By Patricia Flesher
AANA Public Relations & Communications
For Kay Moore, MSN, CRNA, a Certified Registered Nurse Anesthetist (CRNA) in Lanham, Md., working during the COVID-19 pandemic has meant every day is different and challenges require some out-of-the-box solutions.
“We have gone from working in the OR to being part of the airway intubation team, to medically managing ICU patients,” Moore said. “However, because of the high number of COVID-19 patients at our facility, these ICUs are outside of normal Intensive Care wards.”
All of this is being done while rationing PPE and reusing N95 respirators. "We don’t have a lot of PPE, so we are developing creative ways to try to preserve what inventory we do have,” Moore said.
“For example, a co-worker has used her personal 3D printer to create plastic face shields that we can wear over N95 respirators. The plastic shield is easily cleaned and protects the N95s from being contaminated.”
Since the outbreak of COVID-19, CRNAs have continued to provide top-of-the-line anesthesia care, but they have also seen their roles change drastically. CRNA expertise in airway management, hemodynamic monitoring, management of patients on ventilators, placement of invasive lines, and overall management of critically ill patients uniquely positions them to provide life-saving care to those suffering from the novel coronavirus. In fact, the Centers for Medicare & Medicaid Services (CMS) recently recognized the valuable role CRNAs are playing in the treatment of COVID-19 by granting long-overdue full practice authority during this pandemic.
“I think that it is really hard for everyone on the front lines. We are putting ourselves at risk, and then coming home and hoping we are not also putting our families at risk,” Moore said. "Our first priority is our safety and even without resources we would normally have, we are still taking care of patients. It’s a big job but we still come in and do it.”
Fortunately, although hospital spaces are being converted into ICUs, the facility has not had to convert anesthesia machines into ventilators. “We acquired 25 more ventilators so although we have anesthesia machines converted and ready to use, we have been able to connect all the patients to traditional ventilators.”
In addition to PPE limitation, Moore said the facility is also having challenges in obtaining medications used during the intubation process and afterwards. “When patients are put on a ventilator, it is necessary to induce a coma. The medications we would normally use for that procedure are in short supply.”
The state of Maryland did put in an executive order that allowed CRNAs and other advanced nurse practitioners to work within their full scope of practice. “Without this order, we would not be in the ICU at night nor medically managing patients outside of the OR,” Moore said. “Now we are rounding patients and working independently as well as alongside other intensive care professionals to deliver the care our patients need.”