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Helping an at-risk workforce

June 25, 2012
by Gary A. Enos, Editor
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Art Zwerling

Art Zwerling’s never-dull life, ever busy in the face of health challenges, offers numerous examples of myth busting. First, his substance use history and that of his family shatter the mistaken notion that addiction bypasses the Jewish community. More recently, Zwerling demonstrated that someone with an addiction can in theory receive a safe administration of pain medication, though it took significant prodding from his addictionologist to convince him, given his own background in healthcare.

“I’ve seen too many disasters,” says Zwerling, 60. “I saw far more people fail than succeed.”

Zwerling’s understanding of addiction’s effects stems in part from his work in addiction counseling, as a physician assistant, and finally as a nurse anesthetist. In recent years he has served as a national leader in educating nurse anesthetists on their profession’s unique risks for addiction. He was instrumental this year in getting the organization that accredits training programs for nurse anesthetists to mandate the inclusion of addiction education in all training curricula for the profession.

In 2010 Zwerling was honored in the annual America Honors Recovery event by Faces & Voices of Recovery, where he was credited for “constantly developing new and innovative strategies for educating others, eradicating stigma, and advocating for better systems.”

“The major drugs of abuse in nurse anesthetists, once we get past alcohol, are IV opioids,” says Zwerling, who serves as chief anesthetist at a cancer center in Pennsylvania. “These drugs in some cases are up to 1,000 times more potent than morphine.”


Classic achiever

Zwerling describes his own substance use story as fairly commonplace, but with a somewhat unusual twist. He first was exposed to alcohol by sneaking swigs of what was left over from family poker games. In school he routinely would be suspended in the morning and reinstated by afternoon, his high test scores carrying the day.

“There was impermeable denial in my family,” Zwerling says. “Even though there are no Jewish alcoholics, all of my friends in AA were anomalies,” he adds sarcastically.

Zwerling would drop out of high school but then earn his GED and proceed to college, where at one point he decided to pursue the study of pharmacy—he admits to that not being the best choice. During this period in the mid-1970s he would meet up with some “shady folks” who tapped into his knowledge of medicinal chemistry. “I found out that the Philadelphia Fire Department had me under surveillance,” Zwerling says.

He would end up leaving the country for a year, having discovered that the Drug Enforcement Administration (DEA) also was familiar with him. Upon his return, he would say goodbye to past acquaintances and pursue treatment.

Zwerling worked at Eagleville Hospital in the late 1970s and early 1980s, then transitioned to working as a physician assistant before a pain issue led to a relapse in the mid-’80s. The founder of an association for recovering nurses in Philadelphia became his first sponsor, introducing him in a meeting by saying, “This is Art. He’s a PA, but he’s OK.”

He would be named to the recovering nurses group’s board of directors, using his intervention training from Eagleville to serve on the intervention team for a number of nurses and nurse anesthetists. “These folks were dying with regularity,” says Zwerling. “It piqued my intellectual curiosity about impaired professionals.”

Zwerling then decided to attend nursing school, and eventually would become a certified nurse anesthetist. In his efforts to highlight the particular risks this profession faces, he says that “one of our major struggles is that people lump in nurse anesthetists with LPNs and RNs who have different practice issues.”


No secrets

Zwerling remains very open about his personal story, including his current issues with back pain that for a period of several weeks required him to be carefully monitored on pain medication.  (At the time this interview was conducted, Zwerling was preparing to have a spinal cord stimulator implanted.)

“I’m a believer that keeping secrets is what kills people,” he says.

Zwerling credits the Peer Assistance Advisory Committee of the American Association of Nurse Anesthetists (AANA) for much of the effort to highlight addiction and recovery issues in the profession. The committee’s work encompasses peer assistance, education and research.

Now that academic programs will be mandated to teach nurse anesthetists in training about chemical dependency and wellness issues, a task force within the AANA is drafting a curriculum, Zwerling says. Expanded education is one of many marks that Zwerling has been able to leave on his current profession; he also has established web-based forums that allow nurse anesthetists to gain important insights about early recovery issues. All of this has been made possible through the strength of Zwerling’s own recovery.

“I’m kind of a typical story of an adolescent with early-onset addiction, who was pounded enough times to get sober,” Zwerling says.



WOW! I cannot bievlee some of the comments I am reading! As a nurse anesthetist in a state which has been opted out for many years, I can confidently state that a large part of our state would go without anesthesia care if it were not for CRNAs willing to work in these rural, underserved areas. And although they may not be doing anesthesia for open hearts and craniotomies every day, they certainly shoulder the liability for the care they provide alone, often without any backup for a difficult airway or a hemorrhaging trauma that may roll through the door. CRNAs ARE looked to as the expert in these situations, where they are expected to keep the patient alive with all available rescusitative means while the surgeon focuses on surgery. These CRNAs have every bit the same responsibility in selecting safe anesthestic techniques, communicating and collaborating with the surgeon, and in leading the rescucitative efforts. In these underserved rural areas, not all patients are stable enough to ship out and in these cases, it is teamwork between the anesthesia provider and the surgeon (as well as the entire OR staff) that saves patients' MD your comments regarding surgeons' intolerance of communicating with CRNAs speaks volumes to the attitude so prevalent amongst your colleagues which is so detrimental to safe patient care. first, communication between ALL team members is essential to quality outcomes and medical error prevention! (this is a JCAHO initiative). your ego and attitude of superiority and elitism is the very root of a host of problems in medicine! it makes you appear inapproachable to patients, as well as your coworkers, and literally a pain in the ass to work with for surgeons and your entire OR team. as someone who works in both MDA-CRNA care team and CRNA-only practice environments, I can say that I have ALWAYS communicated with my surgeon (regardless of the practice environment) and have found them very open and appreciative to it. in fact, i am quite certain that they respect my practice and appreciate my competency more because of it. open communication is best, not only for patient outcomes, but also for a cohesive work environment. We are all human (MDs not excluded) and communication ensures that the very best decisions are made for the patient and that nothing is overlooked. The attitude you present is the very reason many surgeons prefer to work with CRNAs nobody needs two egos in the same room.And this misperception that CRNAs only do minor cases is SO misinformed. In my career (even while a student), I have done hundreds of heart, liver, and lung transplants, cardiac and neuro surgeries, you name it. Sure they were under an anesthesiologist's supervision , but most often, they were rarely around. Occasionally on a light sports night, they might come in and help you get a CABG or cardiac transplant off-pump. Obviously, most CRNAs who practice solo are not doing huge, high-acuity cases on a regular basis, but let's not forget the thousands of CRNAs in this country who do big cases on very sick patients everyday, providing care and making critical autonomous clinical decisions while their physican colleagues take all the credit. Our competent care is, in many cases, what makes your practice lifestyles possible.Lastly, I wonder if the American public was aware that in many care team environments, MDA's only showed up to sign the paperwork, that they were absent for the majority of surgical cases to hang out in the break room, watching sports or surfing the net, all the while charging for four cases (in which the CRNAs were doing all the work), would they would be so trusting of physician care and so willing to pay those $600,000/year salaries???so let's just be honest the practice of anesthesia started as and is mostly the practice of advanced nursing. CRNAs are not the new kid on the block. We have been delivering excellent anesthesia care since the 1800 s. let's face it: MDA's are too highly trained and think too highly of themselves to sit on a stool and deliver anesthesia. it is a job full of nursing tasks! so do what you're good at and go practice medicine. you chose anesthesia because it is the only profession where you can have someone else do your work for you and still bill the big dollars. EVERYONE in health care knows that most anesthesiologists make up to twice as much as their surgeon colleagues!!! Maybe its time the public was aware of that as well.