Dr. Michelle Canale is the President of the Florida Association of Nurse Anesthesiology, as well as the USF Nurse Anesthesiology Program Director. Her passion is professional advocacy and educating future CRNA professional leaders. She models evidence-based advanced nursing practice, service, scholarship, and leadership to her graduate students.
What You’ll Learn In This Episode
- Certified Registered Nurse Anesthetists – who we are, what we do
- Veterans Care and Wait Times
- ICAN Legislation
- CRNAs in the Military
This transcript is machine transcribed by Sonix.
Intro: Broadcasting live from the Business RadioX studios in Atlanta, Georgia. It’s time for Association Leadership Radio. Now here’s your host.
Lee Kantor: Lee Kantor here another episode of Association Leadership Radio and this is going to be a good one. Today on the show we have Michelle Canale with the Florida Association of Nurse Anesthesiology. Welcome, Michelle.
Michelle Canale: Thank you so much. Lee Thanks for having me.
Lee Kantor: Well, I am so excited to learn about your association. Tell us about FANA. How are you serving folks?
Michelle Canale: Well, Fana was founded in 1936. It is the professional association for 5400 Certified Registered Nurse Anesthetist in Florida. We advocate for patients and members in legislative and governmental affairs and serve as a resource for CNAS, the nursing and medical profession, hospitals, health care facilities and other interests, other people that are interested in anesthesia care.
Lee Kantor: So what’s your backstory? How did you get involved in association work?
Michelle Canale: Well, I have been a member of Fana since I was a student in my anesthesiology training program, and after that I just started serving on a committee. I first served on the Government Relations Committee of Fana and then ran for an office. So I became a director and I served in that capacity for a couple of years and then just kind of progressively took the next steps. I served as vice president for a year and then president elect, and now I am the current president of Fana.
Lee Kantor: Now, when you started your career, was this something you aspired to be doing or is this work that as you started kind of getting more and more involved, that just became a passion area for you?
Michelle Canale: Well, I think I was inspired during my education and training in anesthesiology. My mentors in my academic program really highlighted the importance of professional involvement and advocacy, something that I modeled to my own students today. And I think that that’s where it all started. And I just became very passionate about advocating for our profession and for patients.
Lee Kantor: Now, are you seeing young people also following that path, or is this something that you wish more young people would kind of go down that that road?
Michelle Canale: We are absolutely seeing our up and coming future seniors involved in advocacy. Fana does a tremendous job of involving our student registered nurse anesthetists in advocacy. They’re meeting with legislators and educating the public on what Sierra’s are, who we are and what we do. Of course, we always welcome more membership and more involvement, and there’s plenty to do on our committees as well as in our office positions.
Lee Kantor: Can you talk a little bit about the RNAs in the military? How has that role changed maybe over time?
Michelle Canale: Yeah, So syringes were the original anesthesia experts providing anesthesia for more than 150 years as far back as on the battlefield of the Civil War. They are educated and trained to practice independently on day one coming out of their program, just as their physician counterparts are. They’re the only providers of anesthesia on the battlefield in forward surgical teams still today, whereas physician anesthesiologists are not deployed into combat zones like CNAS are, They practice in every setting in which anesthesia is administered, including traditional hospitals, labor and delivery suites, interventional pain management, critical care units and ambulatory surgery centers. And they are able to care for patients before, during and after their procedures as their sole anesthesia professionals in rural hospitals and medically underserved areas. So they really play a critical role in maintaining access to care all across the US. And 100% of Sierra’s are board certified.
Lee Kantor: Now, is there something that you would like to share regarding maybe some misconceptions of Sierra names? Or maybe there’s something the public needs to know about the importance of this? You mentioned how how critical their services. Is there a shortage of them? Do you do we need more of them?
Michelle Canale: Well, we really don’t have a shortage of anesthesia providers. We have a shortage of providers that are performing anesthesia. In many instances, the anesthesia services are duplicated where a physician anesthesiologist supervises a certified registered nurse anesthetist, when in fact, the RNAs are trained to the full scope of anesthesiology services and can practice independently on day one. So that is a very common misconception about anesthesia care in the US. It does vary by state law, but over. All Sierras can practice independently and create a very cost effective and high quality way to deliver anesthesia care.
Lee Kantor: So that’s something that’s happening. It’s almost like a duplication of services sometimes.
Michelle Canale: Yes, exactly. It’s a duplication of services. The supervision is often superfluous and is not really required. For example, in the Veterans Health Care Administration, there’s a lot of supervision of certified registered nurse anesthetist, which is causing a delay in care and decrease access to care for our veterans.
