Nurse Anesthetists Are in Short Supply in the Southeast. A New Grant to Emory’s Nursing School Will Help.

The nation’s nursing shortage has created a difficult situation for care providers and patients everywhere, but few regions have it as bad as the Southeast. Not only does every Southeast state have a low nurse-to-population ratio, but the region also has a high prevalence of rural areas.

In these circumstances, nurses are stretched thin or take on more responsibilities, particularly advanced practice registered nurses like certified registered nurse anesthetists (CRNAs). In a rural area, a CRNA shortage means fewer surgical procedures, longer patient travel and wait times, and worsening patient outcomes — all while exacerbating the ongoing nurse burnout problem.

Help may now be on the way. To increase the number of CRNAs in the Southeast’s most underserved communities, the U.S. Health Resources and Services Administration (HRSA) awarded a grant to Emory University’s Nell Hodgson Woodruff School of Nursing as part of its Nurse Anesthetist Traineeship Program.

“Nurse anesthetists contributing to these communities play a crucial role, frequently acting as the primary anesthesia provider or one of a limited number, emphasizing the significance of their expertise and the diversity they bring to their representation,” said Erica Moore, DNP, CRNA, and assistant director of Emory’s CRNA program, in a statement announcing the grant. “We are excited to be a part of this grant, which will make a difference among our students and communities.”

According to the 2023 Environmental Scan from the National Council of State Boards of Nursing (NCSBN), each Southeast state employs fewer than 1,000 nurses per 100,000 people. Georgia, in particular, is one of only three states to employ fewer than 750 nurses per 100,000 people. As a result of the shortage, the state also received one of the worst care delivery and population health rankings, according to the 2023 Scorecard on State Health System Performance.

As with most Southeast states, Georgia’s rural regions suffer the most. Of the state’s 159 counties, 120 are rural and have only 59 hospitals between them. That limited access to care can be disastrous for many rural Georgians already facing higher rates of chronic disease and increased health risks because of lifestyle behaviors.

Many anesthesia responsibilities fall on CRNAs in rural areas across the country, exacerbating the situation. This can be particularly challenging in Georgia because it has 25% fewer CRNAs than the national average. It also is one of 12 states with major scope-of-practice restrictions for CRNAs.

CRNAs in Georgia need a supervisory physician for certain tasks and treatments. With poorer wages and opportunities for physicians in rural areas, however, many regions struggle to employ and maintain these professionals. For example, nine Georgia counties have no physician, let alone an anesthesiologist.

Yet, the situation could change at any moment, and the field needs to be prepared. More than half of all states have granted CRNAs full practice authority, and many of Georgia’s healthcare organizations, including the Georgia Association of Nurse Anesthetists, are urging the state to follow suit.

In the meantime, HRSA and Emory are doing their part to improve service for rural regions throughout the Southeast. In 2023, the Emory School of Nursing enrolled over 200 students across its three doctor of nursing (DNP) programs. HRSA’s grant totaling more than $142,000 will support the education of about 60 additional students in the nurse anesthetist DNP program over the next four years.

To encourage these future CRNAs to seek employment in the region’s underserved communities, Emory will package the HRSA funding in scholarships for students who plan to take on permanent roles in rural counties. The program will also embrace disadvantaged and underrepresented students in an effort to diversify the next generation of CRNAs coming out of Emory.

Students will also complete their clinical experiences in these rural areas. Kelly Wiltse Nicely, Ph.D., CRNA, and the director of the Emory CRNA program, believes this initiative will have lasting benefits for both the program participants and the hospitals that host them for placements and beyond.

“This program will give students experiential learning opportunities in health equity, culturally competent care, and social determinants of health,” she said. “It will allow for meaningful connections between the communities we serve and the students who will soon be the providers in those communities.”