Job Description

The nurse anesthetist is an advanced practice nurse (CRNA). Within this role, under the supervision of an Attending Anesthesiologist, the CRNA, administers monitors and manages patient care before, during and after anesthesia.

Responsibilities

Responsible To
Designated Attending Anesthesiologists/ Vice President, Nursing and Chief Certified Registered Nurse Anesthetist for performance appraisals and scheduling

Responsible For
The performance of pre-anesthesia assessment, induction and maintenance of and emergence from anesthesia, monitoring of the patients physiological condition and performance of clinical intervention as necessary, under the supervision of an Attending Anesthesiologist.

Principal Duties and Responsibilities
Clinical Practice
1. In conjunction with Attending Anesthesiologist, performs a thorough and completed pre-anesthesia assessment. Responsible for obtaining and reviewing relevant tests and discussing findings with the Attending.
2. Obtains and/or verifies that an informed consent has been obtained for the planned anesthetic intervention from the patient or legal guardian. Discusses anesthetic options and risks with the patient and/or legal guardian after discussion with Attending Anesthesiologist. Documents in the patient's medical record that informed consent was obtained.
3. Formulates a patient-specific plan for anesthesia care in conjunction with the Anesthesiologist. The plan is based upon comprehensive patient assessment, problem analysis, anticipated surgical or therapeutic procedure, patient and surgeon preferences, and current anesthesia principles.
4. Induces anesthesia under the supervision of an Attending Anesthesiologist and maintains anesthesia at required levels. Assesses continuously the patient's response to the anesthetic and/or surgical intervention and must immediately notify the Attending Anesthesiologist of significant changes in the patient's condition and intervenes as required, under the supervision of an Attending Anesthesiologist to maintain the patient in a satisfactory physiologic condition.
5. Monitors the patient's physiologic condition as appropriate for the type of anesthesia and specific patient needs.
* Monitors ventilation continuously. Verifies intubation of the trachea by auscultation, chest excursion, and confirmation of carbon dioxide in the expired gas. Continuously monitors end-tidal carbon dioxide during controlled or assisted ventilation. Uses spirometry and ventilatory pressure monitors.
* Monitors oxygenation continuously by clinical observation, pulse oximetry, and if indicated, arterial blood gas analysis.
* Monitors cardiovascular status continuously via electrocardiogram and when appropriate, heart sounds.
* Records blood pressure and heart rate.
* Monitors body temperature continuously on all pediatric patients receiving general anesthesia and when indicated, on all other patients.
* Monitors neuromuscular function and status when neuromuscular blocking agents are administered.
* Monitors and assesses the patient positioning and protective measures.
The omission of any monitoring standards shall be documented and the reason stated on the patient's anesthesia record. The CRNA shall be in constant attendance of the patient until another qualified health care provider has accepted the responsibility for care.
6. Maintains complete, accurate, and timely documentation of pertinent information on the patient's medical record. Must document all anesthetic interventions and patient responses.
7. Transfers the responsibility for care of the patient to other qualified providers in a manner that assures continuity of care and patient safety.
8. Adheres to appropriate safety precautions, as established within the institution, to minimize the risk of fire, explosion, electrical shock and equipment malfunction. Documents on the patient's medical record that the anesthesia machine and equipment were checked.
9. Inspects the anesthesia machine prior to use, and monitors according to established guidelines. Checks the readiness, availability, cleanliness, and working condition of all equipment to be utilized in the administration of the anesthesia care. When the patient is ventilated by an automatic mechanical ventilator, monitors the integrity of the breathing system with a device capable of detecting a disconnection by emitting an audible alarm. Monitors oxygen concentration continuously with an oxygen supply failure alarm system.
10. Takes precautions to minimize the risk of infection to the patient, the Nurse Anesthetist, and other healthcare providers.

Professional Practice
1. Participates in the ongoing review and evaluation of the quality and appropriateness of anesthesia care as a member of the Department of Anesthesiology. Evaluation shall be performed based upon appropriated outcome criteria and reviewed on an ongoing basis.
2. Participates in a continual process of self-evaluation and strives to incorporate new techniques and knowledge into practice.
3. Participates in departmental Grand Rounds, presenting relevant cases as appropriate.
4. Respects and maintains the basic rights of patients.
5. Assists in research projects as directed by an anesthesiologist.
6. Participates in the instruction and supervision of Student Registered Nurse Anesthetists (SRNAs).
Administrative Practice
1. Collaborates with members of the health care team in the development, implementation and ongoing review of policies, procedures and standards of care for a designated patient population.
2. Evaluates and documents the patient care outcomes for the Department of Anesthesia and influences Departmental changes in staffing, patient assignment and standards of care.
3. Participates in the identification of performance improvement indicators and develops quality improvement programs with the health care team.
4. Participates in risk management activities including the identification and communication of risk in a timely manner.
5. Responds to budgetary constraints and incorporates financial principles into program development, patient care activities and allocation of resources.
6. Formulates trends and identifies potential problems in the delivery of patient care in the perioperative setting and implements action plans and educational programs for faculty and staff.

Qualifications

• Bachelors of Science degree in Nursing
  Masters Degree in Nursing with a specialization in nurse anesthesia preferred or a graduate of an accredited program in Nurse Anesthesia. Doctorate in Nursing Anesthesia preferred.
  At least of 2 years of critical care and/or ED nursing.
• BCLS, ACLS and PALS Required.