Certified Registered Nurse Anesthetists (CRNAs) are some of the most widely used Advanced Practice Nurses in the medical field, and also some of the most relatively unknown. According to the American Association of Nurse Anesthetists, CRNAs are anesthesia professionals who safely administer more than 49 million anesthetics to patients each year in the United States and they have been providing anesthesia care to patients in the United States for more than 150 years. In addition, numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts. In the aftermath of this latest iteration of the Corona Virus, CRNAs have found themselves on the front lines of caring for patients battling this disease and its sequelae. Enter Donnell Carter, CRNA. I had the pleasure of interviewing him in the midst of a shopping trip. Here’s how our conversation went:
Can you tell me a little bit about your background as a Nurse and how you came to be a CRNA?
I’ve been in healthcare for about thirty years and it started out actually in the military where I was a hospital corpsman for about 4 1/2 years. After becoming a hospital corpsman and serving 4 1/2 years in the Navy, I got out and went in to college and went and got my Bachelor’s in Nursing at the University of Massachusetts, Boston. From that point on, obviously I worked for a little bit. Got some experience, got my critical care experience in Cardio-Thoracic surgery and went on to Anesthesia school back in 2005 and completed a program at Central Connecticut University. From that point on, I’ve been working in Boston, Massachusetts for pretty much my entire career. I’ve been a Nurse Anesthetist for just about 13 years. During that time, I went back and got my MBA with a specialization in Entrepreneurship and Innovation. I also hold currently 4 certifications in nutrition, because I’m very big into Health and Wellness. And I’m working on a Personal Fitness cert at the moment which I’m almost finished with. So in terms of like, the entrepreneurial aspect of doing things, I’m trying to do things outside of the healthcare field to kind of tackle new ground; and part of that is a passion in Health and Wellness. So pretty soon, you know, I’ll be hopefully offering a different service in terms of helping people control weight and get back to a healthy lifestyle.
Well that explains the sudden change in your social media! All of a sudden you went and got diesel!
(laughs) Workin’ on it, workin’ on it! Yeah, I’m a work in progress.
Well, it’s definitely needed. For us in general and us specifically, especially for Health and Wellness. I’m also on that train, so that’s good to see! So, where are you currently practicing?
So I’m in Boston, Massachusetts right now and I’ve been here for my entire 13 year career.
Are you in a hospital? Surgery Center? Office based? What are you doing?
I’m in a hospital at the moment.
Have you always worked in the hospital setting outside of the military?
Yes, pretty much.
Are you an employee? A contractor?
I’m mostly a W2 employee.
You said mostly… so, you dabble? You moonlight?
I have dabbled, I’ve moonlighted. Not as much as I should, but I’ve definitely done it.
So what drove your decision to be (or stay) a W2 employee and how is that actually affecting your transition into the Health and Wellness aspect? Or has it at all?
You know, the reason why I stayed a W2 was mostly because of the stability I needed to kind of focus on other things. So, you know, most people who do, like independent practice, they’re very mobile, which is fine; but my lifestyle is not set up in that way for me to be mobile at the moment because I’m thinking of other things. In order for me to sit down and be able to focus, I can’t add on other things like having to up and move all the time to a new location, to get used to a new environment, new people, a new system. So I pretty much wanted to stay in a system that I’m familiar with.
Right now, I’m at a facility where the benefits are pretty good, so the benefits kind of outweigh the alternative of doing 1099 at the moment. Plus I have the stability that I need to be able to focus on things outside. So in terms of transitioning into the Health and Wellness aspect of it, being stable gives me that stability I need to kind of focus on those things because it is something that I definitely want to grow.
What have been the biggest changes to your practice since the start of the Covid-19 Pandemic?
The biggest changes occurred after the operating rooms got shut down and there were no more elective surgeries. At that point, my particular facility, they were kind of ahead of the game. In terms of putting in protocols, repurposing their staff, building new systems, reengineering the hospital to be able to facilitate the onslaught of Covid patients. As Nurse Anesthetists, we were repurposed into the Intensive Care Teams, where it was led by the Intensivist, and it was made up of other disciplines too. So, I was in the same team with the Dermatologist or Surgical Resident, or what have you. ER Doc, or something like that… as well as other CRNAs. And we were also on the emergency airway teams too. So, those were the two biggest changes.
Of course, our shifts changed too. So we were doing a lot more call, a lot more weekends, a lot more longer shifts so that we could, first of all so they could keep us working! (he laughs) So we could get a paycheck. They were trying really hard to not lay us off. And they did a really good job at that.
Did you have to take call before that?
