Awakened Anesthetist

UPDATE: Trailblazing the CAA Licensure Movement in Nevada ft. Stephanie Zunini, CAA

• Mary Jeanne, Certified Anesthesiologist Assistant • Season 4 • Episode 62

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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

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Speaker 1:

Welcome to the Awakened Anesthetist podcast, the first podcast to highlight the CAA experience. I'm your host, Mary Jean, and I've been a certified anesthesiologist assistant for close to two decades. Throughout my journey and struggles, I've searched for guidance that includes my unique perspective as a CAA, At one of my lowest one. I encourage you to stick around and experience the power of being in a community filled with voices who sound like yours, sharing experiences you never believed possible. I know you will find yourself here at the AwakendAnesthetist podcast. Welcome in. Hello AwakendAnesthetist family. This is your host, Mary Jean, and this is a really special episode. This is my first update on a process episode. Today I am reintroducing Stephanie Zunini. Stephanie was the season three opening process episode, episode 35, and I've linked it down in the show notes. If you've not listened to that, I do suggest you listen to that first and then come back and hear what Stephanie's up to now. This is just a really exciting time in our profession.

Speaker 1:

We're definitely at, you know, an inflection point of growth, and I had interviewed Stephanie right as the Nevada CAA licensure bill had passed in June of 2023. And Stephanie was the president of the Nevada Academy of Anesthesiologist Assistants at that time, and so I interviewed her and two other people who were really instrumental in getting that licensure bill passed, and in the conversation with Stephanie I finally, for once for myself, learned what it really takes to pass an AA bill. I really, more so, understood the licensure process. I've been a CAA for years and years and just never really understood what was happening at the legislative level. So if any of that interests you, I do recommend you go back and listen to process episode 35 and then come back to this and catch up with Stephanie.

Speaker 1:

Now she is living and working in Nevada and we talk about the steps that have to happen after an AA bill passes to then step foot inside a hospital in a new state. It's not just like snap your fingers and it works out perfect. So Stephanie shares behind the scenes there and then just generally what she's doing and what she hopes for next in her life, as she has some big things to update. So if you're someone who hopes to one day work in Nevada or maybe open a new state and move back to your home state, this is a really great episode to see to believe what's possible for you. All right, let's jump in. Why don't you? In case people haven't listened to your process episode, which they should go back and listen. Just brief us on your journey from AA school through passing the AA bill, just where you were in the world, what AA school you went to. Just like a really brief introduction to catch everyone up to where we're going to be launching off from in this episode.

Speaker 2:

Got it. So, yes, my name is Stephanie Zunini and I went to a school, at Case Western in Washington DC. I graduated from there in May of 2021. And just before I graduated and just before I graduated, I started this whole venture about trying 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 many people that were involved in the profession from Nevada. So I told myself I wanted to give it one shot or at least try and see what happens. So fast forward, I moved from DC, worked in Southern Indiana for a year, then I moved to Denver for two years and, spoiler, but the bill passed and I just moved to Las Vegas at the beginning of September of this year, 2024.

Speaker 1:

And when did the bill pass exactly?

Speaker 2:

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 of 2024, so this year.

Speaker 1:

Okay, yeah, so Stephanie's past process episode is actually with two other people who were really integral in having the AA bill pass in the state of Nevada and it was not a super quick process. It occurred over many years. And it was not a super quick process. It occurred over many years. So if you go back to that episode I believe it's episode 35, you'll get to hear more of how the bill passed and Stephanie's role in that. You were and still are the Nevada Academy of Anesthesiologists Assistance President, correct.

Speaker 2:

Yes, okay. So I feel like after the bill passed, I definitely took a little bit of a break. Everyone who was involved in the Nevada AAA and everything definitely felt especially me, felt a little bit burnt out after the legislation passed, after this huge accomplishment that we had been working for so long towards, huge accomplishment that we had been working for so long towards. So I felt like we took definitely a long break, but we're excited to kind of get back into it, mm-hmm.

