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ALANA NewsBulletin advancing quality anesthesia care, serving our members, promoting the nurse anesthesia profession ALANA NewsBulletin Winter 2014 www.alabamacrna.org Celebrate National CRNA Week January 25-31, 2015 www.future-of-anesthesia-care-today.com Each year, Certified Registered Nurse Anesthetists (CRNAs) provide more than 34 million anesthetics and related services for patients during surgery and other procedures, labor and delivery, acute and chronic pain management, and trauma care. CRNAs stay with their patients throughout their procedure, monitoring their vital signs and adjusting their anesthetics to ensure the safest, most comfortable anesthesia experience possible. With a nurse anesthetist by your side, you are in the care of a healthcare professional who is committed to watching over you from the time you go to sleep until the time you wake up. ©2015 American Association of Nurse Anesthetists

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ALANA

NewsBulletin advancing quality anesthesia care, serving our members, promoting the nurse anesthesia profession

ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org

CelebrateNational CRNA Week

January 25-31, 2015www.future-of-anesthesia-care-today.com

Each year, Certifi ed Registered Nurse Anesthetists (CRNAs) provide more than 34 million anesthetics and related services for patients during surgery and other procedures, labor and delivery, acute and chronic pain management, and trauma care. CRNAs stay with their patients throughout their procedure,

monitoring their vital signs and adjusting their anesthetics to ensure the safest, most comfortable anesthesia experience possible.

With a nurse anesthetist by your side, you are in the care of a healthcare professional who is committed to watching over you from the time you go to sleep until the time you wake up.

©2015 American Association of Nurse Anesthetists

2 ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org

President’s Message . . . David Gay, CRNA, MSN, MNA

ALANANewsBulletin

Winter 2014 • www.alabamacrna.org • ALANA NewsBulletin 3

Volume 32, Number 4 Winter 2014PublisherAlabama Association of Nurse Anesthetists Post Office Box 240757 • Montgomery, Alabama 36124 334.260.7970It is with great privilege and humility that I give my first

President’s Message to the membership of the Alabama Association of Nurse Anesthetists. It is an honor to serve you and promote the profession of nurse anesthesia as the President of the ALANA. I would like to begin by thanking Past-President Jennifer Overton. She has done a fantastic job leading the ALANA this past year through challenging obstacles, the implementation of the Affordable Healthcare Act, Alabama Blue Cross Blue Shield reimbursement, and guiding us through a very detailed state organizational health assessment. She has proven to be a remarkable leader that has served selflessly and has left a legacy of leadership that will not soon be forgotten. This year, I hope to build upon the momentum and success of this past year, to challenge our association to reach even greater goals, and develop a vision that will continue to gain us recognition as leaders in anesthesia care.

In keeping with building momentum, this year’s Fall Meeting provided new opportunities for our association. The meeting was held at the Renaissance Birmingham Ross Bridge Golf Resort and Spa. This first class facility provided a quiet getaway from the bustle of the city allowing attendees to relax, golf, learn, and socialize all while being surrounded by the beautiful environment of the resort. The program committee, Patrick Hubbard, Larry Vinson with Group Management Services, and countless others worked tirelessly to put together a fantastic educational experience at an incredible resort. Attendees were able to participate in an Adult and Pediatric Cardiovascular Symposium that included testing for ACLS and PALS certifications. Saturday opened with former AANA President Terry Hicks and our newly elected AANA Region 7 Director, Dr. Garry Brydges who provided the AANA update. The weekend included The Funderburg Lectureship Series, sponsored by the Samford University Nurse Anesthesia Program and its alumni, featuring Dr. Dru Riddle. The day concluded with the ALANA State of the State Address by President Jennifer Overton and the business meeting. This year’s Fall Meeting offered a hands-on ultrasound-guided regional workshop by Patrick Moss, MS, CRNA, APN. At the conclusion of the business meeting on Saturday, all attendees were invited out to the pool for a reception as

October 16 & 17, 2015 ALANA Fall Meeting Ross Bridge Resort

April 24-26, 2015 ALANA Spring Meeting Destin, FL

April 22-24, 2016 ALANA Spring Meeting Destin, FL

we welcomed the latest class of CRNA students from the Samford and the UAB programs.

