MUSC College of Health Professions Anesthesia for Nurses program brochure

C O L L E G E O F H E A LT H P R O F E S S I O N S DIVISION OF ANESTHESIA FOR NURSES

M E S S AG E F RO M T H E D I R E C T O R

Angela Mund, DNP, APRN, CRNA Division Director, Anesthesia for Nurses

T

he Anesthesia for Nurses (AFN) Division has a long history at the Medical University of South Carolina

(MUSC). We celebrated our 50th anniversary in 2017 and are the only original program within the College of Health Professions still accepting students today. The division’s success and longevity can be credited to the breadth of our curriculum and programing, the reputation of our faculty and alumni, and the quality of our students. We are proud to be recognized by our peer institutions and professional organizations for our innovation and leadership.

In 2014, we were the first nurse anesthesia program in South Carolina to offer a post-master’s Doctor of Nurse Anesthesia Practice (DNAP). Soon after, our entry-to-practice DNAP program was approved – another first in the state. Our program also boasts a top-notch faculty. We have the only Certified Healthcare Simulation Educator in South Carolina and a presence on the national board for the American Association of Nurse Anesthetists (AANA).

Over the last 5 years, the AFN Division has expanded its scholarly output with a 95 percent success rate for research posters accepted at peer-reviewed national and international meetings.

We are fortunate to be able to recruit quality students from across the country. They continue to excel in the classroom, the clinical area, and in student leadership roles on campus and in our professional organizations, both at the state- and national-level. Our faculty proudly educates our students in political advocacy and encourages them to actively participate in issues and policies related to the nurse anesthesia profession. In fact, many of graduates of our program continue to advocate after their time at MUSC and have gone on to hold leadership roles in state and national organizations.

Graduates of our program are highly sought after, excellent clinicians who put patients and families first. Our 100 percent employment rate at the time of graduation is a testament to their skills, commitment to education, and clinical experience.

We look forward to continuing this tradition of success in the clinical, leadership, and scholarship arenas as we meet the mission of the Division of Anesthesia for Nurses.

E D U CAT I O N

Mission To prepare independent, ethical, culturally aware nurse anesthesia providers to lead in the clinical and professional areas. This is accomplished by providing evidence-based, high-quality didactic, clinical, healthcare policy, and simulation education.

Vision To be a nationally-recognized nurse anesthesia educational program that graduates highly sought after, innovative nurse anesthesia leaders.

Values

INTEGRITY

INNOVATION

DIVERSITY AND INCLUSION

WELLNESS

PROFESSIONAL ADVOCACY Quick Facts

100 2014: %

EMPLOYMENT RATE POST-MASTER’S DNAP APPROVED

EVIDENCE-BASED EDUCATION

97 2016: %

GRADUATION RATE POST-BACCALAUREATE DNAP APPROVED

In 2016, when the post-baccalaureate DNAP program offered by the Anesthesia for Nurses Division at MUSC’s College of Health Professions was approved, it was one of only 50 programs, out of 116 programs, approved to offer the degree in the United States.

National Certification Exam for Nurse Anesthetists Performance

93

%

FIRST–TIME PASS RATE*

*The national average pass rate is 84.8%

100

%

OVERALL PASS RATE

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ACA DE M I C E XC E L L E N C E A N D I N NOVAT I O N Program leadership has long recognized the importance of being on the forefront of changes in education. In 1991, early in the conversion from the baccalaureate to master’s degree requirement, the program transitioned to offering an entry-level graduate degree. More recently, in 2016, the AFN program was among the first 43 percent of nurse anesthesia programs to obtain approval to offer the entry-level clinical doctorate.

Faculty acknowledged that graduates must be prepared to meet the health care needs of patients through additional education in evidence-based practice, health care policy, leadership, and managing change.

Promoting patient safety is at the forefront of our program.

Students learn the intricacies of human anatomy through dissection in a full cadaver laboratory; manage high-risk, lowoccurrence crisis in the AFN simulation center; and discover approaches to provide acute and chronic pain management in a course specifically designed for this purpose. Adjunct faculty provide expertise in health care economics, information systems, pain management, and ultrasound technology. Graduates

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leave our program well-prepared to practice in diverse clinical environments including Level I Trauma Centers, independent certified registered nurse anesthetist (CRNA) practices, and the military.

C L I N I CA L A N E S T H E S I A P R AC T I C U M Throughout the perioperative period of the post-baccalaureate DNAP program, students are educated in all facets of nurse anesthesia practice. After completing their foundational learning, students participate in a series of 19 clinical rotations, each four to five weeks. During this time, students administer anesthesia to all types of patients, including complicated pediatric and adult patients, in a variety of practice settings. Our 24 clinical locations throughout South Carolina and Georgia range from Level 1 Trauma Centers to community hospitals to rural independent CRNA practices. Each clinical setting has student coordinators and instructors who serve as preceptors and role models for the student registered nurse anesthetist. Through their guidance and teaching, students are prepared to be autonomous, compassionate, competent, and ethical entry-level nurse anesthetists.

C L I N I CA L S I M U L AT I O N MUSC’s AFN Division has its own dedicated laboratory space, task trainers for all anesthesia airway and invasive skills, and a high-fidelity mannequin within a simulated operating room.

Students use the task trainers to learn basic airway management and eventually advance to practicing crisis situations in highfidelity simulation. Throughout the program students have unlimited access to all task trainers so that they can practice skills at their convenience. Using small group instruction, students are given the opportunity to use their knowledge, develop skills, learn behaviors, and work with equipment that is used in daily anesthesia practice.

Both the post-baccalaureate and post-master’s DNAP programs at MUSC use clinical simulation to teach hands-on skills and reinforce critical thinking throughout the curriculum. Simulation gives both novice and experienced students the opportunity to be trained in a variety of skills and be exposed to multiple patient scenarios, before advancing to their clinical training. Clinical simulation is taught over three of the seven semesters of the post-baccalaureate program and students are required to pass a skills assessment at the end of each semester before advancing to the next level.

Throughout both programs, simulation curriculum is designed to parallel didactic content. As students advance, the focus of simulation changes from skill performance to critical thinking and the application of anesthesia didactic content. Scenarios and situations faced in simulation become more complex and students are required to work together within the highfidelity simulator to manage cases and troubleshoot patient’s complications as they arise in real time. Crisis simulation is taught, exclusively using the high-fidelity simulator, at the end of the post-baccalaureate and post-master’s programs. The course trains students for situations that are infrequent yet significantly life threatening to patients such as malignant hyperthermia, anaphylaxis, and hemorrhage.

Students work in the program’s dedicated simulation laboratory both independently and under faculty supervision. >

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RESEARCH AND SCHOLARSHIP Over the last five years, students and faculty have presented posters at the South Carolina Association of Nurse Anesthetists (SCANA) annual meeting, the American Association of Nurse Anesthetists (AANA) Annual Congress, and the International Federation of Nurse Anesthetists (IFNA) World Congress of Nurse Anesthetists. The AFN Division’s primary faculty, Michele Ballister, DNP, APRN, CRNA, CHSE, Candace Jaruzel, Ph.D., APRN, CRNA, and Angela Mund, DNP, APRN, CRNA, have published works in the areas of pharmacology, simulation, preoperative anxiety, clinical research, and policy.

PUBLICATIONS & POSTERS Publications

Ballister, M. (2019). Sugammadex Use in Anesthesia Practice.

CRNA Today eJournal. Online content.

Ballister, M. (2018). Basics of the Objective Structured Clinical Exam. Journal of the American Association of Nurse Anesthetists. Online content, 60-63.

Ballister, M. (2018). Student Registered Nurse Anesthetists: Impact of Structured High Fidelity Simulation on Anesthesia Ready Time. Anesthesia eJournal. 6(2) 7-11.

Jaruzel, C. B., Gregoski , M. J., Mueller, M., Faircloth, A. C., & Kelechi, T. J. (2019). Aromatherapy for preoperative anxiety among female breast surgery patients: A pilot study. Journal of PeriAnesthesia Nursing. doi: 10.1016 /j.jopan.2018.05.007.

Jaruzel, C. B., & Gregoski, M. J. (2017). Instruments to measure preoperative acute situational anxiety: An integrative review. AANA Journal, 85(1): 31-35.

Mund, A. (2018). Professional Socialization and Political Advocacy. Journal of the American Association of Nurse Anesthetists. 86(2), Retrieved from aana.com/publications/ aana-journal.

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Posters

Hord, Krista; Newbry, Sean; Sharp, Rachel; Williams, Shakesha; & Ballister, Michele M. (2018) “Dexamethasone for Postoperative Nausea and Vomiting Prophylaxis: A Comparison of Clinical Practice to Recommended Guideline.” [Poster] South Carolina Association of Nurse Anesthetists Annual Meeting.

Campbell, Shatericka; Grambeau, Kalie; Reuter, Amanda; Sturm, Martha; & Ballister, Michele M. (2018) “An Evaluation of Goal Directed Therapy Algorithm Implementation in Free Tissue Transfer Patient.” [Poster] American Association of Nurse Anesthetists Annual Congress.

Delany, Jenna; Fawcett, Nicholas; Galletta, Ryan; King, Holly; Leoshko, Julia; & Ballister, Michele M. (2017) “ A Comparison of Novice Student Registered Nurse Anesthetists Performance in Simulation and the Clinical Setting Using the Creighton Simulation Evaluation Instrument.” [Poster] South Carolina Association of Nurse Anesthetists Annual Meeting.

LaCombe, David; Skariah, A.J., Walston, Russel; Williams, Rachel; & Ballister, Michele M. (2017) “ The Impact of High-Fidelity Simulation on Malignant Hyperthermia Management.” [Poster] American Association of Nurse Anesthetists Annual Congress.

Cash, C. & Jaruzel C. (2019), South Carolina anesthesia provider knowledge and utilization of transversus abdominal plan block for perioperative pain management. AAN Annual Congress, Chicago, IL. Jennings, M., Huber, D., Wolf, B., & Jaruzel, C. (2019).

Anesthesia techniques for total hip arthroplasty. AANA Annual Congress, Chicago, IL. Davis, A., Phillips, R., Schwade, L., Singletary, O., Torres, W., & Jaruzel, C. (2018). Comparing attitudes toward nurse anesthetist and anesthesiologist collaboration in an anesthesia care team model. SCANA Annual Meeting and Conference, Charleston, SC. 1st place in poster contest.

Boice, S., Fox, R, Hyer, M., Gonzales, E., McCabe, B., Murphy, B., & Jaruzel, C. (2018). Effects of dexmedetomidine loading doses on bariatric surgical patients. SCANA Annual Meeting and Conference, Charleston, SC. 2nd place in poster contest.

Beattie, C., Brauner, N., Hayes, R., Kittrell, A., Yost, T., & Mund, A. (2018) Intraoperative Administration of Dexmedetomidine to Minimize Emergence Delerium in the Pediatric Population [Poster] State of the Science, International Federation of Nurse Anesthetists, Budapest Hungary.

Belle-Isle, S., Mello, J., Mikan, G., Pritchett, B., Schiller, B., & Mund, A. (2017) Predictors of Student Registered Nurse Anesthetist Success on the National Certification Exam: a Retrospective Study. [Poster] State of the Science, American Association of Nurse Anesthetists, Seattle WA. Beattie, C., Brauner, N., Hayes, R., Kittrell, A., Yost, T., & Mund, A. (2017) Intraoperative Administration of Dexmedetomidine to Minimize Emergence Delirium in the Pediatric Population [Poster] State of the Science, American Association of Nurse Anesthetists, Seattle WA. Owens, C., & Mund, A. (2019) Barriers to Physician Supervision Removal of CRNAs in South Carolina. [Poster] State of the Science, American Association of Nurse Anesthetists, Chicago IL. Hollinshead, J., Mund, A., & Chew, M. (2019) Continuous Peripheral Nerve Blocks (CPNB) for Patients with Traumatic Orthopedic Injuries. [Poster] State of the Science, American Association of Nurse Anesthetists, Chicago IL.

GRANTS Candace Jaruzel, Ph.D., APRN, CRNA

is currently part of an interdisciplinary team of anesthesia providers, human factors and systems engineers, pharmacists, and biostatisticians working to engineer reductions in anesthesia medication errors in the operating room. This collaborative team enlists professionals from MUSC, Johns Hopkins University, and Clemson University. Their project, The Operating Room Systems-based Medication Administration Error Reduction Team (OR-SMART), Patient Safety Learning Lab was awarded a $2.37 million multi-center grant, distributed over four years, by the Agency for Healthcare Research and Quality.

Angela Mund, DNP, APRN, CRNA

has been awarded traineeship grant funding from the Health Resources and Services Administration (HRSA).

All funds received from the grant are provided directly to nurse anesthesia students to offset the cost of nurse anesthesia clinical education, especially costs associated with attending clinical sites in rural South Carolina and Georgia. The purpose of this grant is to increase the number of CRNAs providing to rural and underserved populations. Over the last seven years, Mund has been awarded over $300,000, benefiting over 350 student registered nurse anesthetists.

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FACULTY PROFILES 8

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Angela Mund, DNP, APRN, CRNA

Associate Professor Mund serves as the program administrator of the Anesthesia for Nurses Division. She has been a clinical certified registered nurse anesthetist (CRNA) and an educator for over 20 years. During her career, she has transitioned two nurse anesthesia programs to an entry-level doctoral program. Her areas of academic and scholarly expertise are health care leadership and policy. In 2018, she received the South Carolina Association of Nurse Anesthetists Helen Arndt Award for her demonstration of dedication to the profession of nurse anesthesia. In addition to her administrator duties, Mund teaches advanced health assessment and advanced principles of nurse anesthesia practice while also maintaining a clinical practice. She has served in state and national leadership roles including her current appointment on the American Association of Nurse Anesthetists Board of Directors. Dr. Mund served in the U.S. Army Reserves Nurse Corps for 10 years.

Candace Jaruzel, Ph.D., APRN, CRNA

Assistant Professor Jaruzel serves as the assistant program administrator for the Anesthesia for Nurses Division. She also serves as the clinical director overseeing 24 clinical sites across South Carolina and Georgia. She is a published author and expert in the area of complimentary therapies and preoperative anxiety. Jaruzel teaches a variety to topics including evidence-based practice and introduction to clinical anesthesia. Her expertise in a diverse set of topics provides opportunities for mentoring and advising doctoral student scholarly projects. Dr. Jaruzel currently serves on an interprofessional, multicenter grant project focused on identifying and reducing errors in perioperative anesthesia medical delivery.

Michele Ballister, DNP, APRN, CRNA, CHSE

Associate Professor Ballister serves as the director of simulation and chair of the Admissions Committee. She is a nationally-recognized expert in simulation development and evaluation and is one of less than 100 CRNAs certified as a healthcare simulation educator. Her area of scholarly inquiry is simulation. Ballister is a published author and has presented scholarly posters in this area. As chair of the Admissions Committee, she developed and implemented the holistic admissions model using an emotional intelligence approach to interviewing prospective students. Prior to entering a nurse anesthesia program, Dr. Ballister served as an active duty registered nurse in the U.S. Army Nurse Corps.

Brian Gegel, DNAP, CRNA

Gegel serves as adjunct faculty providing expertise in regional anesthesia and acute and chronic pain management. He has a certificate in advanced pain management and is the course director for the Foundations in Pain Management Course. Gegel is a published author and presenter on the effects of hemostatic agents and hemorrhage as well as the use of interosseus transfusions during trauma. He has served as a primary and associate investigator on multiple funded research projects. He served in the U.S .Army including tours in Iraq.

Steven J. Mund, DNP, CRNA, FACHE, CENP

Mund serves as adjunct faculty providing expertise in anesthesia management, billing, and reimbursement. He has served in hospital leadership roles for 20 years including as a senior director of surgical services. He is a Fellow in the American College of Healthcare Executives and earned a Certified in Executive Nurse Practice credential. Mund has served on several state and national nurse anesthesia professional committees and, as a member of the U.S. Army Nurse Corps, served in Iraq and Afghanistan. He is a nationally known speaker on the topic of medical malpractice deposition.

Lisa Rogers, DNAP, CRNA

Rogers serves as an adjunct faculty providing teaching support in nurse anesthesia principles courses, chemistry, and physics. Her area of scholarly expertise is in the area of anesthesia management for the neurosurgical patient.

Rogers also serves as a mentor for doctoral scholarly projects. She is a clinical staff CRNA and instructor at Prisma Health.

Benjamin “Eddie” Thomas, MSNA, CRNA

Thomas serves as an adjunct faculty member providing expertise in regional anesthesia and the use of ultrasound. He is a clinical staff CRNA and instructor in a variety of clinical practices including an independent CRNA

practice in rural Georgia. Thomas is a recipient of the MUSC Excellence in Clinical Instruction Award. He has served on state and national committees, taskforces, and as the president of a state nurse anesthesia association. He serves as a mentor for doctoral scholarly projects in the area of peripheral nerve blockade and pain management.

