CERTIFIED REGISTERD NURSE ANESTHETIST

POSITION DESCRIPTION NURSE ANESTHETIST (CRNA) INTRODUCTION: This position is located in the Anesthesiology Department of the Rosebud Comprehensive Health Care Facility, Rosebud, South Dakota. Rosebud Hospital is a 35 bed general medical and surgical hospital with three surgical suites and serves as a primary healthcare facility for the Native American Indian population. Rosebud Healthcare is a remote facility located over two hundred miles from the nearest metropolitan area. Its location demands that the anesthesia provider possesses a comprehensive knowledge of anesthesia theory and mastery of anesthesia practice. The Certified Registered Nurse Anesthetist serves as an "Independent Licensed Practitioner", who performs pre-op evaluations, orders pertinent diagnostic tests, develops the anesthetic treatment plan considering such factors as multi-system disease and type of procedure to be performed, selects anesthetics to be used, and coordinates choice and administration of anesthesia during operations. Assesses and documents patient's medical condition continuously during surgery through recovery from anesthesia. MAJOR DUTIES AND RESPONSIBILITIES: Serves as an Independent Licensed Nurse Anesthetist providing services for patients undergoing a wide variety of surgical operations. Participates in the pre-operative assessment of the surgical patient by reviewing the clinical chart and interviewing the patient in order to ascertain the physical status, recommends the specific type of an anesthesia to safely perform the required procedure. Also provides psychological support for the patient and family. The CRNA is an expert in the administration of general anesthesia to induce the patient to the proper state of narcosis utilizing a variety of drugs and techniques, and regional anesthesia to produce insensitivity to surgical stimuli. Also administers conscious sedation utilizing varying amounts and combinations of medications. Degree of sedation is determined by patient's medical condition and surgical procedure. Administering anesthesia and anesthesia related care in four general categories: (1) pre-anesthetic preparation and evaluation; (2) anesthesia induction, maintenance and emergence; (3) post-anesthesia care; and (4) perianesthetic and clinical support functions. Closely manages patients condition throughout surgery which involves interpreting and utilizing data from a variety of monitoring devices and determining the need for and applying appropriate supportive therapy including artificial ventilation, administration of vasopressors, antihypertensives, narcotics, and paralytics; adjustment of fluid, electrolyte, and acid-base balance; and transfusion of blood products. The CRNA manages the post-anesthesia care of patients by reviewing clinical chart, conducting interviews to determine presence or absence of complications, assessing adequacy of pain therapy and monitoring ventilatory status, assuring continuity of care from surgery to recovery room. The CRNA is the expert decision maker and evaluator in providing the ASA Classification Score for all surgical patients. Provides emergency resuscitation techniques for Emergency Medical Conditions and provides resuscitation techniques throughout the medical facility. Including and not limited to the Emergency Room, Neonatal Nursery, Obstetrical/Gynecology Ward, Dental Department, Medical & Surgical Units, Pediatric Unit and all aspects of the Surgical Ward. CRNA is involved in the development of optimal anesthetic care plans derived from expert knowledge of basic and advanced principles of anesthesia, individual research, and problem solving skills. Performs and documents a pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, or administering pre-anesthesia medications and fluids. Manages emergence and recovery from anesthesia by selecting, obtaining, ordering, or administering medications, fluids, or ventilatory support in order to maintain homeostasis, to provide relief of pain and anesthesia side effects, or to prevent or manage complications. Masters new anesthetic drugs and techniques as they become available, determines if they supersede accepted standards and applies them to the care of patients with complex health problems, modifies current hospital policies, consequently maximizing patient outcome. Performs administrative functions for department of anesthesia. The services provided by the anesthesia department are extremely important to the overall functioning of an anesthesia program and directly affect the efficiency and quality of services provided. The CRNA is individually responsible for the anesthesia care delivered. CRNA is accountable for judgments made and actions taken in the practice of nurse anesthesia. Neither physician's orders nor institutional policies relieve the Certified Registered Nurse Anesthetist of accountability for actions taken and judgments made relative to the care of the patient. The CRNA must be certain that informed consent has been obtained and that safe anesthesia care has been rendered to the patient. Prepares reports of results whereby new techniques, information and criteria are established from the utilization of new drugs. Maintains medical records and reports on assigned surgical patients in all Departmental Area's covered above. Responsible for the selection, inventory, ordering, cleaning, and maintenance of specialized anesthesia equipment and supplies necessary for the delivery of quality anesthesia services. Participates in and provides consultation services for the facility Pain Management Program. Possesses the expertise and knowledge required in order to provide the highest Quality of Care to the population served, improving the chronic pain patient's quality of life. Through expert knowledge and experience, develops policies and procedures for anesthesia program and for the delivery of emergency medical