La dernière réunion sur les pratiques avancées, initiée par le DGOS (ex DHOS), a eu lieu le 27 avril 2010.
Après bien des difficultés, essentiellement d’ordre médical par le biais des syndicats SNARF, SMARNU et SNPHAR, il semble que la bonne volonté l’ait finalement emporté et qu’un pragmatisme ait fait place à une vision bornée.
Petit état des lieux (d’après le compte-rendu de madame Christine Renon (cadre supérieur, Rennes)).
Le SNIA et le SNPHAR se sont rencontrés avant la réunion du 27 avril 2010, pour aplanir les difficultés et arrondir les angles. Car les acteurs de l’anesthésie française ne pouvaient pas apparaitre divisés devant le ministère.
Il est donc affirmé :
– L’exercice professionnel du IADE devait être d’ores et déjà reconnu à un niveau d’expertise de types pratiques avancées, et l’élaboration de nouvelles pratiques avancées devait concerner l’ensemble de la profession IADE et pas seulement une partie.
Le champ de compétence des IADE a été précisé dans le pré-per et post opératoire.
Per opératoire :
L’IADE a un rôle propre durant toute la phase d’entretien de l’anesthésie.
L’infirmier(e) anesthésiste doit pouvoir dans cette période faire face à des défaillances physiologiques en pratiquant une diagnostic infirmier basé sur une observation clinique et para clinique si nécessaire. L’IADE devra donc apporter par le fruit de sa reflexion professionnelle, des actes thérapeutiques afin de garder les fonctions d’homéostasies du patient et appliquer les protocoles, dans l’attente du médecin anesthésiste, joignable à tout moment.
Post-opératoire :
– Il est vivement demandé par les acteurs médicaux et IADE que l’on reconnaissent aux IADE le rôle d’expert dans l’encadrement de l’équipe des IDE en SSPI.
– Que l’IADE soit reconnu dans sa capacité à la prise en charge de douleur aiguë du post-opératoire immédiat.
– Qu’un droit de prescription limité aux antalgiques validés par un protocole, soit donné aux IADE afin d’adapter le traitement si besoin.
Le Master
La prochaine réunion du 5 juillet 2010 devra déterminer les pratiques a valider pour enrichir le référentiel de formation des stagiaires en anesthésie.
Les connaissances
Dans le domaine clinique et pharmacologique, elles seront détaillées dans le cadre de la masterisation du diplôme d’État.
Le manque de formation théorique avancée par madame Bachelot, devrait être levé par le consensus. Toutefois, un master ne se décide pas sur un nombre d’heures minimale mais sur un contenu.
Une réunion, prévue le 21 septembre 2010 avec le ministère de l’enseignement supérieur et de la recherche, dirigé par madame Valérie Pécresse, le ministère de la santé et les centrales syndicales médicales et infirmier(e)s anesthésistes.
En conclusion temporaire :
Si l’avancée réelle a permis de débloquer une situation vouée à l’échec, rien n’est encore gagné de façon pérenne pour les IADE.
Les évaluations sur les pratiques professionnelles, les protocoles IADE, les référentiels et les actes de l’ALR notamment doivent encore être décidés.
Les divers audits, gestions des risques, évaluations transversales que l’on nous propose devraient avoir leur socle à l’issue des réunions pré-estivale et post-rentrée.
Pour une véritable évolution de la carrière des IADE. Dans l’intérêt, le renouvellement, la reconnaissance de ce que nous faisons depuis des années et que l’on ne perçoit que maintenant.
Il est grand temps.
Arnaud BASSEZ
IADE
Administrateur
En annexe, et pour madame Bachelot, un extrait du site du cente médical de l’Université du Mississippi qui forme des CRNA (infirmier(e) anesthésiste certifié(e)s.
L’ensemble du territoire américain forme ses professionnels de cette façon. Et leur efficience est à l’œuvre chaque jour.
Ne pourrions-nous en faire autant ?
Welcome to all interested !
As you may already know, the field of Nurse Anesthesia (NA) is a growing, challenging and greatly rewarding professional career. Here you will find some basic facts and frequently asked questions about a career in NA.
What is a Nurse Anesthetist ?
A Nurse Anesthetist (NA) is a specially educated advanced practice registered nurse who specializes in anesthesia. Upon completion of an accredited NA program and successfully passing a national certification exam, the Student Registered Nurse Anesthetist (SRNA) then becomes a Certified Registered Nurse Anesthetist (CRNA). CRNAs must follow practice guidelines set by the American Association of Nurse Anesthetists (AANA) and often more specific hospital or clinic guidelines and protocols. Although providing anesthesia to patients who are undergoing surgical procedures is the primary role of CRNAs, they are often key assets in the perioperative process including education of patients, families and peers.
Most nurse anesthetists are employed by hospitals, clinics, or physicians. Some are self-employed, in group practice, or in military service. Provision of 24-hour on-call service, ease of geographic mobility, opportunity to subspecialize, and good salaries are typical characteristics of employment.
Can One Acquire a Degree in Nurse Anesthesia and live in Mississippi ?
Yes, the University of Mississippi Medical Center and the University of Alabama at Birmingham currently have an affiliation. This allows Mississippi residents to complete didactics in Birmingham and clinical training at the University of Mississippi Medical Center in Jackson.
Accreditation : Effective October 7, 2000, the program received ten years full accreditation by the Council on Accreditation of Nurse Anesthesia Educational Programs.
Credentials Conferred : MNA Degree. The Master of Nurse Anesthesia is awarded by the University of Alabama at Birmingham.