Speaker 1:

Yeah, I think that is really real and a part of the conversation I want to have today, because what many people may not understand is that, even though the state passed the bill so that it is legal for AAs to work in the state of Nevada, there are several other layers that need to be cleared in order for an AA to actually physically walk into a hospital and deliver anesthesia. So let's pick up the conversation. Stephanie, maybe with the bill passed in June and rightfully so you were pretty burned out. It sounds like and sort of like this huge exhale after this really big push gun. You were maybe like halfway there. Take us to that moment, sort of right, when you're burned out but you're like, gee, do I want to move back home? What's my next step?

Speaker 2:

What was your mindset right when we were recording September of last year? Yes, I definitely during that time when we talked about all the intricacies of the legislative session and that was a roller coaster in itself of the legislative session and that was a roller coaster in itself. And then when we last talked, I was definitely on a huge high. We were all very ecstatic that this bill passed. And now, you know, our gear shifts a little bit Like we're pretty exhausted and we had been working for this goal for two and a half years and now I didn't realize.

Speaker 2:

Now I kind of went on this new roller coaster of getting our licenses in Nevada and credentialing at, you know, hospitals or in cities that we're hoping to work in now. But I definitely started picturing myself moving back to my hometown, which was the reason that I started this whole journey from the beginning. But to be honest, I definitely knew all along deep down that even though the bill passed, it didn't mean that we were going to magically be able to walk in and start working anywhere that we wanted to. So that definitely made me pretty apprehensive and knew that there was still a lot of work to be done. But at the same time, even though I knew there was a ton of work to be done, I felt super burnt out in regards to the legislative stuff because that was a huge grind for the two and a half years that I really dove into that.

Speaker 1:

So let me ask you something because I'm not sure if even I can exactly explain what the exact steps are after a bill passes. Do you feel like you've got a good handle on the other levels that needs to get passed? Can you describe?

Speaker 2:

that, yeah. So obviously, the governor signed it into law in June of 2023, and then it became effective January uh, january 1st of 2024. So what that means is that the medical boards in Nevada are required by law to, you know, give out licenses to those applicants that obviously meet all the requirements, but by law, they are required to start issuing licenses to those applicants as of January 1st of 2024. It definitely took a while for boards to now translate the legislation into their own regulations. So now each board has to write their own regulations to enforce the law. So if you are not following something that's written in the legislation, it's the board's responsibility to enforce it and say oh, you did this, now your license is suspended. X Y, z, so xyz, so um, they have to go through their own regulatory writing process.

Speaker 2:

So that wasn't. You know, nothing is quick. So people were asking why, if the bill passed in june of 2023 and became effective in january 2024, why didn't we start working in ne till September of 2024? Which, to be honest, that was probably one of the quickest turnarounds, I would guess, in all the states that have passed legislation the boards, and then, not to mention, starting to educate the hospitals, from the surgeons, to the nurses, to the background staff, the credentialers, on our scope of practice and what we can do. And they have to write out our delineation of privileges for the hospital and change their bylaws to write in that we are, you know, recognized as a provider at that hospital, not to mention also, you know, educating the groups on the billing process or just the infrastructure to hire us. So there's, I realized that, you know, the legislative session was a huge roller coaster, but that was only a small piece of the puzzle. For sure, that's kind of what I've been dealing with over the past year, since we last chatted.

Speaker 1:

And who's helping you do this? Who's the team making these pushes?

Speaker 2:

So I would say a lot of the same people that were involved in the legislative effort have been here along the way. A lot of it is kind of out of our hands because it really fell on the boards. Typically in Nevada the two different boards the could assist along the way and clarify the ways in which we practice or questions that they had. And then obviously a lot of help was coming from the Nevada anesthesiologists that were key in the legislative session and then they also were following up to watch as their own boards were going through the regulatory process.

Speaker 1:

How critical do you think it was to have a CAA pushing to want to work in Nevada, like, do you think other people would have just carried all of this work for you if there was not a very specific CAA who wanted to work as soon as possible for you if there was not a very specific CAA who wanted to work as soon as possible.

Speaker 2:

Yeah, I think that was a key part in this legislative session or this whole process this go around.

