Introduction
Nursing is a profession that offers a broad range of opportunities all over the world. While choosing nursing as a career, it is possible to select a particular nursing specialty area to work with patients of various health conditions and age groups. Even though a great variety of groups representing nursing in different specialties can be regarded as the reflection of nurses’ various functional and clinical needs and interests, it can also be perceived as the embodiment of continuous fragmentation and disintegration of the profession. However, this fragmentation can worsen nursing’s proficiency in informing policies and meeting the nursing standards, specifically when policy-makers witness conflicting messages from those groups (Klainberg and Dirschel, 2009, p. 200).
About the problem considered above, anesthesia practice is identified by various paradoxes (Iyer, 2001, p. 349). Although it is a highly technical specialty, it is contrary to other health care specialties, engaging patients with a wide variety of therapeutic, surgical, and diagnostic requirements.
Research Question
The American Association of Nurse Anesthetists has been a pioneer in creating the nursing specialty (Iyer, 2001, p. 348). The problem is that the specialty creates certain deviations from the overall standards and, at the same time, makes nurses acquire more specific skills in decision-making and problem-solving processes. In this regard, it is necessary to consider the reasons for creating this specialty and how this nursing group affects the nursing profession in general.
Main Discussion
The Pioneer Introducing the Specialty to the Nursing Profession
Nurse anesthesia has been recognized as the first medical specialty that was developed as a result of surgeon reaction to high mortality and morbidity connected to anesthesia. Being the pioneers in the anesthetic profession, nurses became engaged in a wide range of surgical procedures and the optimization of anesthesia equipment and approaches (Mason et al., 2007, p. 579). Hence, the most famous person who introduced this specialty to the nursing process was Alice Magaw, who is internationally acknowledged as the “mother of anesthesia” due to her numerous achievements in this field (Mason et al., 2007, p. 580).
Particularly, her invention – the inhalation technique using chloroform – has been recognized as a real discovery at the end of the nineteenth century (Mason et al., 2007, p. 580). Many physicians and nurses all over the world, and in the United States, in particular, made use of Magaw’s techniques. The practical excellence of these approaches was documented in 1906 when about 14,000 nurse anesthetics applied them successfully.
After World War I, anesthetists have become the chief producers of anesthesia in combat areas where the US representatives have also been involved (Mezey and McGivern, 2003, p. 280). Due to the increased demand for anesthesia during the war, the establishment of educational programs became an urgent necessity. In this respect, the American Association for Nurse Anesthetists (AANA) was founded in 1931 that represented about 27,000 health care professionals (Mason et al., 2007, p. 580).
This organization advocates practice and education standards and is considered to be a resource to governmental and private entities about nurse anesthetists. The main function of the AANA involves the accreditation and certification of the presented specialty and the development of specific educational programs.
Identifying Key Nurse Leaders Who Have Impacted the Specialty Area
It should be stressed that contemporary anesthesiology is much more effective and much more complicated compared to those that existed at the end of the nineteenth century. Nurses have been supplying anesthesia to patients since its discovery in the United States, which has considerably improved the quality of health care services. As the field of this nurse specialty has gradually been advancing, there has been a growing importance of the research.
This exploration can be achieved through the introduction of Certified Registered Nurse Anesthetists (CRNA) that is attained to the secondary purpose of the specialty development (Mezey and McGivern, 2003, p. 281). Many other programs are promoting this profession and advanced research. Among those is the ANNA Foundation that encourages the examination by the nurse anesthetists who document the workshops and research grants and awards. In general, the foundation presented several other priorities and goals to be accomplished in the nearest time.
Some less known leaders have influenced the development of nurse anesthesia practice, like the New York Society of Anesthetists, which is also called the American Society of Anesthesiologists, and the American Society of Regional Anesthesia founded in 1923 (Stoelting and Miller, 2007, p. 12). The latter was merged by the American Society for Anesthetists in 1941, pursuing the same goals and programs (Stoelting and Miller, 2007, p. 12).
Discussing the evolution of the specialty
Changes in education requirements
As has been mentioned previously, nurse anesthesia was the first specialty of nursing practice that officially appeared in 1946. Since then, the National Association of Nurse Anesthetists has attempted to preserve rigid standards for certification, education, and practice the nurses from this field. The procedures and strategies established by anesthetists created a model for consistently certifying practitioners in the field of nursing (Cherry and Jacob, 2005, p. 102). Later in 1961, the American College for Nurse-Midwives started the campaign of certified nurses.
In the course of educational programs development, the necessity for standardization of certified programs became urgent. In 1975, the Association summoned a national conference at the University of Wisconsin-Milwaukee for considering this important issue (Cherry and Jacob, 2005, p. 102). At the meeting, 75 nursing organizations were present to introduce and recommend the creation of a central organization for registering and certifying nurses (Cherry and Jacob, 2005, p. 102).
It has been estimated that certified nurse anesthetists who participate in about 50 % of all practices in the United States should have a registered nurse degree and spend at least one year in the capacity of a critical care nurse (Stoelting and Miller, 2007, p. 13). After that, a future anesthetist should complete from 2 to 3 years of clinical training and under the approved anesthesia training program (Stoelting and Miller, 2007, p. 13). In this regard, the AANA bears responsibility for the development and implementation of nurse anesthesia educational programs and the establishment of the main criteria for certification and registration of nurse professionals in the specialty area.