Thank you to the members of the ALANA for giving me such a talented Board of Direc-tors. You have chosen a dedicated team that has already begun great work seeking to serve the membership of the state. The new Board of Directors for 2015 met officially on October 12, 2014. The new board met at the conclusion of the ALANA Fall Meeting. I was impressed and challenged as I listened to each board member describe their work and life experiences and their plans to apply those experiences to this year’s goals and vision planning. I left our first meeting confident that the 2015 board was going to accomplish great things. The new board met again in Birmingham on October 25 and 26 for its Annual ALANA Board Retreat. This intense weekend of planning, orientation, and strategy implementation should never be construed as a retreat. The weekend consisted of the board pouring long hours into the plans for the upcoming year. The emphasis of this weekend was around using the information received from the state organizational health assessment to implement tactical initiatives, develop tasks, and set short and long term goals with budget implications for the upcoming years. The board left Birmingham that weekend exhausted, yet full of ideas and plans to further our association and profession.

Shortly after our planning retreat, members of the board traveled to Chicago during the second week in November to attend the AANA’s Fall Leadership Academy. President-elect Michael Humber, GRC Chair Jay Kendrick, GRC Co-chair and PAC Chair Lisa McKinley, Federal Political Director Dr. Amy Neimkin, and State Reimbursement Specialist Brad Hooks attended and met with current and future healthcare leaders and participated in personalized leadership tracks that broaden their perspective and reinforce leadership skills. These members gained critical insight into state government affairs, influencing key decision makers, how to best protect and advance CRNA reimbursement, and how to develop a

high-performing state association. This investment into the future leadership of the Board ensures that leaders are being given the tools and training necessary to meet the needs and demands of the membership.

We are approximately two months into our new Board year, and I have to say that the operational tempo of your 2015 Board is impressive. To quote one senior board member, “this board is on fire.” We have set into motion waypoints to measure our progress towards accomplishing the goals that we set for ourselves. We have enthusiasm, we have a purpose, we have goals, we have a plan, and we have people willing to accomplish great things.

I, and your Board, need your help to reach these goals and accomplish the vision that will continue to gain us recognition as leaders in anesthesia care. We are moving forward. We will accomplish great things. Come be a part of this board and the great work that we are accomplishing. Your active participation is much needed. You can become involved by joining a committee, attending state meetings, having a presence during the legislative session, or with a financial contribution. Help shape the future of your profession. Please contact me or any of the board if you can serve somehow. If you cannot give of your time, give of your treasure. If you can’t give of your treasure, please give of your time. You have chosen a worthy profession. Please see that it is protected through your active participation.

In closing, be proud of your profession. Promote your profession. Protect your profession. It’s a great day to be a CRNA.

If you have any interest in becoming more involved, to join alongside your ALANA Board of Directors, and to move our profession towards further recognition as leaders in anesthesia care, please contact me. As always, I am here to serve the membership.

Respectfully, David Gay, CRNA, MSN, MNA

Board of DirectorsDavid Gay, CRNA, MSN, MNAPresident-Elect6615 Lubarrett WayMobile, AL 36695251.895.2880 (cell)[email protected]

Michael W. Humber, CRNA, DNP, MNAPresident-Elect1816 Hardwood View DriveBirmingham, AL. 35242205.981.0557 (home)205.934.5977 (office) 205.999.7544 (cell) [email protected]

Heather Fields, CRNA, MBA, MSNVice-President/Secretary2330 Ridge RoadOpelika, Alabama 36804334.749.3031 (home)334.728.3030 (cell)[email protected]

Matt Hemrick, CRNA, MSNTreasurer709 Braddock AveBirmingham, AL 35213205.246.0183 (cell)[email protected]

Todd Hicks, CRNA, MNASenior Director8600 Lenox WayMontgomery, AL 36116334.559.9333 (cell)[email protected]

Jay Kendrick, CRNA, MSNSenior Director2529 Simpson Point RoadGrant, AL 35747256.728.7308 (home)770.547.5793(cell)[email protected]

Lisa Vallely, CRNA, MSNASenior Director 4314 Boulder Lake CircleVestavia Hills, AL 35242205.977.9931 (home)205.504.1090 (cell)[email protected]

Trey S. Burg, CRNA, MNADirector202 Pebble Creek LnEnterprise, Al. 36330334.308.1012 (home)334.494.2178 (cell)[email protected]