Speaker 2:

I think I mentioned in the last episode that there were attempts in 2011, 2015, and 2017 for a previous A licensure in Nevada and I think having the professional advocacy of the Nevada AAA this time around and just more involvement from actual AAs that are licensed and working in other states, it really motivated the you know, not only the legislators, but also now the groups to hire us because they see that, oh my gosh, there are actual, real people wanting to come back. So it's a huge feat to take on for the physicians or the groups that are interested in hiring us, because it's a ton of work up front with not much personal or any sort of gain for the group immediately. They have to learn about the billing and everything. So it's a huge thing to take on for them without knowing that anyone wants to come back and work. So I think knowing that we're ready just tell us when we can come was a huge, huge help to get it going here so fast.

Speaker 1:

Let's maybe walk the listeners just your own timeline in Nevada, if you can, from bill passing to walking into an operating room to delivery anesthesia for the first time. Do you have those dates that you could do that kind of roughly?

Speaker 2:

Yes, so I got my medical license through the Nevada State Board of Medical Examiners at the beginning of this year. I want to say it was probably January or February because, like I said, they are required by law as of January 1st of 2024 to start licensing us. So after I got my license through the Nevada State Board of Medical Examiners in January, February, the regulatory process was starting through the hospital and they started writing delineation of privileges and approving us, adding us to their bylaws and approving us, adding us to their bylaws. So, yes, I started work the very beginning of September of 2024 in Las Vegas.

Speaker 2:

So the first group that successfully hired the first four of us and that started working is one of the big private practice corporate groups that is located, one of the big private practice corporate groups that has a practice in Las Vegas, which was honestly a great way to break into the state, because this specific group uses AAs in other parts of the country and so they have a ton of infrastructure just within the company.

Speaker 2:

On knowing how to bill for us, they leaned on a ton of other locations that already are using AAs. So it was actually quite a smooth transition and we were all very pleasantly surprised with how we transitioned into the state. Obviously, we knew we were going to be guinea pigs regardless, because it's always new. No one knew who we were. But our employer did so much groundwork for us and education of the surgeons and the nurses and all the other staff at the hospital up to the C-suite, and then you know they worked internally with their other groups nationwide on. You know the onboarding of us or you know what we need as AAs or how, how to make it a smooth transition. So that was really, really helpful. How?

Speaker 1:

to make it a smooth transition, so that was really, really helpful. I think it's maybe overwhelming for people who are listening when you're not inside the process. It sounds very confusing, very convoluted, slow and sort of like hard to get motivated to start maybe. What does it feel like now to be on the other side?

Speaker 2:

I think it definitely feels super surreal. I still can't believe that we are at this period. I thought that when I first even heard of going to AA school, I knew it was a huge risk for me to take, that I could potentially never be able to move back to my home state or closer to my family. So being here now and seeing that it all actually happened which I never thought was possible definitely made all the work very worth it, and I have to be honest, I had no idea what I was doing. I definitely took one day at a time and learned so much day to day as I went and I thought, oh my gosh, what am I doing? I'm not qualified to be doing this, but I just kept telling myself that if no one is out there trying, then it will never happen, and it was something that I was pretty passionate about.

Speaker 2:

So I think for anyone out there that is from a state that we can't work in, or maybe from a state that we can work in that they wish there could be changes made to the legislation or licensure that, just just try. Like I said, it's not going to happen if you don't try. And so just to take one step at a time, and there's so many people out there and we have just such a great family of A's across the country that if you just start those conversations you'll probably be surprised of how many people are willing to help you or how many people are out there. Yeah.

Speaker 1:

Yeah, it is the age old CAA story that there's so few of us that one person can make a difference, which is a huge privilege and also a really big burden, like there's just no other way around it.

Speaker 1:

Yes, for sure, but yeah, you've literally forever changed the course of what it means to be a CAA Like. That's amazing. It is so incredible that in you know, 25 years, all the people who are working in Nevada may not even know that this whole thing happened. Hopefully the podcast is around. They can listen to this episode. We'll see where podcasts are in 25 years. But I'm so grateful that you did this update with me and that we can celebrate that you are now working in your home state and I know that you're working in Nevada. But would you really want to work in Reno? Is that the dream of all dreams?

