By Patricia Flesher
AANA Public Relations & Communications
Before the COVID-19 pandemic, Dr. Michael Greco’s team focused on treating patients in operating rooms or outpatient surgery suites. “Our days have changed significantly,” said Greco, PhD, DMP, CRNA. As Assistant Vice President for the Nurse Anesthesia Practice at Northwell Hospital--New York’s largest healthcare system serving New York City, Long Island and Westchester—all of Greco’s facilities have CRNA teams managing COVID-19 patients—in an innovative way.
As advanced practice nurses, CRNAs (Certified Registered Nurse Anesthetists) have vast experience in critical care settings and advanced education and training in anesthesiology. CRNAs provide care across all settings and in all patient populations with expertise in advanced airway and ventilator management.
While managing patients with COVID-19, Greco’s team is also assisting with supply chain issues.
Northwell has not experienced the shortages of personal protective equipment (PPE) that has plagued so many hospitals, but it has had to look for ways to conserve materials and at times create their own.
“We are very fortunate that we have access to a 3-D printer,” Greco said. “This has enabled us to independently create much needed equipment like video laryngoscope handles and plastic devices used to turn Bi-PAP sleep apnea machines into ventilators. Having the ability to create our own supply chain has made all the difference in being able to quickly respond to our patients’ needs.”
The large number of COVID-19 patients needing intubation and ventilators has impacted an area of care that Greco says is currently “under the radar.” The CRNA team is starting to see a higher demand for the appropriate medications to intubate COVID-19 patients.
“There is a limited supply and we are trying to be very conscious of our medication supply," Greco said. “This means making alternative drug choices that are still standard practice and effective in providing quality care to the patients, but under conditions that are new to us.”
In March, New York Governor Andrew Cuomo removed physician supervision requirements for CRNAs. This opened them up to practice within the full scope of their expertise and knowledge and according to Greco, has created a spotlight on CRNAs and the role they play in patient care.
“The work of CRNAs on the front lines during the COVID-19 pandemic has shown how our advanced skill set are quickly transferable and utilized in many remote areas of the hospital to help support the patients. CRNAs are in the ICU leading care teams, taking on our own assignments and prescribing and order pharmacological therapies. We are monitoring cardiovascular therapy and the insertion of invasive monitoring devices to help ensure our sickest patients are monitored appropriately. We have been given access to new areas outside the OR and have shined and showcased the talent and strong knowledge base that CRNAs have. CRNAs are earning respect for their ‘Where do you need me, what can I do?’ attitudes. This pandemic has allowed us to show all that at every second, every breath, every beat CRNAs are there!”
Unfortunately, Greco said being around COVID-19 and the exposure has led to CRNAs contracting COVID-19 themselves. With that comes a staffing gap.
“Thankfully, we have had many out-of-state CRNAs who have stepped in to help the besieged New York healthcare workers. Many of these CRNAs were furloughed in their state and have taken advantage of our call for help. We really appreciate all the help we are being given by CRNAs and other healthcare workers.”
Greco said he is appreciative not just of the support he and his team have received from the healthcare system and administration, but throughout the profession. “The AANA has been incredible supporting the frontlines with the most up-to-date information. This has not just helped me do my job, but I have been able to share items with our hospital administrators to showcase CRNAs and the role we play in patient care.”