November 1, 2024 • 27 mins
This is an update to Stephanie Zunini's original PROCESS episode 35 released September 1st, 2023. We catch up with Stephanie more than a year later to discuss the arduous process required to actually practice in a new state after passing a CAA licensure bill. Stephanie's experience in Nevada highlights the emotional and physical toll of this long, slow legislative process. She shares the behind the scenes of why she made the incredibly hard decision to leave her thriving career in Denver to move to a less than perfect set-up in Nevada. With her eyes set on working in Reno, Stephanie's journey is a powerful reminder of the influence one person can have on an entire profession. My hope is that Stephanie's story inspires others to be change makers in their own states.
Listen to the original [PROCESS] episode HERE
Nevada bill AB 270 was signed into law on June 9th, 2023 thereby giving CAAs legal status to practice anesthesia in the state of Nevada. Learn more about the CAA legislative process by watching other CAA legislative testimonials and listen to episodes 35, 36, 56.
Find more information on the Nevada Academy of Anesthesiologist Assistants HERE.
Follow NVAAA on IG and give them your congrats!
Stephanie Zunini @ info@nv-aaa.org
Inspired to make change? Donate to the AAAA legislative fund HERE and contact the AAAA Director of Government Affairs Brian Flynn via bflynn@anesthetist.org
You can now text me! Questions/Suggestions
Sign up to learn how you can join the first Pre-AA cohort of CAA Matters and get a rare head start in AA school. Learn More
+Check out my Pre-AA Highlight on IG
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Awakened Anesthetist podcast,
the first podcast to highlightthe CAA experience.
I'm your host, Mary Jean, andI've been a certified
anesthesiologist assistant forclose to two decades.
Throughout my journey andstruggles, I've searched for
guidance that includes my uniqueperspective as a CAA, At one of
(00:42):
my lowest one.
I encourage you to stick aroundand experience the power of
being in a community filled withvoices who sound like yours,
sharing experiences you neverbelieved possible.
I know you will find yourselfhere at the AwakendAnesthetist
podcast.
Welcome in.
Hello AwakendAnesthetist family.
(01:05):
This is your host, Mary Jean,and this is a really special
episode.
This is my first update on aprocess episode.
Today I am reintroducingStephanie Zunini.
Stephanie was the season threeopening process episode, episode
35, and I've linked it down inthe show notes.
If you've not listened to that,I do suggest you listen to that
(01:27):
first and then come back andhear what Stephanie's up to now.
This is just a really excitingtime in our profession.
We're definitely at, you know,an inflection point of growth,
and I had interviewed Stephanieright as the Nevada CAA
licensure bill had passed inJune of 2023.
And Stephanie was the presidentof the Nevada Academy of
(01:51):
Anesthesiologist Assistants atthat time, and so I interviewed
her and two other people whowere really instrumental in
getting that licensure billpassed, and in the conversation
with Stephanie I finally, foronce for myself, learned what it
really takes to pass an AA bill.
I really, more so, understoodthe licensure process.
(02:12):
I've been a CAA for years andyears and just never really
understood what was happening atthe legislative level.
So if any of that interests you, I do recommend you go back and
listen to process episode 35and then come back to this and
catch up with Stephanie.
Now she is living and working inNevada and we talk about the
steps that have to happen afteran AA bill passes to then step
(02:36):
foot inside a hospital in a newstate.
It's not just like snap yourfingers and it works out perfect
.
So Stephanie shares behind thescenes there and then just
generally what she's doing andwhat she hopes for next in her
life, as she has some big thingsto update.
So if you're someone who hopesto one day work in Nevada or
maybe open a new state and moveback to your home state, this is
(02:58):
a really great episode to seeto believe what's possible for
you.
All right, let's jump in.
Why don't you?
In case people haven't listenedto your process episode, which
they should go back and listen.
Just brief us on your journeyfrom AA school through passing
the AA bill, just where you werein the world, what AA school
(03:18):
you went to.
Just like a really briefintroduction to catch everyone
up to where we're going to belaunching off from in this
episode.
Speaker 2 (03:27):
Got it.
So, yes, my name is StephanieZunini and I went to a school,
at Case Western in Washington DC.
I graduated from there in Mayof 2021.
And just before I graduated andjust before I graduated, I
(03:49):
started this whole venture abouttrying to pass this licensure
bill in Nevada.
I figured that if no one tries,that it'll never happen, and I
really didn't know that manypeople that were involved in the
profession from Nevada.
So I told myself I wanted togive it one shot or at least try
and see what happens.
So fast forward, I moved fromDC, worked in Southern Indiana
(04:13):
for a year, then I moved toDenver for two years and,
spoiler, but the bill passed andI just moved to Las Vegas at
the beginning of September ofthis year, 2024.
Speaker 1 (04:31):
And when did the bill pass exactly?
Speaker 2 (04:34):
So the governor signed the bill into law in June
of 2023.
And then it became effective,which was just how the
legislation worked.
It became effective January of2024, so this year.
