Tens of thousands of nurse anesthetists helped care for critically ill patients during the COVID-19 pandemic, making certified registered nurse anesthetists (CRNAs) among the top specialties that served Medicare patients in non-telehealth during the first few months of the pandemic, according to a report by the Centers for Medicare & Medicaid Services (CMS).1

“I think this supports what we’ve known for a while,” says Randall Moore, DNP, CRNA, MBA, chief executive officer of the American Association of Nurse Anesthetists (AANA). “Nurses and nurse anesthetists are intimately and deeply involved in healthcare and in the global pandemic and healthcare crisis. The CMS report illustrates the growth and impact of nursing anesthesia in the United States.”

From March through June 2020, many nurse anesthetists were redeployed from operating rooms and ASCs to hospital ICUs and critical care units (CCUs). Some anesthesiologists and surgery centers helped hospitals turn surgical anesthesia machinery into respirators for COVID-19 patients. Nurse anesthetists became frontline workers, helping these patients with intubation and mechanical ventilation.

When the pandemic started, many states suspended elective surgeries, which meant some CRNAs were furloughed, says Melissa Ramirez Cooper, MBA, director of public relations and communications for AANA. “Many of the CRNAs furloughed used that time to volunteer, providing relief in states hit hard with COVID patient surges,” she says. “Throughout the pandemic, CRNAs had gained recognition in national news media for their critical role in caring for ill patients.”

Also during the pandemic, CMS waived the physician supervision requirement for CRNAs, and many state governors issued executive orders enabling CRNAs to practice within the scope of their license.

“If you had told me three years ago that all of this would happen, I would tell you it was nuts, but they were exhausting resources at that time. Nurse anesthetists were doing things we don’t usually do,” Moore says.

One study of nurses in Massachusetts, Pennsylvania, Illinois, and other states revealed hospitals struggled to find skilled nurses for their ICUs during the early months of the pandemic. Staff trained and redeployed nurses, including CRNAs, from endoscopy suites, cardiac catheterization, and other sites.2 Perioperative nurses became part of proning teams that repositioned patients with COVID-19 to lie face down to facilitate easier breathing.

The Veterans Health Administration issued guidance to VA medical facilities to give CRNAs full practice authority to provide anesthetic care.3

“They took significant risks to take care of patients, who frequently were very ill and required intubation,” Moore explains. “Putting in a breathing tube is a dangerous procedure because you’re in the patient’s airway, which is how the virus spreads.”

The AANA was aware of nurse redeployment mostly through anecdotal evidence, not through hard data. “The data on this are not very good because the redeployment happened so quickly. We have sent some surveys out about it,” Moore says.

As the pandemic continued and knowledge about COVID-19 treatment evolved, hospitals stopped using ventilators as often, but CRNAs still were called to ICUs when areas experienced case surges.

For example, hospitals in Iowa experienced a surge of COVID-19 patients after Thanksgiving. There were not enough clinicians at some facilities to handle the load. Administrators asked CRNAs and student nurse anesthetists to help staff the ICUs.4

The redeployments, the ongoing pandemic, and the emotional toll of working with sick and dying patients have led to stress and burnout among nurses. “I’ve talked with nurse anesthetists who were stretched very thin,” Moore says. “A crisis is one thing, but a sustained crisis over [a year] has an accumulative stressful impact.”

Stress from the pandemic affects even nurses who were not redeployed. “The stress they’re feeling is uncertainty about what’s going to happen in the community or in the hospital that might require them to stop elective surgery,” Moore observes.

Surgery center nurses also worry about what might be ahead. Their workplace could shut down because of another COVID-19 surge. They could be asked or be required to redeploy to an ICU if their employer is part of a health system. Their surgery center may have to handle a flood of surgery cases that were delayed.

“There is a backlog of surgical cases, and we think this backlog will persist well into 2022,” Moore predicts. “There will be a lot of surgical centers doing a lot of cases.”

All these factors that contribute to nursing stress should be viewed in the context of a national nursing shortage that began before the COVID-19 pandemic started.

“The nursing shortage is a big concern for us, and it’s one of the things we’re talking about the most right now,” Moore says. “Baby boomers increasingly are retiring, and they’ll increasingly consume healthcare services.”

There likely will be a significant uptick in demand for surgical and other healthcare services that outpaces the supply of new nurses. Plus, the pandemic has driven some nurses out of their profession. A survey from July 2020 revealed a sharp rise in the number of nurses who reported they were considering quitting the profession.5 “The question is, ‘Will we have enough nurse anesthetists to take care of patients?’ For me, it’s very concerning.” Moore says. “Across all healthcare providers, including nurse anesthetists, we are asking more of them now than we ever have in the past. They are exposing themselves and their families to COVID-19 because they can’t isolate or work from home.”

Moore worries about the lack of attention to the mental well-being of all healthcare professionals and how the industry will address the issue. Surgery center leaders should intentionally focus on their employees’ mental health and well-being.

“Talk with staff, provide resources, so they know you care and they know where to go for help,” Moore says. “Above all else, make sure providers are being taken care of and that you are providing resources for them.”

REFERENCES

  1. CMS.gov. New CMS report highlights four years of accomplishments in healthcare. Jan. 13, 2021.
  2. Retzlaff KJ. Staffing and orientation during the COVID-19 pandemic. AORN J 2020;112:206-211.
  3. Congressional Research Service. Full practice authority for VA registered nurse anesthetists (CRNAs) during the COVID-19 pandemic. May 27, 2020.
  4. Nicpon J. Iowa’s nurse anesthetists switch gears during pandemic. University of Iowa College of Nursing. Dec. 14, 2020.
  5. Ford M. ‘Even more’ nurses considering quitting the profession, survey reveals. Nursing Times. July 17, 2020.