Lisa M. McKinley CRNA, MSDirector9900 Turtle Creek Lane SouthMobile, AL 36695251.259.2020 (cell)[email protected]

David Sloan, CRNA, MSNDirector125 Easy StreetAnniston, AL 36207256.741.1606 (home)256.310.5855 (mobile)[email protected]

Bryan A. Wilbanks, CRNA, DNPDirector105 Shady Spring DriveHarvest, AL 35749256.721.8531 (home)256.503.4360 (mobile)[email protected]

Salima P. Mulji, CRNA, MNANominating Committee Chair1503 Scout Ridge Dr,Birmingham, AL 35244205.835.5234 (cell)[email protected]

Christina Smyth, SRNAUAB Student Representative633 12th Street NWAlabaster, AL 35007)334.558.2052 (cell)[email protected]

Brittney Kilgore, SRNASamford Student Representative802 Woodland VillageBirmingham, AL 35216256.504.3349 (cell)[email protected]

Brad A. Hooks, CRNA, MSNAReimbursement Chair9411 DunleithMontgomery, AL 36117(334) 414-3435 (cell)(334) 356-9970 (office)(334) 269-8783 (fax)[email protected]

Amy P. Neimkin, CRNA, DNP, MBAFederal Political Director368 Woodward Ct.Birmingham, AL 35242205.991.9405 (home)205.243.8382 (cell)[email protected]

Susan HansenGovernment Relations Specialist4120 Wall StreetMontgomery, AL 36106334.244.2187 (office)334.320.7539 (cell)[email protected]

Joe Knight, CRNA, JDALANA General CounselKress Building, Suite 500301 19th Street NorthBirmingham, Alabama 35203205.655.4501 (home)205.458.1200 (office)205.531.5157 (cell)[email protected]

Larry Vinson, CAE, MPAALANA Executive DirectorPost Office Box 240757Montgomery, AL 36124334.395.4663 (home)334.260.7970 (office)334.462.8035 (cell)334.272.7128 (fax)[email protected]

ALANA NewsBulletin Copyright 2014 • Alabama Association of Nurse Anesthetists, Inc. • All Rights Reserved.

The ALANA NewsBulletin (USPS 019-869) is published quarterly by the Alabama Association of Nurse Anesthetists, Inc, Post Office Box 240757, Montgomery, Alabama 36124.

Calendar of Events April 24-26, 2015 ALANA Spring Meeting Destin, FL

October 16 & 17, 2015 ALANA Fall Meeting Ross Bridge Resort

April 22-24, 2016 ALANA Spring Meeting Destin, FL

Call for Nominations Salima Mulji, CRNA, MNA, Nominating Committee Chair

How long have you been an ALANA member? I have been a member of the ALA-NA since graduating Samford’s Nurse Anesthesia school in 2012.

What sparked your interest for a career in nurse anesthesia? I honestly had no idea what the scope of a CRNA was. For someone who was set on being an Emergency Room NP, it was as simple as a cousin convinc-ing me to come shadow her for a day. I was hooked and the rest is history.

What is your favorite aspect of being a CRNA? Instant gratification. I love being able to alleviate anxiety, manipu-late a patients hemodynamics or mitigate a patients level of pain.

How do you introduce yourself to your patients? “Hello, my name is Jared Box. I am going to be your Nurse Anesthetist” (insert blank look from patient). “I work with Dr. Jones to provide your anesthesia. I’ll be taking you to the Operating Room, putting you to sleep and waking youup. I’ll be with you the whole time.”

What are your hobbies out-side of anesthesia? I enjoy doing Crossfit, playing guitar and beating my children in card games…most of the time.

What has been your most reward-ing experience as a CRNA? Being able to bring brief moments of levity to patients who are nervous and about to have surgery…then keeping them versed and laughing with them some more.

What was your most challenging experience? Doing vascular and cardiothoracic anesthesia. Patients are more critical and there is a smaller margin for error.

Would you recommend this profession to others? Absolutely! Such a rewarding career. At least two that I have encouraged to do this are in Nurse Anesthesia school right now.

What advice would you give to others who are interested in our profession? It’s not impossible. Get in CRNA school, study hard and be patient, it is worth it.

