POSITION DESCRIPTION COLUMBUS REGIONAL HEALTHCARE SYSTEM JOB TITLE CERTIFIED REGISTERED NURSE ANESTHETIST JOB CODE 0265 DEPARTMENT FLSA (Exempt/Non-Exempt) ANESTHESIA Non-Exempt DEPARTMENT DIRECTOR SIGNATURE ADMINISTRATIVE DIRECTOR SIGNATURE V. P. HUMAN RESOURCES SIGNATURE EFFECTIVE DATE 09/13/94 REVISION DATE 03/04/05 DESCRIPTION SUMMARY: Administers intravenous, spinal and other anesthetics to render persons insensible to pain during surgical procedures, deliveries or other medical procedures. Maintains life support of patients during surgical procedures. EDUCATION, CREDENTIALS AND TRAINING: Required: Graduate of accredited program for nurse anesthesia. Current NC (or compact state) RN license and Advance Practice Registered Nurse (APRN) certification from NC Board of Nursing. Current certification as CRNA and be a member of AANA, or if a new graduate must have a NC Board of Nursing issued certificate as Graduate Nurse Anesthetist. A new graduate must pass the examination by the Council on Certification of Nurse Anesthetists and obtain NC CRNA certification within 18 months of employment. CPR and ACLS certified. Incumbent will be required to demonstrate competence in the performance of duties specific to the age groups of the patients for whom he/she will be assigned. Preferred: Masters degree in Nurse Anesthesia. PALS certification EXPERIENCE: No previous experience required. Given training and on-the-job experience incumbent should be proficient in the basic aspects of the job within 3 months. OTHER: Ability to work under pressure and respond to emergency situations quickly. Interpersonal skills. Self directed and motivated. Problem solving and decision making skills. ORGANIZATIONAL RELATIONSHIPS: Supervises: None Reports To: Medical Director of Anesthesia Department and Chief CRNA COMMUNICATIONS: Requires frequent communications with physicians, patients, Operating Room and Recovery personnel and personnel in other nursing and
ancillary departments. Periodic communications with sales representatives. Purpose includes giving and receiving information, explaining services, rules or procedures, or providing instructions or directives regarding policies or standards of care. Involves authority to make professional decisions and give professional advice. Requires extensive communication skills, tact and discretion in order to obtain cooperation and understanding, discuss and resolve complex problems, make recommendations and maintain goodwill. WORKING HOURS AND OVERTIME STATUS: Required to be on duty until operation schedule is complete, Monday - Friday. May be required to work alternate schedules or additional hours as the workload demands. Required to be on call 1-3 days per week and 1-2 weekends per month. Required to stay within 15 minutes of the hospital when on call. Classified as non-exempt for purposes of overtime. DRESS POLICY: Surgical scrubs. Sturdy closed-toed shoes with non-slip soles. Hair and shoe covers when in OR. Minimal jewelry. WORKING ENVIRONMENT: Spends almost all of the time in the Operating Suite including the third floor C-section suite and O.B. Epidural service. Some times spent in patient room. Radiology, Emergency Department and CCU. Exposed to anesthetic gases routinely. Exposed to somewhat unpleasant odors and fumes routinely. Routinely handles sharp objects and contaminated or potentially infectious materials, supplies and equipment. Routine potential exposure to air and blood borne pathogens. EXPOSURE DETERMINATION: OSHA requires an exposure determination concerning which employees may incur occupational exposure to blood or other potentially infectious materials. The exposure determination is made without regard to the use of personal protective equipment (i.e. employees are considered to be exposed even if they wear personal protective equipment.) This exposure determination is required to list all job classifications in which all employees may be expected to incur such occupational exposure, regardless of frequency. It is the department s responsibility to perform exposure determination for all employees and to list job classifications in one of three categories. Category 1 includes employees who are routinely exposed to blood borne pathogens Category 2 includes employees who are not usually exposed, but for whom contact with infectious materials can be reasonably anticipated during the course of their duties. Category 3 is for employees who are not exposed to infectious materials during the normal operations of their job duties. This job is rated as a category 1 (1, 2, or 3). BIOHAZARDOUS DRUGS: As a health care facility which dispenses drugs, some of which have been identified as hazardous by NIOSH, our goal is to provide training and where necessary, personal protective equipment (PPE) to insure employee safety. *See list of hazardous drugs in Pharmacy Policy Manual, Chemotherapy Preparation section. Warning labels will be used to identify drugs requiring special handling or waste disposal procedures. It is the department s responsibility to train in safe handling and disposal. It is the employee s responsibility to follow policies and procedures, and to report situations and/or make recommendations to improve safety. It is also the department s responsibility to perform exposure determination for all employees and to list job classifications in one of three categories. Category 1 includes employees who are routinely exposed to hazardous drugs. Category 2 includes employees who are not usually exposed, but for whom contact with hazardous drugs can be reasonably anticipated during the course of their duties. Category 3 is for employees who are not exposed to hazardous drugs during the normal operations of their job duties. This job is rated as a category (1, 2, or 3). WORK AIDS: Monitor. Laryngoscope. Fiberoptics. Stethoscope. Other anesthesia equipment and supplies. Patient records. Administrative records, reports and manuals. Reference books and materials.