Nowadays, educational programs in the sphere of anesthesiology require a minimum of 2 years in length and are conducted under a master’s degree condition. In 2008, about 55 % of educational programs were affiliated with schools of nursing, offering a variety of degrees having anesthesiology as their major (Jansen et al., 2009, p. 22). Judging from the statistics, the necessity for implementing educational programs in the specialty area has acquired a much more serious character.
Changes in state laws about licensing and practice
Even though the major focus was made on nurse practitioners, the nurse anesthesia specialty kept on developing.
At the end of the twentieth century, four master’s programs were created in the United States, yet the conflicts between the specialties did not cease. The growing tension between nurse anesthetics and medicine was critical, although specific legal cases (Chalmers-Frances vs. Nelson and Frank vs. South) presented a solid basis for establishing litigations (Keeling, 2007, p. 148). The major problem consisted of the fact that nurse anesthetists were not able to ratify their services and that created reimbursement disincentives for the nurse staff.
Over time, the necessity to work out effective programs and strategies for ensuring nurses’ skills and quality of services in the specialty has become more critical. Concerning this problem, the American Board of Anesthesiology started issuing time-limited certificates of nurses. Being launched in 2000, the program is focused on “self-improvement…and evaluation of clinical skills and practice performance to ensure quality, as well as public accountability” (Stoelting and Miller, 2007, p. 13). Hence, one of the main components includes unrestricted state license, an indicator of professional standing. All certifications and licensing procedures are aimed at certifying requirements and conducting written examinations.
It should be stressed that the profession of nurse anesthetists has the longest history in legal terms, specifically in the sphere of practice. Therefore, the overlap in performing functions is well acknowledged within the health care community. Such a situation has a significant influence on medical services and workforce employment.
Discuss key events/issues in the specialty areas and their influence on nurses’ practice
The nature of anesthesia care is complex because physiological and surgical events being beyond the control of the health care professionals may require a rapid intervention for sustaining activities and decision-making processes (Iyer, 2001, p. 349). In this regard, a nurse working within this specialty area should have a high level of autonomy and competence and share responsibility with other health care professionals in a constantly changing medical environment.
There are many critical factors shaping events in the anesthesia field, yet health care representatives try to sustain their obligations and function by health care standards. The examination of cases connected with CRNA care should be more careful to understand the main clinical principles of anesthesia safety, as well as legal responsibilities, hold up by the professionals.
Nowadays, CRNAs work with surgeons and anesthesiologists and, therefore, it is the main actor in creating specific requirements and programs sustaining the nurse practice. Nevertheless, there are many other events and factors influencing nursing activities and politics is one of them. The AANA has gained experience in legislative and political spheres and has found that political aspects play an important role in changing the nurse practice and specialties development (Mason et al., 2005, p. 587). Even though politics cannot be always fair, it is essential for health care professionals to be engaged in the political process. There are also other sources of power regulating the nurse specialties which have a detrimental impact on nurse anesthesia.
The above considerations of legal and political aspects of nurse practice in the field of anesthesiology have revealed that it has a great influence on the nurse profession and practice in general (Mason et al., 2005, p. 588). In particular, it has a huge impact on establishing professional, legal, and ethical standards and provides certain changes to the medical care standards. Because the profession of a nurse anesthetist is complicated, it is still more connected with legal responsibility for the chemicals and drugs that nurses deal with. In addition, the involvement of legal issues has greatly affected other nurse specialties where the focus is now made on the considerations of professionals’ duties and accountability.
Conclusion
A deep analysis of such a nurse specialty as anesthesia practice has revealed a great number of issues and paradoxes. In particular, this nurse specialty is recognized as a highly technical and complex sphere that opposes significantly to other care specialties and engages patients in a wide range of surgical, therapeutic, and diagnostic procedures.
The major problem lies in the fact that nurse anesthesia creates serious deviations from the established standards in medical care. Similarly, it makes nurses acquire more specific skills and take responsibility for decision-making and problem-solving processes. In this respect, the analysis of reasons and underpinning of the specialty affects greatly the nursing profession in general and nurse practice in particular.
This influence is specifically disclosed through legal, ethical, and practical issues that are closely connected with the long history of adjustment and adoption of this specialty. In this regard, the leading role in this situation is granted to such leading organizations as the American Association for Nurse Anesthetists and the Certified Registered Nurse Anesthetist who take full responsibility for regulating and administering all educational programs and legal procedures.
Reference List
Cherry, B., and Jacod, S. R. (2005). Contemporary nursing: issues, trends, & management. US: Elsevier Health Sciences.
Iyer, P. W. (2001). Nursing Malpractice. US: Lawyers & Judges Publishing Company.
Jansen, M. P., Jansen, M. P. M. and Zwygart-Stauffacher. (2009). Advanced practice nursing: core concepts for professional role development. US: Springer Publishing Company.
Keeling, A. W. (2007). Nursing and the privilege of profession, 1893-2000. US: Ohio State University Press.
Klainberg, M. B., and Dirschel, K. M. (2009). Today’s nursing leader: managing, succeeding, excelling. US: Jones & Barlett Learning.
Mason, D. J., Leavitt, J. K., and M. W. Chaffee. (2007). Policy and politics in nursing and health care.
Mezey, M. D., and McGivern, D. O. (2003). Nurse Practitioners: Evolution of advanced practice. US: Springer Publishing Company.
Stoelting, R. K. and Miller, R. D. (2007). Basics of Anesthesia. US: Elsevier Health Sciences.