After spending three years working in the cardiology intensive care unit at the Medical College of Georgia, Dennis Woods decided he wanted to take his nursing career further. He found a program that matched his needs at Duke's School of Nursing, which just last year reconstructed its anesthesia program.
"I found out about the [nurse anesthetist] program kind of by accident through a mutual friend," Woods said. "I've always like the intensive part of critical care nursing... and I didn't expect to be accepted, but here I am." Woods has completed his first semester of classes--the first semester of Duke's nurse anesthesia program since 1983--and says that even though it meant hard work and long hours, he's okay with that. "Everything is hands on. We were kind of thrown in, and we are managing our own patients," he said.
Duke's nurse anesthetist program, which had been in existence for 52 years, was eliminated in 1983. But as demand surged for the specialists in rural areas, Duke recreated the program last January after the Department of Health and Human Services supported the program with a grant worth about $750,000.
"Nationally, the training of nurse anesthetists has been flat in the last 10 years," said Mary Karlet, director of the program.
"But the surgical needs have increased; we have a more elderly population today."
Increased demand for nurse anesthesists has been paired with more competition for entry into anesthetist programs such as Duke's. Karlet has already received over 700 application inquiries, and she expects to have at least 60 applications for the school's 10 spaces.
Nurse anesthetists, who complete a two-year masters program on top of their nursing bachelor's degree, work either independently or in coordination with a physician to deliver anesthesia to patients. Within the health services industry, there has been debate as to how freely to define the role of nurse anesthetists--some argue that nurse anesthetists should work independently from physicians, others that anesthesia should be delivered solely by physicians.
The nursing school teaches a moderate model. "I've always practiced in a team approach, and I'm a believer that a team of anesthesiologists and nurse anesthetists is the optimal model for anesthesia care," Karlet said. "I think it is an effective and safe approach to anesthesia."
The program also strikes a balance between clinical and academic work. During the 24-month program, students take a full load of classes.
They also spend three days each week doing clinical work in both rural small care facilities and large trauma centers.
Despite the potential pitfalls of a relatively young and small program, students say these attributes were two of the best of the program.
"I like that nothing is set in stone," said Katie Miller, adding that the faculty and the nursing school itself are well-established.
Karlet said the program has benefited from its small size. "We have an open door to them, and we encourage them to talk to us. They have our home phone numbers," she said.
Though the nursing program is small, Mary Champagne, dean of the nursing school, said the school's relationship with the much larger Medical Center, and specifically the anesthesiology department, has made the program feasible. "Given our hospital and broad community support, it was really clear we could do it well and students would want to come to school here because of the resources of the Medical Center," she said,
Dr. Mark Newman, interim chair of anesthesiology, said the nurse anesthetist program helps provide a team-based approach. "I think there are benefits to us and benefits to patients.... One of the best ways we can do this is to train excellent fellows and [nurses]," he said.
Newman said his department was able to provide the school with support in designing the curriculum.
"Our education director played a key aspect in... making sure that their clinical experience at Duke and at their other teaching sites is as good as it can be," he said.
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