by Douglas Walter
nursing field with a unique independence and responsibility helped Cheryl Blankemeier decide that she would pursue training as a certified registered nurse anesthetist (CRNA). She was working at the now-decommissioned Fitzsimons Army Medical Center in Denver in the mid-1970s.
Blankemeier joined the military late in the Vietnam War and took advantage of the government’s large nurse-training program at the time. She earned a bachelors degree while serving and eventually became a staff nurse at Fitzsimons’ intensive care unit.
While there, she shadowed a nurse anesthetist to learn about administrating anesthesia to patients during surgery. She saw that the work allowed the nurse to work with one patient at a time, which sparked her interest.
"CRNAs are trained to work independently," Blankemeier said. "For me, that was very appealing. It was taking everything I had learned and using it to focus on one patient who needs me very badly."
Much of the patient’s comfort and safety is in her hands during surgery.
Nurse anesthetists are one of the oldest and first recognized certified nursing specialties, dating back to the late 1800s. At the time, doctors wanted to reduce a high mortality rate associated with anesthesia, according to the American Association of Nurse Anesthetists. Surgeons believed that nurses should administer anesthesia and give their undivided attention to the patient.
The first formal educational programs for the field were established in 1909. A decade later, during World War I, nurses became the primary anesthesia provider in combat areas, which continues today.
In fact, Blankemeier served during the first Gulf War as a nurse anesthetist, working at the first ground hospital established in the region after the invasion of Iraq. Today, she works for Anesthesia and Pain Management PC, a group of nurse anesthetists. With the group, Blankemeier contracted to provide her service at three surgical centers in the Denver metro area, an arrangement typical for this field, she said.
But with great responsibility comes ample training.
Nurse anesthetists have to go through rigorous process before being certified. They must complete a bachelors degree, have at least a year working in intensive care and then two to three years of additional training and education in a specialized nurse anesthetists program. Often, the additional education is part of a masters degree program.
Nurses in this field become experts in pharmacology, understanding what agents are needed for different types of patients and different types of surgeries. They must know how fast an agent will take affect, when it is peaking and when it wears off.
"There is a certain art in having a patient sleep smoothly and waking them up at the right moment," Blankemeier said.
Along with understanding the pharmacology, nurse anesthetists monitor cardiovascular changes and breathing, as part of being responsible for the overall well being of the patient while being under sedation. Sometimes they administer artificial airways to insure breathing or titrate anesthesia agents to control heart rates.
"We are intensely monitoring the patient," Blankemeier explained.
"It’s heartbeat to heartbeat monitoring ... With any nursing job, there are certain skills you have to have. With us, we develop skills in airway management and monitoring cardiovascular changes."
As far as patient care, the field is also fairly unique when compared to floor nursing positions. The nurse anesthetist can have a limited relationship with the patient. But at the same time, the patient puts a tremendous amount of faith in the nurse, who sits at the head of the bed and guides them through the operating-room experience.
"I think that in terms of developing a rapport with a patient, it happens fairly quickly in this field," Blankemeier said.
And like other nursing fields, nurse anesthetists have a broad range of choices when it comes to the type of job they want. They can pursue working in trauma or pediatrics, for example, and become specialized in particular fields.
The job also pays pretty good, largely because of the educational requirements. Blankemeier, who also is the president of the Colorado Association of Nurse Anesthetists, estimated that the salaries start around $120,000 locally, but can vary depending on the schedule and the type of work.
Typically, nurse anesthetists compete directly with doctors trained as anaesthesiologist. In some situations, the doctors could get paid a little more. But currently, there’s a drought of good people in the field, making nurse anesthetists just as sought after as doctors, Blankemeier said.
And salaries have reflected this need for the nurses. Physician recruitment firm LocumTenens released a survey this year that suggest that salaries have risen 46 percent between 2000 and 2005, with average compensation in 2005 around $150,000 a year.
Blankemeier is working to draw more attention to the field to recruit more nurses. She said it can be difficult, because nurse anesthetists work behind closed doors.
"Whenever you work in an operating room, you work behind closed doors and people don’t understand what you do exactly," she said.