Movers and Shakers is a new section that’s been added to our website. It will highlight CRNAs, SRNAs, legislators, hospital administrators and other folks who make a difference in our state and specifically for our profession. If you know of someone who makes a difference in your practice, please let us know. We will gladly feature them.
Please take a moment to read about these amazing CRNAs!
LTC Christine Tine (Cleaves), CRNA
As a nurse anesthetist in the U.S. Army Reserves, I have had multiple mobilizations and deployments. I have been in the Armed forces since 1999 initially commissioning in the U.S. Navy as a Critical Care Registered Nurse. I transferred to the Army in 2004 and completed Nurse Anesthesia school under the Army’s System Training Program (STRAP).
In 2019 I deployed to Baghdad, Iraq with the 1897th Head and Neck Trauma team. I was the sole anesthesia provider for team. Our most notable case was a foreign national with a gun shot wound below the left orbit. He underwent a 5 hour surgical repair after a massive transfusion resuscitation. This case was labor intensive and required an “all hands on deck approach”. This case exemplifies the military medical service. All members of the team worked to their full capacity. The team worked tirelessly to ensure this foreign national soldier received the highest quality medical care from this austere environment.
In 2016 and 2021, I served with two Forward Resuscitative Surgical Team (FRST) on forward bases in Afghanistan. I have been part of a wide range of missions from combat field anesthesia to COVID assessments and vaccination assistance. I served in Afghanistan as part of a Golden Hour Offset Surgical Team (GHOST). This mission included support for the combat forces within 1 hour from the front lines. These teams provided immediate, high quality surgical care for combat wounded U.S. and NATO special operations forces. My missions included multiple trauma surgical cases and massive causality event sustained after small arms fire attacks and an Improvised Explosive Devise (IED) explosion. I functioned as the sole anesthesia provider in the majority of these cases.
For me personally, the best part of military service included caring for U.S. hero’s, men and woman willing to stand in harms way to preserve the freedoms we take for granted. I have trained and care for foreign nationals willing to risk their lives for the NATO coalition. Individuals, who dream of a better tomorrow for their country. Individuals who serve their native countries beside the US fighting forces.
My service in both the US Army and US Navy have provided me with lifelong friendships. I have served along and beside the best clinicians the world has to offer. The training I have received has been invaluable for my military as well as my civilian career. The individuals who serve in the US Armed forces are truly dedicated. The term “selfless service” is not taken lightly. I am truly blessed to have been able to serve this country along side these service members.
It has been an honor to serve in the U.S Armed Forces. I have received amazing training from the U.S. Government and the American people. It is truly an honor to wear the uniform of a US army soldier.
LTC Christine Cleaves
Cheryl Nimmo, DNP, MSHSA, CRNA
President Susan DeCarlo asked me to write about myself for the MeANA website. Even though I am not an “official” member of MeANA, I feel like I’ve been half a “Maniac” for many years. I’ve lived in Rhode Island for more than 30 years and made many Maine friendships during this time.
I did my nursing education at Newport Hospital in Newport, RI- when hospital programs were the norm. I earned my BS degree at Evangel College and my anesthesia certificate from St. John’s Hospital in Springfield, Missouri more than 40 years ago. My family moved back to Rhode Island in the early 80’s and I earned a Master’s in Health Administration from Salve Regina University in Newport, RI and my DNP from Northeastern University in Boston. I have worked in most types of clinical practices including a Level I trauma center, community hospitals, an office practice, and the US Army Reserves.
My advocacy and political activism began when I attended a New England Assembly of Nurse Anesthetists meeting and was recruited for a board position. I had zero idea what I was getting into but it was a great training ground for business, education, networking, and some of the issues facing our profession. After 10 years on the NEANA board, Rhode Island asked me to consider running for the state association board. Eventually I held the office of president several times.
