Bruce Weiner, a certified registered nurse anesthetist, took office as American Association of Nurse Anesthetists president-elect in 2016 and will assume the role of president in September 2017. As the healthcare industry adapts to changes coming down the pipeline, Mr. Weiner believes CRNAs have an important role to play in providing excellent care to patients during a time of much uncertainty.
Mr. Weiner is currently pursuing his doctorate in nursing practice at Tampa-based University of South Florida. His doctoral research focuses on developing and implementing a standardized perioperative multimodal analgesic with emphasis on preemptive pain control strategies for patients undergoing spinal fusion. The project looks at preventative strategies to combat and alleviate pain before it becomes part of a patient's daily routine, which is of personal interest to Mr. Weiner after undergoing spine surgery a year ago. He notes that the project's overall aim is to lower the need for opioids, yield shorter hospital stays and ensure better patient outcomes by using multimodal techniques in acute and chronic pain management.
Here are three thoughts from Mr. Weiner:
1. CRNAs are well educated and highly qualified providers of acute and chronic pain management. Managing pain before, during and after a procedure is what anesthesia professionals are educated and trained to do. CRNAs work with patients to offer holistic, multimodal pain management both in and out of the hospital. Fellowships and other educational opportunities exist to help CRNAs stay on par with healthcare's shift toward multimodal, patient-centered care. For example, Texas Christian University, in conjunction with the AANA, offers a fellowship program in pain management accredited by the Council on Accreditation of Nurse Anesthesia Education Programs. This robust program allows CRNAs to enhance their understanding of the interventional, didactic and clinical aspects of pain management. Currently, 16 fellows are enrolled in the class and will complete the course in August. An additional 13 students are enrolled and slated to begin the program in the fall.
"The goal of this course is to approach pain management holistically by addressing the treatment of pain in ways that ultimately seek to restore normal homeostatic well-being," Mr. Weiner says. "There are many ways to treat pain without putting a needle in a patient."
2. CRNAs are part of the solution to solving the opioid crisis. The nation has put a spotlight on the increasing opioid misuse and abuse, which has taken the lives of many Americans. In 2015, there were 20,101 overdose deaths related to prescription painkillers. The epidemic has caused the medical community to start limiting opioid prescriptions and take on a different approach to treating pain. When evaluating a patient's pain, providers look at the many factors influencing pain and its evolution from acute to chronic pain, such as a patient's lifestyle or culture.
The AANA believes CRNAs' holistic, multimodal approach to pain management is a model for helping solve the opioid crisis. While medications may be required as part of a pain patients' care, the overprescribing of highly addictive opioid drugs has fueled patients' growing dependence on medicating when alternative solutions to pain management are available. According to Mr. Weiner, CRNAs have the education and expertise to safely treat chronic and acute pain patients and help make a positive impact on the overuse of opioids. He cites research published since 2000 illustrating the safety and quality of care that CRNAs provide, including a 2010 study in Health Affairs titled "No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians," and a 2015 study in the Journal for Healthcare Quality titled "Complication Rates for Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injections Performed by Certified Registered Nurse Anesthetists in Diverse Practice Settings."
"CRNAs are working doggedly with other healthcare professionals and policymakers to stay out in front of this dire situation, and we will continue to do so until the crisis is finally averted," says Mr. Weiner.
3. Collaboration among providers is key. All facets of a patient's care team, from physicians to nurse anesthetists, have to work in tandem to provide the appropriate care for each patient.
"Anesthesia providers don't function in a vacuum," Mr. Weiner said. "They assess, adjust, plan and communicate with their healthcare colleagues in the OR, ER or pain clinic. Team-based care is about all members of the patient care team working together and using multimodal techniques for the patient’s benefit."
Every care team member can use their individual expertise to meet the shared goal of providing excellent care for each and every patient while also aligning with a patient's comfort level.