ELKO - Nurse anesthetists in Elko have more challenges than those working in big cities, and their skills are crucial to Northeastern Nevada Regional Hospital and Great Basin Surgical Center.
"We do keep busy, very busy in fact," said Jim Cooper of Ruby Dome Anesthesia, who is one of three certified registered nurse anesthetists covering the hospital 24 hours a day, seven days a week.
"We cover surgical services, emergency services and obstetrics," said Cooper, who was also recruiting a fourth CRNA last week.
Steve Heelis, who works at Baptist Hospital in Knoxville, Tenn., said one reason he is interested in coming to Elko is because of the reputation of the CRNAs at the hospital, and their predecessors.
Rick Kidwell and Chuck Locuson provided hospital coverage for years, and Heelis said "those guys set the mark of excellence, and the current CRNAs at the hospital have maintained that level."
Kidwell is still working in Elko, but he now owns Silver State Anesthesia, which provides coverage for Great Basin Surgical Center. CRNAs Greg and Gina Kronenberg work with him.
Cooper works with Chris Weisenfels and Ron Wing, and they were giving Heelis a tour last week as they try to add a fourth person to the practice.
Heelis said their work in rural Nevada offers the opportunity for a broader practice than in Knoxville, and both Cooper and Kidwell agreed.
Kidwell said he does general anesthesia, regional anesthesia "to put parts of the body asleep" and chronic pain work, including epidural steroid injections.
Cooper said the Elko hospital recruited an anesthesiologist a few years ago, who worked here 18 months, but when he left, "we received the unanimous vote of the surgeons to go back to an all-CRNA group."
An anesthesiologist has a medical degree and makes more money, so the difference in pay allowed for another CRNA to split calls, according to Cooper. The savings in turn benefits the hospital, he said.
"We love our CRNAs," said Ann Cariker, the chief of nurses and chief operating officer at the hospital.
"We do make less, but it is still a good living, and we're able to feed our families," Cooper said.
Kidwell said this is Certified Registered Nurse Anesthetist week, and the Nevada Association of Nurse Anesthetists wants to get the word out about the role CRNAs play in rural health care in this state. He estimated there are 78 CRNAs in Nevada.
"When you work in rural Nevada, you are pretty much on your own," Kidwell said. "I have learned to be more independent, efficient, and to ensure that my medical knowledge and anesthesia skills are always at their best.
"Rural Nevadans count on nurse anesthetists," Kidwell said. "We enable many hospitals to keep their operating rooms and emergency rooms in business, providing essential, high-quality anesthesia services. I feel good about that contribution to health care in Nevada."
Cooper said Kidwell and Locuson put Elko on the CRNA map because the level of service they performed was "very, very high and very unique. There are only a handful of places where we could practice like this."
Working in Nevada's rural counties is not without its challenges. Many CRNAs who prefer the wide-open spaces to urban congestion are the sole anesthesia providers in their hospitals, according to the association.
They frequently care for sicker patients and work in older facilities with equipment that, while adequate, may not be cutting edge.
"When I started here in 1971, I mostly used my eyes to assess patients," Kidwell said. Noting that he has stayed ahead of the technological and educational curve over the years, he added, "My most 'state of the art' equipment at that time was a stethoscope and a blood pressure cuff."
Kidwell said technology has made it to rural areas, and that CRNAs in Elko now utilize state-of-the-art technology to serve their patients.
"When I came to Elko, I was working in a 50-bed hospital and doing many of the same things I was doing at the 150-bed hospital in Olympia, with a population of 50,000," Kidwell said. "But I like seeing the same patients. Now I am treating the family members of patients I treated when I first started here. Knowing my patients on a first-name basis puts them at ease.
"Surgeons truly respect your abilities, administrators appreciate your dedication, and best of all, you really get to know your patients and their families because you see them around town all the time," Kidwell said. "In that sense, it's very different from practicing anesthesia in any other setting."
A native of Lewiston, Idaho, Kidwell learned his profession at a private hospital in Olympia, Wash. Following graduation, he moved to Elko where he has been a practicing CRNA since 1971.
He said two other CRNAs in the region also have many years of experience. June Puckett has been providing coverage for Ely for roughly 30 years, and Carole Cain has been doing so in Winnemucca for 17 years.
"That's a lot of years," Kidwell said, adding that both the women have been providing 24-hour, seven-day coverage for many years.
All the CRNAs at the Elko hospital have master's degrees, and Cooper said CRNAs must work at nurses in intensive care before they can get into the CRNA training programs. Then, it takes two and a half years to obtain a master's degree.
And that's after obtaining their bachelor's degrees in nursing.
"We're all master's prepared. For me, it took eight and a half years," Cooper said.
Heelis said he met Ron Wing at the University of Tennessee, where they trained.
Cooper said he has been in Elko four years, after completing a training program at the Mayor Clinic in Rochester, Minn.
"We're trained to do the whole gamut, from ear tubes to open heart," Cooper said, noting that Weisenfels worked in open heart surgery before coming to Elko, where he is partners with Cooper.
Wing works under contract to Ruby Dome Anesthesia.
According to the American Association of Nurse Anesthetists, more than 65 percent of all rural hospitals rely on CRNAs to provide anesthesia care.
"CRNAs have an extensive history of providing high-quality, cost-effective anesthesia care throughout Nevada," said Steve Sertich, president of the Nevada Association of Nurse Anesthetists. "We proudly practice anesthesia in undeserved areas."
Without these advanced practice nurses, some 1,500 facilities across the country would be unable to maintain trauma stabilization, surgical, and obstetrical capabilities, forcing many patients to travel long distances for such services, according to the national association.