The AANA welcomed more than 4,800 state legislators, legislative and executive agency staff, and representatives from trade and professional associations to its booth at the National Conference of State Legislatures (NCSL) Legislative Summit in San Antonio, Texas on Aug. 9-11. The 2011 meeting was an invaluable opportunity for local nurse anesthetists, student registered nurse anesthetists, and AANA state government affairs staff to visit informally with legislators and their staff from all 50 states. Several student registered nurse anesthetists from the U.S. Army Graduate Program in Anesthesia Nursing in San Antonio volunteered at the AANA booth. An estimated 20 percent of all state legislators attend the NCSL’s Legislative Summit.
Innovative pain techniques taught at tri-service ultrasound course
By Capt. (Dr.) John Gasko
Army Medical Department Center & School
Army, Air Force and Navy certified registered nurse anesthetists recently learned new and innovative techniques using ultrasound for regional pain management. The techniques were taught during the “Ultrasound Guided Nerve Block Course for Anesthesia Providers,” a course offered through the U.S. Army Graduate Program in Anesthesia Nursing at the Army Medical Department Center & School. The anesthesia nursing program is rated nationally as number one in its field by U.S. News & World Report and AMEDDC&S is one of two military schools that produce military certified registered nurse anesthetists. The graduate program also sponsors continuing education workshops to promote continuing education for all military anesthesia providers. Acquisition of ultrasound- guided regional skills for nurse anesthetists and the effects of battlefield anesthesia on long-term pain management are among the leading research priorities for Army nurse anesthesia researchers, according to the Army Nursing Research and Evidence Based Practice Priorities list.
This course addresses all three topics and allows the program to play a direct role in the education of nurse anesthesia providers. Among many professionals, the use of ultrasound for image guidance in regional anesthesia is
anticipated to become a standard of care. “Anesthesia providers agree that direct visualization of internal structures may lead to safer, quicker, and more successful blocks with fewer complications,” said Lt. Col. Joseph O’Sullivan, USAGPAN program director.
The course focused on the principles of the ultrasound machine and upper and lower extremity anatomy and blocks. Participants from various Army, Air Force and Navy medical treatment facilities performed blocks on cadavers supplied by the graduate program during the course. A follow-on discussion session gave providers an opportunity to share experiences and anecdotal input. Topics included increased effectiveness and decreased incidence of complications associated with ultrasound guided regional anesthesia. “The primary goal of this course was to ensure that all anesthesia providers have the skill sets necessary to provide the best care for Soldiers downrange,” O’Sullivan said. “This course was great for me. I’ve done the trauma rotation in Baltimore but we didn’t get the regional ultrasound focus like we did here,” said Capt. Jeff Gainok, 274th Forward Surgical Team (Airborne), Fort Bragg, N.C. “I was already pretty familiar with ultrasound guided regional from school but being able to get the hands-on and one-on-one instruction was definitely beneficial,” Gainok added. “This course allowed attendees to augment their knowledge and experiences with ultrasound and anatomy,” said Dr. Justin Boge, an anesthesiologist at Wilford Hall Medical Center, Lackland Air Force Base, who also taught and attended the course.
“These opportunities allow the clinicians to return to their medical treatment facilities and share their knowledge and information learned and disseminated throughout the course,” Boge added. “This provides an immeasurable impact on the military’s mission to provide world class healthcare.” Participants have enrolled from as far away as Hawaii while some are attached to U.S. Army Forces Command positions, although most are from major military medical centers. “We continue to use the team approach in caring for Soldiers, families and retired members of our armed services,” O’Sullivan said, adding that faculty felt it so important they volunteered their time to instruct. The course provided 14 continuing education credits for professional certification and is planned to be an annual event.
By John Sherner
New and innovative techniques using ultrasound for pain management were recently introduced in the Army Medical Department Center & School’s first “Ultrasound Guided Nerve Block Course for Anesthesia Providers,” offered through the U.S. Army Graduate Program in Anesthesia Nursing last month.
