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More Leadership Stories and How You Can Write One of Your Own

By on Jul 14, 2015 in Announcements, Board Updates | 3 comments

We thought you might like to hear from a few more TANA leaders about what their service has meant to them.  Enjoy reading their stories below!  And remember, Wednesday, July 15th, is the deadline for completing your Intent to Serve form so that you too can join the ranks of these dedicated individuals and all the other wonderful TANA leaders. “Serving TANA has been a wonderful experience, whether as a Committee member, Chair or Director.   I have enjoyed networking with colleagues across the state, meeting our state legislators, and understanding in more detail how AANA and TANA work.  As a full-time CRNA with a family, life is busy.  My primary concern when I got involved was the time commitment.  I can honestly say that the time commitment has been more than reasonable, and being engaged provides me with professional rewards.  Being a part of our organization who protects our practice rights during this dynamic time in healthcare is paramount.  Engaging with the SRNAs and mentoring them through leadership further insures our future.  Lastly, being active allows me to keep co-workers current and informed.  I hope that you will consider running for a position… you won’t regret it.” David L Klappholz, CRNA, MSN, APN District V Director “Serving on the TANA board has been more of a delight than I had imagined.  As a new member I was unaware of the very difficult task of running our organization.  However after attending my first board member meeting I saw professionalism exuding from all the elected officials.  Also working with people like Lisa Bowler, her business associates, and the TANA “lobbyist” organization make for an even more enjoyable job.” Eddie Milam, CRNA, APN District I Director “I have been privileged to serve TANA and the TN CRNAs in several capacities, either as a committee member or chair and most recently as Director of District IV for the past 4 years.  It has been exciting, and sometimes frustrating, to be in midst of meeting with legislators about vital issues that threaten and/or support our scope of practice at both the state and federal levels.  The passion of the those who serve is contagious.  It is rewarding to watch our state’s students become engaged and committed to supporting our profession as they, too, become CRNAs.  I have met people I likely would not have had the opportunity to meet otherwise.   You build friendships that will last a lifetime.  I am so proud to support our noble profession through TANA.”   Linda Hill, DNSc, CRNA, APN District IV...

TANA Leaders Tell All: What Serving You Means to Them

By on Jul 13, 2015 in Announcements, Board Updates | 0 comments

It’s time once again for TANA members to choose those who will serve them throughout the coming years as TANA officers, board members, district directors, and committee members.  And time is running out to submit your Intent to Serve forms. If you have an interest in serving, please click here to complete this form no later than Wednesday, July 15, 2015.  You can also read more about the positions currently being filled and the requirements for each by clicking here. To help answer your questions about why we serve, we thought we would ask some current TANA leaders what serving their state association has meant to them.  Read a few of their responses as to what they’ve enjoyed about giving back to their profession and how much they have benefitted both personally and professionally from the experience. “I chose to serve TANA to give back to the profession that has given me so much.  I had no experience with this type of work on the state level previously, so I wasn’t sure what to expect. I quickly learned that I gained an immediate support system of mentors and colleagues from across the state to help guide and educated me. As a District Director, I realized that the time commitment was not overwhelming, and that the experience I was gaining was worth more than the time I volunteered.  Networking has also been one of the most valuable aspects of serving TANA.  I’ve always said that the anesthesia community is very small, but in serving as your state President, I realize that this still holds true at the national level.  Because I served, I now have a more fully developed appreciation for nurse anesthesia as a profession, and not just an ordinary job.” -Julie Bonom, CRNA, DNP, APN TANA President “Starting with my first meeting, serving on the board has been very eye opening, and the educational value is priceless. I now realize what happens behind the scenes and how much time is volunteered. The time on the board has allowed me to meet senators, representatives, and many other influential people, along with many new friends. It has been an honor to serve on the board and one I feel anyone should do if you are so driven.” -Bob Silvia, CRNA, MS, APN District II Director “I have been blessed to have the opportunity to serve on the TANA board. I believe strongly with much privilege comes much responsibility. I also believe it is important to pay it forward. Many CRNAs have gone before me advancing the profession so I may enjoy the fruits of their labor. Can I do any less? I am grateful to be a CRNA; it has been a great blessing to me and my family. I also have learned so much from the experienced and talented board members who work diligently to protect our right to practice. I have entered a profession not just taken a great job. Our right to practice is always in danger and being involved gives me a great deal of satisfaction serving our members. I would suggest the more your involvement the more your appreciation.” Matt Demaree, CRNA, MSN, APN District III...