KEY ELEMENTS: CRNA Administers medications in accordance with physicians' orders, and established policies, procedures and techniques, with no more than 2-3 noted exceptions, and with no exceptions resulting in the need for medical intervention or a delay in the surgical procedure. Determines and performs appropriate and timely clinical and technical anesthesia procedures in accordance with established policy and procedure, and patient's condition, with no more than 2-3 noted exceptions, with no exceptions resulting the deterioration of patient condition. Applies and documents the pre- and post- anesthesia care and education process in accordance with procedure and time frames, as evidenced in 10 of 10 randomly audited cases, and no more than 2-3 otherwise noted exceptions per year. Met Did Not Meet AGE SPECIFIC COMPETENCIES Employee should be able to demonstrate the ability to implement interventions based on the physical, psychosocial and cultural needs of the patient/family. Evaluate by checking only; enter N/A where not applicable. Newborn (birth to 1 month): Responds promptly, consistently and lovingly to infant s distress and needs. Uses distractions when providing uncomfortable and/or stressful procedures. Creates a safe environment for the neonate. Children (1 month 13 years): Explains procedures/equipment to child I terms he/she can understand. Creates a safe environment for the child. Offers choices when available. Adolescent (13 19 years): Establishes rapport prior to implementation of interventions. Provides privacy prior to and during procedures. Involves adolescent in decision making. Adult (20-60 years): Supports cultural and religions beliefs. Develops education for patient and significant other. Involves patient and significant other in decision making/plan of care. Elderly/Geriatric (>60 years): Adapts education for the normal aging changes Creates a safe environment for the geriatric patient. Plan of action for improvement if any areas are deficient: Met Did Not Meet
JOB ACCOUNTABILITIES 1. Perform pre-anesthetic evaluations on selected patients. -Perform pre-operative assessments and choose appropriate pre-operative medications and anesthesia -Explain anesthesia procedures to patients during pre-operative visits and address their questions and concerns a. Competently perform pre-anesthetic evaluations on patients utilizing established guidelines. b. Order additional testing when warranted and consult with anesthesiologists or other physician as appropriate. c. Patiently and clearly explain purpose and nature of procedures to patients and/or their families, insuring that any questions or concerns are satisfactorily addressed. d. Select and apply appropriate procedures, techniques and communications based on the age of the patient/customers, with no more than 1 noted exception per year. 2. Prepare anesthesia plan. a. Competently plan and coordinate anesthesia management consistent with patient status and proposed medical intervention requirements. 3. Prepare for anesthesia administration. -Assemble anesthesia equipment and ensure functioning prior to surgeries -Procure and prepare required drugs for procedure a. Obtain and organize required equipment and IV drugs in advance of scheduled time for procedure, so that no procedures are delayed due to untimely preparation. b. Ensure that each syringe is accurately labeled with the name and concentration of IV drug when indicated, prior to scheduled time for procedure. c. Ensure that anesthesia machine, breathing circuits, monitoring equipment, suction device and all other equipment that will be utilized is fully operational prior to scheduled procedure. d. Ensure availability of backup and emergency drugs an anesthesia cart, to include necessary equipment for their administration. e. Prevent administration of any drug by anyone who has not cleared the drug with the primary anesthetist or anesthesiologist. 4. Conduct final pre-anesthesia evaluation of patient. a. Verify patient identity and check for appropriate physical status for anesthesia, following through as warranted by review. b. Ensure completeness and accuracy of consent form. 5. Administer anesthesia and maintain physiological status of patient. -Position patient appropriately for operative procedure -Administer general anesthesia -Perform IV injections and manages IV activity -Perform spinal and IV regional blocks -Monitor patient's blood pressure, respiration, pulse, and other physical indicators or abnormalities