Among many professionals, ultrasound use for regional anesthesia is anticipated to become the standard of care. “New studies in research support the use of regional nerve blocks in theater to decrease Soldiers’ pain medicine requirements postoperatively and in the recovery period,” said John Gasko, an assistant professor with USAGPAN. Gasko was one of several instructors for the course. “Anesthesia providers agree that direct visualization of internal structures may lead to safer, quicker and more successful blocks,” said Lt. Col. Joseph
For more information
Created 03/09/2011 - 00:44
Major Michael Bentley, PhD, US Army Graduate Program in Nurse Anesthesia answers a few questions on nurse anesthesia training in the US Army.
The US Army Graduate Program in Anesthesia Nursing has a mission to prepare a full service provider for medical missions during peacetime, war, civil disorder, natural disasters, and during humanitarian efforts. I would not say there is a mystique so to speak, just an expectation of our faculty that our graduates will be leaders at the head of the bed, be able to critically analyze data, diagnose an anesthetic problem, and make prompt and safe patient care decisions. We graduate students that have the ability to function independently in several settings ranging from the austere to the state-of-the-art.
What do you consider the strengths of the US Army programs specifically ?
As a result of that mission, military anesthesia students do not run into many of the roadblocks to training which is encountered in civilian institutions. Political issues regarding financial incentives and billing practice do not impede our training mission. In that respect we are isolated and unique.
As well the program offers the students the following:
The robust simulations program at Phase I has greatly enhanced student learning and has eased their transition into the clinical Phase II. For images of our simulation equipment please refer to www.usagpan.org  .
Another asset is a dedicated ultrasound machine specifically for the SRNAs at each site and thus graduates have, on average, placed ½ of their PNBs with ultrasound guidance.
To be eligible for a US Army program, must you join the Army ?
Yes, a civilian or reservist will be accessed onto active duty for the training (3 years) and obligation (5 years). It is an 8 year commitment in total.
The military must compete with civilian practices in order to retain CRNAs. What are some of the advantages of being an Army CRNA?
The most glaring advantage is the practice environment. Military CRNA practice is based upon the medical mission and requires practitioners to provide a full range of skills and thus must “train as we fight”. As a result, daily CRNA practice encourages autonomous practice.
Another advantage is the expectation of the Army that a clinician will not remain stagnant during their career and will continue to build upon their educational experience. Opportunities for further education are abundant within this system.
While compensation may not be on par with the civilian sector, there is a yearly incentive bonus. Also, one has to consider that if they attended the USAGPAN program,there is no school debt and no malpractice premiums to pay.
Finally, some say deployment is a disadvantage, but I disagree. It is true that one’s personal life will be put on hold (family, etc). But as a clinician, I discovered that my deployment experience was invaluable in promoting my clinical expertise. That experience could never be duplicated in the civilian sector.
CRNAs in civilian life often are employed by or directed by anesthesiologists. How does that compare to anesthesia practice in the Army ?
I think I have addressed this question with my previous comments.
Major Bentley, where can we obtain additional information on the US Army Nurse Anesthesia Graduate Programs ?
At our website: 
I appreciate your candor and insights, Sir.
Army CRNA program earns top ranking as graduates get an outstanding education and a dose of adventure.
When a shepherd with five gunshot wounds staggered to the medical tent in Kosovo, Lt. Col. Joseph O'Sullivan, PhD, CRNA, immediately stabilized him and whisked him to the ICU. Army docs ultimately saved the critically injured man who turned up 6 weeks later with a gift of two sheep. After months of "meals ready to eat," fresh mutton was a welcome change.
Such incidents in far-flung lands are not for everyone, but those with a taste for adventure may indeed find the military life to be just what the doctor ordered. Two decades after Kosovo, O'Sullivan now heads up the U.S. Army Medical Department Center and School's Graduate Program in Anesthesia Nursing, and his unique experiences serve to enrich an educational program that U.S. News & World Report recently dubbed the nation's best in anesthesia nursing.
The program at Fort Sam Houston in San Antonio, rose to the 2012 top spot after ranking second in the past two consecutive reports (2004 and 2008). Not surprisingly, such a program takes a rigorous and focused approach that usually starts with about 40 students during phase 1 in San Antonio. "We accept civilians and military," O'Sullivan explained. "If you want to be one of us, be the best at what you do. You may want to go to anesthesia school, but to get there you must show you are motivated. One of the things we look at for entrance is a recommendation from the supervisor indicating this person is highly motivated and ready to take the next leap in responsibility."