The Two Best Ways You Can Take an Active Role as a TANA Member

By on May 14, 2014 in Announcements, Board Updates, Notes from the President | 0 comments

Dear TANA Members: The 2014 TANA election is approaching, and now is the time for you to represent and support your profession- Nurse Anesthesia.  CRNAs experience practice, reimbursement, and recognition threats annually, and the only way to procure and promote your profession, practice and livelihood is by being involved as an active TANA member. Ask yourself these important questions.  Is now the time for me to increase my involvement in TANA and gain exposure to the inner workings of the organization? Am I encouraged to evaluate the importance of my profession in my daily life? Am I giving back?  And can I do more? If you answered yes to any of those, here are two ways you can increase your involvement. First, take the time to serve on the TANA Board of Directors or as District Director.  Many CRNAs shy away from this and feel intimidated by the thought of serving.  They have strong reservation about the time commitment, and their own lack of experience.  This fear of the unknown is common but–like so many other new things–it often only takes a moment for those fears to dissipate and those initial apprehensions to be alleviated. This holds true to serving TANA as well.  Take the time to put your name on the ballot.  You never know if you will like something until you try it.  The reward will be invaluable.    This year the following positions are up for election: *        President Elect (must have served as a TANA board member to run for this office) *        District I Director- Memphis area.  Must live in the district. *        District III Director- Nashville/Middle TN area.  Must live in the district. *        District V Director- East TN.  Must live in the district. *        TANA Nominating Committee Member Click here to see which district you live in if you are uncertain. To run as a candidate, a TANA Intent to Serve Form must be submitted to the TANA office no later than July 15th per the TANA Bylaws.  Click here to fill out the online form. The second way you can get involved is by serving on or being the chair of a committee.  Click here to see a list of committees on the TANA website. Now is the time to be part of the process and keep TANA growing and moving forward.  Let’s have multiple CRNAs on the ballot for each position.  We are looking forward to getting to know you and serving with you! Mark J. Haffey MSN, CRNA, APN TANA...