Speaker 1 (04:50):
Okay, yeah, so Stephanie's past process episode
is actually with two otherpeople who were really integral
in having the AA bill pass inthe state of Nevada and it was
not a super quick process.
It occurred over many years.
And it was not a super quickprocess.
It occurred over many years.
So if you go back to thatepisode I believe it's episode
35, you'll get to hear more ofhow the bill passed and
(05:11):
Stephanie's role in that.
You were and still are theNevada Academy of
Anesthesiologists AssistancePresident, correct.
Speaker 2 (05:20):
Yes, okay.
So I feel like after the billpassed, I definitely took a
little bit of a break.
Everyone who was involved inthe Nevada AAA and everything
definitely felt especially me,felt a little bit burnt out
after the legislation passed,after this huge accomplishment
(05:41):
that we had been working for solong towards, huge
accomplishment that we had beenworking for so long towards.
So I felt like we tookdefinitely a long break, but
we're excited to kind of getback into it, mm-hmm.
Speaker 1 (05:54):
Yeah, I think that is really real and a part of the
conversation I want to havetoday, because what many people
may not understand is that, eventhough the state passed the
bill so that it is legal for AAsto work in the state of Nevada,
there are several other layersthat need to be cleared in order
(06:15):
for an AA to actuallyphysically walk into a hospital
and deliver anesthesia.
So let's pick up theconversation.
Stephanie, maybe with the billpassed in June and rightfully so
you were pretty burned out.
It sounds like and sort of likethis huge exhale after this
really big push gun.
(06:38):
You were maybe like halfwaythere.
Take us to that moment, sort ofright, when you're burned out
but you're like, gee, do I wantto move back home?
What's my next step?
Speaker 2 (06:54):
What was your mindset right when we were recording
September of last year?
Yes, I definitely during thattime when we talked about all
the intricacies of thelegislative session and that was
a roller coaster in itself ofthe legislative session and that
was a roller coaster in itself.
And then when we last talked, Iwas definitely on a huge high.
We were all very ecstatic thatthis bill passed.
And now, you know, our gearshifts a little bit Like we're
(07:27):
pretty exhausted and we had beenworking for this goal for two
and a half years and now Ididn't realize.
Now I kind of went on this newroller coaster of getting our
licenses in Nevada andcredentialing at, you know,
hospitals or in cities thatwe're hoping to work in now.
But I definitely startedpicturing myself moving back to
my hometown, which was thereason that I started this whole
(07:48):
journey from the beginning.
But to be honest, I definitelyknew all along deep down that
even though the bill passed, itdidn't mean that we were going
to magically be able to walk inand start working anywhere that
we wanted to.
So that definitely made mepretty apprehensive and knew
(08:08):
that there was still a lot ofwork to be done.
But at the same time, eventhough I knew there was a ton of
work to be done, I felt superburnt out in regards to the
legislative stuff because thatwas a huge grind for the two and
a half years that I really doveinto that.
Speaker 1 (08:28):
So let me ask you something because I'm not sure
if even I can exactly explainwhat the exact steps are after a
bill passes.
Do you feel like you've got agood handle on the other levels
that needs to get passed?
Can you describe?
Speaker 2 (08:46):
that, yeah.
So obviously, the governorsigned it into law in June of
2023, and then it becameeffective January uh, january
1st of 2024.
So what that means is that themedical boards in Nevada are
required by law to, you know,give out licenses to those
(09:09):
applicants that obviously meetall the requirements, but by law
, they are required to startissuing licenses to those
applicants as of January 1st of2024.
It definitely took a while forboards to now translate the
(09:30):
legislation into their ownregulations.
So now each board has to writetheir own regulations to enforce
the law.
So if you are not followingsomething that's written in the
legislation, it's the board'sresponsibility to enforce it and
say oh, you did this, now yourlicense is suspended.
(09:52):
X Y, z, so xyz, so um, theyhave to go through their own
regulatory writing process.
So that wasn't.
You know, nothing is quick.
So people were asking why, ifthe bill passed in june of 2023
and became effective in january2024, why didn't we start
(10:14):
working in ne till September of2024?
Which, to be honest, that wasprobably one of the quickest
turnarounds, I would guess, inall the states that have passed
legislation the boards, and then, not to mention, starting to
(10:36):
educate the hospitals, from thesurgeons, to the nurses, to the
background staff, thecredentialers, on our scope of
practice and what we can do.
And they have to write out ourdelineation of privileges for
the hospital and change theirbylaws to write in that we are,
(10:58):
you know, recognized as aprovider at that hospital, not
to mention also, you know,educating the groups on the
billing process or just theinfrastructure to hire us.
So there's, I realized that,you know, the legislative
session was a huge rollercoaster, but that was only a
(11:19):
small piece of the puzzle.
For sure, that's kind of whatI've been dealing with over the
past year, since we last chatted.
Speaker 1 (11:28):
And who's helping you do this?
Who's the team making thesepushes?
Speaker 2 (11:33):
So I would say a lot of the same people that were
involved in the legislativeeffort have been here along the
way.
A lot of it is kind of out ofour hands because it really fell
on the boards.
