White coat black art26:30Should Canada be a Nurse Anesthetist?
The impact of the shortage of anesthesiologists could be ameliorated if specially trained nurses were allowed to provide anesthesia care — which they do in the United States, nursing advocates say.
But doctors' groups have pushed back against the idea in at least two provinces since it was raised more than 25 years ago, even as surgery wait times have increased since the pandemic.
In America, there are 65,000 certified registered nurse anesthetists (CRNAs) working. In Canada, nurses haven't been able to provide anesthesia since the end of World War II, says Valerie Grdisa, CEO of the Canadian Nurses Association. .
Now nurse associations, and some Canadian nurses working as nurse anesthetists in the U.S., are paying attention to how they can effectively address the shortage of anesthesia care providers in this country.
While Gradisa notes that the US health-care system has enough problems with access and cost, one thing it does well is make efficient use of its workforce.
“They're optimizing their very talented workforce in a way that we're not (in order to) get the same or better value for money at the same outcome,” said Grdisa, who has a PhD in nursing. She was part of an effort to establish a nurse practitioner program in anesthesia at the University of Toronto that ran for a few years in the early 2000s, but she said it was dismantled before graduates could enter the Ontario health-care workforce. The Physician Lobby” persuaded the province to abandon the idea.
Nurse anesthetists in America administer more than 58 million anesthetics—medications that cause loss of feeling or consciousness—to patients each year. American Association of Nurse Anesthesiology. In rural areas, they provide more than 80 percent of anesthesia care.
Canadian nurse Jo Toma lives in Windsor, Ont., and works as a nurse anesthetist at Henry Ford Health, just across the border from Detroit. He says three of his classmates who graduated from CRNA training also make the half-hour commute every day.
On the day he spoke to the CBC, Toma said he had been transferred to the endoscopy unit, where the inside of a patient's organs are examined with a scope. Since one anesthesiologist could supervise four CRNAs at his hospital, Toma and two others were in the room with patients, while the anesthesiologist worked in the pre-op area assessing patients before their procedures.
“So it's like a great use there where one person is able to assess patients in the pre-op and recovery areas and respond if there's an emergency,” Toma said.
“Obviously there are long wait times in Canada and I think everyone knows that one of the major contributing factors is the shortage of anesthesia providers,” he said. “So, if you have CRNAs in Canada, you will definitely improve operating room access for Canadian citizens.”
Surgical waiting
In the years leading up to the pandemic, surgical wait times were long but improving, according to statistics Canadian Institute for Health Information (CIHI). But closures related to COVID-19 meant that in the two years between April 2020 and March 2022, about 600,000 fewer surgeries were performed than usual.
Although surgery volumes have returned to pre-pandemic levels, CIHI data show that fewer people today undergo surgery within the recommended time frame — 48 hours for hip fractures, for example — than they did in 2019.
An editorial published late last year Canadian Journal of Anaesthesia A shortage of anesthesiologists in Canada has developed and created a major barrier to surgical access, with “most anesthesiology departments in Canada now reporting significant challenges in recruitment and retention.”
Given the global shortage of anesthesiologists, the editorial also said that anesthesia human resources in Canada are handled in a “patchwork manner” at the provincial and local levels and called for a national standard. More than three decades of strategy in anesthesia have had limited impact.
Canadian CRNA Josh Booth works at William Beaumont University Hospital in the Detroit area, although unlike Toma, he now lives in Bloomfield Hills, Mich., in the US.
“I'm friends with nurses who work in operating rooms in southern Ontario, and they tell me they don't understand how there are any nurse anesthetists practicing in Canada,” Booth told Dr. Brian Goldman. White coat, black art.
While he admits there are a variety of reasons why surgery can be postponed, Booth says a lack of anesthesia care is one of the reasons behind the backlog of surgeries.
He says he knows about 200 fellow Canadians who work as nurse anesthetists in the U.S., and he believes some of them want to provide care in Canada, although “nothing seems to have changed.”
The BC plan went awry
In 2012 He said he was checking the options Nurse practitioners were committed to and advancing anesthetists. The BC Nurses Union says it is fully behind the plan.
But it didn't advance to 2021 or again, which is When the province said it was considering creating new nursing roles such as nurse anesthetists one more time.
“The use of nurse anesthetists in BC will be a positive step in collaboration between different health disciplines and will be beneficial in improving patient care,” the BC Nurses Association said in a written statement provided to CBC.
A spokesperson for BC's Ministry of Health said it plans to add 152 anesthesiologists and 71 anesthesia assistants between 2020 and 2024. During that time it has also established a task force to increase residency spots for anesthesia and work in areas where anesthesiologists are most needed. The new grades, the spokesperson said.
Defines the Canadian Society of Anesthesiologists Anesthesia adjuncts As a specially trained health professional who participates in the care of stable surgical patients under the supervision of anesthesiologists.
CRNAs qualified as autonomous anesthesia providers are able to make independent decisions about patient care and can work in settings both with and without a supervising anesthesiologist. They can intubate patients, provide anesthesia to people undergoing surgery and administer epidurals in labor and delivery wards, for example.
The Canadian Society of Anesthesiologists opposed plans to introduce CRNAs in 2021 and came out with a position statement that said “Strongly denies“Nurse Anesthetist in Canada. This job is for doctors.
Anesthesiologist at the Jewish General Hospital in Montreal. Giuseppe Fuda is president of the Canadian Society of Anesthesiologists.
“We prefer to work on the anesthetist assistant system rather than importing American solutions,” Fuda said.
While a lack of anesthesiologists can sometimes be behind surgery cancellations, Fuda said, “mostly they're not.”
“Unfortunately, there are other reasons why operations are cancelled. And that could be because of nursing shortages or non-availability of beds. Patient calls, sometimes equipment is also missing,” he said. “It happened to me yesterday where we lost the tools to be able to fix a broken hip, and we had to cancel the surgery because of that.”
Fuda said the society is working to address the shortage by increasing residency spots for medical graduates interested in anesthesiology, lowering barriers for internationally trained anesthesiologists, and addressing barriers in hospitals that limit access to beds.
“A physician-dominated system in Canada” prevents nurse anesthetists from working here, said Grdisa, with the Canadian Nurses Association, adding, “We know it would be better workforce optimization and lower costs.”
An article in the Canadian Journal of Anesthesia in December was titled “The anesthesia human resource crisis in Canada” – written by anesthesiologists – the current model is “not meeting population needs.”
See | Lack of anesthesia affects access to epidurals:
Health PEI says epidural pain medication during labor may not be available until Sept. 2 at Prince County Hospital due to a lack of physician coverage.
An accompanying editorial emphasized the importance of learning from how anesthesia care is delivered in other countries. “Such evaluation necessarily involves an examination of our own old prejudices and an openness to new ideas.”
Gradisa said Canada's health-care system is the second-most expensive among OECD nations, and a “siloed” model where the workforce is not used to its full potential is to blame.
“It's really unfortunate that we have these skilled, highly talented nurses across the country who seek graduate-level education south of the border, and they can't be adapted to the Canadian health-care system.”
