Certified Registered Nurse Anesthetist (CRNA)

The Certified Registered Nurse Anesthetist (CRNA) performs the following:

• Documents a pre-anesthetic assessment and evaluation of the patient.
• Requests consultations and diagnostic studies.
• Selects, obtains, orders and administers pre-anesthetic medications and fluids.
• Obtains informed consent for anesthesia from the patient or legal guardian.
• Develops and implements a patient-specific anesthetic plan.
• Tailors plan to manage anatomical, physiological, psychological and behavioral differences related to a patient's age, gender, race, religion, nationality, and disability, social or economic status.
• Consults anesthesiologist on pediatric patients under age 2, patients designated ASA Class 3 or greater, and as needed for questions/concerns related to patient condition.
• Initiates the anesthetic technique which may include general, regional, local, and sedation.
• Selects, applies, and inserts appropriate non-invasive and invasive monitoring modalities for continuous evaluation of the patient's physical status.
• Selects, obtains, and administers the anesthetics, adjuvant drugs, and fluids necessary to manage the anesthetic.
• Maintains the patient's physiologic homeostasis.
• Corrects abnormal responses to the anesthesia or surgery.
• Manages a patient's airway and pulmonary status which may include endotracheal or nasotracheal intubation, fiberoptic laryngoscopy, mechanical ventilation, pharmacological support, respiratory therapy, and extubating.
• Facilitates emergence and recovery from anesthesia.
• Selects, obtains, orders and administers medications, fluids, and ventilation support to maintain homeostasis.
• Provides relief from pain and anesthesia side effects.
• Prevents or manages complications.
• Provides relief from nausea and vomiting.
• Discharges the patient from the post-anesthesia care unit.
• Provides post-anesthesia follow-up evaluation and care related to anesthesia side effects or complications.
• Orders, initiates or modifies pain relief therapy.
• Utilizes drugs, regional anesthetic techniques, or other accepted pain relief modalities.
• Ensures complete, accurate, and timely documentation of pertinent information on the patient's medical record.
• Inspects, maintains, and operates anesthesia machine and all adjunct equipment.
• Implements operator trouble-shooting and corrective actions.
• Responds to emergency situations. ? Provides airway management.
• Administers emergency fluids and drugs.
• Implements basic or advanced cardiac life support techniques, as indicated.
• Contractor providers shall perform procedures compatible with the medical facility's operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation to, and approval of, the Chief of the Anesthesia Service and the Medical Executive Committee.
• Coordinates patient care activities with other health care team members (anesthesia; surgeons, OR and nursing unit's staff; ancillary services).
• Develops an anesthetic plan of case based upon comprehensive patient assessment, problem analysis, anticipated surgical procedure, patient and surgeon preferences, and current anesthesia principles.
• Consults the anesthesia care team and/or surgeon, as necessary, to review case management and problem areas.
• Follows criteria for reporting anesthetic incidents to Performance Improvement coordinator and prepares and presents case at RCAs meeting when requested to do so.
• Continuously assesses the patient's response to the anesthetic and/or surgical intervention and intervenes as required to maintain the patient in a satisfactory physiologic condition.
• Adheres to appropriate safety precautions to minimize the risk of fire, explosion, electrical shock, and equipment malfunction. ? Monitors and assesses patient positioning and implements appropriate protective measures.
• Takes precautions to minimize the risk of infection to the patient, the CRNA, and other health care providers.
• Accurately reports the patient's condition and all essential information to the health care provider assuming responsibility for the patient.
• Documents all anesthetic interventions and patient responses to facilitate. Comprehensive patient care, provide information for retrospective review and establish a medical-legal record.
• Communicates clearly, concisely and courteously verbally and in writing.
• Maintains good interpersonal relationships through courtesy, sensitivity and respect.
• Uses proper chain of command.
• Shares information, knowledge and expertise through formal and informal venues.
• Participates in feedback sessions to keep rater informed of accomplishments and goals. Quality Assurance: Priorities and guidelines are established by the supervisor of the surgery department (Chief of Anesthesia) or their designee who will monitor and evaluate contract performance. The contract CRNA shall perform day to day workload requirements to assure compliance with regulations, policies, standards of care, Joint Commission guidelines, CMS standards and completeness of timelines. The contract CRNA performs as an independent licensed practitioner responsible for detecting complications and correcting any deficiencies without physician intervention. The contracting 3 officer’s representative (COR) will interpret the statement of work and assist the contractor with technical problems encountered during performance of the contract. The CRNA is responsible to complete all Joint Commission reporting requirements and shall review cases for effectiveness of anesthetic plans. Although a nonpersonal services requirement, the Government will evaluate the quality of professional and administrative services provided and record in the Contractor Performance Assessment Reporting System (CPARS). Quality assurance methods will include both written and verbal feedback from the Clinical Directors, staff and patients. Should the Government be made aware of a critical, major or minor non-conformance matter the locum company will be notified in writing and given the opportunity to remedy. All Non-Conformance Reports will be made a record of the locum company’s past performance.