What Opt-out Is and Is Not

By on Mar 7, 2014 in Board Updates, Uncategorized | 4 comments

HISTORY OF PHYSICIAN SUPERVISION OF CRNAS UNDER MEDICARE In 1982 the Health Care Financing Administration (HCFA) that later became know as the Centers for Medicare and Medicaid (CMS) revised the conditions of participation for ambulatory surgical centers (ASCs) to require physician supervision of CRNAs and in 1986 revised the conditions of particiaption for hospitals to require supervision of CRNAs. What are “Conditions of Participation”?  These are the conditions that ASCs and hospitals must meet for reimbursement for providing services and care to Medicare patients under Part A of Medicare. As you know there are three parts to Medicare. 1)    Part A is for facilities such as ASCs, hospitals and critical access hospitals. 2)    Part B is for providers such as physicians, CRNAs and other providers that are allowed to bill Medicare directly. 3)    Part D which is prescription drugs. There are no supervision requirements for physician supervision under Part B of Medicare. In 1990, the President of a state nurse anesthetist association wrote a letter to HCFA regarding concerns about the federal supervision requirement and requested a definition of the term “supervision”.  HCFA responded with a general definition of supervision and a policy interpertation.  This lead to many meetings between HCFA and the AANA in which AANA requested that the physician supervison requirement be dropped, and that the federal government defer to the states. In 1994, legislation was introduced in both the House and Senate providing for fair anesthesia payment and defferal to state law on the issue of physician supervison.  Also in the fall of that year, HCFA issued draft regulation in the Medicare Conditions of Participation for Hospitals which includes the removal of physician supervision of nurse anesthetists. During 1995, AANA continued to inquire of HCFA when the regulations would be released and members continued to lobby Congress for direct reimbursement and removal of the supervision requirement.  Bills were introduced for removal of the supervision requirement, and direct reimbursement for CRNAs, but were not included in the final Medicare package.  In 1995, direct reimbursement was passed to become effective in 1998, but the supervision issue remained unresolved. In December 1997, HCFA issued a proposed rule deferring to the states on the supervison issue.  A comment period was held, and AANA members continued to lobby Congress during the Mid Year Assemblies. On January 18, 2001, two days before President Clinton was to leave office, HCFA  and HHS published the rule to defer to the states in the Federal Register.  The rule was to go into effect March 18, 2001. March 18, 2001, President Bush freezes the rule for 60 days pending further review.  May 18. 2001, the Bush Administration freezes the final rule for 180 days and suggested a new rule be issued that would permit state governors to request a waiver from the Secretary of HHS and require a study of anesthesia outcomes.  There was a 60 day comment period and the final rule on Opt Out was final on November 13, 2001. OPT-OUT Essentials for Each State For a state to opt out of the federal requirement for supervision of CRNAs, the state’s governor must send a letter to the Secretary of HHS requesting that the state opt out of the supervision requirement.  The letter must attest: 1. The state’s governor has consulted with the state boards of medicine and nursing about issues related to the access to and the quality of anesthesia services in the state; and, 2. That it is in the best interest of the state’s citizens to opt-out of the current federal physician requirement; and. 3. That the opt-out is consistent with state law. The consultation with the boards of medicine and nursing is not defined by CMS and gives the governor flexibility and the boards do not have to submit comments.  CMS believes that the governors are best suited to make the determination for an opt-out.  Governors can at any time request that a previous opt-out be withdrawn as well.  This happened in one state, where the governor later after a period of time, decided to continue the opt-out. When a state has opted out of the federal requirement, it does not necessarily change the practice of CRNAs in the state.  The facilities may still require physician supervison of the CRNAs in the bylaws of the facility.  The opt- out would not permit a CRNA to practice outside the scope authority granted by state law. A state opt-out takes a great deal of planning and each state needs to prepare for the battles to follow. It should be noted that lawsuits are most likely going to be filed, and legislation be introduced for strict supervision.  Having a relationship with the Governor’s office is essential to the opt-out process. There are those that would have facilities and others providers to believe that the requirement for physician supervision is a practice requirement, but it is not a practice issue, it is a reimbursement issue for the facility to be reimbursed for those services rendered to medicare patients. To date, 17 states have opted out of the supervision requirement.  Some of the states have been faced with lawsuits being filed to reverse the opt-out but the outcomes have been positive. Iowa 2001 Nebraska 2002 Idaho 2002 Minnesota 2002 New Hampshire  2002 New Mexico 2002 Kansas  2003 North Dakota 2003 Washington 2003 Alaske 2003 Oregon 2003 Montana 2004  A new Governor reversed the opt-out but after...

