New Degree, New Role in a World Changed by COVID

John Tomasello

COVID-19’s relentless spread across the New York area in Spring 2020 clearly impacted John Tomasello (DNP, APN, CRNA) and his experiences as a practicing nurse and soon-to-be nurse anesthesiologist.

A few years after beginning his RN career in 2013, Tomasello enrolled in the three-year Nurse Anesthesia DNP program at Rutgers School of Nursing. After completing the demanding coursework and clinicals, he was looking forward to graduating in May 2020 and getting on with his new career.

But in March 2020, “there was a sudden change,” he remembers. “Everybody was talking about COVID-19. We had enough clinical hours to graduate, so our anesthesia faculty encouraged us to help out where we could.”

While he had studied to become a nurse anesthesiologist, Tomasello, and many of his classmates, initially took jobs as RNs in intensive care units. “I signed on with a classmate to work at a hospital in Queens, where we were desperately needed.”

“In my previous ICU job, each nurse took care of two patients. We did our best to control the variables and manage each patient’s care so well,” he explains. “Last March, with just a four-hour orientation, we were on our own in a massive hospital, each caring for four critical patients. They were so sick, all intubated, some on continuous dialysis, with no central monitoring. I had to learn to stay calm amid chaos. It was like a wartime situation.”

In the beginning of May, hospital life started normalizing. Tomasello passed his boards in June and was credentialed as a certified registered nurse anesthetist (CRNA) in August 2020. “CRNAs have an expert knowledge of intubation and ventilator management,” he points out. “While elective surgeries were on hold, CRNAs were on intubation teams and overseeing the care of ICU patients.”

August marked the tail end of the COVID-19 crisis in area hospitals, Tomasello notes, and operating room cases started up again. Today, he works at two major North Jersey hospitals, where “it’s business as usual for CRNAs now,” he says, “except there are some patients who are COVID positive and need surgery, and there are surgeries related to the side effects of COVID-19. We are seeing an uptick in patients with a variety of clots and long-term respiratory complications. COVID has become part of their permanent medical history.”

“I see each patient as a new challenge,” he says. “I ask myself, ‘What do I need to prepare and do for this particular person, so that they are safe and comfortable throughout the surgical period?’ Because CRNAs are the patient’s best advocate.”