resuscitation. Maintains professional knowledge and proficiency in nurse anesthesia through continuing education, staff meetings and workshops. Works on a regularly assigned and/or stand-by basis to provide continuity of services during evenings, nights, weekends, and holidays. Coverage is provided around the clock for consults, referrals, and all emergencies. Assumes delegated supervisory responsibilities in absence of supervisor. Performs other duties as assigned. FACTOR 1: KNOLWEDGE REQUIRED BY THE POSITION Knowledge of professional and advanced nursing policies and procedures related to the preoperative care of surgical patients. Extensive advanced knowledge of nurse anesthesia, which is gained through graduating from an accredited nurse anesthesia program and/or Master's Degree program. Expert knowledge is required to assign anesthesia risk, and to select drugs and routes of administration for patients who exhibit large differences in health, physiological condition, emotional state, size and age. Administration of anesthesia requires comprehensive knowledge of the effects that different diseases and debilities have in changing patient's responses to anesthetic drugs and surgical stress and uses many finely graded discriminations made rapidly and continuously during the course of anesthesia to modify and later anesthesia methods, techniques, and drug doses in order to minimize, avert and resolve anesthesia problems. Possesses comprehensive and expert knowledge of pharmacological properties and physiological effects of anesthetic drugs and techniques utilized in the administration of inhalations, endotracheal intubations, intravenous and intramuscular administration. Also possesses a mastery of regional anesthetic techniques. Expert skill in the management of anesthesia services for patients with multiple health problems undergoing a wide range of surgical operations including general surgery; eye, ear, nose, and throat; obstetrical and gynecological; genitourinary, and pediatrics. Masters new anesthetic drugs and techniques as they become available, determines if they supersede accepted standards and applies them to the care of patients with complex health problems, modifies current hospital policies, consequently maximizing patient outcome. Possesses in depth knowledge of operating room procedures, anesthesia methods and equipment required to provide the patient with the highest quality anesthetic. Possesses the ability to effectively coordinate anesthesia activities with the operating room team. Current registration as a Certified Registered Nurse Anesthetist is required for continuing employment. CRNA is involved in the development of optimal anesthetic care plans derived from expert knowledge of basic and advanced principles of anesthesia, individual research, and problem solving skills. Possesses comprehensive and expert knowledge in administering anesthesia and anesthesia related care in four general categories: (1) pre-anesthetic preparation and evaluation; (2) anesthesia induction, maintenance and emergence; (3) post-anesthesia care; and (4) perianesthetic and clinical support functions. Expert in performing and documenting a pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, or administering pre-anesthesia medications and fluids. Expert knowledge in selecting, obtaining or administering the anesthetics, adjuvant drugs, accessory drugs, and fluids necessary to manage the anesthetic, to maintain the patient's physiologic homeostasis, and to correct abnormal response to the anesthesia or surgery. Expert knowledge and experience in selecting, applying, or inserting appropriate non-invasive and invasive monitoring modalities for collecting and interpreting patient physiological data. Expert in managing a patient's airway and pulmonary status using endotracheal intubation, mechanical ventilation, pharmacological support, respiratory therapy, or extubation. Possesses comprehensive knowledge in managing emergence and recovery from anesthesia by selecting, obtaining, ordering, or administering medications, fluids, or ventilatory support in order to maintain homeostasis, to provide relief pain and anesthesia side effects, or to prevent or manage complications. Possesses comprehensive knowledge in administering new drugs and manage them. Infinite experience and skill in preparing reports of results from the use of new drugs whereby new techniques, information and criteria are established from these reports. Possesses the comprehensive knowledge with the administration and evaluation of new drugs and new anesthetic techniques that may be utilized by other CRNAs or Anesthetists. FACTOR 2: SUPERVISORY CONTROL General supervision is provided by the Chief of Medical Services or designee who provides administrative direction with assignments in terms of broadly defined missions or functions. CRNA is responsible for planning, designing, and carrying out programs, projects, and other work independently. The CRNA provides consultation and participates in medical decisions with the surgeon and members of the medical team. The nurse anesthetist is an expert, who plans and performs work independently, applies new procedures, practices, and approaches, and resolves anesthetic emergencies consulting other professionals when appropriate. Work is evaluated through Peer Review Process for effectiveness of professional skills and judgment in caring for patients. Results of work are considered as technically authoritative and are normally accepted without significant change. Clinical privileges approved through the Medical Staff Executive Committee and Chief Executive Officer. Participates in medical peer review and other quality assurance processes to assess and evaluate the quality of care/practice for purposes of public protection. FACTOR 3. GUIDELINES Guidelines for the development of policies, procedures and standards of care are obtained from nationally recognized