Tracy Castleman, CRNA, MS, APN-A, DNP candidate at Rush University. Castleman is a Certified Nurse Anesthetist (CRNA) at Monmouth Medical Center (MMC) in Long Branch, New Jersey. Castleman has been wearing several hats during the COVID-19 pandemic both as a anesthesia care provider and at the state level advocating for policy that removed barriers to practice for nurse anesthetists. Castleman is the past president for the New Jersey Nurse Anesthetist Association (NJANA) and current leader of NJANA’s task force on COVID-19 and CARES, the charitable arm of the NJANA. Castleman also serves on the NJANA Government Relations Committee (GRC) and worked with governors from the tri-state area to remove barriers to practice for nurse anesthetists and other advanced practice providers. 

“New Jersey has one of the most restrictive practices for nurse anesthetists in the country. The state requires nurse anesthetists to enter a joint protocol with a physician anesthesiologist to provide care. On April 1, Gov. Phil Murphy issued an executive order that suspended the joint protocol and expanded access to care during the COVID-19 pandemic. The big advantage in New Jersey is the executive order allowed advanced practice nurses to cross state lines to help where needed as healthcare workers to deal with an overwhelming number of patients and the emotional toll of the crisis,” Castleman said. 

The entire environment of the operating room (OR) changed as surgeries came to a screeching halt and hospitals quickly converted many patient care floors into COVID-19 ICU units. Castleman leaned in and worked with the MMC leadership and within her company the North American Partners in Anesthesia (NAPA) to make sure Nurse Anesthetists, as  advance practice nurses, were not redeployed into roles that did not take advantage of their depth of experience and knowledge and deployed into roles of leadership as intensivists. “In this capacity, as advanced practice nurses, nurse anesthetists were still able to generate revenue and buffer loss of revenue when not in operating rooms.  The foundational education of Nurse Anesthetists is critical care. The practice of Nurse anesthesiology is built upon the critical care knowledge base and enriched with high level pharmacology, physiology and biochemistry while mastering the skills and interventions needed to maintain a patient’s well-being in the face of trauma. We were built to lead this fight against COVID-19. It was a natural fit for us to lead these quickly formed ICUs and to partner with pulmonologists and intensivists in the battle. This was the impetus for NAPA to move many contracts in that direction. It also results in better care and higher visibility of nurse anesthetist as intensivists with hospital administration,” said Castleman.

“The spotlight is being shined upon us in the most favorable view. Look at what has come together – the 200th anniversary of the birth of nursing’s founder – Florence Nightingale, 2020 as the International Year of the Nurse, and now the pandemic of our lifetime. It is nursing’s responsibility to use this unique time as an opportunity to rise and show the world who we should be as a profession. We all rise when we are kind, respectful and support one another,” said Castleman.

Call to Action

“Collective Impact- Think of the impact nurses could have if all the professional nurse organizations worked strategically together with professional messaging to apply pressure on policy makers. Continue to apply pressure to maintain that emergency lifting of restrictions on the profession. Nursing is poised to say – You needed us, we stepped up, we provided the care and helped mitigate what could how been a far more horrific event and we did the job well,” said Castleman.