All right, so when a SRNA or a resident is doing a long case, the patient is stable, is it necessary to be in the room at all times? Can I be within 30 feet and still be compliant? The short answer is yes, you can leave the room, okay. Next question. No, to be honest, I mean, many programs are like this, right? Many programs utilize a model where students are more independent. They work very independently, either with a CRNA or under the guidance of an anesthesiologist. Certainly they're not there the whole time. They need to be there for critical portions, the COA outlines that. I think some of this has been covered a little bit already. But I would also say that you have to, as a clinical coordinator and as someone who mentors students all the time, it's dependent upon the case acuity. It's dependent on your hospital and the situation there, your current model. There are a lot of factors at play here. So I know this is kind of a general question, but again, there's a lot of gray area there, I think. But ultimately, yes. I mean, you do have the ability. Now, you can't go across the street to the coffee shop, right? I mean, you need to be immediately available. You certainly need to be available to deal with things as they potentially arise. But you do not have to be in the room with a student the whole time. Are there any different thoughts in the audience? Anybody have any thoughts about that or any added comments? I'll touch on that just briefly. I came from a facility where the students were not left alone. Until your last few months of your education, we did a two-to-one with a CRNA. That's when I went and started working at, it was then Northeast Medical Center, and we got students. Everybody loved it. Yay! We can, you know, not leave and go get a cup of coffee across the street, but run to the bathroom and that kind of thing. Well, that, not too long after that started happening, was kind of disallowed by the medical director of anesthesia. And it's challenging, or a little bit different for the students, because in many of their other clinical sites, they are left alone. So then they come here and suddenly it's, well, I have to stay in the room with you the whole time. But I do try to make it as an independent type case for them as possible, despite me staying in the room with them. And I think we all should try to do that as much as possible. When you talk to students and they tell you that, you know, it is completely different. Even if I'm just standing outside the door and they can't see me, versus me standing in the corner, it's a completely different situation for them, right? And we need them to be independent thinkers. We need them to be able to have that autonomy and make those decisions and feel comfortable with those decisions. And so I really encourage everyone, if you have that ability to have that kind of model, I think that that's really what we need to really, truly provide full-practice providers that can do anything and go anywhere, and that's ultimately what we want. But standing in the room is really still a bit of a crutch for them, which I certainly can appreciate. So even if you have the ability to take a little walk around the loop or whatever, it's good for them to have that experience. Yeah. I think there was a comment. I'm sorry. But if they don't have any chance to be autonomous during their training, you know, I mean, obviously upon graduation, they're going to be expected to, you know, run the whole room and manage the whole case. You know, we do allow, there's a couple of clinical sites that my students rotate through that have the same policy as you, Lucy, where the CRNA cannot leave the room. And we just let the students know that's the policy at that institution, but you're going to have opportunities at others to, you know, to have some autonomy. And I know that those CRNAs try their best to give the students the autonomy, but when they're right there, the student's going to be constantly looking to the CRNA. The other thing is, you know, just trying to educate those institutions that really are requiring that the students are one-on-one supervised. You know, I always refer them back to the definition of clinical supervision that the COA has. Clearly one to two, one CRNA to two, student nurse anesthetist or resident nurse anesthetist, whatever the title you use is, is certainly fine. Obviously it depends on the complexity of the case and the acuity of the patient. I mean, that always has to be taken into consideration. As Brent said earlier, I mean, we have a workforce issue. So we have an opportunity here to go back to your place and say, look, you know, we can help you with this shortage by just utilizing students in a manner that they can be utilized based on the COA's definition. So we have the ability to go back to our administrators and our chief, you know, whatever the situation is and say, hey, I know that this has always been our model, but we're struggling to get people in the door here. And we can technically really improve things by just utilizing the people that we have that we know can do the job. So I think it's incumbent upon us to really take that back and try to be those change agents. Thank you. I'm Bibi Ade-Nuzif. I'm City of Christ College program director. Regarding the 30 feet, I think we usually tell them, provided you're readily available, if there's any problem, on some site we try to tell them to allow a student to have this independent, able to critically think things through. So they have like a monitor in the room while the CRNA is outside watching the student and the monitor, but the student are able to still critically think and do what they need to do. And with the 30 feet, it depends. If you work in a large institution, it could be a bridge across another big building. So that's something I think defining the distance could be hard than saying you're readily available for emergency. Thank you. Yeah, Frank Chibasi. I see part of the question, you know, can we be 30 feet away? And I think that's part of the question often, what does immediately available mean? Does it mean that you're right next to the OR? Does it mean that you're out in the parking lot? Does it mean you're home and you're available by phone? What's immediately available? And it used to be years ago, an individual, whoever was supervising, had to be within three minutes of the OR. That was back in years. And then we really tried to figure out what was so magical about three minutes. So then the current requirement, and this is in the standards, the master standards, is a CRNA or a physician anesthesiologist must be present in the anesthetizing location where a graduate student is performing or administering an anesthetic and available to be summoned by the graduate student. So the requirement is they have to be in the anesthetizing area. They can't be down in the cafeteria, you know, having lunch or something along those lines. So I think, and like Laura has said, obviously patient safety and considering the learner's level is critical in making that decision. I really appreciate, Mike, your comment about... All of the comments, I guess, summatively make me think that, you know, we are the only option for learners who can help this anesthesia workforce shortage, right? And I think we need to take advantage of that. You know, we can help be a solution to that. And it's likely that that conversation isn't going to be with an anesthesiologist to help them understand, right? Because they're not necessarily going to want to see that be successful. So I think as we look at some strategies moving forward, I think having those conversations with other members of the health care team will help us move forward.

SRNA supervision

residents

autonomy

patient safety

workforce shortages