The package includes an allotment for housing, food, full officer pay, full dental and medical benefits, plus $500 per year for incidental educational expenses. O'Sullivan points out that other anesthesia nursing programs in the country (just over 100) can't come close to these perks.
The inevitable "catch" is the active duty service obligation (ADSO) of 4 /12 years, a period of time when all graduates must serve as military CRNAs. The post-graduation assignment usually takes newly minted CRNAs to one of about 50 different military facilities around the country where surgeries are performed. "There you will hone your skills, get some experience, and after a year you could be on the deployment list," O'Sullivan said. "Usually deployments are about once every 3 years. You may end up in Iraq or Afghanistan. Some people enjoy going out into the field and living in a MASH environment, which can be intense."
Civilians coming in to the program are accepted directly into the Army, where the first priority is an 11-week officer basic leadership course. Here new trainees are taught how to shoot, wear the uniform and abide by the rules and ethics. After the course, anesthesia school begins in earnest.
Early morning jogs with colorful chants are not part of the routine, ensures O'Sullivan. "As a graduate student in the program, you are expected to do physical fitness on your own time," he said. "We have gyms and pools here. And you have to pass the fitness test twice a year - April and October. As an officer, it is your responsibility to stay in shape."
The typical applicant is in his or her late 20s or early 30s, with some ICU training, and a GPA hovering around 3.5. About two thirds are active duty military, and half are male - which is a bit higher than other sectors of nursing.
The current policy is to accept 100 percent of all fully qualified applicants, and O'Sullivan is always looking for strong candidates to apply. Phase 1 can accommodate up to 60 students, and the typical phase 2 bottleneck for most civilian clinical sites is usually not a problem on the military side. "Good clinical sites to learn the trade can be difficult to find," reported O'Sullivan, who began his military career as a combat medic in the National Guard. "We are blessed with enough sites for up to 60 students. The benefit of the military is that I have other hospitals that I could use in a pinch."
Despite the considerable financial help offered by the Army, O'Sullivan again cautions that "the military is not for everybody." As with all endeavors, he recommends candidates do their research and know what they are getting into. "Some civilians have called me and said they were not aware we were at war and that they might have to go to Afghanistan," O'Sullivan mused. "Some have young children and families, and it can be tough on families to be deployed. Usually deployments are 6 months, so about every 2 or 3 years you are away from your family. That gets to be stressful."
Those who thrive under these circumstances will work on multidisciplinary teams, and have many opportunities for experience in leadership and administration, beyond what is available in the civilian sector. The former head of the Army Nurse Corp, for example, used to be a CRNA, and was a two-star general. Yet another CRNA in Hawaii recently became the 18th MedCom Commander, in charge of all medical assets in the Afghanistan war.
O'Sullivan estimates that roughly half of all graduates bolt for the private sector once their ADSO is up, but it all depends on the number of years already in the military. Those who leave can write their proverbial ticket to wherever they want to go. "Lots of head hunters and hospitals are looking for qualified, talented and independent nurse practitioners," said the 54-year-old O'Sullivan. "You can basically do whatever you want when you get out of the Army. If we can coax you into staying, we will. If not, we thank you for your service and bid you farewell.
"I believe a key reason for our consistently high rankings is the stellar skills our student nurse anesthetists display in a clinical setting," O'Sullivan added. "We prepare our students to work under wartime conditions, as well as during civil disorder, natural disaster and humanitarian missions."
Doctorate on the Horizon
The Army's anesthesia nursing program is among 12 graduate programs under the Academy of Health Sciences at the U.S. Army Medical Department Center and School. Graduates receive a Master of Science in Nursing Anesthesia from Northeastern University School of Nursing, but starting in 2012 they will earn a Doctorate of Nursing Practice (DNP).
