Certified Registered Nurse Anesthetist
The CRNA (Certified Registered Nurse Anesthetist) is authorized to perform routine duties on a regular, repetitive basis. These duties may be performed after specific prior discussion with the supervising physician. The CRNA works with an anesthesiologist in the performance of duties. These duties include, but are not restricted to:
Performing and documenting a pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, and administering pre-anesthetic medications and fluids; and obtaining informed consent for anesthesia. Developing and implementing an anesthetic plan that must be authenticated preoperatively by the responsible anesthesiologist, physician, or surgeon. Initiating the anesthetic technique, which may include general, regional, local, and sedation. Selecting, applying, and inserting appropriate non-invasive and invasive monitoring modalities for continuous evaluation of the patient's physical status. Selecting, obtaining, and administering the anesthetics, adjuvant and accessory drugs, and fluids necessary to manage the anesthetic. Facilitating emergence and recovery from anesthesia by selecting, obtaining, ordering, and administering medications, fluids and ventilatory support. Discharging the patient from a post-anesthesia care area using established criteria and providing post-anesthesia follow-up evaluation and care. Responding to emergency situations by providing airway management, administration of emergency fluids and drugs, and using basic or advanced cardiac life support techniques Utilizes appropriate resources and tools to document, track, and assure follow through on patients with high risk needs or care management coordination. Conducts a comprehensive assessment of the patient's health and psychosocial needs, including health literacy status and deficits, and develops a plan collaboratively with the patient and family or caregiver. Facilitates communication and coordination between members of the health care team, involving the patient in the decision-making process in order to minimize fragmentation in services. Educates the patient, the family or caregiver, and members of the health care delivery team about treatment options (including but not limited to CVT, HT, evidenced based protocols), community resources, psychosocial concerns, and case management, so that timely and informed decisions can be made. Empowers the patient to problem-solve by exploring options of care and alternative plans to achieve desired outcomes. Encourage the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis. Assist the patient in the safe transitioning of care to the next most appropriate level. Strive to promote patient self-advocacy and self-determination. Advocate for both the patient and facility to facilitate positive outcomes for the patient, the health care team, and the facility. Proficient in understanding Reusable Medical Equipment (RME) guidelines and demonstrates competency in application of pertinent equipment RME processes. Support agency mission and vision to include but not limited to HPDP, tele-health, and patient centered care. Attends Medical Center and community meetings, seminars, conferences and represents a professional image of a CRNA and licensed health professional member of the VA San Diego Healthcare System when called upon. Designs/revises formal standards of practice to improve patient outcomes and health care delivery process at the service, functional group, Medical Center, network, or community levels. Collaborates with interdisciplinary VASDHS or Network groups in research and educational initiatives to improve patient care outcomes and the care delivery system. Participates as a clinical instructor for all trainees that affiliate with the Anesthesiology Clinical Care Center for their clinical anesthesia education. Actively participates in the process of teaching, monitoring, evaluating, documenting and possible planning and coordinating of educational activities. Develop quality indicators and collaborates with Performance Improvement Service representatives regarding performance issues with a team approach. Demonstrates current knowledge and the ability to implement Joint Commission standards to improve patient care outcomes, including patient satisfaction by assessing and improving those processes that most affect patient care outcomes. Work Schedule:
Monday - Friday, 0730 - 1600. May be required to be on-call and work overtime. Financial Disclosure Report:
Not required 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. Citizenship:
U.S. Citizen. Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. 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. 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). 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 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. Registration:
(1)Condition of Employment. 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. The nurse anesthetist must maintain a current, full, active and unrestricted registration to continue employment with VA. Certification:
(1) On and after May 4, 1993, certification by the Council on Certification of Nurse Anesthetists is a requirement for employment. This requirement does not apply to non-certified nurse anesthetists employed by VA as a nurse anesthetist prior to May 4, 1993 and continuously thereafter. Any nurse anesthetist who leaves VA employment or vacates the nurse anesthetist occupation for another VA position, must meet the current requirement of certification for re-appointment as a nurse anesthetist. (2) Nurse Anesthetists will maintain recertification by meeting the Council on Recertification of Nurse Anesthetist's requirements as a condition of employment. Grandfathering Provision. All nurse anesthetists employed in VHA on the effective date of this qualification standard are considered to have met all qualification requirements for the title, series and grade held, including positive education and licensure/certification/registration that are part of the basic requirements of the occupation. Recent Graduates. (1) A graduate nurse anesthetist who has applied to take the national Certification Examination (NCE) and has been declared Certification Eligible may be given a temporary appointment for a period not to exceed one year as a graduate nurse anesthetist. The graduate nurse anesthetist must take the NCE at the earliest schedulable date following the date of their temporary appointment. (2) Failure to become certified within the one year period will result in removal as a nurse anesthetist and may result in termination from employment. Physical Requirements. See VA Directive & Handbook 5019 English Language Proficiency. Nurse Anesthetists must be proficient in spoken and written English. Grade Determinations:
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. Full Performance Level:
(Nurse III) 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. Demonstrated Knowledge, Skills, and Abilities. 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. 8. Ability to perform as a mentor, preceptor, or nurse educator providing didactic and clinical instruction for graduate-level nurse anesthesia students and/or other anesthesia care providers. 9. Ability to participate in the development of anesthesia patient care audit processes involving in depth review and analysis of anesthesia records. 10. Ability to provide guidance and instruction in preparing others for positions of leadership and ethical practices which impact patient care. References:
VA Handbook 5005/27, Part II, Appendix G7
Estimated Salary: $20 to $28 per hour based on qualifications.