Typically in Nevada the twodifferent boards the could
(11:55):
assist along the way and clarifythe ways in which we practice
or questions that they had.
And then obviously a lot ofhelp was coming from the Nevada
anesthesiologists that were keyin the legislative session and
then they also were following upto watch as their own boards
(12:17):
were going through theregulatory process.
Speaker 1 (12:21):
How critical do you think it was to have a CAA
pushing to want to work inNevada, like, do you think other
people would have just carriedall of this work for you if
there was not a very specificCAA who wanted to work as soon
as possible for you if there wasnot a very specific CAA who
wanted to work as soon aspossible.
Speaker 2 (12:39):
Yeah, I think that was a key part in this
legislative session or thiswhole process this go around.
I think I mentioned in the lastepisode that there were attempts
in 2011, 2015, and 2017 for aprevious A licensure in Nevada
(13:02):
and I think having theprofessional advocacy of the
Nevada AAA this time around andjust more involvement from
actual AAs that are licensed andworking in other states, it
really motivated the you know,not only the legislators, but
also now the groups to hire usbecause they see that, oh my
gosh, there are actual, realpeople wanting to come back.
So it's a huge feat to take onfor the physicians or the groups
(13:27):
that are interested in hiringus, because it's a ton of work
up front with not much personalor any sort of gain for the
group immediately.
They have to learn about thebilling and everything.
So it's a huge thing to take onfor them without knowing that
(13:47):
anyone wants to come back andwork.
So I think knowing that we'reready just tell us when we can
come was a huge, huge help toget it going here so fast.
Speaker 1 (13:59):
Let's maybe walk the listeners just your own timeline
in Nevada, if you can, frombill passing to walking into an
operating room to deliveryanesthesia for the first time.
Do you have those dates thatyou could do that kind of
roughly?
Speaker 2 (14:13):
Yes, so I got my medical license through the
Nevada State Board of MedicalExaminers at the beginning of
this year.
I want to say it was probablyJanuary or February because,
like I said, they are requiredby law as of January 1st of 2024
(14:33):
to start licensing us.
So after I got my licensethrough the Nevada State Board
of Medical Examiners in January,February, the regulatory
process was starting through thehospital and they started
writing delineation ofprivileges and approving us,
(14:55):
adding us to their bylaws andapproving us, adding us to their
bylaws.
So, yes, I started work thevery beginning of September of
2024 in Las Vegas.
So the first group thatsuccessfully hired the first
four of us and that startedworking is one of the big
private practice corporategroups that is located, one of
(15:18):
the big private practicecorporate groups that has a
practice in Las Vegas, which washonestly a great way to break
into the state, because thisspecific group uses AAs in other
parts of the country and sothey have a ton of
infrastructure just within thecompany.
On knowing how to bill for us,they leaned on a ton of other
(15:39):
locations that already are usingAAs.
So it was actually quite asmooth transition and we were
all very pleasantly surprisedwith how we transitioned into
the state.
Obviously, we knew we weregoing to be guinea pigs
regardless, because it's alwaysnew.
No one knew who we were.
But our employer did so muchgroundwork for us and education
(16:06):
of the surgeons and the nursesand all the other staff at the
hospital up to the C-suite, andthen you know they worked
internally with their othergroups nationwide on.
You know the onboarding of usor you know what we need as AAs
or how, how to make it a smoothtransition.
(16:26):
So that was really, reallyhelpful.
How?
Speaker 1 (16:28):
to make it a smooth transition, so that was really,
really helpful.
I think it's maybe overwhelmingfor people who are listening
when you're not inside theprocess.
It sounds very confusing, veryconvoluted, slow and sort of
like hard to get motivated tostart maybe.
What does it feel like now tobe on the other side?
Speaker 2 (16:52):
I think it definitely feels super surreal.
I still can't believe that weare at this period.
I thought that when I firsteven heard of going to AA school
, I knew it was a huge risk forme to take, that I could
potentially never be able tomove back to my home state or
closer to my family.
So being here now and seeingthat it all actually happened
(17:17):
which I never thought waspossible definitely made all the
work very worth it, and I haveto be honest, I had no idea what
I was doing.
I definitely took one day at atime and learned so much day to
day as I went and I thought, ohmy gosh, what am I doing?
I'm not qualified to be doingthis, but I just kept telling
(17:41):
myself that if no one is outthere trying, then it will never
happen, and it was somethingthat I was pretty passionate
about.
So I think for anyone out therethat is from a state that we
can't work in, or maybe from astate that we can work in that
they wish there could be changesmade to the legislation or
(18:03):
licensure that, just just try.
Like I said, it's not going tohappen if you don't try.
And so just to take one step ata time, and there's so many
people out there and we havejust such a great family of A's
across the country that if youjust start those conversations
you'll probably be surprised ofhow many people are willing to
(18:24):
help you or how many people areout there.
Yeah.
Speaker 1 (18:27):
Yeah, it is the age old CAA story that there's so
few of us that one person canmake a difference, which is a
huge privilege and also a reallybig burden, like there's just
no other way around it.
