Advanced Practice Nurse (Nurse Anesthetist)

Summary

This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) & eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.

Duties

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The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being.

Nebraska Western Iowa VA Health Care System is currently seeking a CRNA to join Surgical Care which includes general surgery, vascular surgery, ophthalmology, audiology, cardiology, dentistry, orthopedics, podiatry, and urology. Special procedure anesthesia care is also provided to other service lines. The incumbent ensures quality and timeliness of services provided, customer satisfaction, and compliance with standards of accrediting bodies such as Joint Commission and Inspector General's Combined Assessment Program. CRNA is authorized to perform routine duties on a regular, repetitive basis. These duties include, but are not restricted to:

• Provision of care in the most complex surgical procedures.
• Perform and document a preanesthetic evaluation of the patient before surgery including requesting consultations, additional diagnostic and/or laboratory studies within the scope of practice, consulting with the anesthesiologist for further preoperative work up when necessary.
• Initiation of the planned anesthetic technique that may include general, regional, MAC, or local anesthesia. Interventions include administration of fluids, medications, ventilator support, provision of homeostasis, provision of adequate pain relief and management of anesthesia and surgical side effects.
• Induction of general anesthesia and initial airway management.
• Endotracheal intubation for surgical or procedural cases.
• Placement of endobronchial tubes or blockers for procedures requiring one lung ventilation or lung isolation.
• Central line placement; Pulmonary artery (Swan-Ganz) catheter placement
• Peripheral nerve blocks. Central neuroaxial blocks.
• Epidural blood patches.
• Adjustment of anesthetic drugs and techniques utilized in the maintenance of anesthesia.
• Sedation for field blocks or MAC as discussed in the anesthetic care plan.
• Manages emergence from anesthesia and transition to the post anesthesia care unit.
• Provide anesthetic for: electroconvulsive therapy not requiring intubation; routine eye surgery not requiring general anesthesia; elective cardioversions; ICD checks.
• May participate on the Code Blue Team, primarily to manage the patient's airway, but also to perform other tasks which they are qualified to perform, as directed by the Code Team Leader.
• Emergency airway management throughout the facility, following the ASA Difficult Airway Algorithm and department protocols, as requested.
• Administer sedation or local anesthesia to facilitate urgent/emergent endotracheal intubation.
• Placement of intravenous lines throughout the facility, as requested.
• Management of epidural catheters for post-op pain relief within a protocol guideline ordered by the anesthesiologist.
• Placement of arterial lines as requested by the ICU's.
• Maintains anesthesia equipment in constant readiness and cleans equipment in accordance with hospital guidelines, SOPs, manufacturer's recommendations and CDC guidelines.
• Prepares drugs properly for use in anesthesia administration
• Precepts CRNA students
• Ensures that OR/anesthesia safety regulations and procedures and infection control policies and procedures are observed.
• Complies with Joint Commission National Patient Safety Goals
• Complies with VA and Joint Commission documentation requirements
• Eligible to take weekend call when all criteria are met.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards

Pay: Competitive salary, regular salary increases, potential for performance awards

Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)

Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA

Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)

Work Schedule:

Telework/Virtual: Not authorized

Relocation/Recruitment Incentives: Not authorized

EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact vhaedrpprogramsupport@va.gov, the EDRP Coordinator for questions/assistance. Learn more

Requirements

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Conditions of employment

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• English Language Proficiency. In accordance with 38 U.S.C. 7402(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
• Selective Service Registration is required for males born after 12/31/1959.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• Must pass pre-employment physical evaluation.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• You may be required to serve a probationary period.
• Complete all application requirements detailed in the "Required Documents" section of this announcement.

As a condition of employment for accepting this position, you will be required to serve a 2-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:

• your performance and conduct;
• the needs and interests of the agency;
• whether your continued employment would advance organizational goals of the agency or the Government; and
• whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your probationary period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.

Qualifications

Advanced Practice Nurse (Certified Nurse Anesthetist) Basic Requirements

• Education. A masters or doctoral degree in nurse anesthesia. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Nursing education must be from a school of professional nursing anesthesia accredited by Council on Accreditation of Nurse Anesthesia Education Programs (COA) at the time the program was completed by the applicant.
• Licensure and Certification. The following licensure and certification requirements are considered conditions of employment.
  