Speaker 2:

Yes. So that was definitely this decision to move back was so difficult for me because basically, after the bill passed, after we were on this big high that you know, I started picturing myself moving back to Reno and I definitely realized that some parts of the state, like Vegas, were progressing a lot more quickly in the sense of hiring us than other parts of the state, like Reno, which is my hometown. So I definitely had to make a huge decision if I wanted to move somewhere like Vegas, which I didn't initially ever see myself moving from my practice in Denver where I felt so comfortable, I felt established there. I had great, amazing friends that I know I will have for a lifetime that were so hard to leave. But I felt like if I still moved to Nevada, that it could help other areas of the state be more confident to follow suit and start hiring us if they see that it worked well in other areas.

Speaker 2:

So it was really hard to tell my group in Denver that I was going to move away, obviously because they knew that I loved working there. But I don't think it was as big of a surprise because they knew how hard I was working on the legislative stuff and they were helping me arrange my schedule so that I could go testify, and they knew that I have family in Nevada, so I don't think it was a huge surprise to them. But regardless, it never is easy telling an employer that you're leaving and, again, it's never easy making a huge, life-changing decision like that. But I just felt like it was in my gut and I just had to continue on with this process and just dive in and see what happens.

Speaker 1:

We're going to have to do an update to your update, Stephanie, in a year.

Speaker 2:

We're just going to keep updating.

Speaker 1:

Stephanie, I'm just so proud of you. I've just learned so much through watching the process through you and learning about it through you. I hope this audience and all the future CAAs are inspired to take the first step, to try to open a new state or a new hospital or a new practice, because truly, one person can make that difference if you stay dedicated and persevere, because that's how Stephanie did it and that is the living proof that that that works. So I just really again want to thank you for coming on and doing this update and, yeah, I hope you have a wonderful, lovely day. She's actually in Reno right now visiting her family. You must have the day off from your job.

Speaker 2:

Yes, I do so. Yes, it's been very, very lovely. I have really been enjoying my new job in Vegas. It has been, even though I'm not home home, it is the next best thing and it's so easy to get home. For those that aren't aware of how the geography is in Nevada, 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 the drink service before the flight lands usually, so it's been super easy for me to Zoom home on a long weekend or even just a day trip if I wanted to. So I've been really enjoying being closer and I think that everything happens for a reason and I really think that this is just part of the journey and where I need to be, and I've been really enjoying it.

Speaker 1:

So yeah, well, I'm really happy for you and I'm really grateful to have you back on. And, yeah, we'll just keep. We're just watching you and we're rooting for you.

Speaker 2:

So thank you so much and thank you for everything that you do just highlighting our profession and getting the word out there and making people feel seen, and so everything that you do is awesome. Thank you, Stephanie.

Speaker 1:

Feelings mutual.

Speaker 2:

Thank you.

Speaker 1:

I hope you loved catching up with Stephanie and feel inspired by her journey to actually practice in her home state, and I will continue to follow Stephanie's journey as she hopefully one day soon is working 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 to let you know when she crosses that last hurdle for herself and for our CAA profession. If you loved this episode or you know someone in your life who would really be inspired, I would love for you right now to share this episode with that other CAA or AA student or person in your life who needs to hear Stephanie's story. Tell them why you loved this episode and why you think they'll love this episode. That one-to-one connection is really what's helping to grow this Awaken Anestis community and therefore our CAA profession as a whole. I'm just so excited to be a part of it with you all.

Speaker 1:

As always, you can check the show notes for a bunch more ways to connect. I have the season four mindful connection sessions that are running through March of 2025. We meet monthly to practice a little bit of mindfulness, to meet within this CAA community. Everyone's invited, whether you're a student or a practicing or retired CAA or a prospective AA student. This is just a time for us to get together in a like-minded community and to learn a little bit more about who we are and how we work in the world. All really in this hopes that we can use our CAA profession to live a life by design rather than default.

Speaker 1:

So there's more information about the upcoming sessions in the show notes. You can get on the email list there. I also have just a general newsletter you can subscribe to and hear more updates. Just get it right there in your inbox. What else? You can follow me on Instagram at Awakened Anesthetist. I tend to show some behind the scenes there on my Instagram and I think that's it. I hope you all have a wonderful rest of your day and let's talk next week.

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Mary Jeanne Roberts, CAA

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