As some of you know I did spend some time on the AANA national board and was extremely fortunate to become president of the AANA. That experience enabled me to travel to many state meetings, meet thousands of CRNAs and SRNAs, and meet many high-level government officials. The year was like none other in my life, full of good and bad, problems and solutions, and not much free time or sleep. It seemed like I was always on a plane to somewhere, in a Go-To-Meeting, or on a conference call. My life belonged to the members that year and it was an honor to spend that year for all CRNAs and SRNAs.
Eight years ago, I was offered the job as the assistant program director of the nurse anesthesia program at UNE and became the program director three years ago. Being involved in the education and mentoring of future CRNAs has proven to be one of the most rewarding jobs I have had. Educating students to be excellent CRNAs encompasses didactics, clinical experiences, and an understanding of the CRNA’s responsibilities towards the profession. It is rewarding to see the “light bulb go on” when the student understands issues such as supervision, billing, and scope of practice. It has also been wonderful to meet so many CRNAs who precept students at the clinical sites. Your dedication to the students is both noticed and appreciated.
I never imagined or planned the career I’ve had. Most of the jobs, degrees, and board positions came about because opportunities presented themselves and I just said “yes” and worked hard to learn how to do the job. I had and still have mentors who freely give me advice and insights. I am proud to say that some of those mentors and friends have been ‘Maniacs’. I hope to see many of you again in person at future meetings.
Representative Anne Perry
Anne Perry (Democratic Party) is a member of the Maine House of Representatives, representing District 140. This District encompasses the towns of Baileyville, Baring, Calais, Charlotte, Pembroke, Perry, Robbinston, Passamaquoddy Indian and Passamaquoddy Pleasant Point. Her current term ends on December 6, 2022. She has served the citizens of her district since 2016. Of interest, Representative Perry graduated from the University of Southern Maine with a BS in Nursing and Husson College with an MS in Nursing, specializing in family practice. Our lobbyist Chris Jackson says of Anne “She is so thoughtful, kind and measured but can be tough when she has to be, and it is one of the reasons she is so respected by her peers in the Legislature.”
Earlier in her career, she worked for Moses Ludington Hospital as an obstetrics nurse, and the Essex County Head Start Program as a nurse and social worker. Following these appointments, she accepted various roles in the field of medicine, including a prepared childbirth instructor, a clinical director, an office nurse and a family nurse practitioner for Essex County Clinic, Southern Adirondack Planned Parenthood, Adirondack Mountains Family Practice and Family Practice of Laurie Churchill, Maryland. More recently, Ms. Perry excelled as the president of the Maine Nurse Practitioner Association, the vice chief for Staff Calais Regional Hospital and an adjunct professor of health policy for Husson University’s nurse practitioner program. In 2004, she was the recipient of Nurse Practitioner of Excellence Award of the Maine Nurse Practitioner Association and the American Academy of Nurse Practitioners.
Although her career has been filled with highlights, Ms. Perry is especially proud of earning the Nursing Leadership and Advocate Award from the Maine chapter of the American Nurses Association in 2019. For her outstanding work, she has been featured in multiple editions of Who’s Who in the East and Who’s Who in American Politics. Looking toward the future, Ms. Perry intends to continue utilizing her nursing expertise in her work with the Maine House of Representatives.
Anne is a staunch advocate for the citizens in Washington County and rural Maine. She passionately said: “Washington County deserves a senator who puts Washington County people first.” “Our region has critical needs and I will do my best to put those needs at the top of the legislative agenda. “She believes by working together, one can build and sustain a strong rural Maine.
Anne is very much aware of the legislative issues and battles facing advanced practice nurses in our state. A real spitfire when she needs to be, this retired nurse practitioner who worked at Calais Regional Medical Services. She currently serves on the Ethics and the Health and Human Services Committees. Just this past year, Representative Perry has sponsored 10 bills, including LD 254 “An Act to Allow Certified Registered Nurse Anesthetists To Bill for Their Services.” This legislation took over 3 years of hard work to pass and Representative Perry led the charge and won. Other legislative battles she has recently faced but lost is LD 295 “An Act to Repeal Restrictions That Prohibit Certain Advanced Practice Registered Nurses from Providing Essential Health Care Services,” In a recent interview, Representative Perry stated that there is still much work to do and it’s just a matter of time before Advanced Practice Nurses, including CRNAs, are given “true” independent practice from physician supervision. She assured her audience that it would happen but sadly she predicts it’ll take many more years of hard work before it’s a reality.
