VANA in the Military: How CRNAs Impact Virginia’s Success
This month, VANA spoke with Bridget Wolfe, CRNA of MedStream Anesthesia at Fauquier Health (Warrenton, VA). We discussed her military background, the importance of advocacy, and why CRNAs are critical to the success of healthcare in Virginia.
Can you share a bit about yourself and your background?
I graduated from the United States Army Graduate Program in Anesthesia Nursing (USAGPAN). I received my didactic education in San Antonio but did my clinical portion in the national capitol area at (then) Walter Reed Army Medical Center, National Navy Medical Center, Fort Meade, Fort Belvoir, and the VA Medical Center in Washington DC. I was educated and trained almost entirely by CRNAs, all of which demonstrated to me that CRNAs can practice independently. My first duty assignment after graduation was at Blanchfield Army Community Hospital, Fort Campbell, KY. We practiced to the full extent of our credentials. We took primary call, performed central and peripheral regional techniques, and planned/executed our anesthetics from pre-op through PACU.
I was deployed to the Middle East while stationed at Fort Campbell. I was with a surgical hospital that had 10 CRNAs and 2 physician anesthesiologists. We didn’t have large numbers of casualties, which was a good thing, but we did care for pediatric through geriatric civilian patients in addition to military personnel. That presented several challenges because most deployment equipment isn’t designed to care for pediatric patients, but I packed two footlockers full of basic pediatric anesthesia equipment, so we had supplies to handle that part of the mission.
I left active-duty December 2003. I took a contract position at Winn Army Community Hospital, Fort Stewart, GA, followed by a civil service (GS) position at Tripler Army Medical Center, Honolulu, HI. I got back into the Army Reserve in Hawaii, in order to continue my military career and work toward a military retirement. I did a reserve activation to Fort Belvoir Community Hospital (now) in 2011, returning to mainland USA, and then subsequently took a contract position at Fort Belvoir until 2019. I retired from the Army Reserves in October 2022.
Why did you decide to be a CRNA?
When I was a very junior officer, (I think I had been on active duty about six months!) I was deployed to the Gulf War (1990). I was working with a group of army nurse corps officers (who were CRNAs) from all over the country that were staffing the 47th Field Hospital. I’d never heard of nurse anesthetists (and I’m originally from Iowa!) and was curious about what these CRNAs did, fascinated by the level of autonomy, and then decided that was what I was going to with my nursing career. They explained what steps I needed to take to make that happen and I spent the next few years working toward the goal of acceptance into USAGPAN.
It’s difficult being a CRNA at all, but to be a CRNA in the military presents its own set of challenges and rewards:
Certainly! I was looking for more autonomous practice. I grew frustrated in the ICU where I would see a critically ill patient in pain, and I couldn’t do much about it besides ask the physicians managing the patient for pain management orders. As a CRNA, I’m able to design and execute an anesthesia plan and manage their pain in multiple ways as well as modify that plan as needed. I take care of my patients, ask for help if I need it, and still love the profession more than 20 years later!
Let’s talk about Full Practice Authority:
Absolutely. It’s why, even after I left active duty, for many years I only took positions at military hospitals. I’d done some moonlighting while on active duty and realized that not all CRNAs were able to practice the way we (CRNAs) did in military hospitals. I wanted to maintain my autonomous practice, so I avoided the medically directed positions.
I’m fortunate that my current position at Fauquier Health in Warrenton, VA (a small community hospital) gives me the autonomy I love. It’s loosely supervised, we have a physician anesthesiologist available, and the relationship between the CRNAs and the anesthesiologist is very collegial.
That autonomy is why I kept taking positions in military hospitals, so I could serve my patients to the fullest extent of my education and training. I wouldn’t have taken my current position if that autonomy weren’t part of the equation. It hasn’t been without challenges. The anesthesia group that was at Fauquier Health prior to MedStream was a medically directed model. The CRNA credentials were written in such a way that for CRNAs to perform any procedures, an anesthesiologist had to be “on premises”. That didn’t work for our current practice taking primary OB call. The anesthesiologist wasn’t on premises in the middle of the night or on weekends whenever we were putting in epidurals and managing labor anesthesia. It needed to be updated so we weren’t practicing out of scope. It took several long and repetitive meetings to help the medical staff and credentials personnel understand we weren’t asking for something more, we were asking for our credentials to reflect what was actually happening.
You come from a strong military background – how do you feel those experiences have helped you as you’ve served both as a CRNA and during your time as a healthcare advocate?
I think my military background and experience has given me more strength in execution of patient advocacy. In my undergraduate nursing education, my professors constantly reiterated “Nurses are the last line of defense in prevention of patient harm”. I think the military fostered that belief and expanded it. Having been empowered during my military service to speak up and advocate for my patients (not being afraid to do that, but also being diplomatic) is vital to safe patient care. I advocate for my patients everyday, so being comfortable with speaking up is absolutely necessary. Admittedly, sometimes my delivery is a bit abrupt, but the people I work with know that my primary concern is the patient, and everything else is a distant second.
In the military, we’re frequently required to practice in an austere environment, you get used to troubleshooting issues related to equipment, supplies, etc. There’s a different level of problem solving associated with being in the military that I think is important.
You’re also a strong VANA advocate – why is it important to volunteer your time in professional organizations?
I haven’t always been involved in VANA, but I’m happy and excited to have made the decision to make the time to do it now! I’m learning so much about how the legislative process can influence our profession. I would love for all Virginia CRNAs to micro volunteer, donate to the PAC, and come to the conferences VANA organizes.
Speaking to legislative personnel was terrifying to me, but accompanying Shannon Noffsinger to the congressional offices during the MidYear assembly and going to VANA legislative days has helped me overcome that fear. I’m currently the treasurer for VANA, and it’s given me a better understanding of where our AANA dues money is spent, and how important PAC donations are to fund the legislative initiatives we have. (All about preserving and improving our practice!)
I understand that CRNAs are busy with work, family, outside interests, etc. There is a level of comfort that can lead to apathy about advocating for our profession. We need to remember that a rising tide raises all ships, and that if we work together to advocate/advance our professional legislation we all profit from the improvements. Just a few minutes of your time, when and where you can spare it, can make a world of difference for VANA and for our profession overall.
No one makes it as far in a career as you without some incredible mentors. Anyone you want to recognize specifically?
Yes! I received my education and training to become a CRNA almost exclusively by CRNAs. One in particular, Terry Lasome, I remember thinking “if I could be half as good as him, I’d be great!” He instilled the importance of continuing to learn and advocating for your patients unlike any of the other CRNAs I learned from. Frank McShane, Tim Newcomer and Tom Albee were the clinical faculty during my training. They were phenomenal, instrumental in expanding my clinical experiences and education.
Julie Eldred and Steve Aretz were two of my chief CRNAs at my first duty station. They entrusted me with being able to do any and all cases, including a lot of pediatric anesthesia. That has helped me throughout my career, they instilled confidence in me that has helped me throughout my career. Judy Bock, my chief CRNA at Tripler, was an incredible advocate for CRNA practice, for full practice authority. When she was challenged by physicians and the command group about CRNA practice, she used evidence and diplomacy, an amazing leader.
Pam Wulf was one of my bosses when I was at Fort Belvoir, she was a terrific boss and advocate for her patients and her CRNAs.
