• The Impact of the University of Puerto Rico Nurse Anesthesia Program

    A Conversation with Program Administrator Jose L. Bonilla Garcia, DNAP, CRNA

    Dr. Jose Bonilla Garcia sat down for a virtual conversation with the AANA about the University of Puerto Rico (UPR) Nurse Anesthesia Program’s impact on healthcare in the northern side of San Juan, Puerto Rico, and beyond.

    When was the University of Puerto School of Nurse Anesthesia established? There are three nurse anesthesia programs in Puerto Rico, and the University of Puerto Rico was the second program established in 1993. The founder of our program was Brunilda Malave, MSN, CRNA. Initially, this was a post certificate program, but in 1995, the University of Puerto Rico School of Nursing was established and accredited.

    To your knowledge, was there a particular reason or need that spurred the founding of this nurse anesthesia program? Very similar to the United States, the more than 70 hospitals here use an anesthesia care team model where supervision by a physician anesthesiologist is in place. There are four anesthesia providers in every room. If there are five operating rooms, there’s one physician anesthesiologist. Additionally, if there are 20 rooms, there are six or seven physician anesthesiologists. There is an increased demand for nurse anesthetists in Puerto Rico. At this time, there is only one physician anesthesiologist residency program in Puerto Rico, and they graduate approximately three or four residents each year.

    How did you become interested in nursing and nurse anesthesia? I’ve always been passionate about helping others, and I knew I would be in the medical field. As a medical and science major, I shadowed a nurse. From there, I received an internship, where I witnessed the holistic care of a nurse. That caught my attention and inspired me to pursue nursing. After graduation, I worked in the cardiovascular intensive care unit, and I can remember anesthesia providers giving me a report before handing the patient off to me. I would also go to the operating room to get advanced information about a patient I would be caring for in a few hours. I was always impressed by the anesthetist’s knowledge of pharmacology.

    What made you interested in becoming an educator? It was a gradual transition to becoming a program director. I accepted the position as an assistant program director in December 2018, and I remained in that role for two years. In January 2020, I became the program director. Currently, the UPR Nurse Anesthesia Program has two cohorts comprised of nine and 11 students. In June 2022, we will mark the beginning of our first cohort that will graduate with a doctorate of nursing practice degree in anesthesia from UPR.

    What is the size of a typical University of Puerto Rico School of Nurse Anesthesia Cohort? We typically receive 40-50 applicants per year and accept eight to 12 students per cohort. Historically, the UPR applicants are more male than female, with women comprising 40 percent of the applicants.

    How well are CRNAs known within Puerto Rico’s healthcare system or Puerto Rico as a whole? Our program here at UPR has really increased the awareness of nurse anesthetists in San Juan and across the island. We use social media to highlight events, such as our annual open house for prospective students, where we highlight the accomplishments of nurse anesthetists, and we visit colleges around the island to make them aware of this profession. We also actively participate in the promotion of CRNA Week every January.

    What type of impact do you feel your program is making on healthcare in Puerto Rico? I believe the high caliber of students who graduate from UPR has made the biggest impact in healthcare on the island. When doctors and other healthcare professionals work with nurse anesthetists, they can witness these autonomous providers who have received a quality education from the UPR nurse anesthesia program.

    Is there anything else you would like to add? I’m proud of the resilience of Puerto Rico. I know we are still in the midst of a pandemic and have been for nearly two years. However, before the pandemic, Puerto Rico has withstood back-to-back hurricanes and earthquakes. Through all of these challenges, the citizens of Puerto Rico, students, and faculty at UPR have never given up. Students enrolled at the time of these natural disasters have kept up with their studies, despite a lack of everyday resources. As for myself and other nurse anesthesia educators, we ensured that our program remained compliant with all Council of Accreditation standards for our students.