This is the first in a two-part story looking at advanced practice nursing. Next month we will explore opportunities for nurse practitioners.
D'Ann Somerall, DNP, FNP-BC, says people tend to look at nursing differently from other professions. In general, they assume that nurses will give bedside care for their entire career. But the assistant professor and family nurse practitioner specialty track coordinator at the UAB school of nursing knows otherwise.
"When you are in a profession, you always want to do better," she said. "Nurses enter the profession to give bedside care, but they want to advance like anyone else."
Advanced practice nursing provides that opportunity, while proving to be a large part of the solution for the lack of primary care physicians in rural Alabama.
There are a number of options for nurses who desire expanded responsibility. One possibility is to become a sexual assault nurse examiner (SANE). Chris Jolliffe, RN, SANE-A, SANE-P, is the coordinator for the sexual assault program for Children's of Alabama.
A minimum of one year of experience as an RN is required for certification, along with 40 hours of advanced training. While they are not technically advanced practice nurses, SANEs do see patients independently in collaboration with a medical director. There are currently only about eight board certified nurses for adults and five for children in the state. Only three of those are certified for both populations. Jolliffe sees a need for more SANEs, and she is currently training 30 more nurses to serve in this capacity. It is not required to have board certification to work as a SANE, but the Alabama Board of Nursing requires coordinators to obtain certification.
Jolliffe specializes in pediatric abuse (patients up to 18 years old). Other nurses may serve through rape response centers and see adults (14 years old to death). They perform the post-abuse examination and refer victims and their families for counseling. They also testify in court. Most of the work in this area is contract work, and nurses are paid for call and per exam.
"We need more SANEs at Children's, but they have to work in the emergency department to be part of our program," Jolliffe said. "There are hospital-based rape response programs around the state looking for more SANE nurses."
Jolliffe resisted the pull to do this work for several years. Then she helped with the care of a little girl who was being seen by a sexual assault nurse. "That three year old had lost so much blood, but she had a smile on her face, because the sexual assault nurse was so compassionate," she said. "Seeing them interact made me fall in love. We hear horrible stories, but to be able to take such a horrific day for these patients and soften it for them makes it worthwhile."
Brent Ledford, CRNA completing case documentation before heading to the recovery room.
Nurses who complete the Certified Registered Nurse Anesthetists (CRNA) advanced practice degree also find their work to be worthwhile, according to Brent Ledford, CRNA, president of the Alabama Association of Nurse Anesthetists. "According to our national association polls, CRNAs have a job satisfaction rate of roughly 95 percent," he said.
"We are often termed the best-kept secret in health care," he said. "We do most of our work in the operating room, and often patients don't even realize they've been cared for by a CRNA. The anesthesia provider gets to spend only a few minutes with them before their surgery, and when I see them in recovery, they are often still foggy."
In addition to earning a bachelor's degree in nursing, CRNAs must have a minimum of one-year experience in an intensive care unit setting. Anesthesia programs currently run 27 months and award degrees at the master's level. The successful graduate must then pass the certifying exam, and maintain 100 hours of continuing education every four years to be eligible for recertification.
Ledford wants to see CRNAs have a more visible role in the healthcare community. "The nearly eight years of education and work experience that it takes to become a CRNA allow us a unique perspective within the operating room environment," he said. "The more we can interact with healthcare professionals outside of the operating room, the more impact we're able to have. We are bright, capable providers, and we often have ideas to offer that can increase efficiency, cut costs, and maintain quality and safety. We have a full range of abilities and can be an effective resource on general health care committees."
CRNAs can also play an important role in serving rural communities in the state. "CRNAs are often the primary care providers in much of rural America," Ledford said. "We do anesthesia for obstetric surgery, pain management, and trauma stabilization. Many rural hospitals with an anesthesia program have it partly because a CRNA was willing to move to that area and provide anesthesia services there."
Ledford touts the cost effectiveness and the safety record of CRNAs. "Of the three practice models for anesthesia delivery - where an anesthesiologist personally delivers anesthesia; an anesthesiologist and a CRNA work together; or a CRNA delivers anesthesia without an anesthesiologist's supervision - the most cost effective model is the CRNA doing the cases. And, our safety record is stellar," he said.
Advance practice nursing degrees have proven to be an effective way for nurses to interact with patients on an increased level.
"Nursing has been named the most trusted profession," Ledford said. "It means a lot to be there for our patients."
Brent Ledford, CRNA - have to get a caption for this.
Chris Jolliffe, RN:
Chris Jolliffe, RN, SANE-A, SANE-P, is the coordinator for the sexual assault program at Children's.