Janet Izlar, CRNA, DNAP, '06
Janice Izlar, CRNA, DNAP, (MS ’06) is the current president of the American Association of Nurse Anesthetists (AANA). The Association represents 44,000 Certified Registered Nurse Anesthetists (CRNAs), and sets practice standards and guidelines on behalf of CRNAs, with a special emphasis on advocacy for legislative and regulatory scope of practice, the equitable reimbursement of services and strengthening education programs. With the re-election of President Obama, we wondered what challenges are facing nurse anesthetists now that health care reform is taking shape across the nation.
Q. The AANA has an active legislative and regulatory agenda. What do you see as one of its high-priority issues?
A. Many of the 30 million people who will be eligible for government financed health care in 2014 will require anesthesia and pain management services. We want to be sure that we will be there for them when they need anesthesia services without any restrictions to scope of practice. Right now, as the laws are written, generally nurse anesthetists have the ability to practice to the full extent of their education and training, and thus our challenge is focused on maintaining current opportunities and assuring appropriate interpretation of laws and regulations.
Where we recently had a challenge, however, is in the area of reimbursement for chronic pain management services. Nineteen months ago, two Medicare carriers stopped paying for CRNAs providing this service requiring the AANA to go directly to CMS to reinstate the payment. The outcry by CRNAs was enormous, as well as support from patients and organizations such as the American Nurses Association, National Rural Health Association and the AARP. This past January the rule that Medicare carriers must pay for anesthesia services provided by CRNAs was reinstated. Going forward, we want to be sure that our services can be delivered unobstructed by a funding mechanism.
Q. What can be done from a clinical perspective to ensure they are ready to meet the challenge of health care reform?
A. Cutting edge education for entry-level CRNA preparation is essential, as well as continued professional competencies. We were the first nursing specialty to mandate continuing education. It is an ongoing challenge and of paramount importance to have the adequate clinical experience — in all techniques of anesthesia — prior to entering the workplace. When you graduate we are saying that you are competent to practice and we work to ensure that your competence continues at the highest standard possible for the future. The Council on Accreditation of Nurse Anesthesia Programs surveys our grads and their employers carefully and find they are competent anesthesia providers. Healthcare economics will demand that CRNAs assume more autonomous practices, and we are absolutely prepared to do that.
Q. You were already a nurse anesthetist when you came back to Columbia University School of Nursing for a Master’s degree. Why did you go back and get the advanced degree and why did you choose Columbia?
A. The short answer is that it bothered me that I didn’t have a degree from my educational training. I went back to get a BS in biology soon after graduating from a diploma CRNA program, but it troubled me, as a nurse anesthetist leader, that many of my peers in the 80’s and 90’s had Master’s degrees and I did not. I wanted my signature to have a Master’s degree on it, too. So after extensive research I decided on pursuing a Master’s degree at Columbia University School of Nursing because the program was just right for me and matched my needs. Because I had been away from an academic setting for many years, I didn’t want an online program so I flew back and forth from Georgia to New York every week for a year. I am enormously grateful for the opportunity CUSON gave me. It was worth the money and it was worth the time. It broadened my knowledge as a CRNA and expanded my perspective of the healthcare system. By graduation I received far more than letters after my name.
Q. The contribution of advanced practice nurses like CRNAs are often invisible to patients, their families, and the community. What can be done to give CRNAs a higher profile?
A. The first thing I’d say is that regardless of the setting where you are providing care, nurses need to step into leadership roles and educate the community of the value we bring to the system. We need to proudly let other members of the healthcare system and community leaders know the benefits we offer as health care providers, which not only encompasses the care and compassion we give our patients, but also the intellectual ability and education to provide that care as nurses.
As nurse anesthetists, we care for patients during some of the most high stress moments of their lives. They are afraid, and are entering an unfamiliar world. We reassure patients and their families then deliver high quality anesthesia care until they are transferred to the post-anesthesia care nurse. We need to be extremely proud to be nurses. It’s an honor to be a nurse caring for a patient.