What do feel the ALANA does best? The ALANA really does a great job of keeping the CRNA community informed on the pulse of the anesthesia community.

Introduce Yourself CampaignJared Box, CRNA

Are you passionate about the nurse anesthesia profession? Are you interested in how new healthcare legislation will affect you as a CRNA? Do you have ideas about how the ALANA can be more effective in promoting and advancing our profession?

If so, then I’d like to encourage you to get involved in your professional organization. To be effective, the ALANA must have CRNAs who are willing to contribute their time, talents, knowledge and expertise. Serving your fellow nurse anesthetists as an ALANA Board Member is one of the most rewarding aspects of a career as a CRNA.

The ALANA is looking for motivated CRNAs to serve on the Board of Directors. In 2015 we will elect a President-Elect, Vice President/Secretary, three Board of Director positions and a Nominating Committee Chair. If you or someone you know are interested in applying, please contact me or any member of the ALANA Board of Directors. The ballot will be approved at the Spring Meeting, with the election to follow in the fall.

Please consider this incredible opportunity to give back to the profession that has given us all so much. We look forward to hearing from you soon!

Salima Mulji, CRNA, MNAALANA Nominating Committee [email protected]

Jared Box is a CRNA at St. Vincent’s in Birmingham. He woke up one morning to

find one of his daughter’s “beginning-of-the- school-year” projects for 5th grade. What a

great “Wake Up’ gift.

4 ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org Winter 2014 • www.alabamacrna.org • ALANA NewsBulletin 5

Medical Business Management

“CRNA Billing Specialist”Contact: Joe Gribbin

1025 Montgomery Highway, Suite 100Birmingham, AL 35216

[email protected]

www.MBMPS.com

Winter 2014 • www.alabamacrna.org • ALANA NewsBulletin 7

Abstract, continued from previous page

Results A total of 16,555 medical records in the database met the inclusion criteria for analysis. Of those, 9,167 pa-tients received general anesthesia, 6,875 received spinal anesthesia, and 513 received epidural anesthesia for the primary procedure. All told, n = 7,388 patients received either spinal or epidural anesthesia. Several significant differences were found between groups in demographics and in the prevalence of comorbidities.1. The neuraxial group: a. was Older b. had lower BMIs c. was partially dependent or completely dependent in regards activities of daily living d. was more frequently diagnosed with hypertension requiring pharmacologic management1. The general anesthesia group had more: a. preoperative renal disease b. coagulopathies c. prior surgeries within 30 days

There was no difference in overall mortality between the two groups. The neuraxial group had a statistically significant-ly lower incidences of post-surgical pneumonia (odds ratio = 0.51, P = 0.035) and composite systemic infections (odds ratio = 0.77, P = 0.006). Using logistic regression analysis with risk adjustment techniques considering comorbidities, the neuraxial group was associated with a lower odds of pneumonia and any systemic infection compared to the general anesthesia group.

Conclusion Information analyzed from the NSQIP database demonstrated that those who had neuraxial anesthesia for total knee arthroplasty had a 49% reduction in pneumonia risk and a 23% reduction in the risk of systemic infectious complications compared to those who had general anesthesia. The reduction in pneumonia risk could be related to the fact that there were less systemic immune disturbances in the neuraxial group as well as the absence of airway instru-mentation, which can lead to increased risk of airway trauma and atelectasis formation.

CommentAccording to the American College of Surgeons NSQIP website, each year that a hospital uses information from their quality improvement program, it has the opportunity to massively improve patient care outcomes. The statistics are astounding; preventing 250-500 surgery/anesthesia related complications, the ability to save 12-36 lives, and an overall reduction in healthcare costs exceeding millions of dollars is almost hard to imagine. What was happening before we had this data? Irrespective of the answer, the good news is related to the explosion in healthcare informatics and the utilization of this type data. Both the contribution of and resulting analysis of quality improvement programs is beyond beneficial to the recipients of our care, the institutions, and us as CRNAs. Becoming intimately involved in the quality and outcomes improvement processes is critical. We have such a key role within the surgical team; our ability to con-sistently use techniques that are considered best practice is truly non-negotiable. This study was a fine example of using an existing database with an overall aim to discover which type of anesthetic, in certain patient specific scenarios, had the potential to prevent postoperative complications. It was not highly complex or extremely technical. However, it is grounded in rigor. I encourage all anesthetists to find out how you can contribute in meaningful Quality Improvement endeavors.

