MORGANTOWN, W. Va. — Andrea Drayer, a senior Doctor of Nursing Practice (DNP) Nurse Anesthetist student at the West Virginia University School of Nursing, has helped educate and track the implementation of a medical device that will improve working conditions for providers, patients, and staff at WVU Hospitals – J.W. Ruby Memorial.
As part of her DNP project, Drayer coordinated with Dawn Yost, Clinical RN VI & Surgical Services Business Manager at J.W. Ruby Memorial, to facilitate the rollout of smoke evacuators in the operating room. These devices are used to safely suction away the smoke created during certain medical procedures.
“When surgeons use lasers or other medical tools to cut, ablate or cauterize a wound, it creates a smoke plume — sometimes noticeable, sometimes not,” Drayer said. “The smoke created from this equipment is toxic for us to inhale. The smoke created in those rooms is equivalent to smoking 25 to 30 cigarettes per day.”
As of Jan. 1, 2025, West Virginia enacted a law, HB 4376, requiring surgical smoke to be properly evacuated from operating rooms. Ahead of these changes, DNP Program Director Dr. Kendra Barker connected Drayer with the WVU Medicine team to see how she could help.
“It was an opportune time, and it was the opportune program,” Yost said. “As a future CRNA (Certified Registered Nurse Anesthetist), the surgical smoke would affect Andrea, too, once she graduates. If I come up with a topic or a plan, Dr. Barker is especially good at matching a student based on their interests or their working environments.”
As part of Drayer’s project, she was tasked with educating providers about the health risks of smoke not being properly evacuated. She compiled information from the American Nurses Association (ANA), as well as the Association of periOperative Registered Nurses (AORN). She also provided education about the changes being made in Epic Systems, the comprehensive Electronic Health Record software used by providers.
“There’s a correlation between the smoke plumes and lung issues, such as cancer, asthma, bronchitis, and other respiratory complications, especially for the care team who are right by the smoke, like surgeons and surgical techs,” Drayer said. “Smoke evacuators are placed on the end of the medical tools so that the smoke doesn’t go into the air or sit on surfaces. Some of the smoke particles are too heavy to rise. If these are occupational hazards you didn’t think about before, it opens your eyes.”
When the devices were first created, some providers found them too bulky or heavy for comfortable use. But over time, the equipment has been improved for better ease of use, which Drayer was also able to discuss in her materials. She created posters, presented at morning staff meetings, and shared the information with hospital representatives.
“As a student CRNA, Andrea was making people aware of the risks of the smoke and the benefits of the evacuation tools,” Yost said. “We had early adopters, but she helped educate doctors and staff in real-time about why it’s important.”
As the policy began rolling out, Drayer also worked with providers on charting needs for Epic. She worked with the operating room IT specialist to review and audit charts to ensure the smoke evacuators were included in the case carts, so the surgical teams could be prepared to use them. She said the WVU Medicine staff were very communicative and receptive of her work with the project.
“To me, as a nurse, if someone is telling me to make a change, I want to know the relevance,” Drayer said. “I tried to make the information as relevant to them as possible. A lot of people were surprised by the potential health risks, so it was important to fill that knowledge deficit, to help answer questions, get feedback, and provide the equipment that makes the most sense for them.”
As of 2025, West Virginia is one of 20 states with smoke evacuation laws in place to protect providers. Legislation is currently pending in both Maryland and Pennsylvania, so Drayer was able to provide education to providers in surrounding states as well to illustrate the importance.
“It feels good to be able to bring it to people’s attention,” Drayer said.
Dr. Billie Vance, Director of Evidence Based Practice and Quality Improvement at the WVU School of Nursing, said Drayer's project highlights the role of DNP-prepared clinicians in identifying practice gaps, translating evidence into action, and leading system-level change.
“By leveraging evidence and engaging stakeholders, she addresses an important occupational health concern while promoting a culture of safety,” Vance said. “We are grateful to our clinical partners for hosting students and fostering strong collaboration between education and practice.”
Originally from California, Drayer worked as a trauma nurse for five years. She knew she needed to move to the East Coast to earn her DNP and become a CRNA, so she landed on WVU. After she graduates in August, she plans to move back home for work, but she said she’s grateful for her experience in the Mountain State.
“The people are so kind here. The ‘help your neighbor’ concept really holds true here,” she said. “Moving across the country with no family or friends here, the WVU School of Nursing and the surrounding community made it a really easy transition for me. Everyone has been so helpful and inclusive.”
Clinical sites interested in partnering to support student learning and advance practice initiatives are encouraged to reach out to Dr. Vance at Billie.Vance@hsc.wvu.edu.
She added, “We welcome opportunities to collaborate in improving care and strengthening the future workforce.”
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