Yes, for sure, but yeah, you'veliterally forever changed the
course of what it means to be aCAA Like.
(18:48):
That's amazing.
It is so incredible that in youknow, 25 years, all the people
who are working in Nevada maynot even know that this whole
thing happened.
Hopefully the podcast is around.
They can listen to this episode.
We'll see where podcasts are in25 years.
But I'm so grateful that youdid this update with me and that
(19:09):
we can celebrate that you arenow working in your home state
and I know that you're workingin Nevada.
But would you really want towork in Reno?
Is that the dream of all dreams?
Speaker 2 (19:21):
Yes.
So that was definitely thisdecision to move back was so
difficult for me becausebasically, after the bill passed
, after we were on this big highthat you know, I started
picturing myself moving back toReno and I definitely realized
that some parts of the state,like Vegas, were progressing a
(19:43):
lot more quickly in the sense ofhiring us than other parts of
the state, like Reno, which ismy hometown.
So I definitely had to make ahuge decision if I wanted to
move somewhere like Vegas, whichI didn't initially ever see
myself moving from my practicein Denver where I felt so
(20:03):
comfortable, I felt establishedthere.
I had great, amazing friendsthat I know I will have for a
lifetime that were so hard toleave.
But I felt like if I stillmoved to Nevada, that it could
help other areas of the state bemore confident to follow suit
(20:23):
and start hiring us if they seethat it worked well in other
areas.
So it was really hard to tell mygroup in Denver that I was
going to move away, obviouslybecause they knew that I loved
working there.
But I don't think it was as bigof a surprise because they knew
how hard I was working on thelegislative stuff and they were
(20:46):
helping me arrange my scheduleso that I could go testify, and
they knew that I have family inNevada, so I don't think it was
a huge surprise to them.
But regardless, it never iseasy telling an employer that
you're leaving and, again, it'snever easy making a huge,
life-changing decision like that.
But I just felt like it was inmy gut and I just had to
(21:08):
continue on with this processand just dive in and see what
happens.
Speaker 1 (21:16):
We're going to have to do an update to your update,
Stephanie, in a year.
Speaker 2 (21:20):
We're just going to keep updating.
Speaker 1 (21:23):
Stephanie, I'm just so proud of you.
I've just learned so muchthrough watching the process
through you and learning aboutit through you.
I hope this audience and allthe future CAAs are inspired to
take the first step, to try toopen a new state or a new
hospital or a new practice,because truly, one person can
(21:46):
make that difference if you staydedicated and persevere,
because that's how Stephanie didit and that is the living proof
that that that works.
So I just really again want tothank you for coming on and
doing this update and, yeah, Ihope you have a wonderful,
lovely day.
She's actually in Reno rightnow visiting her family.
(22:07):
You must have the day off fromyour job.
Speaker 2 (22:10):
Yes, I do so.
Yes, it's been very, verylovely.
I have really been enjoying mynew job in Vegas.
It has been, even though I'mnot home home, it is the next
best thing and it's so easy toget home.
For those that aren't aware ofhow the geography is in Nevada,
(22:31):
las Vegas is about seven hours,a seven hour ish drive south of
Reno, where my family is so um,they have about a flight every
hour, so the flights they.
They can't even finish thedrink service before the flight
lands usually, so it's beensuper easy for me to Zoom home
(22:51):
on a long weekend or even just aday trip if I wanted to.
So I've been really enjoyingbeing closer and I think that
everything happens for a reasonand I really think that this is
just part of the journey andwhere I need to be, and I've
been really enjoying it.
Speaker 1 (23:13):
So yeah, well, I'm really happy for you and I'm
really grateful to have you backon.
And, yeah, we'll just keep.
We're just watching you andwe're rooting for you.
Speaker 2 (23:22):
So thank you so much and thank you for everything
that you do just highlightingour profession and getting the
word out there and making peoplefeel seen, and so everything
that you do is awesome.
Thank you, Stephanie.
Speaker 1 (23:39):
Feelings mutual.
Speaker 2 (23:40):
Thank you.
Speaker 1 (23:43):
I hope you loved catching up with Stephanie and
feel inspired by her journey toactually practice in her home
state, and I will continue tofollow Stephanie's journey as
she hopefully one day soon isworking in Reno, which is her
dream location.
That's where her family is,within the state of Nevada and
so, yeah, I'm totally going tolet you know when she crosses
(24:06):
that last hurdle for herself andfor our CAA profession.
If you loved this episode oryou know someone in your life
who would really be inspired, Iwould love for you right now to
share this episode with thatother CAA or AA student or
person in your life who needs tohear Stephanie's story.
Tell them why you loved thisepisode and why you think
(24:28):
they'll love this episode.
That one-to-one connection isreally what's helping to grow
this Awaken Anestis communityand therefore our CAA profession
as a whole.
I'm just so excited to be apart of it with you all.
As always, you can check theshow notes for a bunch more ways
to connect.
I have the season four mindfulconnection sessions that are
(24:48):
running through March of 2025.
We meet monthly to practice alittle bit of mindfulness, to
meet within this CAA community.
