive.