This Issue2014 Annual MeetingPresident’s MessageExecutive Director’s ReportPresident Elect’s MessageRegional ReportsGovernment RelationsMembership CommitteeScholarship CommitteeAVANA Leadership Project for SRNAs

The 2013 AVANA Annual Meeting was held in April at the Hilton Hotel & Towers in downtown Portland, OR with members from 19 facilities in 12 states attending. Current Director at Large, Rita Silen, CRNA, BSN worked tirelessly before the meeting, as well as during the meeting to make this one of the best annual meetings in AVANA history. Rita also organized an incredible banquet on one of the last evenings of the meetings which featured Oregon wine and northwest fare. A very special thank you and “KUDOS” to Rita for all she did to make this an outstanding meeting.

2013 AVANAAnnual Meeting

vacrna.org

There will be an Ice-breaker wine & cheese reception for meeting attendees on Wednesday, April 9th, the night before the meeting begins. The themed topics for the 2014 meeting are Patient Safety, Patient Advocacy and Evidence Based Practice in Anesthesia.

The Annual Meeting discounted rate for AVANA members includes: Meeting in a relaxed envi-ronment for CEUs, networking with fellow VA CRNA from across the country, and a banquet dinner. Breakfast and lunch are included each meeting day. Guests of the hotel will have full use of the hotel wellness center, discounted valet parking and unlimited WiFi. This meeting promises to provide attendees with a plethora of good information and networking opportunities.

This is a very busy weekend in Pittsburgh for seminars and assemblies and there is also a major hockey game just up the hill from the hotel - a 3pm game on Saturday - with Pittsburgh’s archrival, Philadelphia. For this reason, AVANA recommends you make your reservation as

early as possible (now is NOT too early) as rooms will definitely sell out. The hotel rate is $119/night for attendees who must present their government-issued ID card in order to

receive this rate. (This is also tax exempt with the ID card.) See you in Pittsburgh!

2014 AVANA Annual Meeting - PittsburghThe 2014 AVANA Annual Meeting will be held in Pittsburgh, PA April 10-13, 2014 at the Pittsburgh DoubleTree by Hilton Hotel and Suites.

City Pittsburgh, PADates April 10 - 13, 2014Place DoubleTree by Hilton HotelContact 1 Bigelow SquarePhone 412.281.5800 Room Rate $119/per nightDiscount Must Show Government IDIcebreaker April 9, 2014PittsburghdowntownDoubleTree.comPlease Note: The hotel on-line reservation site will reflect a rate of $159/night. However, the $119/night is honored and guaranteed at check-in with a government ID card. Visit the hotel web-site, use Promo Code “AVA”, entering desired dates, click on “View Availability,” then select “Government/Military” in the “Narrow Your Re-sults” column on the left side of the webpage.

SAVE THE DATE

©2013 Depositphotos.com

I wish to thank the members of AVANA for the privilege of serving as the 2013-2015 president. I accepted the

responsibility of president at the AVANA annual meeting in Portland, Oregon, succeeding Dave Polner who

served as president and my role model and mentor.

For those of you who were unable to attend, the Portland meeting was an incredible success thanks to the tireless

efforts of Rita Silen, who arranged a wonderful panel of speakers, selected an excellent hotel as a venue and spent

countless hours on a minutiae of details, not the least of which was a lovely banquet featuring local, Oregon wines and culinary delights. Thank you

Rita, from the AVANA Board of Directors, and those members who had the good fortune to attend this outstanding meeting.

The 2014 annual meeting will be held in Pittsburgh, Pennsylvania, April 10-13, 2014. Pittsburgh is an exciting city and Eastern Region Director

and meeting planner, Diane Boettger, has already shared plans with the board which promises to make the 2014 meeting just as fabulous as our last.

The 2014 meeting is planned to span over a weekend, rather than a Tuesday-Friday as in past years, in order to facilitate making it easier for more

members to attend. As this is a busy weekend in Pittsburgh with regard to meetings and seminars, reservations will be limited. We encourage you

to book your room early! For more information visit www.vacrna.org.

The current AVANA Board of Directors is highly motivated with lots of great ideas. I am blessed to have such a talented and responsible assembly

of professionals with which to work over the next two years. We are utilizing conference calls to keep in touch and communicate with each other.

To date I have been impressed with everyone’s willingness to participate and stay on track in spite of being employed full-time with families and

the other extra curricular activities, which we each have. Among the goals for this next year is a complete rewrite of our Bylaws in order to update

them for the current times. The Scholarship Committee has restructured the student scholarship program to be more of a leadership/mentoring

program. Please look for more information on the website as this progresses. The Communications Committee is working on ways to keep the

membership better informed and the Membership Committee is busy recruiting new members and working on ideas in order to reunite with past

members who have not renewed. If any of you know of someone that has not renewed their AVANA membership, please encourage him or her to

renew. Lastly, please let the AVANA Board of Directors know what we can do to encourage membership by sharing your ideas with us. AVANA

is much stronger with more members. We also wish to encourage any members who may wish to become more actively involved to volunteer to

serve on one of the many committees. Please contact me at sherryswearngin@gmail.com.

At the recent AANA meeting in Las Vegas, AVANA had a “meet and greet” for all AVANA members and VA CRNAs and celebrated a very special

milestone, the 40th anniversary of the inception of AVANA. This gathering provided an opportunity for AVANA members and VA CRNAs alike to net-

work and share information regarding our various practices in the VA system. We were also very fortunate to have Roberta L. Reedy, CRNA, DNSc.

Deputy Director, Anesthesia Service, present an update from VA Central Office of Anesthesia. In her update, Roberta discussed several items of

importance to VA CRNAs, the first being the new version of CPRS and controlled substances. The new version will implement electronic ordering of

controlled substance and will require the provider to utilize their personal VA PIV card for authentication. This will necessitate having a DEA number

to order controlled substances. Roberta’s suggestion to VA CRNAs was to obtain a DEA number if you order controlled substances at your facility. If

you reside in a state which does not have prescriptive authority you may, through reciprocity, obtain a nursing license from a state which has prescrip-

tive authority and then obtain the DEA number. (As a reminder, a CRNA employed in the VA system is not required to have a nursing license in the

state in which you practice.) The DEA number is fee exempt for federal employees. Roberta did some research to find the state with the least restric-

tive nursing license and the broadest scope of practice. She also considered how frequent the renewal process would be for prescriptive authority and

the number of continuing education credits which would be required for renewal. Roberta’s research reveled the nursing license for the State of New

Hampshire met these requirements. No doubt there will be a great number of questions as this proceeds. The Boise VA has already rolled out the new

version of CPRS and the CRNAs found it to be an easy process in obtaining a DEA number. Please let me know how this is progressing at your facility.

Roberta mentioned the pay freeze is still in effect through December 31, 2013. She also mentioned anesthesia productivity and the successful

capture of non-OR workload, the documentation of difficult airway, and regional anesthesia time-outs. This update will be available on the

anesthesia SharePoint website.

I am genuinely excited as I look forward to the next two years as I feel AVANA is poised to experience phenomenal growth and impact upon

each of us within the VA system. I welcome this opportunity to serve the AVANA membership and ask each member to feel free to contact me

if you have any questions or concerns.

Sherry Swearngin, CRNA, MHSAVANA President 2013-2015

From The President’s DeskKeeping AVANA Members Informed and Educated in 2014

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A greeting to the members of AVANA and to all CRNA’s working in the Department of

Veterans Affairs. I hope that everyone is having a great summer even though this weather has been so unpredictable. Over the last year, AVANA members have been busy working to strengthen AVANA and its membership.

It is a great year in that we are celebrating the 40th Anniversary of the formation of AVANA. It was back in 1973 that three CRNA’s had an idea to establish an organization that represented the CRNA’s in the VA system. I am so happy to be involved in an association that has made some great strides over the years and is on the road to another 40 years! Thank you to our founders Phyllis Roberts CRNA, Romona Doran CRNA and Bonnie Winters CRNA!

The AVANA website has been up and running for a little over two years now and the information available has grown based on feedback from members. Check it out if you haven’t been there recently. There is a lot of information throughout the site and in the member’s only section. If you need access to the member’s only area, please email me at garrettcrna@gmail.com and we can

get you set up. In April 2013 at the AANA Midyear Assembly,

members of AVANA had the opportunity to meet with staff from the Committee on Veterans Affairs. We met with Dolores Dunn who is the Staff Director: Subcommittee on Health for the House Committee on Veterans Affairs and Kathryn B. Van Hast who is the Senior Legislative Assistant for the Senate Committee on Veterans Affairs. Our goal was to provide information regarding AVANA and our purpose. During out meeting, we discussed the Workplace Productivity Analysis Directive that has begun in the VA, Education Debt Reduction Funding, CareGivers Act for realignment of pay, and the Office of Nursing Handbook update. Both staff members were very appreciative to learn about the organization, our thoughts and how they could support us.

In an effort to make our bylaws user friendly, the AVANA Board of Directors has decided to rewrite the bylaws which will make it easier for the day to day operations of the association. Stay tuned for more details.

The 2013 AVANA meeting took place in Port-land. OR. Member Rita Silen CRNA organized

a wonderful meeting that included rel-evant topics to our practice of anesthesia along with opportunities for networking. It was a nice time to collaborate with CRNA’s from around the country. Thank you Rita! Presentations from the meeting are available on the website.

In 2014, the AVANA meeting will take place April 10-13th in Pittsburgh, PA. Member Diane Boettger CRNA has been working since the meet-ing in Portland with setting up a great educational program for us. I am looking forward to the 2014 meeting and hope that you may choose to join us. Information regarding the meeting can be found on the AVANA website under annual meeting. http://vacrna.org/annualmeeting.html

Garrett Peterson DNP, RN, CRNAAVANA President-Elect

Executive Directors’ Message

President-Elects’ Message

“What you get by achieving your goals is not as important as what you become by achieving your goals.”

Building on our AVANA History to Achieve Even Greater Things!

Henry David Thoreau

I can stil l remember the day I first became a member of AVANA. I was a new CRNA at the

Minneapolis VA in 2000 and my Chief called me into his office to discuss how things were going. He knew I took a pretty good pay cut to come to the VA but I wanted the freedom of this practice environment. We had a short discussion about the clinical environment and the usual things but then something happened that changed the course of my career. He talked with me about get-ting on the AVANA Board of Directors. Not only was it a great way to learn the intricacies of em-ployment in the VA system but I could also earn a merit increase in pay. He had been extensively involved in AVANA and was a past president.

I immediately joined and agreed to run for Central Region Director. Through my movement up in the ranks in AVANA, I met brilliant CRNAs who taught me about the dealing with challenges in recruitment/retention, engagement in public policy, and advocacy for our profession and, more

importantly, advocacy for our patients. Thank you to Ken Wetjen, Carol Craig, Maureen Reilly, Laura Cohen, Bev O’Connor-Griffin and others for en-couraging a young CRNA to become involved and then supporting all CRNAs with their information and dedication to the VA.

Now I challenge all of you: If you have not joined AVANA – JOIN! And if you are a member, there is room for your talents and engagement on our Board of Directors and on our Committees. You do not have to be an expert – You will learn more and be more professionally rewarded then you imagined. Take it from an old-timer who will never regret accepting the challenge to becoming involved!

Now is an exciting time to be a CRNA! We have proof regarding our record of safety. We are the answer to the economic challenges facing our healthcare system. We can be leaders in health-care and in anesthesia care in the Veteran’s Af-fairs System and beyond. An important part of

being an ad-vocate for our patients is recogn iz ing the impor-tance of be-ing visible on hospital wide committees and national committees.

I sign off with another very important quote by an eloquent group. Join us for the next AVANA Annual Meeting in wonderful Pittsburgh PA! More info to follow.

“Celebrate good times, C’mon!”

Please let me know if you have any questions or comments.

Angela Mund CRNA DNPAVANA Executive Director

Kool and the Gang

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2012-2013 has provided the Eastern Region with a number of challenges. A number of

CRNAs from the region have reported cessation of their retention bonuses. Despite last year’s pay scale revision, most facilities in the region cap off the Nurse 3 level with a salary that is below compet-itive rates for the area, thus the retention bonus was still warranted. In fact, most pay scales in the region did not change at all on the Nurse 3 level. Aside from call, over-time, or outside employment, ac-complished VA CRNA’s who have reached the Nurse 3/12 level do not have any way to supple-ment their salary, nor does it seem they can look forward to a raise of any kind, based on the elu-sive nature of the cost of living increase. Loss of the retention bonus has triggered actions towards retirement for several VA CRNAs.

As many have heard, Super Storm Sandy, which struck the East Coast in late October, caused extensive damage to the Manhattan Cam-pus of the New York Harbor Healthcare System, forcing its closure. Luckily, the Manhattan VA was one of the few New York hospitals, to preemp-tively evacuate staff and patients before the storm hit. Staff and patients from the Manhattan VA were diverted to other VISN 3 VA facilities, mainly the Brooklyn Campus. Operating room staff from Manhattan have set up shop at the Brooklyn VA, including 4 CRNAs and 10 anesthesiologists.

With limited space, the Brooklyn staff have adapted to accommodate ad-ditional people and cases. As of March, outpatient services have been restored in Manhattan, with hopes of restor-ing inpatient and operative services in the coming months. Best wishes to those East Coasters who may have been individually affected by the storm and hats off to those who weathered it successfully.

It has been my pleasure to serve the AVANA Eastern Region for the past 3 years. This spring I have relocated to Florida, where I am staying in the VA family at the James A. Haley VA Medical Center in Tampa. In doing so, I will be stepping down as your Eastern Regional Director. I am pleased to announce that Diane Boettger, CRNA, from the Pittsburgh VAMC will be succeeding me in serving the Eastern Region. I will continue to serve AVANA in other capacities and thank you for your support over the past 3 years. Please join me in welcoming Diane as your AVANA Eastern Regional Director. For questions please contact dianeboettger@gmail.com.Melanie Clemens, CRNA, MSNAVANA Eastern Regional Director

Greetings from Wichita, Kansas! I would like to extend a warm welcome to all VA

CRNAs who work in the Central region. The AVA-NA Central Region encompasses Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota and Wisconsin. Our current membership is 24 members. We have no members from Indiana, Iowa, Kentucky or Nebraska.

AVANA is a wonderful organization for VA CRNAs to network and be kept up to date on is-sues affecting VA employed CRNAs.

Currently in VISN 15 (Kansas, Missouri) there is a plan for implementation of an Anesthesia Re-cord Keeping system over the next 18-24 months. Purchase of anesthesia machines and selection of physiologic monitoring is also in process.

With the Out of OR Airway Management direc-tive rolled out, all VAs are required to have a lo-cal policy in place to address this directive. Rep-

resentatives from Anesthesia (Anes-thesiologists and CRNAS) and re-spiratory therapists from several VAs have attended Sim-LEARN OOORAM training with the intention to be able to facilitate airway management simulation for providers at their local VAs.

I look forward to delivering more news and in-formation to members. I would love to hear back from CRNAs in my region and encourage mem-bership to AVANA. Please e-mail me if you want any info. Nursers@cox.net.

From Rebecca Steinhardt CRNA,APRN,MSNAVANA Central Region Director

2013 Eastern Region Report

2013 Central Region Report

In the past years, the West-ern Region was proud to have

the highest number of AVANA members, but we have had fewer renewals this year and hope to strengthen our numbers. If anyone in the region (or the nation) wants to renew, it isn’t too late! Use the AVANA website and follow the prompts to renew on-line or contact Rita Silen in Portland, our Mem-bership Chair and Director at Large. Contact her at ritasilen@yahoo.com.

We are very proud to say that our President, Sherry Swearngin, is from the Western Re-gion and Boise, ID, where their busy CRNA’s have 100% AVANA membership. Kit DuBois, CRNA, is the recent past president of the Idaho Association of Nurse Anesthetists. San Diego CRNA, Stephanie Corbett still serves on the Field Advisory Committee and is cur-rently the Chair of the Scholarship Committee.

Across the region there have been re-ports of the loss of retention pay. One facility reports a salary increase replacing that loss, which is preferable for retirement benefits. In Portland, where there is almost full AVANA membership, the retention pay is being negotiated. Without this retention pay, the compensation package is lower than the community standard. Portland hosted the outstanding AVANA meeting in April…kudos to Rita Silen, CRNA who worked tire-lessly to arrange a great program!

Congratulations to Central California VA (Fresno) and Wyoming (Cheyenne) who can boast 100% AVANA membership. Any-one else willing to meet the challenge?

Anesthesia students continue to rotate through our VAMC’s, gaining valuable clini-cal experience with complicated patients having a variety of surgical procedures. CRNA’s are essential to their educational process in every region.

Our CRNA’s are involved in pre-operative clinics, every aspect of introp anesthesia management, and out-of-OR anesthesia care with increasing complexity. We proudly provide quality, safe anesthesia care to the veterans that served us.Darla G. Bussey, CRNA, MSNWestern Regional Director

2013 Western Region Report

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I would like to introduce myself to our many members in the Southern states. Our chair-

person of the membership committee Rita Silen, CRNA has been kind enough to send out the membership report. I would like to welcome one of our new members from New Orleans, Cecelia.

This communication needs to be more than just a rehash of important membership info. I would like to talk about our vision and purpose singly and as a group of collegial individuals with joint goals and visions. Eduard Pinero, AVANA’s Secretary and head of communications has mentioned that the new Orlando, FL VAMC will be open in the near future, while Jean Crosby, Houston’s Chief CRNA, has sent an article that one of her CRNA’s and an MDA were showcased on TV for a case involving a double aneurysm. What do all of these things have in common? They are not just isolated news articles. They are harbingers of expansion serving millions of more patients with newer techniques and technology. Advancements are accompanied by challenges. How we respond to those challenges shows our mettle. Will we be complacent or push ourselves to meet a new age of anesthesia service and medical advances? You may have heard that the VA sends deserving candidates to the Army Nurse Anesthesia school which has changed its curriculum to a doctoral degree in nurse anes-thesia practice. Lisa Lucas, CRNA, Program Phase 2 director at the Memphis VAMC has an-nounced that the class starting in 2012 will be the first to graduate with a DNP. This is fabulous and a monumental step for our profession. Our Doctorate is in effect being recognized by the US Army and the US Government. The Army’s CRNA program has been rated number one with Virginia Commonwealth University by US News and World Report.

This may pose many questions and some con-troversy. The writing is on the wall. Older practi-tioners will still provide invaluable experience to undergrads. Older CRNA’s will not be required to get the newer advanced degree but there is no question that we must meet the challenge of newer technologies , teaching responsibilities, reimbursement; and the competition of other practitioners who would very much like to replace us. AA’s on their website condescendingly refer to CRNA’s as NA’s; reportedly no better than they are. I met a gentleman whose son was starting an AA program. His qualifications were that he had a BS in engineering from South America and skated for Disney on Ice. Another candidate had a BS degree in food management. That is at least

closer to the human condition but not nearly as much training as an RN with ICU/CCU ex-perience. News items from the AANA’s various in-dividual states report these continuing challeng-es. The Texas Association of Nurse Anesthetists reported the failure of AA’s to become licensed in their state. Florida’s FANA reported a controver-sy in which MDA’s were allegedly trying to bill for AA services without adequate supervision. This practice is illegal as they are not independent licensed practitioners and has been verified in a recent statement by Medicare. In more than 17 states, CRNA’s have no legal Medicare supervi-sion requirements. We must all step forward and improve ourselves with training in new skills, cer-tifications and improved degrees. We will all be under the public microscope and will be our own best diplomats for our service and organization.

I was recently appointed to the APRN council at the VA Medical center. Discussions included autonomy under the independent practitioner rules and the move towards getting bonuses for NP’s. Yes, we are NP’s too. Questions have arisen as to why NP’s are not given bonuses on a level playing field with other practitioners. MD’s are given bonuses even if they are part time subcontractors. Full time employees bo-nuses depend on the successful completion of tasks frequently completed by the CRNA’s. I am sure that these questions will suggest new procedures and protocols for bonuses given to CRNA’s and NP’s. We also will need more con-certed cooperation with HR to implement such bonuses if and when they are applicable. I am sure that I have raised more questions than I have answered and also made some challenges to you the individual practitioner. Make our case know to your fellow CRNA’s in the system. Urge them to become involved. Show them that ignor-ing the future and the current challenges will not solve problems or make them go away. There is strength in numbers.

I hope to see you all at the next AVANA meet-ing in Pittsburgh. Please contact me when you have something interesting or just to say hello.

Dr. Edward Salkind CRNA, DNAPAVANA Southern Region Director

2013 Quarterly Southern Region Report Government Relations Summer, 2013

While we have not seen any dramatic changes occur within the Central Office in Washington, several areas of our work and political environment has been taking place. Surgical Workload, Quality Management, Pro-ductivity and Resource Utilization continue to be closely monitored. These elements impact our daily, and long term, practice in several ways. Staffing requirements, classification of the facility we work in and funding are but a few of the factors being analyzed. Data from these areas will be used to develop our prac-tice parameters in the future.

Currently, several members of the Board are attending the AANA Annual Meeting. While there, they have an opportunity to dis-cuss issues affecting CRNAs in the VA sys-tem, as well as, national issues. As we ap-proach year’s end, Government Relations will be helping to develop AVANA’s presentation to the NOVA Roundtable in early 2014. This is a critical meeting for AVANA, as members of the Board meet with Service Organizations ( VFW, DAV, American Legion ), Nursing Or-ganizations, Legislators and Administrators to discuss current and future health care funding and practices. AVANA continues to enjoy a very strong working relationship with the AANA Federal Relations Office. Frank Purcell, Director, and the staff in this office, have always offered advice and assistance to your Board, helped to formulate strategies and lobbied on our be-half. This service is provided with-out cost from the AANA to AVANA.

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©2013 Depositphotos.com

The Membership Committee, chaired by Rita Silen, Portland OR VAMC, is comprised

of four new members, named at the April 2013 gathering of AVANA in Portland OR. From the Western Region, Darla Bussey of Fresno; from the Central Region, Diane Boettger of Pittsburgh; from the Eastern Region, Rebecca Steinhardt of Wichita; and from the Southern Region, Ed Salkind of Lexington, SC, all stand ready to as-sist and support those in their regions who might need to inquire about, report on or simply pro-mote issues relative to Membership as well as local situations.

As reported elsewhere in the Newsletter, our membership numbers have dropped this year relative to last year and the recent past. While we understand that some renewals were overlooked due to changes in the dates to do so, we must all look at our organiza-tion, the role we play as the only voice of a large group of CRNAs func-tioning in the VA system, and work toward engag-ing every CRNA working in a VA Hospital in our mission. We hope that all members will take a proactive stance and invite their colleagues to look at the website where much of what we do all year long is noted with details and photo-graphs. Those of us who have been involved for longer than a couple of years, and have attend-ed at least one meeting, will attest to the fact that familiar faces become contacts across the coun-try and have resulted in friendships, all of which make working on behalf of VA CRNAs even more

interesting.The Membership

Committee will be working this year to reach out to facili-ties where we are not represented, but we need the help of the membership! If you know of a colleague who moved to another VA, please engage him or her. If you are the only one in your facility or even your STATE, please contact me, or any of the Regional Directors with names and contact information if you have CRNAs to invite! Please, use personal email ad-dresses, as we are not authorized to use our work emails to conduct any business on behalf of AVA-NA. However, you could easily ask a colleague

for a personal email address using work email, and if you would like, let me know. I will be excited to contact your colleague along with your note.

In a few states we have but ONE member for that entire state! Examples include: Al-abama, Georgia, Kan-sas, Massachusetts, Missouri, Montana, New Mexico, New York, Rhode island, South Carolina, Ten-nessee, and Colorado! AVANA hopes to keep those members and to help them to engage others among them. If

you have suggestions, please write! (ritasilen@yahoo.com) Together we can increase our num-bers and make our voice louder!

Report from the Membership Committee

L-R Kathy White, DNP, CRNA, Scholar-ship Committee; Sherry Swearngin, CRNA, MHS, President; Emily Grost, SRNA, RN, 2013 Scholarship Recipient; Angie Mund, CRNA, DNP, Executive Director

L-R Garrett Peterson, DNP, RN, CRNA, President Elect; Sherry Swearngin, CRNA, MHS, President; Claire LeDuc, SRNA, RN, 2013 Scholarship Recipient; Kathy White, DNP, CRNA, Scholarship Committee

Back Row L-R: Darla Bussey, CRNA, MSN, Western Region Direcctor; Rebecca Steinhardt, CRNA, MHS, Central Region Director; Diane Boettger, CRNA, MSN, Eastern Region Director; Edward Salkind, CRNA, DNAP, Southern Region Director; Rita Silen, CRNA, BSN, Director at Large; Front Row L-R: Eduard Pineiro, CRNA, ARNP, Secretary; Melanie Clemens, CRNA, MSN, Treasurer; Sherry Swearngin, CRNA, MHS, President; Garrett Peterson, DNP, RN, CRNA, President Elect; Angie Mund, CRNA, DNP, Executive Director

2013/2014 Board of Directors

We urge you to consider the benefits our professional organization offers. Joining AVANA is easy – just complete the application today by visiting vacrna.org. When you join AVANA you will receive: • Access to the only professional association devoted solely to VA CRNAs• Effective representation at the federal level• Electronic updates on issues affecting VA CRNAs• Access to AVANA’s website www.vacrna.org and MEMBER only page• AVANA’s Newsletter• Discounts on our annual educational symposium• Access to AVANA’s network of CRNAs capable of advising you regarding issues affecting your workplace6

©2013 J. Chris Price

Association of VA Nurse Anesthetists Scholarship Committee

Scholarship Committee met via conference call on Friday April 5th, 2013. Prior to the meeting, the Chairperson, Kathy White, dis-

tributed copies of all complete applications to all committee members along with an evaluation rating sheet that was utilized for the last two years to rank applicants.

Present on the call:Stephanie Corbett, Diane Boettger, Kathy White. Cyndi Holgate was unable to connect.Discussion: AVANA Treasurer Cyndi Holgate reported that there was $3,200.00 in the scholarship fund. Sixteen applications were received, fourteen were complete. Candidates were ranked according

to the sheet by each committee member prior to the meeting independently of each other. Consensus was quickly reached on the top five candidates. Initially the committee recommended awarding the top candidate a larger scholarship but in consideration of the will of the BOD of AVANA, we recommend that each scholarship recipient be awarded $500.00 for a total of $2500.00 awarded.

Recipients are:1) Mr. J Jason Wolfe, USAGPAN, recommending $500.00 scholarship2) Ms Claire LeDuc, Minneapolis School of Anesthesia, former MICU nurse at Minneapolis VA, recom-mending $500.003) Ms Emily Grost, University of Pittsburgh, recommending $500.004) Ms Alexis Taylor, USAGPAN, recommending $500.005) Ms Carie Cromwell, USAGAPN, recommending $500.00

The rest of the meeting was spent in discussion of fund-raising strategies. Since attendance is predicted to be lower this year, Stephanie Corbett came up with the idea of opening up the silent auction items and raffle to all AVANA members via the internet. Stefanie will coordinate this effort.

VA Central Office Anesthesia 2013 Update

Education Diane Boettger, Pittsburgh VA (Chair)Anita Ottobre Pittsburgh VASue Bednarek Syracuse VAAudit and Budget committeeJill Smith, Tampa VA (Chair)Melanie Clemens, Tampa VA (ex-officio)Neil Roeper, Tampa VACommunication and PublicationEduard Pineiro, Orlando VA (Chair)Membership and AwardsRita Silen, Portland VA (Chair)Comprised of region directors Diane Boettger, Pittsburgh VA Eastern Region DirectorDarla Bussey, Fresno VA Western Region DirectorEdward Salkind, Columbia VA Southern Region DirectorRebecca Steinhardt, Kansas VA Central Region DirectorBylaws and Standing RulesAngie Mund (Chair)Government RelationsDave Polner, Phoenix VA (Chair)Garrett Peterson, Minneapolis VADiane Boettger, Pittsburgh VASherry Swearngin, Boise VANominating Darla Bussey, Fresno VAScholarship CommitteeStephanie Corbett, (Chair) Rebecca Steinhardt, Kansas VAPaul Safara, CRNA

(above) Christine Allen-Sanders, CRNA, BSEd from Pittsburgh VA was the recipi-ent of the 2013 Federal Political Director of the Year at the AANA MidYear Assembly in Washington DC. Christine Allen-Sanders has been a CRNA at the Pittsburgh VA for 23 years, is a former state president of the Pennsylvania Association of Nurse Anes-thetists and has served in numerous state and national leadership positions including Regional Director of AANA. Christine has been Federal political director for thirteen consecutive years for the state of Penn-sylvania. (Pictured here with Janice Izlar, CRNA, DNAP - AANA President 2012-13.)

2013/2014 AVANACommittees

At the AANA Annual meeting in Las Vegas this past August, Roberta Reedy CRNA PhD presented an update to the members of AVANA at a breakout session. This is a synopsis of the update. CPRS v29 and Controlled Substances

There is a new version of CPRS that will imple-ment electronic ordering of controlled substances. This will require the use of a VA smart card for au-thentication and only apply to CRNAs who currently order controlled substances without a physician signature. If you are currently ordering narcotics, you will be required to obtain a DEA number.Federal Workers Pay Freeze Update

In March of 2013, President Obama issued an across-the-board pay increase of 0.5% freeze that included Title 5 general schedule, Title 5 and Title 38 special rates, Senior Executive Service, Title 38 schedules, VA Nurse Locality Pay Sys-tem (LPS) schedules and all Federal Wage Sys-tem (FWS) schedules. Federal agencies are also complying with the original pay freeze from De-cember of 2010. This will remain in effect through December 31, 3013 or until such time that addi-

tional information is provided by OPM. Thus all VA pay schedules remain frozen and may not be adjusted unless a VA facility can demonstrate they are experiencing extraordinary pay-related recruitment and retention problems. If there is an extraordinary pay-related recruitment and re-tention issue then a locality survey can be done every 3 years. There is also the option of using the Hayes group, which is a national survey group that is available to each VA.Documentation of Difficult Airway