Professional Certification : Graduates can apply to take the certification examination administered by the Council on Certification of Nurse Anesthetists. Satisfactory performance on this examination is necessary to practice as a certified registered nurse anesthetist.
Length of Study : Preprofessional phase – Nursing school to include prerequisite coursework ; Professional phase in SHP – Seven semesters (27 consecutive months).
Program Entrance Date : Fall semester.
Application Deadline : Completed applications must be received by October 1 preceding the expected date of enrollment. Deadline date may be extended by the admissions committee if warranted.
Application Procedure : The following materials must be submitted to the UAB Nurse Anesthesia Program Office :
* UAB graduate application form and $35.00 processing fee
* Official transcripts from each college or university attended
* Completed application to the professional phase of the Nurse Anesthesia Program (form available from program office)
* Two references from professional associates
Requirements for Admission : Applicants must possess a state license as a registered nurse and have a minimum of two years of nursing experience in a critical care environment. Applicants must have a Bachelor of Science Degree or higher prior to entry into the program. The bachelor’s degree may be in nursing or in an appropriate science concentration. Acceptance will be based upon the student’s academic ability, work experience, and aptitude for a career in nurse anesthesia. The candidate is expected to satisfy the following requirements :
* A minimum cumulative grade point average of 3.0 (A=4.0)
* A minimum cumulative grade point average of 3.0 in sciences and statistics prerequisites
* A grade of C or better in each prerequisite course
* A minimum score of 50 on the Miller Analogies Test (MAT) or 500 on each section of the Graduate Record Examination (GRE)
* A personal interview with the selection committee
* Completion, if accepted, of the UAB medical history questionnaire and physical, proof of required immunizations, and a satisfactory screening by the UAB Medical Center Student Health Service
Program Prerequisites – UAB Equivalents
(Course requirements are listed in semester credit hours.)
Sciences and Statistics :
* Anatomy/Physiology (6-8) or
* Anatomy (3-4)
* Physiology (3-4)
* Pathophysiology (3-4) or
* Clinical Physiology (3-4)
* Microbiology (3)
* Statistics (3-4)
* College Chemistry (3-4)
For more specific information, I encourage you to contact
SRNA Program Coordinator : Cheyne Robinson
SRNA Assistant Program Coordinator : Michael Folkes
SRNA Medical Director : John Current, MD
For more information from UMC, contact or write :
Department of Anesthesiology
2500 North State Street
Jackson, MS 39216
(601) 984 - 5900
For more information from UAB, contact or write :
Program Director
Nurse Anesthesia Program
School of Health Professions
Richard M. Scrushy Building, Room 230
1705 University Boulevard
University of Alabama at Birmingham
Birmingham, Alabama 35294-1212
Telephone : (205) 934-3209
Fax : (205) 934-3212
E-mail : mna@uab.edu
For course descriptions, see the UAB School of Health Professions Catalog – Course Descriptions. Go to list of School of Health Professions Programs of Study.
et un panorama sur l’histoire des CRNA des USA, où il n’apparait pas un excédent d’accidents anesthésiques notables, parce que délivrés par des "IADE" ultra formés.
Ce que nous sommes prêts à faire.
CRNAs (Certified Registered Nurse Anesthetists) have been providing anesthesia care to patients in the United States for nearly 150 years. As advanced practice nurses, CRNAs practice with a high degree of autonomy and professional respect.
CRNAs start our getting a BSN (Bachelor of Science in Nursing), have a minimum of one year critical care experience, then two year anesthesia residency obtaining a MSN.
CRNAs practice in every setting in which anesthesia is delivered : traditional hospital surgical suites and obstetrical delivery rooms ; critical access hospitals ; ambulatory surgical centers ; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists ; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.
Nurse anesthetists have been the main providers of anesthesia care to U.S. military men and women on the front lines since WWI, including the conflict in Iraq. Nurses first provided anesthesia to wounded soldiers during the Civil War.
The licensed CRNA is authorized to deliver comprehensive anesthesia care under the particular Nurse Practice Act of each state. Their anesthesia practice consists of many anesthetic techniques including general, epidural, spinal, peripheral nerve block, sedation, or local. Scope of CRNA practice is commonly further defined by the practice location’s clinical privilege and credentialing process, anesthesia department policies, or practitioner agreements.
Legal Challenges
In the United States, there have been three challenges brought against nurse anesthetists for illegally practicing medicine (Hodgins and Crile, 1919 ; Frank v. South, 1917 ; and Chalmers-Francis v. Nelson, 1936). All occurred before 1940 and all were found in favor of the nursing profession. Prior to World War II, the delivery of anesthesia was mainly a nursing function. In 1942, there were seventeen nurse anesthetists for every one anesthesiologist. The numbers of physicians in this specialty did not greatly expand until the late 1960s. Therefore, it was legally established that when a nurse delivers anesthesia, it is the practice of nursing. When a physician delivers anesthesia, it is the practice of medicine. When a dentist delivers anesthesia, it is the practice of dentistry. There are great overlaps of tasks and knowledge in the health care professions. Administration of anesthesia and its related tasks by one provider does not necessarily contravene the practice of other health care providers. For example, endotracheal intubation (placing a breathing tube into the windpipe) is performed by physicians, nurse anesthetists, respiratory therapists, paramedics, and dental (maxillofacial) surgeons. In the United States, nurse anesthetists practice under the state’s nursing practice act (not medical practice acts), which outlines the scope of practice for anesthesia nursing.