Functions as a Licensed Independent Practitioner within the Anesthesia Department at the Robert J. Dole VA Medical Center. Duties include ongoing evaluation and assessment of inpatients and outpatients seen within a specialty clinic setting, and includes management of required labs, medications, consultation and/or follow-up planning on known or suspected surgery pathology. Care planning with collaborating physicians/providers, peers, patients, families and allied services is expected. Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Education (1) A degree in nursing from a school of professional nursing approved by the appropriate state accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: (a) The National League for Nursing Accrediting Commission (NLNAC), an accrediting arm of the National League for Nursing located at 61 Broadway, 33rd Floor, New York, New York 10006. Additional information may be obtained from the NLNAC Web site; or (b) The Commission on Collegiate Nursing Education (CCNE), an accrediting arm of the American Association of Colleges of Nursing (AACN). The CCNE accredits bachelor's and master's degree programs and is located at One Dupont Circle, N.W., Suite 530, Washington, DC 20036. Additional information may be obtained from the CCNE Web site. (c) In cases of graduates of foreign schools of professional nursing, possession of a current, full, and unrestricted registration (see basic requirement in subparagraph c below) and the possession of a Certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS) will meet the requirement of graduation from an approved school of professional nursing. (2) Graduate of an accredited nurse anesthesia educational program approved by the American Association of Nurse Anesthetists (AANA) at the time the program was completed by the applicant. The AANA has compiled current listings of approved training institutions, which are published annually in the December issue of the American Association of Nurse Anesthetists Journal. The American Hospital Association in their "Guide to the Health Care Field" also publishes listings of approved training institutions annually in August. Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Preferred Experience: none beyond the basic requirements GRADE REQUIREMENTS a. General (2) Grades. The level that nurse anesthesia practice may be performed is based on a combination of education and experience. Beyond the minimum education requirements, grade determination upon appointment and advancement is dependent more on acquired knowledge, skills, and abilities than baseline education. As the nurse anesthetist acquires the knowledge and judgment that accrues with experience, the privilege of increased authority for patient care is expanded. (3) Research. At any grade, nurse anesthetists may assist in or conduct approved research projects relative to anesthesia care that enhances their knowledge and skills in the profession. b. Part-Time Experience. Part-time experience as a nurse anesthetist is credited according to the relationship to a full work week. For example, a nurse anesthetist employed 20 hours per week on a half-time basis would receive 1 full-time work week credit for 2 weeks of such service. c. Grade Determination. In addition to the basic requirements stated above, the following qualification criteria must be met in determining the appropriate grade assignment of candidates: (1) Entry Level: (Nurse II) (a) Experience and Education. None beyond the basic requirements. (b) Demonstrated Knowledge, Skills and Abilities. The following list of knowledge, skills and abilities present the minimum skill set expected of an Entry Level Nurse Anesthetist. Entry level into nurse anesthesia practice may include but are not limited to the following: 1. Ability to translate the principles of professional nursing practice in the care of assigned patients in order to provide appropriate care. 2. Ability to do a pre-anesthetic patient history and physical, which includes collecting pre-operative consults and data. 3. Ability to formulate an anesthetic plan and describe the anesthetic risks, benefits and options to the patient. 4. Ability to administer inhalation, regional, intravenous, local, and topical anesthetics and to detect unfavorable reactions in order to continuously evaluate the patient's physical status. 5. Ability to respond to emergency situations by providing airway management, administration of emergency fluids and drugs, and using appropriate resuscitation procedures for patient care. 6. Ability to provide patient care that is abreast of changing concepts and advancements in the profession. 7. Ability to work effectively in an interdisciplinary environment for improvement of services for patient care. 8. Ability to practice nurse anesthesia with colleagues and peers utilizing a collaborative team concept of anesthesia care. (2) Full Performance Level: (Nurse III) (a) Experience and Education. In addition to meeting the requirements for Entry Level, the CRNA has had progressively responsible experience in the administration of anesthetics as indicated in the knowledge, skills and abilities listed below. These individuals must demonstrate the ability to participate in a program for nurse anesthesia care and demonstrate knowledge of anesthetizing locations, methods, equipment and procedures. At this level, the CRNA has experience in the administration of anesthetics that has demonstrated the nurse anesthetist's ability to participate in team programs that are technically challenging and/or complicated. Typically candidates can demonstrate the knowledge, skills and abilities of Full Performance Level within 2 years from entering the occupation. (b) Demonstrated Knowledge, Skills, and Abilities. Full Performance Level practice in nurse anesthesia includes but is not limited to the following: 1. Skill in conducting and managing anesthesia for a broad range of complex surgical procedures. In addition, the CRNA must be able to adapt/modify anesthesia techniques in order to optimize patient care. 2. Ability to complete work assignments selected to add depth and breadth to their technical knowledge and skill competence. Work assignments will vary at each facility depending on the progressive acuity required for anesthesia care. 3. Ability to respond to emergency situations by providing airway management, administration of emergency fluids and drugs, and by the use of basic or advanced cardiac life support techniques in order to perform necessary resuscitation procedures. 4. Ability to effectively blend technology, skills, and competency for the advancement of anesthesia techniques, pharmacology, and equipment. 5. Ability to apply new developments and theories to develop and demonstrate the ability to recognize and solve various complex anesthesia situations. 6. Ability to practice nurse anesthesia with colleagues and peers in a team concept of anesthesia care and blend management skills with technical experience. 7. Ability to recognize clinical and technical aspects of anesthesia care and has in-depth knowledge of anesthesia methods and techniques for the practice of anesthesia. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-7 Nurse Anesthetist Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: Light lifting (under 15 pounds), light carrying, use of fingers, both hands required, walking and standing (less than 2 hours), both legs required, 20/20 vision with corrected lenses, both eyes required, depth perception, hearing without aid. ["VA offers a comprehensive total rewards package: VA Nurse Total Rewards. Perform and document a preanesthetic evaluation of the patient before surgery including requesting consultations, additional diagnostic and/or laboratory studies Initiation of the planned anesthetic technique that may include general, regional, or monitored anesthesia care (MAC). 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. Peripheral nerve blocks. Central neuraxial 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 Provide anesthetic for: electroconvulsive therapy not requiring intubation; routine eye surgery not requiring general anesthesia; elective cardioversions; ICD checks. Participates 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 Placement of arterial lines as requested Participation in staff meetings, mortality and morbidity conferences and other committees as assigned by the Chief Anesthesiologist. 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 Ensures that OR/anesthesia safety regulations and procedures and infection control policies and procedures are observed. Complies with Joint Commission National Patient Safety Goals Fully complies with medical center Correct Site/Universal Protocol requirements, including pausing activities during pre-operative time-out Complies with VA and Joint Commission documentation requirements Labels specimens according to medical center policy. Participates in continuous improvement activities Participates in outcomes evaluation and recommendations for practice improvements Conducts in-service programs for the department and other services within the medical center May assist or conduct approved research projects. Participates in on call Other duties as assigned within scope of practice/licensure. The CRNA functions autonomously within their approved privileges and in Collaboration with physicians/providers, peers and other members of the health care team to develop, implement, and coordinate a system of patient care delivery that effects achievement of quality of care, patient satisfaction, positive outcomes, appropriate utilizations of resources, and cost effective services Pay: Competitive salary, regular salary increases\nLicensure: 1 full and unrestricted license from any US State or territory\nWork Schedule: Intermittent 7:00AM - 3:30PM, Monday through Friday with evening, weekend, and holiday work as needed\nTelework: Not available\nVirtual: This is not a virtual position.\nFinancial Disclosure Report: Not required"]
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