professional organizations, published standards, department and agency regulations and applicable laws. Texts by anesthesia authorities and periodicals in the field of anesthesiology are available as well as continuing educational programs providing current anesthetic modalities. Expert judgment is used in applying or deviating from traditional methods to tailor the anesthetic for high risk patients with multiple health problems. The CRNA provides input to the revision of departmental policy. Participate in evaluation of newly-released pharmaceutical agents and techniques. Abide the Clinical Privileges approved through the organizations Medical Staff Executive Committee. Guidelines established through the Medical Staff By-Laws, Rules and Regulations are provided outlining established policy and procedure. FACTOR 4: COMPLEXITY Work is of a high degree of complexity. It requires application of all knowledge described above in order to establish and maintain a complex anesthesia program that provides quality health care. The care of increasingly complex patients requires innovative organization to meet the health care needs of our customers, while taking into account cultural sensitivity. Work involves prolonged and complex surgical procedures which require intensive analysis before and during surgery to develop the anesthetic plan, administer and manage anesthetic agents. Emergency call necessitates immediate handling of a broad scope of anesthetic problems. As new anesthetic agents and techniques become available updates knowledge and skills. Participates in teaching airway management to members of the medical staff, nursing staff, emergency medical technicians (EMTs), and Paramedics. Work involves managing emergence and recovery from anesthesia by selecting, obtaining, ordering, or administering medications, fluids, or ventilatory support in order to maintain homeostasis, to provide relief of pain and anesthesia side effects, or to prevent or manage complications. Work involves the development of optimal anesthetic care plans derived from expert knowledge of basic and advanced principles of anesthesia, individual research, and problem solving skills. Work involves assigning anesthesia risk, and to select drugs and routes of administration for patients who exhibit large differences in health, physiologic condition, emotional state, size and age. Work requires a comprehensive knowledge of the effects that different diseases and debilities have in changing patient's responses to anesthetic drugs and surgical stress and uses many finely graded discriminations made rapidly and continuously during the course of anesthesia to modify and later anesthesia methods, techniques, and drug doses in order to minimize, avert and resolve anesthesia problems. Continually demonstrates a high level of competence, a composite of the individual's professional knowledge, judgment, values and technological and interpersonal skills. The CRNA plays a critical role in the daily operations in the operating room, performing preoperative screening and interviewing; induction of anesthesia; maintaining anesthesia during procedures; and monitoring and supporting life functions. Perform administrative functions for department of anesthesia. The services provided by the anesthesia department are extremely important to the overall functioning of an anesthesia program and directly affect the efficiency and quality of services provided. The CRNA is individually responsible for the anesthesia care delivered. CRNA is accountable for judgments made and actions taken in the practice of nurse anesthesia. Neither physician's orders nor institutional policies relieve the Certified Registered Nurse Anesthetist of accountability for actions taken and judgments made relative to the care of the patient. The CRNA must be certain that informed consent has been obtained and that safe anesthesia care has been rendered to the patient. FACTOR 5. SCOPE AND EFFECT The purpose of the work is to provide a full range of anesthetic management in an operating room and post-operative setting of a potentially life-threatening nature in administering anesthesia and anesthesia related care in four general categories: (1) pre-anesthetic preparation and evaluation; (2) anesthesia induction, maintenance and emergence; (3) post-anesthesia care; and (4) perianesthetic and clinical support functions. The Nurse Anesthetist functions as a consulting member of the Surgical Team for anesthesia-related issues. The CRNA is the independent decision maker and evaluator in providing the ASA Classification Score for all surgical patients. FACTOR 6. PERSONAL CONTACTS Personal contacts are with patients, families of patients, hospital personnel, and other professional consultants within the agency and those within private healthcare organizations, universities, CRNA organizations and programs. FACTOR 7. PURPOSE OF CONTACTS Contacts with hospital personnel are to exchange information and coordinate activities. Contacts with patients and patients' families are to exchange information, allay fears, and provide psychological support. Contacts involve meeting with outside organizations, schools of certified registered nurse anesthetist, CRNA organizational leaders to assess situations, define problems, delineate solutions and motivate others to cooperate in achieving programs goals and initiatives. FACTOR 8. PHYSICAL DEMANDS Long periods of standing may occur with surgery procedures during the administration of anesthesia. Assistance in lifting, positioning and moving anesthetized patients is required. FACTOR 9. WORK ENVIRONMENT Chronic exposure to anesthetic agents and x-rays may pose a health hazard. There is repeated exposure to anesthetic agents now known to cause abortions and birth defects and possibly cancer. Exposure to infections and infectious agents may be hazardous. Exposure during emergency life threatening situations may pose a risk.