  
  • License. All APN (CNAs) must maintain an active, current, full and unrestricted license to practice as a CNA or equivalent, in a State, Territory or Commonwealth of the United States or in the District of Columbia.
  • Basic Certification. All APN (CNAs) must maintain full and current certification by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) or an equivalent Nurse Anesthetist certification recognized by the COA.

NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (CNA) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification.

The following Education, Experience, and Knowledge, Skills and Abilities must be met for Advanced Practice Nurse (Certified Nurse Anesthetist) II:

Exception to Licensure for Graduate Nurse Technicians. Candidates who otherwise meet the basic requirements, but do not possess the required APN (CNA) licensure and/or certification, may be appointed at the entry step of the Nurse II, as a Nurse Anesthetist on a temporary appointment up to any period not-to-exceed one year and a day under the authority of 38 U.S.C. a7 7405(c)(2)(B).

• Education and Experience Requirement. Meets basic education requirement for an APN (CNA). Nurse II is considered the entry grade level for APN (CNAs); no experience is required.
• Demonstrated Knowledge, Skills, and Abilities. The following list of knowledge, skills and abilities present the minimum skill set expected of an Entry Level CNA. Entry level into practice may include but are not limited to the following:
  
  
  • Ability to translate into anesthesia care the principles of professional nursing practice including the patients' rights to autonomy, dignity, privacy, and safety.
  • Knowledge of current research and practice guidelines to frame anesthesia practice including up to date techniques, pharmacology, and equipment.
  • Ability to obtain, document and verify informed anesthesia consent and perform a pre-anesthetic patient history and physical, which includes managing pre-operative consults and interpreting data.
  • Ability to formulate a patient-specific anesthetic plan and describe salient anesthetic risks, benefits, and options to the patient.
  • Ability to administer inhalational, regional, intravenous, local, and topical anesthetics.
  • Skill in detecting and treating anesthesia or surgically related physiologic changes and ability to treat accordingly in order to maintain homeostasis.
  • Skill in assessing patient status for appropriateness of transfer of care to another healthcare provider and communicating essential patient information to other providers effectively.
  • Ability to participate in collaborative responsibility for proper patient positioning, physiologic monitoring, infection control and anesthesia documentation.
  • Skill in responding to emergency situations by providing airway management, fluid and medication administration, invasive line insertion and management and the use of advanced cardiac life support techniques.
  • Ability to provide patient care that is abreast of changing concepts and advancements in the profession, (e.g., ultrasound techniques.)
  • Ability to practice anesthesia in an interdisciplinary environment utilizing a collaborative concept of anesthesia care.
  • Knowledge of quality improvement processes to maintain ongoing review and evaluation of anesthesia care to improve outcomes.
  • Ability to demonstrate a practice emphasis on safety, current established guidelines and protocols while recognizing the duty to report unsafe conditions or errors.

The following Education, Experience, and Knowledge, Skills and Abilities must be met for Advanced Practice Nurse (Certified Nurse Anesthetist) III:

• Education and Experience Requirement: Meets basic education requirement for an APN (CNA) AND One year of specialized APN (CNA) experience equivalent to the APN (CNA) II grade level.
• Demonstrated Knowledge, Skills, and Abilities: Progressively responsible experience in the administration of anesthetics as indicated in the knowledge, skills and abilities listed below.
  
  
  • Ability to plan, administer and manage anesthesia for a broad range of complex surgical procedures skillfully employing continuous assessment and anesthetic adaptation based on patient response and comorbidities. Work assignments will vary by facility.
  • Ability to participate in assignments that are technically challenging, encompass a variety of anesthetizing locations and utilize advanced equipment and procedures while adapting techniques to solve various complex anesthesia problems including the development of individualized programs of post-op anesthesia care.
  • Skill in responsibility and accountability to perform to the extent of the CNA standards of practice as a licensed healthcare professional in any model of anesthesia practice.
  • Ability to contribute to the educational mission as a mentor or preceptor providing didactic and clinical instruction in anesthesia to student nurse anesthetists, medical and dental residents, and other health care trainees.
  • Knowledge to participate in the development, implementation and maintenance of auditing processes that ensure and improve the quality and consistency of anesthesia and associated documentation.
  • Ability to contribute to departmental administrative pro