There is a template being developed for difficult airway documentation and 6 sites are currently pilot-ing this new template. The notation will be under the posting section as a warning titled Difficult Airway. Only anesthesia providers can determine difficult airways. When filling out the template, it prompts the provider to provide a copy to the patient.Regional Time-Out

The VACO Central Anesthesia continues to re-ceive reports from the field of wrong sided regional anesthesia. Currently they are looking at ways to decrease the incidence of wronged sided blocks. Workload Capture – Productivity

VACO COA is working on a process for suc-cessful capture of Non-OR workload (Stop code

-continued on back page

7

After its adoption, changes were made to the Medicare Act. Cuts

in Medicare reimbursement have caused a need for the restoration of funding for rural hospitals whose counties lost their rural designation and access to services provided by nurse anesthetists. In a re-cent article mentioned by Dr. Angie Mund, CRNA, the IOM (Institute of Medicine) has de-clared that Nurse Practitioners can make health-care both accessible and affordable for the poor and underserved.

Policy experts have concluded that in-creased insurance coverage, portability and a lack of preexisting illness limitations will bring millions into hospitals and clinics. This number has expanded with Republican Governors sign-ing onto Medicaid expansion (Wonkblog). Those who do not meet the standard for free health-care and cannot pay the government penalty will still crowd emergency departments at all hours of the day and night, creating a continued bur-den on hospital services.

Another aspect generated by this process is the turf war between provider groups vying for healthcare dollars and the right to control the application and direction of services provided.

In one instance, AMA groups proposed legisla-tion blocking the increased scope of practice of NP’s. Permission for a patient to be sent to hos-pice or other specialized care must be approved an MD or NP if the law allows. Whoever holds this authority would be able to control hiring for given positions.

This discussion comes full circle to the provi-sion of anesthesia services provided by CRNA’s, vs MDA’s and AA’s. Recent studies published by the AANA have demonstrated no discernible dif-ferences in outcomes between CRNA’S vs MDA supervised teams. One author, Dr. Rothstein, has held up the argument for the ASA and has used studies with poor or unsupportable evi-dence and poorly constructed studies. Cries of flexibility and versatility in the use of MDA run anesthesia teams is not supported by evidence based argument. It just makes more money for the MDA practices. This may be unfair restraint

of trade by MDA practice groups.Governors in 17 states have opted out

of Medicare MD supervision of CRNA’s. Appeals by ASA sponsored groups have failed. MDA’s who have argued for bet-ter trained associates, have brought in AA’s, less well trained and less qualified. The Texas Association of Nurse Anesthe-

tists broke the news that the Texas legislature refused a bill to license AA’s. FANA announced that MDA’s in Miami were reminded that AA ser-vices cannot be billed without adequate legal MDA supervision. AA’s cannot practice in Loui-siana. They also cannot administer regionals in the state of Ohio. With higher educational stan-dards, and advanced training,

CRNA’s meet new demands in a competitive era. The new doctoral degree in Nurse Anesthe-sia Practice has been welcomed by healthcare providers and national educational associations such as the AANA and the COA in cooperation with the Federal Government much to the cha-grin of the AMA and ASA. The focus of care (M. Papachrisanthou RN, DNP-S, 5/12) required in rural and inner cities will best be served by bet-ter trained NP providers educated at a doctoral level to meet these needs.

There is a need for CRNAs to start addressing the effects of the addition of 30 million new patients on the healthcare system in America brought on by the Affordable Care Act (ACA).

by Ed Salkind CRNA, DNAP

“Policy experts have concluded that increased insurance coverage, portability and a lack of preexisting illness limitations will bring millions

into hospitals and clinics.”

The Affordable Care Act and its Effect on NP’s and CRNA’s

8

©2013 Depositphotos.com

The Association of Veteran’s Affairs Nurse Anesthetists (AVANA), Board of Direc-

tors and Scholarship Committee are unveil-ing an exciting new leadership development opportunity for Student Nurse Anesthetists (SRNAs), the AVANA Leadership Project for SRNAs (ALPS).

AVANA is seeking to support SRNA educa-tion and the development of leadership skills

by encouraging SRNAs to become actively involved in educational, advocacy, and leader-ship activities. AVANA believes that this will result in a stronger and more engaged group of future CRNAs. This project promises to be a very enriching educational experience and career development opportunity for the two selected SRNAs.

AVANA will sponsor two SRNA applicants to attend one of the following meetings:

A. AVANA Annual Conference, Pittsburgh, PA, April 10-13, 2014

AVANA will sponsor airfare and two night’s hotel accommodations. The SRNA will meet with the host of the conference and will be asked to present one lecture at the conference on topic of their own research or area of interest. The SRNA will be asked to stay for the conference for one or two days and to join AVANA members for the annual banquet.

B. AANA Mid-Year Assembly, Washington DC, April 6-9, 2014

Airfare and two night’s hotel accommoda-tions will be sponsored. The SRNA will meet with the AVANA members who attend Mid-Year Assembly. The SRNA will enjoy a sponsored meal and discussion with AVANA members and will join them during visits to the House and Senate Committees on Veterans Affairs.