Everyone's invited, whetheryou're a student or a practicing
or retired CAA or a prospectiveAA student.
This is just a time for us toget together in a like-minded
(25:09):
community and to learn a littlebit more about who we are and
how we work in the world.
All really in this hopes thatwe can use our CAA profession to
live a life by design ratherthan default.
So there's more informationabout the upcoming sessions in
the show notes.
You can get on the email listthere.
I also have just a generalnewsletter you can subscribe to
(25:30):
and hear more updates.
Just get it right there in yourinbox.
What else?
You can follow me on Instagramat Awakened Anesthetist.
I tend to show some behind thescenes there on my Instagram and
I think that's it.
I hope you all have a wonderfulrest of your day and let's talk
next week.
Welcome to the Awakened Anesthetist podcast,
the first podcast to highlightthe CAA experience.
I'm your host, Mary Jean, andI've been a certified
anesthesiologist assistant forclose to two decades.
Throughout my journey andstruggles, I've searched for
guidance that includes my uniqueperspective as a CAA, At one of
(00:42):
my lowest one.
I encourage you to stick aroundand experience the power of
being in a community filled withvoices who sound like yours,
sharing experiences you neverbelieved possible.
I know you will find yourselfhere at the AwakendAnesthetist
podcast.
Welcome in.
Hello AwakendAnesthetist family.
(01:05):
This is your host, Mary Jean,and this is a really special
episode.
This is my first update on aprocess episode.
Today I am reintroducingStephanie Zunini.
Stephanie was the season threeopening process episode, episode
35, and I've linked it down inthe show notes.
If you've not listened to that,I do suggest you listen to that
(01:27):
first and then come back andhear what Stephanie's up to now.
This is just a really excitingtime in our profession.
We're definitely at, you know,an inflection point of growth,
and I had interviewed Stephanieright as the Nevada CAA
licensure bill had passed inJune of 2023.
And Stephanie was the presidentof the Nevada Academy of
(01:51):
Anesthesiologist Assistants atthat time, and so I interviewed
her and two other people whowere really instrumental in
getting that licensure billpassed, and in the conversation
with Stephanie I finally, foronce for myself, learned what it
really takes to pass an AA bill.
I really, more so, understoodthe licensure process.
(02:12):
I've been a CAA for years andyears and just never really
understood what was happening atthe legislative level.
So if any of that interests you, I do recommend you go back and
listen to process episode 35and then come back to this and
catch up with Stephanie.
Now she is living and working inNevada and we talk about the
steps that have to happen afteran AA bill passes to then step
(02:36):
foot inside a hospital in a newstate.
It's not just like snap yourfingers and it works out perfect
.
So Stephanie shares behind thescenes there and then just
generally what she's doing andwhat she hopes for next in her
life, as she has some big thingsto update.
So if you're someone who hopesto one day work in Nevada or
maybe open a new state and moveback to your home state, this is
(02:58):
a really great episode to seeto believe what's possible for
you.
All right, let's jump in.
Why don't you?
In case people haven't listenedto your process episode, which
they should go back and listen.
Just brief us on your journeyfrom AA school through passing
the AA bill, just where you werein the world, what AA school
(03:18):
you went to.
Just like a really briefintroduction to catch everyone
up to where we're going to belaunching off from in this
episode.
Speaker 2 (03:27):
Got it.
So, yes, my name is StephanieZunini and I went to a school,
at Case Western in Washington DC.
I graduated from there in Mayof 2021.
And just before I graduated andjust before I graduated, I
(03:49):
started this whole venture abouttrying to pass this licensure
bill in Nevada.
I figured that if no one tries,that it'll never happen, and I
really didn't know that manypeople that were involved in the
profession from Nevada.
So I told myself I wanted togive it one shot or at least try
and see what happens.
So fast forward, I moved fromDC, worked in Southern Indiana
(04:13):
for a year, then I moved toDenver for two years and,
spoiler, but the bill passed andI just moved to Las Vegas at
the beginning of September ofthis year, 2024.
Speaker 1 (04:31):
And when did the bill pass exactly?
Speaker 2 (04:34):
So the governor signed the bill into law in June
of 2023.
And then it became effective,which was just how the
legislation worked.
It became effective January of2024, so this year.
Speaker 1 (04:50):
Okay, yeah, so Stephanie's past process episode
is actually with two otherpeople who were really integral
in having the AA bill pass inthe state of Nevada and it was
not a super quick process.
It occurred over many years.
And it was not a super quickprocess.
It occurred over many years.
So if you go back to thatepisode I believe it's episode
35, you'll get to hear more ofhow the bill passed and
(05:11):
Stephanie's role in that.
You were and still are theNevada Academy of
Anesthesiologists AssistancePresident, correct.
Speaker 2 (05:20):
Yes, okay.
So I feel like after the billpassed, I definitely took a
little bit of a break.
Everyone who was involved inthe Nevada AAA and everything
definitely felt especially me,felt a little bit burnt out
after the legislation passed,after this huge accomplishment
(05:41):
that we had been working for solong towards, huge
accomplishment that we had beenworking for so long towards.