The transition from master's degree to DNP is in line with the American Association of Critical-Care Nurses' directive that all advanced practice nurses - such as nurse anesthetists, nurse midwives and nurse practitioners - should have entry-level DNP programs by 2015. "We will extend our program to 36 months from 30 months, adding more graduate credits, plus a cap stone project, which is similar to a thesis defense," O'Sullivan explained. "Phase 1 will remain 1 year here in San Antonio, but phase 2 will be 2 years instead of 18 months."
Despite the added schooling, O'Sullivan expects to keep the program's coveted 100 percent pass rate for board exams, a factor that U.S. News & World Report took heavily into account when determining its rankings. Why such a stellar pass rate? Great teachers and receptive students combine to form the not-so-secret recipe. "We have a great devoted faculty and commitment from our staff," O'Sullivan enthused. "We have six doctorates on the phase 1 faculty staff and another two are getting their doctorates. We espouse a focused education to ensure our students are well qualified to take the exams and qualified clinically to treat patients."
The U.S. Army Graduate Program in Anesthesia Nursing is open to active duty, reserve and civilian nurses who meet application requirements. For more information visit http://www.northeastern.edu/bouve/nursing/add/armyprograman.html, or to learn more about Army Nurse Corps benefits and opportunities visit healthcare.goarmy.com.
Greg Thompson is a frequent contributor to ADVANCE.
By Phil Reidinger
AMEDDC&S Public Affairs
A recent annual U.S.News and World Report magazine ranking of the nation’s graduate schools ranked the Army Medical Department Center & School’s anesthesia nursing master’s degree program as the best in the nation. The Army graduate program in Anesthesia Nursing is affiliated with Northeastern University and ranked No. 1 in the nation among 112 accredited anesthesia nursing programs. The Army-Baylor University doctoral program in physical therapy ranked fifth in the nation among 228 accredited doctoral programs. The Army-Baylor University graduate program in Health and Business Administration ranked 11th in the nation among 90 accredited graduate programs. The Interservice Physician Assistant master’s degree program that is affiliated with Nebraska University ranked 13th in the nation.
U.S.News and World Report analyzed more than 1,200 graduate programs and the rankings are based on evaluations of curriculum, record of scholarship, quality of faculty and quality of students. “We’re not unique or special … but our mission is,” said Col. Josef Moore, dean of the graduate school. “The level of scholarship and leadership exhibited by not only the ranked programs, but all of our graduate programs, far exceed mission standards and take a back seat to no programs in the country. “Grounded by the roots of our AMEDD heritage, now joined by our interservice colleagues, we are the tip of the spear nationally in graduate education,” Moore added. According to the U.S.News and World Report website (http://www.usnews.com/education/best-graduate-schools/articles/2011/03/14/medical-school-rankingsmethodology-2012), the medical school research model is based on a weighted average of eight indicators, and the primary-care model is based on seven indicators.
Both rankings are based on a weighted average of indicators. Four of the data indicators are used in both the research and primary-care ranking model. They are the student selectivity admission statistics (MCAT, GPA,and acceptance rate) and faculty-to-student ratio. The medical school research model factors in research activity; the medical school primarycare model adds a measure of the proportion of graduates entering primary-care specialties. The Academy of Health Sciences Graduate School hosts seven doctoral and five master’s degree programs partnered with universities to support the graduate programs. Academic affiliations include Baylor University, University of Nebraska Medical Center, Northeastern University, Fayetteville State University and Erskine Theological Seminary. Students earn master’s degrees in health and business administration, nutrition, anesthesia nursing, physician assistant studies and social work. Doctoral degrees include physical therapy, occupational therapy, pastoral care, physician assistant in emergency medicine or clinical orthopedics, sports medicine-physical therapy and orthopedic and manual physical therapy.
The AMEDD Center & School is accredited by the Council on Occupational Education and all programs of instruction are reviewed by the American Council on Education. All graduate programs requiring higher level academic accreditation from their respective professional organizations continue to exceed all national benchmarks. The Academy of Health Sciences manages 14 teaching departments providing 315 programs of instruction to officers, enlisted and foreign students with a total staff and faculty of 1,860. The programs range from one week courses to doctoral and master’s degrees.
USAGPAN ranks #1 by US News and World Report in Graduate Nurse Anesthesia Programs.