Mary Golinski, PhD, CRNANational Surgical Quality Improvement Program (NSQIP) database http://site.acsnsqip.orgAnesthesia Abstracts is A Publication of Lifelong Learning, LLC © Copyright 2014 ISSN Number: 1938-7172

Provided as a service to the ALANA by Anesthesia Abstracts (www.AnesthesiaAbstracts.com)Michael A. Fiedler, PhD, CRNA, Editor

6 ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org

A n e s t h e s i a A b s t r a c t sNeuraxial anesthesia decreases postoperative systemic infection risk compared with general anesthesia in knee arthroplastyAnesth Analg 2013;117,1010-15Liu J, Ma C, Elkassabany N, Fleisher L, Neuman M

AbstractThe purpose of this study was to test the theory that neuraxial anesthesia decreases postoperative infections and related complications compared to those who had general anesthesia for knee arthroplasty surgery.

Background In the USA, total knee arthroplasty is one of the most frequently performed surgical procedures, estimated at >500,000 annually. The typical demographic profile of knee arthroplasty recipients includes numerous comorbidities. Depending on the health history and other considerations, neuraxial and/or general anesthesia is most frequently used. Neuraxial anesthesia is thought to improve surgical outcomes by reducing the physiologic surgical stress response. It blocks noxious afferent inputs and minimizes metabolic disturbances. Surgical trauma combined with general anesthesia, on the other hand, is linked to a range of metabolic and endocrine disturbances and is a source of im-mune suppression. Very little evidence-based data exists supporting the association of anesthesia type and postoperative infectious complications. This study aimed to determine whether or not neuraxial anesthesia decreased postoperative infectious complications post total knee arthroplasty compared to general anesthesia.

Methodology This study was carried out as a retrospective analysis of an existing database. Data was acquired from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database covering 2005-2010. The NSQIP database houses a plethora of information including, but not limited to, surgical outcomes from hundreds of hospitals across the USA, patient-specific demographics, preoperative risk factors, intraoperative variables, and postoperative events for 30 days. Data in the NSQIP database used for analysis included:1. CPT code for either partial or total knee replacement as the principle procedure2. Primary anesthetic technique of general anesthesia, epidural anesthesia, or spinal anesthesiaExclusion Criteria included:1. bilateral knee replacement2. anesthesia other than general, spinal, or epidural3. preexisting infections a. infectious conditions as documented in the data base i.e., pneumonia, SIRS, sepsis, septic shock, contaminated wounds1. ventilator dependency The primary outcomes variables assessed included the following post-surgery infectious complications within 30 days postoperatively: • superficial wound infection • deep incisional wound infections • organ space surgical site infections • surgical wound disruption • pneumonia • urinary tract infection • sepsis • septic shock • any systemic infectious complicationThe researchers compared outcomes for 30 days postoperatively for those who had knee arthroplasty with neuraxial anesthesia and those who had knee arthroplasty with general anesthesia. Appropriate statistical analysis was performed to validate the findings.

further limit seniors access to healthcare. The vast majority of anesthesia practices have very little, if any, control over their volume of Medicare patients. Medicare beneficia-ries make up 18% of the total Alabama population, but are the greatest consumers of healthcare in our state. What impact would a 21.2% reduction of Medicare reimbursement have on your practice, your patients, and your family?

When the call comes, you are encouraged to take a few moments out of your busy day to write, e-mail, and call your elected officials and send Congress a strong mes-sage that the SGR must be repealed. http://fixmedicare-now.org is an informative website from the American Medical Association with interactive portals and Con-gressional action links. Please contact me if you have any questions about SGR cuts to Medicare reimburse-ment or any other CRNA reimbursement concerns.

ReferencesCenters for Medicare & Medicaid Services. Fact sheets: Policy and payment changes to the Medicare Physician Fee Schedule for 2015. 10/31/2014. http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2014-Fact-sheets-items/2014-10-31-7.html, retreived 12/1/2014.

American Medical Association. http://fixmedicarenow.org, accessed 12/1/2014.