Jack Thomas, PT, EdD

Thomas is a professor in the Division of Physical Therapy and teaches multidisciplinary Human Anatomy, Clinical Pathophysiology, and Radiologic Imaging.

He currently serves as chair of the Physical Therapy Policies and Procedures Committee and is chair of the MUSC Cultural Projects Council. His research interests center around teaching methodologies, specifically with regards to human anatomy and computer-based anatomical models.

Heather Shaw Bonilha, Ph.D., CCC-SLP

Bonilha is a speech-language pathologist whose NIH-funded research focuses on improving the care of patients with swallowing and voice disorders. She is an associate professor in the College of Health Professions at the MUSC. Bonilha serves as the medical director of Speech-Language Pathology for the hospital, as the co-director of the Interdisciplinary Doctoral Program in Health and Rehabilitation Sciences, and as the co-director of Translational Workforce Development for the South Carolina Clinical & Translational Research Institute (MUSC’s SCTR). She has served on NIH study sections and on the editorial board of several journals.

Bonilha has published over 50 peer-reviewed articles and has given over 100 scientific presentations. She teaches research methods to the nurse anesthesia students and enjoys watching as they understand and then become advocates for using evidence to drive clinical practice.

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AFN students and faculty on the United States Capitol building steps during the AANA Mid-Year Assembly.

B E YO N D T H E C L A S S RO O M

Advocacy

MUSC’s AFN Division has a longstanding history and a significant national reputation for producing graduates who take leadership roles in professional organizations and committees at the state and national levels as a complement to their work in health care.

Policies regarding the profession, especially as they relate to equity for reimbursement and scope of practice, are at the forefront of those efforts. In 2018, MUSC students and faculty worked alongside the American Association of Nurse Anesthetists (AANA) to rally support for continued, gradual implementation of the Quality Payment Program (QPP) as well as improvements to related policies. Included in the Bipartisan Budget Act of 2018, QPP is focused on allowing eligible clinicians to deliver a higher quality of care to Medicare patients.

In addition to working on a national level, post-baccalaureate and post-master’s candidates and program administrators also work with state officials whenever issues related to the profession arise. Following their time at MUSC, several graduates have served as president or as members of the board of directors for various state nurse anesthesia organizations, in South Carolina and beyond. The collective goal, as always, is to improve access to care and patient outcomes while also decreasing patient costs.

In recognition of those efforts and the active role that MUSC continues to hold in the profession’s evolving landscape, students have access to courses as part of their curriculum that are specific to media training, policy, and lobbying.

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Exposure to these areas has predictably increased involvement in advocacy efforts at every level. Over the past several years, students have explored various areas of health care policy as it relates to professional practices, further instilling the importance of involvement among students, faculty and the profession at large. Many students from the program choose to become involved after being selected to serve in positions on one of AANA’s various committees, including the Political Action Committee (PAC). In 2019, students held active roles on the AANA PAC as well as the South Carolina Association of Nurse Anesthetists Board of Trustees.

Recruitment Events In order to recruit the highest quality candidates to the MUSC DNAP programs, students and faculty are actively engaged in mentoring opportunities with members of the Student Nurses’ Association of South Carolina (SNA-SC), local colleges and universities, and hospitals statewide.

With about a 20% acceptance rate, only the most qualified candidates are encouraged to apply to both the postbaccalaureate and post-master’s DNAP programs. Recruitment activities at MUSC have a renewed focus to attract candidates to both programs who represent diverse ethnic and cultural backgrounds.

“Our goal goes beyond recruiting the best candidates to our school; we want to recruit the best candidates to our profession,” said Angela Mund, DNP, APRN, CRNA, associate professor and MUSC division director. “We want to ensure we have a student body and a profession that’s reflective of the population at large.”

About The Medical University of South Carolina (MUSC) Founded in 1824 in Charleston, MUSC is the oldest medical school in the South, as well as the state’s only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care.

Each year, MUSC educates and trains more than 3,000 students and 700 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state’s leader in obtaining biomedical research funds, in fiscal year 2018, MUSC set a new high, bringing in more than $276.5 million.

As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available, while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians’ practice plan, and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2018, for the fourth consecutive year, U.S. News & World Report named MUSC Health the number one hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.

MUSC and its affiliates have collective annual budgets of $3 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care. For information on academic programs, visit musc.edu.

(843) 792-3328 | chp.musc.edu