Lee Kantor: And that’s something that could easily be alleviated by just having more C.R.A. kind of do that kind of work, rather than wait for the one physician who’s probably in charge of a whole bunch of stuff.
Michelle Canale: Exactly. So interestingly, 23% of veteran households report delays in getting VA health care appointments and surgical procedures, and 88% of veteran health households strongly support legislation granting veterans direct access to seniors in the VA health care system. So the VA is currently considering a proposal to give veterans direct access to CNAS, but that is likely to take years. And as you know, our veterans are waiting for care right now. They’ve already sacrificed so much for our country, and they really shouldn’t have to sacrifice their health waiting for surgical care that they deserve. There are currently 1000 Syrians currently serving in the VA health care system today. And so the glaring question for policymakers remains what changes when crowds leave the battlefield and come home to work in the VA health care administration? Why are these autonomous, independent, qualified providers able to be independent in the most difficult situations but then need antiquated supervision when they’re here practicing in the VA health care administration?
Lee Kantor: Is that a situation where kind of a bureaucracy has just taken hold and it’s hard to kind of get rid of some of the status quo of this is the way we’ve always done it. So this is the way we do it.
Michelle Canale: Yes, that is part of the issue. Another part is just the lack of understanding of the public. And, you know, C.R.A. provide most of the anesthetics around the country. But we are called the best kept secret in health care because our patients are asleep while we’re taking care of them. And patients don’t often remember or they don’t realize that a CRNA even exists. But we’re often the ones who are in the surgical suite or in the labor and delivery suite taking care of the patient the entire time.
Lee Kantor: Right. It’s I don’t think anybody aspires to be a best kept secret. Like, there’s always. That’s not. And it’s a backhanded compliment.
Michelle Canale: Yes. If you’ve ever had surgery or for those who are listening, who have ever had a baby, you were most likely taken care of by a CRNA.
Lee Kantor: Right. And like you said, they’re allowed to be in in a combat situation and nobody blinks at that. And then they go into a, you know, a hospital here in America, a VA hospital, and then all of a sudden they’re kind of put on the bench and it just doesn’t make any sense. I mean, if they can handle that chaos in a crisis mode every day, why can they just handle what’s happening inside of a VA hospital on American soil?
Michelle Canale: That’s exactly right. And additionally, C.R.A. have been working on the front lines during the COVID pandemic. They were leading their have been leading the critical response efforts, working in some of the most difficult situations. And for the last two and a half years, Medicare has temporarily waived practice barriers, allowing serenades to practice to the full scope of their education and training.
Lee Kantor: Yeah, I think this is one of those times where, I mean, when it was good enough for a crisis, why isn’t a good enough or when there’s not a crisis? I mean, if it’s already been proven and it’s successful there, I mean, it just the red tape has got to stop. I mean, it’s just we’re hurting ourselves by not leveraging the skills of these talented cronies.
Michelle Canale: That’s exactly right.
Lee Kantor: Now, for you as a leader of an organization, is this something that, you know, you just got to get the word out for the general public to understand? Hey, you don’t have to tolerate this. You know, we’re going to there’s a better solution here. You don’t have to wait for the one physician. There’s there’s a bunch of qualified and skilled is just waiting here to speed up that wait time so you don’t have to wait any longer is that you need. Kind of a ground up kind of approach to get more and more people clamoring for this so that policy can change.
Michelle Canale: Yes, that’s true. We are constantly needing to educate policy makers, both at the federal level, the state level, as well as the local level and even at the facility level about who C.R.A. are and what we do. Again, it’s sort of a big secret that Sierra’s even exist. And even though we we were the original anesthesia providers, even before anesthesia became a medical specialty. So we are constantly engaging in grassroots efforts to educate our legislators. We continue to educate, educate, educate. And when they term out, we start educating their replacement. And it’s a constant process to try to educate stakeholders about who we are and what we do. And it’s a big misconception that somehow the care is inferior to that provided by a physician anesthesiologist, when in fact there are multiple landmark studies out there showing that the care is equal to that provided by a physician anesthesiologist and at about a 25% reduced rate.
Lee Kantor: Right. Like, it doesn’t make any sense on multiple level. Not only will it be more affordable, it’s you’re getting the same outcomes and it just doesn’t make any sense. I mean, this is what frustrates people with bureaucracy, you know, where there’s a better solution, just clear as day in front of you and then it still can’t be implemented because of a bunch of red tape.