So I felt like we tookdefinitely a long break, but
we're excited to kind of getback into it, mm-hmm.
Speaker 1 (05:54):
Yeah, I think that is really real and a part of the
conversation I want to havetoday, because what many people
may not understand is that, eventhough the state passed the
bill so that it is legal for AAsto work in the state of Nevada,
there are several other layersthat need to be cleared in order
(06:15):
for an AA to actuallyphysically walk into a hospital
and deliver anesthesia.
So let's pick up theconversation.
Stephanie, maybe with the billpassed in June and rightfully so
you were pretty burned out.
It sounds like and sort of likethis huge exhale after this
really big push gun.
(06:38):
You were maybe like halfwaythere.
Take us to that moment, sort ofright, when you're burned out
but you're like, gee, do I wantto move back home?
What's my next step?
Speaker 2 (06:54):
What was your mindset right when we were recording
September of last year?
Yes, I definitely during thattime when we talked about all
the intricacies of thelegislative session and that was
a roller coaster in itself ofthe legislative session and that
was a roller coaster in itself.
And then when we last talked, Iwas definitely on a huge high.
We were all very ecstatic thatthis bill passed.
And now, you know, our gearshifts a little bit Like we're
(07:27):
pretty exhausted and we had beenworking for this goal for two
and a half years and now Ididn't realize.
Now I kind of went on this newroller coaster of getting our
licenses in Nevada andcredentialing at, you know,
hospitals or in cities thatwe're hoping to work in now.
But I definitely startedpicturing myself moving back to
my hometown, which was thereason that I started this whole
(07:48):
journey from the beginning.
But to be honest, I definitelyknew all along deep down that
even though the bill passed, itdidn't mean that we were going
to magically be able to walk inand start working anywhere that
we wanted to.
So that definitely made mepretty apprehensive and knew
(08:08):
that there was still a lot ofwork to be done.
But at the same time, eventhough I knew there was a ton of
work to be done, I felt superburnt out in regards to the
legislative stuff because thatwas a huge grind for the two and
a half years that I really doveinto that.
Speaker 1 (08:28):
So let me ask you something because I'm not sure
if even I can exactly explainwhat the exact steps are after a
bill passes.
Do you feel like you've got agood handle on the other levels
that needs to get passed?
Can you describe?
Speaker 2 (08:46):
that, yeah.
So obviously, the governorsigned it into law in June of
2023, and then it becameeffective January uh, january
1st of 2024.
So what that means is that themedical boards in Nevada are
required by law to, you know,give out licenses to those
(09:09):
applicants that obviously meetall the requirements, but by law
, they are required to startissuing licenses to those
applicants as of January 1st of2024.
It definitely took a while forboards to now translate the
(09:30):
legislation into their ownregulations.
So now each board has to writetheir own regulations to enforce
the law.
So if you are not followingsomething that's written in the
legislation, it's the board'sresponsibility to enforce it and
say oh, you did this, now yourlicense is suspended.
(09:52):
X Y, z, so xyz, so um, theyhave to go through their own
regulatory writing process.
So that wasn't.
You know, nothing is quick.
So people were asking why, ifthe bill passed in june of 2023
and became effective in january2024, why didn't we start
(10:14):
working in ne till September of2024?
Which, to be honest, that wasprobably one of the quickest
turnarounds, I would guess, inall the states that have passed
legislation the boards, and then, not to mention, starting to
(10:36):
educate the hospitals, from thesurgeons, to the nurses, to the
background staff, thecredentialers, on our scope of
practice and what we can do.
And they have to write out ourdelineation of privileges for
the hospital and change theirbylaws to write in that we are,
(10:58):
you know, recognized as aprovider at that hospital, not
to mention also, you know,educating the groups on the
billing process or just theinfrastructure to hire us.
So there's, I realized that,you know, the legislative
session was a huge rollercoaster, but that was only a
(11:19):
small piece of the puzzle.
For sure, that's kind of whatI've been dealing with over the
past year, since we last chatted.
Speaker 1 (11:28):
And who's helping you do this?
Who's the team making thesepushes?
Speaker 2 (11:33):
So I would say a lot of the same people that were
involved in the legislativeeffort have been here along the
way.
A lot of it is kind of out ofour hands because it really fell
on the boards.
Typically in Nevada the twodifferent boards the could
(11:55):
assist along the way and clarifythe ways in which we practice
or questions that they had.
And then obviously a lot ofhelp was coming from the Nevada
anesthesiologists that were keyin the legislative session and
then they also were following upto watch as their own boards
(12:17):
were going through theregulatory process.
Speaker 1 (12:21):
How critical do you think it was to have a CAA
pushing to want to work inNevada, like, do you think other
people would have just carriedall of this work for you if
there was not a very specificCAA who wanted to work as soon
as possible for you if there wasnot a very specific CAA who
wanted to work as soon aspossible.
Speaker 2 (12:39):
Yeah, I think that was a key part in this
legislative session or thiswhole process this go around.