New Things You Want to Learn but Fall Asleep Reading About …

By on Sep 24, 2013 in Board Updates | 1 comment

New Things You Want to Learn but Fall Asleep Reading About … (aka Update! New Advances in Clinical Anesthesia Practice) Let’s face it, we’re all interested in learning about the “latest and greatest” in clinical anesthesia, but after the long working day, afternoon errands, and family obligations, WE’RE EXHAUSTED!  Just as you find that quiet moment to sit down and read, your eyelids simply Refuse. To. Stay. Open…zzzzz So I’ll give you a brief rundown on what’s happening now with links to explore more details whenever your eyelids can cooperate! Intraoperative Acceleromyography The pure technical nature and number of syllables in these words immediately invoked in me the feeling of “you’re really going to have to focus for this one…”  However, once my inner techie discovered that this involves a cool gadget for quantitative monitoring of neuromuscular blockade to more accurately determine residual neuromuscular weakness, I was sold on learning more! The acceleromyograph is a device that measures muscle acceleration across a joint in response to nerve stimulation.  That acceleration correlates with the force of muscle contraction therefore providing a quantitative, objective measure of residual muscle weakness beyond the traditional qualitative, subjective measures typically used. This concept is not really new, but has been in the works for quite some time. Clinicians have been seeking more accurate ways of measuring residual neuromuscular blockade in an attempt to decrease adverse postoperative events that occur as a result.  As with any new technology, it takes time for studies to prove its worthiness, describe its strengths and weaknesses, and produce a device that is affordable and safe for clinical use.  For that reason, this device is just beginning to surface in many ORs.  My experience with the acceleromyograph is a result of its integration into the newest anesthesia machine our department purchased, the GE Aisys.  Other manufacturers are following suit as well. To embrace your inner techie, you can read more here: Brull, S. J. & Murphy, G. S. (2010). Residual neuromuscular block: Lessons unlearned. Part I: Definitions, incidence, & adverse physiologic effects of residual neuromuscular block. Anesthesia & Analgesia, 111(1), 120-128. doi: 10.1213/ANE.0b013e3181da832d The above article is free & available online at http://www.anesthesia-analgesia.org/content/111/1/120.long Brull, S. J. & Murphy, G. S. (2010). Residual neuromuscular block: Lessons unlearned. Part II: Methods to reduce the risk of residual weakness. Anesthesia & Analgesia, 111(1), 129-140. doi: 10.1213/​ANE.0b013e3181da8312 This above article is free & available online at http://www.anesthesia-analgesia.org/content/111/1/129.long Sandberg, W. S., Urman, R. D., & Ehrenfeld, J.M.  (2011). The MGH textbook of anesthetic equipment. Philadelphia: Elsevier Saunders. IV Ibuprofen – Caldolor I recently received a visit from our area’s Cumberland Pharmaceuticals rep to hear his plug for IV ibuprofen (trade name Caldolor).  I’m always a little skeptical about sales pitches in general but try to be open-minded about the potential of any new drug.  Caldolor actually received FDA approval in 2009, but until recently I hadn’t really heard any buzz about it.  This leaves me wondering if there is a new wave of sales promotions designed to ride the coat tails of IV acetaminophen’s (Ofirmev) success.  Regardless, it seems rational to consider the possibilities.  Here are the basics: • Indicated for pain and fever in adults • Administered pre-op, intra-op, or post-op • Dosing:  400mg q 4-6 hours or 800mg q 6 hours • Infuse over 30 minutes • Added anti-inflammatory benefits of other NSAIDs like ketorolac, but with fewer side effects related to bleeding, gastric upset, and renal issues Unfortunately, this drug is not on my hospital’s formulary, so I don’t have any personal experience to comment upon. I would love to hear opinions from those who have! Get the full details and prescribing information at www.caldolor.com. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) In healthcare, we all love the mystery of a new abbreviation.  This time my curiosity was peaked when one of my students told me about a new “hi-tech” procedure she was involved in (but only briefly involved in because it was potentially dangerous for her, at a childbearing age, to be in the room…..THAT got my attention!). HIPEC (not “hi-tech” as I thought I heard) is a procedure available to treat advanced abdominal cancers such as peritoneal mesothelioma, pseudomyxoma peritonei, colorectal cancer, and ovarian cancer. This procedure is new to my facility, but has been performed successfully at other leading medical centers across the country. HIPEC involves surgical exploration, tumor debulking, and application of heated chemotherapy to the peritoneal cavity. The chemotherapy solution is left in the abdomen for 1.5 to 2 hours. This phase of the procedure is referred to as “shake and bake” where the surgeon ensures the chemotherapy solution is evenly distributed throughout the peritoneal space. Confining the chemotherapy to the peritoneal cavity allows for usage of higher concentrations of agents while minimizing systemic toxicity and side effects. Patient and healthcare provider safety is of utmost concern during this procedure due to the potential exposure to cytotoxic agents.  Routes of exposure include: inhalation, contact, ingestion and injection. Essential equipment that should be utilized and/or readily available includes: unpowdered latex gloves, impervious sterile gowns, protective eye wear, respirator mask (if a spill occurs), a spill kit, an impenetrable hazardous waste container, specially marked linen bags and appropriate cytotoxic agent labels. With regard to providers’ repeated involvement with these cases, Stephens et al (2010) state, “Because the toxicities of low level cumulative exposure are not well defined, personnel who have specific medical concerns should...