Michelle Canale: Yeah. The good news is, is that there is the I Can Act, which stands for improving care and access to nurses. It’s legislation that will ensure access to health care for millions of Americans by removing unnecessary barriers to high quality health care services. Specifically, it will provide access to syringe services under Medicaid and remove illusory and superfluous physician supervision of CNAS. This will help health care facilities avoid costly duplication of services and use their resources to further improve patient care in other ways. This legislation is consistent with the recommendations from numerous health care stakeholders, including the National Academy of Medicine. In their report titled The Future of Nursing 2020 to 2030 Charting a Path to Achieve Health Care Equity. The National Academy of Medicine recommends that all state, federal and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers to improve health care access, quality and value.
Lee Kantor: Now, is this something that it’s. Have they voted on this or it’s it’s they’re still debating this or looking at this, but a vote hasn’t occurred yet to put this in place?
Michelle Canale: That’s correct. A vote has not occurred yet. It is simply been legislation that’s been introduced and sponsored by several legislators. It’s important to note that this is a bipartisan legislative effort that has sponsors on both sides of the aisle.
Lee Kantor: So that’s encouraging. Is this one of I guess this is where an opportunity and a frustration is as a leader of an organization like this is that you can see the finish line. It’s just a matter of getting people just to kind of take the ball into the end zone here. It just requires probably relentless, tenacious work on your part in order to get people to take action.
Michelle Canale: It does. And as you can probably imagine, there is our physician counterparts are constantly doing the same thing from the other side and trying to make a case for why physician anesthesia is somehow better, even though the research does not show that. So it’s a constant battle, know the physicians have a lot of money to be able to fight the battle. So, you know, it’s just about continuing to educate those and providing the real research and, you know, showing them how we are the answer to quality care at a cost effective price.
Lee Kantor: Yeah. And let’s let’s see them get in the front lines. Let’s see him line up for that part of the equation.
Michelle Canale: Yes. And there’s plenty of work to go around.
Lee Kantor: I’m sure there is. There’s no shortage.
Michelle Canale: Yes, we need them in the operating room doing cases as well so that we have greater access to care for all of our patients.
Lee Kantor: Right. It’s an and it’s not nor.
Michelle Canale: Exactly.
Lee Kantor: Yeah. Sometimes you know, you get into. These zero sum games. And it just it doesn’t help the consumer at the end of the day.
Michelle Canale: Right.
Lee Kantor: Now, what can we be doing more for you? It sounds like this is a battle that’s been going on for a hot minute and it just requires kind of tenacity to to get this done.
Michelle Canale: Well, so listeners can contact their legislators and ask them to support the icon legislation that is currently being sponsored in a bipartisan fashion from both sides. It’s a win win for patients, for health care costs, for reducing the strain on the health care system, for health care equity. It’s a win win for everybody. So if those who are listening want to help with this, they can contact their legislators and ask them to help with the I Can Act legislation that’s at a federal level. Now, you can also contact your state legislators, your senators and representatives on the state level to ask them to to support CRNA practice at the state level as well.
Lee Kantor: Now, any advice for other leaders of associations when it comes to this type of advocacy where it’s a it’s a battle that’s, you know, takes a while and to just stay the course and to stay focused. Is it a matter of just getting as much data and research as possible to make your case? Like, how do you keep everybody engaged and committed to something as important as this over a long period of time?
Michelle Canale: So I can tell you that Fana works very, very hard at this all the time. We are just one state, one member state in the American Association of Nursing Anesthesiology, which is the national professional organization. The AMA was founded back in 1931, just five years earlier than Fana, and it represents nearly 59,000 Sierra’s and student registered nurse anesthetist nationwide. We work together with our mother organization, if you will, at the national level, the ANA, and they provide a plethora of resources to help the states and the state associations with educating legislators, with monitoring upcoming legislation, efforts that may be for or against our our mission. So I would advise other state organizations to look to the ANA for assistance. They’re incredibly helpful. They have a lot of resources, and they’ve been a huge help to the Florida Association of Nurse Anesthesiology.
Lee Kantor: Well, if somebody wants to learn more, what’s the website? What’s the best way to get ahold of you or somebody on the team?
Michelle Canale: Well, you can reach us at our website, Fana dot org a and a dot org. And there’s a bunch of resources there as well. You can learn all about the different nurse anesthesiology programs in Florida. There are announcements posted from time to time about different legislation that’s going on or resources Q&A, things like that on the website. It’s it’s really there’s a lot of information there for anybody who wants to go to Fana dot org.
Lee Kantor: Well, Michelle, thank you so much for sharing your story today. You’re doing such important work and we appreciate you.
Michelle Canale: Thank you so much, Lea.
Lee Kantor: All right. This is Lee Kantor. We’ll see you all next time on Association Leadership Radio.