I do, but you know, it was voluntary. But (inaudible) it was kind of different. I was doing a lot more weekends. So my schedule really changed a lot. But since the operating rooms opened back up, things are kinda back to normal. Where we’re doing a normal full schedule, and we’re doing the backlog of surgical cases at the moment. So then we’ll see, because you know we’re having an uptick in the numbers again… so we’ll see in the fall.
Now, have you noticed any disparities between what’s being reported in the news and what you’re actually seeing first hand? You made some posts about PPE (personal protective equipment), with what you guys were having to do being on the “front line” taking care of these patients… Have you ever looked at the news like, “That’s not what’s happening” or “There’s more than that happening” or “It’s just totally different than what’s being reported”?
I think, for the most part, it was fairly accurate because in terms of what we were seeing at the hospital, we had a pretty high case number. We were one of the number one facilities that were taking on a lot of the patients in Massachusetts. So what we were seeing was pretty much what was being reported across the world. We talked a lot with docs in Italy and also China. So we were pretty much on par with what they were dealing with at the same time.
What was different from what was being reported was, you know, I think, the misinformation… it kind of misrepresented what was actually happening. And also, the political aspect of this too. Which has been a bit challenging.
What would you say were some of the misrepresentation that you were seeing, or heard?
Well, a lot of people don’t believe in the numbers and stuff like that. But what people don’t understand is that you know, that people are dying from Covid but they’re also dying from the pre-existing conditions and the complications of Covid. You and I work in healthcare, so we understand the sort of clinical sequelae that occurs like thrombotic disease, etc. etc. etc.
So, I think from a healthcare, a health provider standpoint who has an understanding of it, we could see how this disease devolves into other problems for patients. So, you know, what people think is that “well, no, people died of heart disease”, or “they died from strokes”. Yes, that’s true. People have died from that stuff. But those strokes and that heart disease, and those cardiovascular events or those pulmonary events were a direct result of contracting this disease, and also with us not necessarily understanding how to even manage this disease because it was something very new.
So you know, you had a lot of information coming from across the world, a lot of different therapies, you know, a lot of different trials and errors that we were undergoing to try to manage these patients. Plus, we weren’t, we just didn’t know what to do. So as a result of that, things happened. So, I just think that a lot of politics became involved and kind of skewed things a little bit.
This will be my last question unless something else comes out of here. What are some of the things you think need to happen in order to provide the safest care to your patients overall, and then also to maintain the health and safety of our practitioners? If any.
I think that you know, number one, a deeper understanding of this. And because this is very new, it’s going to take some time to study it. So I think what’s going to happen as a result of this is that I think there’s going to be a lot of retrospective studies that will kind of go back and look at how things were done – what worked, what didn’t work – and from that information, I think you know, there will be better information that will lead to better treatments, better therapeutics going forward because I think that this thing is here to stay. We just need to get it under control.
Another issue I think we have is the launching of a vaccine that is safe – that has been thoroughly studied and is deemed safe by the normal scientific measures that all drugs go through to ensure their safety before it’s released to the public. So I think an effective vaccine at some point will be very helpful in gaining control over it. I think that, you know, right now what we have is the, you know, the use of masks and social distancing and things like that to help us kind of control it. But there needs to be sort of a unified front and we don’t have the unity at the moment to gain control over it. If we were more unified in terms of wearing these things, and maintaining the distancing and the masks, etc., I think we’d have much, much, much better control over it until we can get ahead of it. Right now, we’re behind; and you know we’re scurrying for answers, which we don’t necessarily have at the moment.
I do think that there needs to be a change of leadership. A leadership that will, you know, put the scientists ahead of this instead of political aspirations and so forth. We need people that are going to be up front, that are going to be very direct and very honest with the way we need to move forward with this. But that is gonna have to start at the top. And from the top, the top has to listen to the people who actually specialize in this area. And that is the scientists and also the medical professionals who are looking at this thing closely.
Well I appreciate you taking the time! Is there anything you wanna add?
No…that’s pretty much it. You know, let’s just stay healthy. And then, in terms of the black community – I think with the disparities in the numbers of catching and our recovery from it, we really gotta take a hard look at that at the same time so that we’re not affected by this. And I think what we really need to look at as a community going forward – it’s not just with Covid but just in general – we gotta look at our personal accountability and responsibility for the health of our bodies and stuff like that so that we’re not suffering as much. You know, there’s the social aspect of healthcare disparities, the historical structural racism, etc; the poverty, the lack of access to healthcare, the disparities in treatment from healthcare providers and such. You know, those are the things that we can continue to fight to change. But the biggest bang for our buck I think, comes with our own personal responsibility in how we view ourselves and the health of our bodies and implementing the right behaviors and changes in that for ourselves, to either maintain a good healthy state or try to get back to a more healthier state so we’re not hit… we’re not taking the brunt of the disease in terms of the numbers and statistics.