I think I mentioned in the lastepisode that there were attempts
in 2011, 2015, and 2017 for aprevious A licensure in Nevada
(13:02):
and I think having theprofessional advocacy of the
Nevada AAA this time around andjust more involvement from
actual AAs that are licensed andworking in other states, it
really motivated the you know,not only the legislators, but
also now the groups to hire usbecause they see that, oh my
gosh, there are actual, realpeople wanting to come back.
So it's a huge feat to take onfor the physicians or the groups
(13:27):
that are interested in hiringus, because it's a ton of work
up front with not much personalor any sort of gain for the
group immediately.
They have to learn about thebilling and everything.
So it's a huge thing to take onfor them without knowing that
(13:47):
anyone wants to come back andwork.
So I think knowing that we'reready just tell us when we can
come was a huge, huge help toget it going here so fast.
Speaker 1 (13:59):
Let's maybe walk the listeners just your own timeline
in Nevada, if you can, frombill passing to walking into an
operating room to deliveryanesthesia for the first time.
Do you have those dates thatyou could do that kind of
roughly?
Speaker 2 (14:13):
Yes, so I got my medical license through the
Nevada State Board of MedicalExaminers at the beginning of
this year.
I want to say it was probablyJanuary or February because,
like I said, they are requiredby law as of January 1st of 2024
(14:33):
to start licensing us.
So after I got my licensethrough the Nevada State Board
of Medical Examiners in January,February, the regulatory
process was starting through thehospital and they started
writing delineation ofprivileges and approving us,
(14:55):
adding us to their bylaws andapproving us, adding us to their
bylaws.
So, yes, I started work thevery beginning of September of
2024 in Las Vegas.
So the first group thatsuccessfully hired the first
four of us and that startedworking is one of the big
private practice corporategroups that is located, one of
(15:18):
the big private practicecorporate groups that has a
practice in Las Vegas, which washonestly a great way to break
into the state, because thisspecific group uses AAs in other
parts of the country and sothey have a ton of
infrastructure just within thecompany.
On knowing how to bill for us,they leaned on a ton of other
(15:39):
locations that already are usingAAs.
So it was actually quite asmooth transition and we were
all very pleasantly surprisedwith how we transitioned into
the state.
Obviously, we knew we weregoing to be guinea pigs
regardless, because it's alwaysnew.
No one knew who we were.
But our employer did so muchgroundwork for us and education
(16:06):
of the surgeons and the nursesand all the other staff at the
hospital up to the C-suite, andthen you know they worked
internally with their othergroups nationwide on.
You know the onboarding of usor you know what we need as AAs
or how, how to make it a smoothtransition.
(16:26):
So that was really, reallyhelpful.
How?
Speaker 1 (16:28):
to make it a smooth transition, so that was really,
really helpful.
I think it's maybe overwhelmingfor people who are listening
when you're not inside theprocess.
It sounds very confusing, veryconvoluted, slow and sort of
like hard to get motivated tostart maybe.
What does it feel like now tobe on the other side?
Speaker 2 (16:52):
I think it definitely feels super surreal.
I still can't believe that weare at this period.
I thought that when I firsteven heard of going to AA school
, I knew it was a huge risk forme to take, that I could
potentially never be able tomove back to my home state or
closer to my family.
So being here now and seeingthat it all actually happened
(17:17):
which I never thought waspossible definitely made all the
work very worth it, and I haveto be honest, I had no idea what
I was doing.
I definitely took one day at atime and learned so much day to
day as I went and I thought, ohmy gosh, what am I doing?
I'm not qualified to be doingthis, but I just kept telling
(17:41):
myself that if no one is outthere trying, then it will never
happen, and it was somethingthat I was pretty passionate
about.
So I think for anyone out therethat is from a state that we
can't work in, or maybe from astate that we can work in that
they wish there could be changesmade to the legislation or
(18:03):
licensure that, just just try.
Like I said, it's not going tohappen if you don't try.
And so just to take one step ata time, and there's so many
people out there and we havejust such a great family of A's
across the country that if youjust start those conversations
you'll probably be surprised ofhow many people are willing to
(18:24):
help you or how many people areout there.
Yeah.
Speaker 1 (18:27):
Yeah, it is the age old CAA story that there's so
few of us that one person canmake a difference, which is a
huge privilege and also a reallybig burden, like there's just
no other way around it.
Yes, for sure, but yeah, you'veliterally forever changed the
course of what it means to be aCAA Like.
(18:48):
That's amazing.
It is so incredible that in youknow, 25 years, all the people
who are working in Nevada maynot even know that this whole
thing happened.
Hopefully the podcast is around.
They can listen to this episode.
We'll see where podcasts are in25 years.
But I'm so grateful that youdid this update with me and that
(19:09):
we can celebrate that you arenow working in your home state
and I know that you're workingin Nevada.
But would you really want towork in Reno?
Is that the dream of all dreams?
Speaker 2 (19:21):
Yes.