The Henry J. Kaiser Family Foundation. http://kff.org

8 ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org

Fatigue has taken hold of many patients, providers and policy makers with respect to the Medicare Sustainable Growth Rate (SGR) cuts to Part B reimbursement. We are entering a time for increased vigilance and necessary action from CRNAs to ensure Congress exercises common sense correction to the SGR during their Fall 2014 “lame duck” session or the following 114th United States Congress.

The flawed SGR provision continues to threaten 21.2% cuts beginning on April 1, 2015 if Congress does not act to either repeal or delay the draconian cuts. If Congress throws another Band-Aid on the problem by simply delaying the cuts, it will be the 18th “doc fix” in the past eleven years. The previous seventeen congressional delays have cost $169.5 billion and have exceeded the cost of a permanent fix. The Congressional Budget Office (CBO) estimated $131 billion ten-year cost to fix payments through 2024. Two 2014 bills, S.2110 “SGR Repeal and Medicare Beneficiary Access Improvement Act” and S.2157 “Commonsense Medicare SGR Repeal and Beneficiary Improvement Act of 2014”, faced politi-cal and financial failure despite wide bipartisan support and significant lobbying efforts of Part B providers, including the AANA.

Medicare covers 49 million seniors and over 10 million military members and their families with TRICARE health insurance coverage in the United States. There are over 900,000 Medicare beneficiaries in the State of Alabama that will be adversely impacted by SGR cuts. These cuts will threaten access for Alabama Medicare beneficiaries, threaten providers financial stability, and threaten the Medicare program itself. It is a growing trend for providers across the country to refuse Medicare patients; these cuts will only increase that trend and

Reimbursement Threat Looming Brad A. Hooks, MSNA, CRNA

AANA State Reimbursement Specialist to Alabama

2015 Board of Directors & Staff

Winter 2014 • www.alabamacrna.org • ALANA NewsBulletin 9

David GayPresident

Michael HumberPresident-Elect

Heather FieldsVice-President

Matt HemrickTreasurer

Todd HicksSenior Director

Jay KendrickSenior Director

Lisa VallelySenior Director

Trey BurgDirector

David SloanDirector

Brad HooksReimbursement Chair

Amy NeimkinFederal Political Director

Joe KnightGeneral Counsel

Larry VinsonExecutive Director

Bryan WilbanksDirector

Christina SmythUAB Student Rep

Brittaney KilgoreSamford Student Rep

Lisa McKinleyDirector

Salima MuljiNominating Committee Chair

Susan HansenGovernment Realtions

Fall Meeting Highlights

ALANA program Chair Patrick Hubbard (Center) poses with speakers Chad Miller and Patrick Moss.

President David Gay presents outgoing ALANA President Jennifer Overton with gift.

Jennifer Overton, Patrick Hubbard, Matt Hemrick and Donna Dryden socialize at the Membership Reception.

Jennifer Overton presents Shannon Scatturo with the ALANA Distinguished Service Award.

Matt Hemrick (Center) visits with speakers David Sanford and Laura Durchsprung between sessions.

10 ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org

Fall Meeting Highlights

New Director David Sloan, Treasurer Matt Hemrick and Past President Jeff Brown pose between sessions.

Funderburg Lecturer Dru Riddle poses with Samford’s Nina McLain, Lisa Allison and Kerry Gossett.

ALANA Program Director Patrick Hubbard visits with speaker Terry Wicks.

ALANA President Jennifer Overton presents AANA Regional Director Garry Brydges with a set of Alabama Cuff Links.

Joe Watkins wins a cooler of cold beverages at the PAC Raffle.

Winter 2014 • www.alabamacrna.org • ALANA NewsBulletin 11

From the front lines to the VA hospitals, Certified

Registered Nurse Anesthetists (CRNAs)

have proudly and courageously

provided anesthesia care to

enlisted men and women, officers, and veterans in all branches of the military, from World War I to the present.

Certified Registered Nurse Anesthetists: Honoring a tradition of caring for those who protect our nation.

January 25-31, 2015

Vietnam Women’s Memorial, Washington, DCCopyright 1993, Vietnam Women’s Memorial Foundation, Inc. Glenna Goodacre, Sculptor

c e l e b r a t e n a t i o n a l c r n a W e e k

847-692-7050 | ©2015 American Association of Nurse Anesthetists www.future-of-anesthesia-care-today.com

12 ALANA NewsBulletin • Winter 2014 • www.alabamacrna.org