All application materials must be submitted

between October 1 and December 1, 2013. The required application materials will include:

Curriculum Vitae (include projected graduation date)Letter of Intent (please answer the following)a. Why is leadership important in your career

as a CRNAb. How have you been involved in a leader-

ship role in your career so farc. How does participation in a professional

organization make CRNAs stronger as an individual and group

d. What are your plans for the futuree. Which award is sought, A or B (as de-

scribed above)Program Director Confirmation of current cumulative GPAOne Letter of Recommendation by either clinical or didactic faculty or a CRNA in a lead-ership role

All materials should be scanned and emailed to stephcorbett@msn.com.

AVANA Leadership Project for SRNAsIn current practice the staffing of 1:1 or 1:2 MDA: CRNA for OR room staffing is clearly In-defensible. The ratio of CRNA to MDA staffing should depend on a CRNA’s ability to perform tasks and make decisions. This derives from advanced training and scope of practice. When VA hospital staffing ratios are compared with for profit groups, the observer can appreciate that there is no need for a 1:1 or 1:2 ratio. A 1:4 ratio is perfectly feasible without any changes in law. This would require fewer MDA’s and save the VA hospital system millions of dollars.

In another staffing issue, the ability of less qualified non anesthesia trained MD’s to pro-vide conscious sedation safely vs the admin-istration of “MAC Sedation” by better trained anesthesia providers (CRNAs) has not been discussed in any meaningful way in a medi-cal or anesthesia forum. The substitution of CRNAs in this role will greatly affect hiring practices within the VA system.

A white paper released by the National Gov-ernors Association (NGA) has made public the statement in conformity with a review of litera-ture and state rules governing NP’s scope of practice. It evaluates and supports NP’s provid-ing expanded care in primary practice. The ma-jor questions asked were: how does licensing and scope of practice vary across the nation; how do state regulations and scope of practice vary ; to what degree do state regulations and scope of practice vary from evidence based re-search, and would changes in scope of practice and regulation affect healthcare access and quality. In light of equal or higher patient satis-faction and provision of most primary services, the recommendation has been to ease restric-tions of NP practice and increase their scope of practice. In concert with the NGA whitepaper (Dill and Salsberg, 3/12) an estimated US pop-ulation increase of 50 to 350 million between 2006 and 2025, would cause a primary physi-cian shortage of 124,000. US Senate Bill S382 proposes to allow certain critical based hospital and sole community hospitals to use interac-tive telecommunications to satisfy MD supervi-sion to stabilize patients (Advance for NP”s and PA’s 7/13).

In summation, better training and education-al standards have called for increased scope of practice for NP’s and CRNA’s nationwide to provide a wide range of needed healthcare ser-vices to meet the millions of new patients in an orderly , and well qualified manner. We must strive to meet the demands required to provide the rural and underserved patient population in the coming decade. 9

©2013 Depositphotos.com

In celebration of National Nurse Anesthetists Week in January 2013, The CRNA’s of Pittsburgh VA Healthcare System donated two custom made wooden benches for veterans and families to enjoy the outdoors and two pack and plays to be used at the new Fischer House.

Each year the CRNAs in Pittsburgh VA celebrate National Nurse Anesthetists Week by donating to a veteran-associated cause and use this opportunity to share educational information about CRNA’s with veterans and their families. One program is called ‘Cookies with CRNA’s” where CRNA go in prior to their shift and pass out cookies and educational information to veterans, visitors and employees visiting the Pittsburgh VA.

It is important to stay abreast of what is happen-ing with regard to CRNAs within the VA and there is no way to do so than by regularly visiting the AVANA website at www.vacrna.com. You may also visit the website by utilizing your smartphone Quick Response (QR) Code reader on the above symbol.

Get the Latest AVANA News, Stay Intouch!

T A K E A C T I O N T O S E R V EA M E R I C A ’ S M I L I T A R Y F A M I L I E S

J O I N I N G F O R C E S . G O V

vacrna.org

Association of Veterans Affairs Nurse Anesthetists1235 12th Street NorthSt. Petersburg, FL 33705

President Obama issued a challenge to the private sector to hire or train 100,000 unemployed veterans and their spouses. Companies have also committed to improving education and well-ness opportunities for veterans and military families. AVANA is proud to be part of this effort.

434) Roberta reported that Non-OR Workload in FY 13 through May:• O encounters 70 facilities• 1 – 200 encounters 33 facilities• 200 - 500 encounters 14 facilities• 500 – 1000 encounters 4 facilities• > 1000 4 facilities

They have established new clinics stop coded to 434: • ANES NON OR CRIT CARE

• ANES NON OR EP LAB• ANES NON OR GI LAB• ANES NON OR OTHER• ANES NON OR RAD• ANES NON OR MHVA/Army Collaborative Effort to Educate Nurse Anesthetists

The program in now culminating in a DNP. The application deadline for classes to start in the summer of 2015 is July 1st, 2014.

CRNA FAC Vacancy January 2013There will be a vacancy on the field advisory

committee starting January 2013. Ongoing Projects

Continued projects include the quarterly anes-thesia chief and chief CRNA conference calls, the SharePoint Anesthesia Discussion Site, (this site is open to all anesthesia providers), revise of the Moderate Sedation Directive (which is in concur-rence) and the Deep Sedation Directive.

- VA Central Office continued from page 7