There is no “I” in Healthcare: Interproffesional Practice Between CRNAs and ICU Nurses.
The continuity of patient care is essential to maintaining the safety of the patient. This is accomplished through effective communication and collaboration between all healthcare professionals especially ICU nurses and CRNAs. Our goal should be an active and dynamic teamwork approach the entire time the patient is in the hospital all the way from admission to discharge. This holds true especially for areas that stabilize, transport, and care for high acuity patients, such as the emergency room, ICU, and the OR.
Certified registered nurse anesthetists (CRNAs) and critical care nurses both play a vital role when caring for the surgical patient. As a CRNA, I often times go to the ICU to pick up a patient that is having surgery, and for a short period of time will assume care of that patient. Part of my scope of practice includes performing a thorough and complete pre-anesthesia assessment before surgery, and giving a clear and concise report when transferring the patient’s care back to other qualified providers. This interproffessional practice ensures that all the relevant information necessary for providing quality care is passed on to the healthcare professional assuming responsibility for that patient. Top Nurse Anesthetist Programs will train you well for this teamwork and integration between ICU nurses and CRNAs.
ICU Nurses and CRNAs Are Not at War
Often times CRNAs and ICU nurses continue to operate separately with no real connection or communication between themselves. I have worked in healthcare long enough to see that there is a growing trend of healthcare professionals resenting their colleagues. This produces an environment that does not support interprofessional collaboration, and ultimately has a negative affect on patient care. There are a few things to blame for this, but the most important is lack of communication and consideration for other health care professionals. Sicker patients, higher patient to nurse ratios, and shorter turnover times tend to create a stressful environment that can lead to staff that are unmotivated, resentful, and unwilling to work professionally with each other.
I will admit that CRNAs often times drop off patients in the ICU with tangled IV lines, subpar reports, and unprofessional behavior. I hate to say it, but this has been me on a few occasions. While in a frantic hurry to transfer my patient and prepare for my next case, I delivered a short report, had IV lines that were a mess, and probably came across as being in a bad mood. None of this was intentional of course, and I am definitely not proud of it. Many times we let the stress of our job get the better of us, and our performance suffers. I always apologize in these situations, because I don’t want there to be any bad feelings between me and my colleagues. What bothers me though is when I hear jokes like, “Look at all this spaghetti” or “Did they not teach you how to untangle lines in CRNA school?” This creates a hostile relationship, and does not benefit our patients. Even though we work in a stressful atmosphere, both CRNAs and ICU nurses should remember that we chose this profession, and make it our goal to work together and provide our patients with the quality care they deserve.
Taking a Proactive Role
One of the best ways to improve interproffessional practice is for department directors, CRNAs, and ICU nurses to get together and share ideas on how to improve the continuity of patient care. Patient care models can be developed and implemented to ensure adequate reports are given, staff are available to help, and the entire transfer process is done in a safe and efficient manner. A great example of this was seen at the Valley Baptist Medical Center in Harlingen, Texas. CRNAs there were often used to provide anesthesia to patients having procedures done in their cath lab, which is a good distance from the OR. The problem was that the CRNAs were working in an unfamiliar environment, and often times did not have important equipment, resources, or staff available to care for the patients.
The result was delayed surgery start times, upset patients, and a general dislike for doing cases there. The director of their cath lab teamed up with the hospital’s anesthesia group to develop protocols that utilized interdisciplinary teamwork which allowed for a better working relationship between the two areas. The end result was lower patient complaints, faster start times, and a higher overall satisfaction among staff.
How do ICU Nurses and CRNAs Become Partners in Interprofessional Collaboration?
The single best way to form this partnership is to simply create a conversation. As a previous critical care nurse, I know what it is like to work in the ICU, so when I round on my patients I use this as a conversation starter. I always enjoy talking with the nurses about their day and sharing my old ICU stories with them. It’s these types of conversations that form professional friendships that allow for productive dialogue. Nurses and CRNAs are more likely to share ideas if they feel like they are speaking with a friend and not just someone who gives them report from time to time. Really take these opportunities to learn from one other. Nurse anesthesia is truly a fascinating career, so I recommend that if you work in the ICU talk with a CRNA about their job. They can be a great resource in helping you learn how to become a Nurse Anesthetist. Being friendly, open to questions, and helpful opens the door to future conversations.
I always make it a point to ask the nurses if they have any questions. I want them to know that our teamwork is important to me. The truth is, without teamwork everyone suffers especially our patients. I honestly believe that all of us have good intentions in mind. We forget this sometimes, and can become cold and bitter when we let the stress of our job overcome us. Make it a point every day to treat your colleges with the respect and courtesy that you would want in return. ICU nurses and CRNAs are not at war with each other, and when we choose to work together we can form interprofessional collaboration and provide our patients with the highest of quality care.
John Keith | CRNA Career Pro
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