When Angela DiDonato, DNP, CRNA, FAANA, became president of the Pennsylvania Association of Nurse Anesthetists (PANA) in 2020, the organization had spent years advocating for formal state recognition of Certified Registered Nurse Anesthetists (CRNAs), with little success.
At the time, Pennsylvania and New York were the only two states that had not formally recognized CRNAs/nurse anesthesiologists. Despite their specialized education and training, Pennsylvania CRNAs were recognized under the state’s Professional Nursing Law only as registered nurses.
“We were putting forth legislation and trying to garner support for scope of practice change and APRN status,” DiDonato recalled. “And we weren’t really getting anywhere.”
One solution DiDonato championed was establishing a consistent CRNA presence in Harrisburg, the state capital. Although the association worked with a lobbying firm, she recognized the importance of having someone who could explain the nuances of nurse anesthesiology practice while building relationships with lawmakers.
Volunteer board members, many of whom worked demanding clinical schedules, couldn’t always leave the operating room to meet with legislators on short notice. Changes in board leadership also made it difficult to maintain relationships from year to year.
The association considered establishing a dedicated government relations position for a CRNA who could work alongside its lobbying team. But the proposal faced resistance from board members who were hesitant to change the organization’s longstanding approach.
DiDonato believed the idea deserved a chance.
“I told my colleagues, ‘We need to try it for a year. We need to see how it goes,’” DiDonato recalled.
She hadn’t always been comfortable with political advocacy. She initially became involved with PANA by helping plan an educational symposium, but her perspective changed as she saw how policies governing CRNA practice could affect patients’ access to care. By the time she became president, she understood the importance of taking an active role in shaping those policies.
During DiDonato’s presidency, PANA appointed Jessica Poole, DNAP, CRNA, as its director of government relations, a title Poole still holds.
Working with the association’s lobbyists, Poole began building relationships with lawmakers through targeted meetings, events and other opportunities to educate them about CRNAs.
DiDonato said that work made a significant difference. Instead of introducing a new association representative whenever leadership changed, PANA had someone legislators could get to know and trust.
“The people in the legislature don’t care about the title. They care about the person that they see all the time,” she explained.
Having a consistent presence, she said, made it easier to maintain relationships with lawmakers and build support for formal CRNA recognition.
On June 30, 2021, Pennsylvania Gov. Tom Wolf signed Act 60 into law, formally recognizing CRNAs in the state’s Professional Nursing Law. The legislation marked a major milestone after more than a decade of advocacy by Pennsylvania CRNAs.
DiDonato considers the decision to establish the government relations position one of the board’s most important accomplishments.
“It’s one of the best decisions as a board we ever made,” she said.
She is quick to emphasize that the legislative victory was a team effort, made possible by the work of numerous CRNAs, association leaders, lobbyists and supportive lawmakers. The experience also reinforced an important lesson about professional advocacy.
“There’s no better advocate for the profession than you,” she said. “We have wonderful lobbyists who are really, really smart. They have great ideas, they have good relationships, but we needed a CRNA there alongside them in order to get this done.”
Today, DiDonato brings those lessons into her work as associate program administrator of the DNP Nurse Anesthesia program at the University of Pennsylvania School of Nursing, where she teaches health policy courses and encourages Registered Resident Nurse Anesthetists (RRNAs) to become involved in shaping their profession.
“I want them to understand that they can participate,” she said. “I want them to understand that they have the ability to really positively impact the system writ large.”
For CRNAs interested in becoming more involved, her advice is simple: Start with your state association. Volunteer for a committee, attend meetings or reach out to association leaders about issues that matter to you. And most importantly, DiDonato said, don’t let a lack of policy experience hold you back.
“I think it’s less important to be a policy expert and more important to be an enthusiast.”
For someone who once felt uncomfortable with political advocacy, that enthusiasm has become an important part of her professional identity.
“It’s just such an important thing, I think, to be a citizen of the profession and not just an inhabitant.”