A marriage of care

By Brian Chandler
It’s a cold January morning and Peter DeForest is scraping the ice from the windshield of his car while his wife Jennifer fills up two travel coffee mugs and feeds their black Lab before heading out the door to the car.
Peter and Jennifer are a husband and wife team, not only in life, but in their careers as well. Jennifer, 43, and Peter, 53, both hold doctoral degrees from Virginia Commonwealth University. The two met in 2004 when Jennifer was serving as the team leader for the region’s only Neonatal and Pediatric Critical Care Transport program and Peter was director of a multi-facility anesthesia practice group.
For the last two years, the couple have been employees at Pioneer Community Hospital of Patrick County, providing anesthesia services for everything from emergency room procedures to pain management and any and all surgical procedures that require anesthesia. The team also provides anesthesia staffing for the Pioneer facilities in rural Stokes County, N.C. The two are known as Certified Registered Nurse Anesthetists or CRNAs, which typically provide the anesthesia services in nearly 100 percent of rural hospitals throughout the United States.
CRNAs are advanced practice registered nurses (APRN) who hold an advanced degree in a nursing specialty and have passed a national board certification in that specialty. APRNs are an essential component to high quality, affordable, and accessible health care services all over our country.
“Jennifer and I provide basically 98 percent of the hospital’s anesthesia services,” Peter said while putting on a pair of royal blue scrubs, then glancing at a chart showing what procedures were lined up for the day.
“Except for about two weeks during the year when Jen and I take a vacation, we’re working for Pioneer and we’re busy.” The team works in very close collaboration with not only the surgeons but family practice and emergency providers to ensure comprehensive care for each patient.
Nurse anesthetists have been providing anesthesia care to patients in the United States for nearly 150 years. The credential CRNA came into existence in 1956 and these health care providers are considered anesthesia professionals who safely administer approximately 32 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA).
Education and experience required to become a CRNA include:
• A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
• A current license as a registered nurse.
• At least one year of experience as a registered nurse in an acute care setting.
• Graduation with a master’s or doctoral degree from an accredited nurse anesthesia educational program.
Approximately 41 percent of the nation’s 44,000 nurse anesthetists (which includes CRNAs and student nurse anesthetists) are men, compared with less than 10% in the nursing profession as a whole.
“That statistic doesn’t mean much to me here at Pioneer,” Jennifer said with a slight grin. “We’re part of a strong team of both male and female health care professionals all committed to the mission of serving this wonderful community.”
Today Jennifer and Peter have been married for seven years and live about 25 miles from Pioneer Community Hospital of Patrick. Most days, they wake up on the same schedule, ride to work together and occasionally see each other in the hallways of the hospital in between cases. Peter noted that they really do work well together and sometimes patients pick up on the same last names and ask questions.
“It’s my typical response when a patient asks if we are related to say, ‘Yes, you met my wife, she’s the A. Team and I’m just the B. Team,’” Peter said. “It’s really fun to work together though. Some married people can’t wait to get out of the house, but we make a great team both at work and at home.”
If it wasn’t for the DeForests, Pioneer Community Hospital could find itself hard pressed to find and fulfill its anesthesia services. Janet Setnor, president of the Virginia Association of Nurse Anesthetists (VANA), which is the statewide organization that represents more than 1,000 CRNAs throughout the Commonwealth of Virginia, is familiar with the need of these professionals to be in rural areas.
“In a rural area like Stuart and all parts of southwestern Virginia, the importance of having a nurse anesthetist can not be discounted,” Setnor said. “Many medical doctors with anesthesia degrees or anesthesiologists as they are known, don’t want to work in rural areas. Someone has to be willing to serve these areas and the trend nationally is for CRNAs to meet this need.”
However, CRNA practice in Virginia, as well as the rest of the country, has over the last few years become a hot topic of discussion. Today, Virginia is one of a few remaining states that by law require CRNAs to practice under the supervision of a physician.
Setnor notes that the supervising physician is almost never an anesthesiologist in rural hospitals, but a physician who is conducting the procedure or surgery. She also said VANA is working towards legislation that would help clarify the role of CRNAs by defining advanced practice nurses so patients and the public alike can better understand the role CRNA’s play in providing anesthesia care.
“As advanced practice nurses, CRNAs practice with a high degree of autonomy and professional respect,” Setnor said. “They carry a heavy load of responsibility and are compensated accordingly. This stipulation in the law can cause some real problems regarding patients accessing care, but it sounds like Pioneer has done it right.”
Jeanette Filpi, administrator of Pioneer Community Hospital has seen firsthand the value that the DeForest team brings to her hospital.
“If we can save patients from having to drive two hours to another city to get treatment, we can affect patients in a very positive way,” Filpi said. “Many of our patients don’t want to drive to a big facility, fight traffic and struggle with parking. To be able to come to their own community hospital and get this incredibly high standard of care is a great plus for them and for us. It’s also a huge economic factor for our facility.”
By early afternoon on that cold January day, Peter, who is actually the director of perioperative and surgical services for the hospital, was setting up equipment in one of the hospital’s operating rooms preparing for the next procedure, while Jennifer screened their last patient of the day.
“It’s really a unique opportunity that Peter and I can work together here at Pioneer,” Jennifer said as she rolled their last patient down the hall to the operating room. “We have some great stories to tell, but none of them would be possible without the team of support we have that includes the excellent nurses, technicians, therapists, doctors, hospital administration and of course the patients.”
National CRNA week runs from January 24-30. To find out more about the profession, log onto: www.VANA.org.
Pioneer Community Hospital is located in Patrick County. The hospital opened in March 2009 and is committed to providing high-quality health services in a caring, safe, and cost-effective manner. They provide health education and wellness, the recruitment and support of primary care physicians and specialists, 24-hour emergency care, outpatient diagnostic and rehab services, inpatient care and post-acute recovery. Find out more at http://pchpatrick.com.patient DeForests on mtn

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