• CRNA must have at least two (2) letters of reference from health care providers whom have knowledge of the applicant’s clinical practice skills. One letter shall be from the Chief of Staff, or Service at the hospital where the physician holds or last held staff privileges. If the physician has just completed a residency, one letter shall be from the residency program director or serve chief.
• The services shall be performed by a licensed CRNA with full prescriptive authority up to and including CII drugs and/or medications that require a DEA license. The contract provider shall possess and maintain PALS, ACLS and BLS certification in order to provide CRNA services for all surgical and obstetric patients requiring services.
• Must meet the following minimum qualifications and requirements:

1. Current unrestricted license in the United States.

2. Be a graduate of a program accredited by the American Association of Nurse Anesthetists (AANA).

3. Certified Registered Nurse Anesthetist(s) provided by the Contractor shall apply and be accepted as Associate member of the Lawton Service Unit Medical Staff.

4. Shall provide a copy of documentation of physicians Basic Cardiac Life Support (BLS) Pediatric Advanced Life Support (PALS) and Advanced Cardiac Life Support (ACLS) certificates.

5. Shall speak, understand, read and write English fluently and communicate with sufficient clarity to be understood by IHS personnel and patients.

6. Shall be a United States Citizen.

7. Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients of the Native American communities.

8. Shall maintain standards of personal hygiene and grooming such that his/her image as a CRNA that is compatible with the expectations of the Lawton Service Unit.

Immunization Record

• Prior to physician selection and during the term of the contract regarding rubella and measles immunity and negative tuberculosis skin tests of all medical physicians to be utilized in the performance of this contract.
• Physicians requesting privileges shall submit documentation of a current (within the past 12 months) TB skin test or chest xray if the skin test was previously positive. Special considerations may be allowed to individuals, who are allergic to component of a vaccine, has history of severe reaction of a vaccine or who are currently pregnant. Vaccinations are to be complete prior to assignment, should follow CDC’s Recommended Vaccines for Healthcare Workers. Physicians shall provide documented evidence of annual current season influenza vaccination, unless medically contraindicated. All contractors who provide direct care in a federally operated IHS health care facility shall be fully vaccinated for COVID-19. Fully vaccinated is defined as having received two doses of COVID-19 vaccine of a two-dose series, or one dose of COVID-19 vaccine in a single-dose as recommended by the manufacturer and the CDC. Contractors shall be fully vaccinated unless you are granted one of the limited legal exceptions, i.e., medical exemption or sincerely held religious belief, practice, or observance.

Work Schedule

CRNA services are required in the Surgery Department during normal business hours from 7:00 a.m. to 4:00 p.m., with 24-hour immediate callback seven days a week. Call may include continuous coverage over several days or split tours with another staff or contract anesthetist. Work schedules and shifts are to be arranged with the Chief of Anesthesia.

Additionally, CRNA, shall provide on-site anesthesia services and coordinate patient care with appropriate IHS Departments, i.e., Nutrition, Medical, Business Office, CHS. CRNA shall provide 8 hours per day, 40 hours per week of on-site anesthesia services during the period as scheduled. 3) The CRNA shall be required to perform services outside of normal work hours and is subject to call back on Federal Holidays.