[Congressional Record (Bound Edition), Volume 150 (2004), Part 15]
[Senate]
[Page 20993]
[From the U.S. Government Publishing Office, www.gpo.gov]




                CERTIFIED REGISTERED NURSE ANESTHETISTS

  Mr. INOUYE. Mr. President, I commend military certified registered 
nurse anesthetists, CRNAs. CRNAs are advanced practice nurses who 
administer anesthesia. Today, CRNAs administer approximately 65 percent 
of the anesthetics given to patients each year for all types of 
surgical cases in the United States.
  Nurse anesthetists have been the principal anesthesia providers in 
combat areas in every war in which the United States has been engaged 
since World War I. In World War II, there were 17 nurse anesthetists to 
every 1 physician anesthetist. In Vietnam, the ratio of CRNAs to 
physician anesthetists was approximately 3 to 1. During the Panama 
strike authorized in 1989, only CRNAs were sent with the fighting 
forces. In addition, the vast majority of anesthesia providers deployed 
for Operation Iraqi Freedom and Operation Enduring Freedom has been 
CRNAs. Nurse anesthetists are again carrying the load by providing 80 
percent of the anesthesia requirements in Iraq and Afghanistan. We rely 
heavily on CRNAs to accomplish wartime missions and our need for their 
services will only increase in the future.
  In all of the uniformed services, maintaining adequate numbers of 
Active Duty and Reserve CRNAs is of utmost concern. For several years, 
the number of CRNAs serving on active duty has fallen somewhat short of 
the number authorized by the Department of Defense. This lag in 
recruitment has been further exacerbated by a strong demand for CRNAs 
in both the public and private sectors. One reason the military has 
difficulty retaining CRNAs is that a large pay gap exists between 
annual civilian salaries and military pay.
  I am deeply concerned about retention of these CRNAs, particularly in 
the Army Nurse Corps. It has come to my attention that within the next 
3 years, the Army Nurse Corps could lose up to 50 percent of its 
current complement of CRNAs. A recent survey of Army CRNAs revealed 
that despite overall satisfaction with their anesthesia practice, 
dissatisfaction with pay and frequent deployments are the primary 
reasons for leaving active duty.
  One strategy that is proving effective in increasing overall 
satisfaction is the Army Surgeon General's 180-day rotation policy. I 
urge continuation of this policy. However, this is not enough to ensure 
that we meet our mission. I am quite certain that another remedy to 
prevent further losses would be an across-the-board increase in 
incentive speciality pay for all CRNAs, regardless of Active-Duty 
service obligation. I trust that the Department of Defense is also 
concerned and actively pursuing measures to address this very important 
issue.

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