So that was definitely thisdecision to move back was so
difficult for me becausebasically, after the bill passed
, after we were on this big highthat you know, I started
picturing myself moving back toReno and I definitely realized
that some parts of the state,like Vegas, were progressing a
(19:43):
lot more quickly in the sense ofhiring us than other parts of
the state, like Reno, which ismy hometown.
So I definitely had to make ahuge decision if I wanted to
move somewhere like Vegas, whichI didn't initially ever see
myself moving from my practicein Denver where I felt so
(20:03):
comfortable, I felt establishedthere.
I had great, amazing friendsthat I know I will have for a
lifetime that were so hard toleave.
But I felt like if I stillmoved to Nevada, that it could
help other areas of the state bemore confident to follow suit
(20:23):
and start hiring us if they seethat it worked well in other
areas.
So it was really hard to tell mygroup in Denver that I was
going to move away, obviouslybecause they knew that I loved
working there.
But I don't think it was as bigof a surprise because they knew
how hard I was working on thelegislative stuff and they were
(20:46):
helping me arrange my scheduleso that I could go testify, and
they knew that I have family inNevada, so I don't think it was
a huge surprise to them.
But regardless, it never iseasy telling an employer that
you're leaving and, again, it'snever easy making a huge,
life-changing decision like that.
But I just felt like it was inmy gut and I just had to
(21:08):
continue on with this processand just dive in and see what
happens.
Speaker 1 (21:16):
We're going to have to do an update to your update,
Stephanie, in a year.
Speaker 2 (21:20):
We're just going to keep updating.
Speaker 1 (21:23):
Stephanie, I'm just so proud of you.
I've just learned so muchthrough watching the process
through you and learning aboutit through you.
I hope this audience and allthe future CAAs are inspired to
take the first step, to try toopen a new state or a new
hospital or a new practice,because truly, one person can
(21:46):
make that difference if you staydedicated and persevere,
because that's how Stephanie didit and that is the living proof
that that that works.
So I just really again want tothank you for coming on and
doing this update and, yeah, Ihope you have a wonderful,
lovely day.
She's actually in Reno rightnow visiting her family.
(22:07):
You must have the day off fromyour job.
Speaker 2 (22:10):
Yes, I do so.
Yes, it's been very, verylovely.
I have really been enjoying mynew job in Vegas.
It has been, even though I'mnot home home, it is the next
best thing and it's so easy toget home.
For those that aren't aware ofhow the geography is in Nevada,
(22:31):
las Vegas is about seven hours,a seven hour ish drive south of
Reno, where my family is so um,they have about a flight every
hour, so the flights they.
They can't even finish thedrink service before the flight
lands usually, so it's beensuper easy for me to Zoom home
(22:51):
on a long weekend or even just aday trip if I wanted to.
So I've been really enjoyingbeing closer and I think that
everything happens for a reasonand I really think that this is
just part of the journey andwhere I need to be, and I've
been really enjoying it.
Speaker 1 (23:13):
So yeah, well, I'm really happy for you and I'm
really grateful to have you backon.
And, yeah, we'll just keep.
We're just watching you andwe're rooting for you.
Speaker 2 (23:22):
So thank you so much and thank you for everything
that you do just highlightingour profession and getting the
word out there and making peoplefeel seen, and so everything
that you do is awesome.
Thank you, Stephanie.
Speaker 1 (23:39):
Feelings mutual.
Speaker 2 (23:40):
Thank you.
Speaker 1 (23:43):
I hope you loved catching up with Stephanie and
feel inspired by her journey toactually practice in her home
state, and I will continue tofollow Stephanie's journey as
she hopefully one day soon isworking in Reno, which is her
dream location.
That's where her family is,within the state of Nevada and
so, yeah, I'm totally going tolet you know when she crosses
(24:06):
that last hurdle for herself andfor our CAA profession.
If you loved this episode oryou know someone in your life
who would really be inspired, Iwould love for you right now to
share this episode with thatother CAA or AA student or
person in your life who needs tohear Stephanie's story.
Tell them why you loved thisepisode and why you think
(24:28):
they'll love this episode.
That one-to-one connection isreally what's helping to grow
this Awaken Anestis communityand therefore our CAA profession
as a whole.
I'm just so excited to be apart of it with you all.
As always, you can check theshow notes for a bunch more ways
to connect.
I have the season four mindfulconnection sessions that are
(24:48):
running through March of 2025.
We meet monthly to practice alittle bit of mindfulness, to
meet within this CAA community.
Everyone's invited, whetheryou're a student or a practicing
or retired CAA or a prospectiveAA student.
This is just a time for us toget together in a like-minded
(25:09):
community and to learn a littlebit more about who we are and
how we work in the world.
All really in this hopes thatwe can use our CAA profession to
live a life by design ratherthan default.
So there's more informationabout the upcoming sessions in
the show notes.
You can get on the email listthere.
I also have just a generalnewsletter you can subscribe to
(25:30):
and hear more updates.
Just get it right there in yourinbox.
What else?
You can follow me on Instagramat Awakened Anesthetist.
I tend to show some behind thescenes there on my Instagram and
I think that's it.
I hope you all have a wonderfulrest of your day and let's talk
next week.
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