Perry’s motivation has been the people she has worked with, patients and their families. She has enjoyed touching and making a difference in the lives of others. She is a true inspiration for every advanced practice nurse in our state and in our nation.
Ms. Perry is the proud mother of three wonderful children, Heather, Ian and Kristin, as well as a grandmother to her five grandchildren – Perry, Sydney, Rylie, Lucas and Eliot.
I was born and raised in Maine, and with the exception of my years serving in the Army, I have pretty much lived, worked, and/or studied in every corner of this great state. I think it’s a great place to live and work.
I’ve spent the better part of the past nine years living on the Down East coast with my husband, Ryan. We love it there, and when I’m not working in Rumford, I volunteer maintaining hiking trails for Maine Coast Heritage Trust. Maine has beauty everywhere, but I am partial to the raw beauty found Down East. Whether it is hiking along granite cliffs that plunge 30-40 feet straight down into the sea, or camping on an uninhabited island just off the coast, my happiest times are when I’m outside, in the woods, appreciating nature’s simple wonders.
In 2012, while working at my first CRNA job, I started to delve into multi-modal analgesia practices. It took less than a week to leave behind opioids and “balanced anesthesia” in favor of better outcomes – rare, if any, post-op nausea and vomiting; high patient satisfaction scores; and quicker recoveries. It’s been eight years and my practice is nearly 100% opioid-free. I recently completed the state and federal requirements for prescriptive authority, and am looking to add pre- and post-operative medications to my current practice, in an effort to maximize the favorable results I’ve seen so far. I love the flexibility independent practice provides me, and I appreciate the efforts of the MeANA board and membership to further the practice of nurse anesthesia in Maine.
Here’s How You Can Gain Prescriptive Authority Too!
There are multiple steps to getting approved for prescription authority, and they need to be done in sequence.
- Complete a 45-hour graduate level advanced pharmacology course, either through a university graduate school (3 credits) or a CME provider (45 hours). I chose Barkley & Associates, and it cost $545.00. Whichever course the CRNA chooses to take, it MUST include classes on prescription writing and at least three hours specifically on managing opioid prescriptions. The Barkley course was comprehensive, and I had 90 days from registering to complete it. It took me longer, so I ended up paying $50.00 more for a 30-day extension. There were three exams to take throughout the course. Upon successful completion of the final exam, I received a CME certificate showing that it was an approved course for prescribers. I called the BoN to ask if they wanted me to send it in to have on file; they do not. While the course requirement is written into the Chapter 8 rules, it is for a DHHS requirement, not a BoN mandate. I was told to hold onto the certificate until such time I may be asked to provide it.
- The DEA requires all providers who prescribe medications to register with them. To obtain a DEA registration number costs $888.00, however, the Chapter 8 rule stipulates that CRNAs MUST ONLY prescribe using the DEA registration number of the Critical Access Hospital (or rural hospital) by which they are employed. This is important: We are not allowed to obtain our own DEA registration number under the Maine law. Instead, the DEA permits hospitals to allow providers who do not wish to obtain their own registration number to use the hospital’s DEA registration number with a suffix as a unique identifier for the provider. I confirmed this with the Boston office of the DEA and the BoN.
- Go to your hospital’s chief pharmacist and request s/he add the CRNA to the list they are required to maintain of providers who use the hospital’s DEA registration number. The number is two letters followed by seven digits followed by a hyphen followed by a four digit unique suffix assigned to the CRNA. Once you have that, then
- Create an account with the Maine Prescription Monitoring Program as an advanced practice nurse specializing in anesthesiology (there’s no drop-down option for CRNA). You’ll need your DEA registration number for this. It’ll take a few days to get approved, but once approved you’re required to check the PMP prior to writing any prescriptions.
- Educate your surgeons on your intentions to prescribe.