Performing and documenting a pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, and administering pre-anesthetic medications and fluids; and obtaining informed consent for anesthesia. Developing and implementing an anesthetic plan that must be authenticated preoperatively by the responsible anesthesiologist, physician, or surgeon. Initiating the anesthetic technique, which may include general, regional, local, and sedation. Selecting, applying, and inserting appropriate non-invasive and invasive monitoring modalities for continuous evaluation of the patient's physical status. Selecting, obtaining, and administering the anesthetics, adjuvant and accessory drugs, and fluids necessary to manage the anesthetic. Facilitating emergence and recovery from anesthesia by selecting, obtaining, ordering, and administering medications, fluids and ventilatory support. Discharging the patient from a post-anesthesia care area using established criteria and providing post-anesthesia follow-up evaluation and care. Responding to emergency situations by providing airway management, administration of emergency fluids and drugs, and using basic or advanced cardiac life support techniques Utilizes appropriate resources and tools to document, track, and assure follow through on patients with high risk needs or care management coordination. Conducts a comprehensive assessment of the patient's health and psychosocial needs, including health literacy status and deficits, and develops a plan collaboratively with the patient and family or caregiver. Facilitates communication and coordination between members of the health care team, involving the patient in the decision-making process in order to minimize fragmentation in services. Educates the patient, the family or caregiver, and members of the health care delivery team about treatment options (including but not limited to CVT, HT, evidenced based protocols), community resources, psychosocial concerns, and case management, so that timely and informed decisions can be made. Empowers the patient to problem-solve by exploring options of care and alternative plans to achieve desired outcomes. Encourage the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis. Assist the patient in the safe transitioning of care to the next most appropriate level. Strive to promote patient self-advocacy and self-determination. Advocate for both the patient and facility to facilitate positive outcomes for the patient, the health care team, and the facility. Proficient in understanding Reusable Medical Equipment (RME) guidelines and demonstrates competency in application of pertinent equipment RME processes. Support agency mission and vision to include but not limited to HPDP, tele-health, and patient centered care. Attends Medical Center and community meetings, seminars, conferences and represents a professional image of a CRNA and licensed health professional member of the VA San Diego Healthcare System when called upon. Designs/revises formal standards of practice to improve patient outcomes and health care delivery process at the service, functional group, Medical Center, network, or community levels. Collaborates with interdisciplinary VASDHS or Network groups in research and educational initiatives to improve patient care outcomes and the care delivery system. Participates as a clinical instructor for all trainees that affiliate with the Anesthesiology Clinical Care Center for their clinical anesthesia education. Actively participates in the process of teaching, monitoring, evaluating, documenting and possible planning and coordinating of educational activities. Develop quality indicators and collaborates with Performance Improvement Service representatives regarding performance issues with a team approach. Demonstrates current knowledge and the ability to implement Joint Commission standards to improve patient care outcomes, including patient satisfaction by assessing and improving those processes that most affect patient care outcomes. Work Schedule:
Monday - Friday, 0730 - 1600. May be required to be on-call and work overtime. Financial Disclosure Report:
Not required 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. Citizenship:
U.S. Citizen. Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. 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. 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). 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 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. Registration:
(1)Condition of Employment. 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. The nurse anesthetist must maintain a current, full, active and unrestricted registration to continue employment with VA. Certification:
(1) On and after May 4, 1993, certification by the Council on Certification of Nurse Anesthetists is a requirement for employment. This requirement does not apply to non-certified nurse anesthetists employed by VA as a nurse anesthetist prior to May 4, 1993 and continuously thereafter. Any nurse anesthetist who leaves VA employment or vacates the nurse anesthetist occupation for another VA position, must meet the current requirement of certification for re-appointment as a nurse anesthetist. (2) Nurse Anesthetists will maintain recertification by meeting the Council on Recertification of Nurse Anesthetist's requirements as a condition of employment. Grandfathering Provision. All nurse anesthetists employed in VHA on the effective date of this qualification standard are considered to have met all qualification requirements for the title, series and grade held, including positive education and licensure/certification/registration that are part of the basic requirements of the occupation. Recent Graduates. (1) A graduate nurse anesthetist who has applied to take the national Certification Examination (NCE) and has been declared Certification Eligible may be given a temporary appointment for a period not to exceed one year as a graduate nurse anesthetist. The graduate nurse anesthetist must take the NCE at the earliest schedulable date following the date of their temporary appointment. (2) Failure to become certified within the one year period will result in removal as a nurse anesthetist and may result in termination from employment. Physical Requirements. See VA Directive & Handbook 5019 English Language Proficiency. Nurse Anesthetists must be proficient in spoken and written English. Grade Determinations:
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. Full Performance Level:
(Nurse III) 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. Demonstrated Knowledge, Skills, and Abilities. 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. 8. Ability to perform as a mentor, preceptor, or nurse educator providing didactic and clinical instruction for graduate-level nurse anesthesia students and/or other anesthesia care providers. 9. Ability to participate in the development of anesthesia patient care audit processes involving in depth review and analysis of anesthesia records. 10. Ability to provide guidance and instruction in preparing others for positions of leadership and ethical practices which impact patient care. References:
VA Handbook 5005/27, Part II, Appendix G7
- Department:
0605 Nurse Anesthetist (Title 38) - Salary Range:
$143,335 to $219,200 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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