By Julie Ciaramella
AANA Public Relations & Communications
In rural communities across the country, Certified Registered Nurse Anesthetists (CRNAs) are the primary providers of anesthesia. As COVID-19 spreads from cities and urban centers to rural America, CRNAs are confronting problems unique to rural areas.
Rural healthcare systems have faced significant challenges in recent years. With the closure of 128 rural hospitals over the past decade, hospitals can sometimes be one or two hours away from home for some patients, making healthcare difficult to access. The population in rural areas also tends to be older with multiple comorbidities, putting them in the high-risk category for COVID-19.
James Stockman, APRN, CRNA, NSPM-C, a nurse anesthetist in Nacogdoches, Texas, who is on his hospital’s board of directors, said COVID-19 has “pushed our hospital’s clinical and financial resources to the edge” and that a lack of funding for rural hospitals could mean the potential for greater spread of the virus.
“Our population is particularly vulnerable. There are poor and elderly populations that live in these rural areas, and they’re all susceptible to COVID-19,” Stockman said. “We have absolutely got to make sure that our rural hospitals are being funded, otherwise people are going to be going a long way for treatment. That’s just going to open them up to exposing others and a lot more harm.”
In many rural communities, hospitals are an economic driver. Without them, the community and patients suffer, according to Sarah Tweedy, DNP, CRNA, ARNP, who serves as the Federal Political Director for the Iowa Association of Nurse Anesthetists.
“We provide a lot of services for people who don’t want to drive one or two hours to the next big facility,” she said. “The hospitals are a big driver of our economy in smaller communities, so keeping them open is also essential to keeping a community going.”
Now more than ever those services are needed close to home, and CRNAs are ensuring access to care. Tweedy’s primary site is a 25-bed critical access hospital in rural northeastern Iowa that is preparing for a potential surge in COVID-19 patients. CRNAs have been an integral part of the facility’s planning and are leading an intubation team and proning team. They have also been educating other providers on critical care management and how to appropriately care for a ventilated patient.
“Our hospital does not usually keep ventilated patients if they’re going to be long-term ventilated,” she said. “CRNAs have been doing a lot of education to make sure nursing and other staff are up to speed on taking care of a ventilated patient, as well as critical care management.”
Across the country, CRNAs are leading the way in preparing their rural facilities for an influx of patients as the virus spreads. They are using their skills and expertise in intubation, ventilator management, and critical care to save lives.
“Our group of CRNAs has stepped up and will be taking over 100 percent of the intubations and central lines in the facility to limit others’ exposure. We will be taking over the code team and the rapid response team as well as responding to needs from the ICU and ER,” said Mike MacKinnon, DNP, FNP-C, CRNA, who works in rural Arizona and is one of five owners of a 16 CRNA-only group. “We will be utilizing our skills in ventilator management and hemodynamic management, as well as critical care, to open an additional ICU space, which we will run as needed.”
Due to their education and training, and their backgrounds in critical care, CRNAs are qualified to step into these leadership roles and manage the sickest patients.
“As a CRNA, we’re uniquely qualified to help with airway management, which can be difficult in COVID patients,” said Brian Kvamme, CRNA, a member of the South Dakota Association of Nurse Anesthetists’ Board of Directors. “At my hospital we put in central lines, arterial lines, and we’re a major resource for our critical patients that we’ll be taking care of. We’ll also be helping with sedation and ventilator management.”
As rural hospitals face COVID-19 along with financial challenges, CRNAs are delivering high-quality care—and they’re helping facilities save money and stay open to serve their communities.
“We are capable of providing the same service as anesthesiologists at a better rate,” said Stockman. “I think for us, particularly in Nacogdoches, that has helped tremendously as far as the hospital’s bottom line and being able to save money.”
He added, “CRNAs are out here in these rural hospitals, and we need to be supporting them as much as we possibly can.”