-Keep surgeon informed of patient's status during surgical procedure -Intervene with appropriate procedure in the event of problems a. Appropriately establish and secure intravenous/intra-arterial lines, applies appropriate monitors based on patient needs and procedure requirements. b. Induce and maintain inhalation, intravenous, local, regional, and topical anesthesia commensurate with commonly used anesthetics and techniques, constantly monitoring drug effects and altering dosage to maintain optimal physiological function consistent with patient well-being, safety and surgical goals. c. Maintain appropriate fluid balance and blood volume and monitors for any adverse effects of medical condition, reporting to appropriate members of the surgical team, seeking consultation as warranted. d. Assure patency and position of the endotracheal tube after intubation by bilateral auscultation of lungs and observation and/or palpation of thoracic excursions and ETCO2 monitor, seeking consultation relevant to any unresolved questions concerning the adequacy of an airway. e. Ensure the safety of the patient with regard to positional, environmental or other hazards while under anesthesia. f. Remain in constant contact with the patient throughout the procedure, accepting relief only by another qualified anesthesia provider, and noting such relief on the anesthesia record. g. Promptly respond in accordance with instructions or established protocol in emergency or STAT situations. 6. Recover patient from the effects of anesthesia. a. Reverses anesthetic process consistent with procedure requirements and departmental practices. b. Ensure that the patient is stable, prior to transferring patient to PACU, and that the patient status and needs are communicated to qualified PACU personnel upon transfer. 7. Follow up with patient during recovery process. -Remain in hospital until post-anesthesia patients are released from PACU -Monitor progress through post-operative visits and chooses post-operative medication. a. Periodically check patient progress in PACU, recommending and/or participating in care as required, to assure patient welfare. b. Competently perform follow-up evaluation of anesthesia effects on patients remaining in the hospital for 24-72 hours, to identify and advise on any possible complications c. Patiently and clearly answers patient and/or family questions about the anesthesia and informs patient/family of adverse drug reactions due to patient sensitivity, or any occurrence that might have implications for future anesthetics. 8. Document patient care. -Maintain log of cases and prepare statement of charges for items used. -Maintain concurrent record of anesthesia, types and amounts of drugs used, and patient s response to each. a. Patient records are legible, complete, accurate, timely, and, if altered are done so in accordance with established editing procedures. b. Ensure that information pertaining to physician coordination and/or consultation, time and name of relief by other significant data is entered on the record.
9. Prepare, process or maintain other required records, reports, logs, charges, forms, and documentation. a. Required record keeping is accurate, up-to-date and in accordance with established procedure. 10. Collaborate and coordinate care with physicians and other patient care providers. a. Appropriately coordinate, or collaborate on, the provision of care with physicians and other pertinent care providers, when needed, ensuring that communications are clear and relevant, and that time factors are adequately addressed. 11. Maintain equipment, and supply and drug inventories. -Requisition drug and supplies as needed -Clean and maintain anesthesia equipment and work room a. Follow established procedures for the procurement of supplies and drugs, and keep designated inventories restocked to par levels on a daily basis. b. Ensure that equipment is maintained in accordance with procedure and time frames, so that no damage, or undue wear and tear occurs due to failure to comply. c. Ensure that out-of-date drugs and supplies are removed from anesthesia inventory, on a timely basis. d. Ensure there are no variances or irregularities between controlled substances in inventory and documentation of same. 12. Maintain skill competence. a. Remain capable of communicating and demonstrating all skills required for the position, as assessed through periodic skill assessment checks. 13. Perform miscellaneous duties as required. -Respond to CODEs -Participate in quality assurance activities -Perform other duties as assigned a. Promptly carry out assigned role during CODEs and other emergency situations that occur outside of surgery. b. Effectively perform data collection, analysis and idea generation pertinent to the department's quality assurance and quality improvement programs, on an on-going basis, without prompting. c. Accomplish special and non-routine assignments in accordance with procedure or instructions, and time frames.