Anesthesia E-ssential

AANA Anesthesia E-ssential, April 16, 2020
 
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AANA Sends Letter to VA on CRNA Practice

As the AANA continues our partnership with the Department of Veterans Affairs (VA) to hire more CRNAs through the Travel Nurse program, and in light of a recent American Society of Anesthesiologists letter with misguided suggestions on CRNA practice, the AANA last week sent a letter to VA leadership as well as local leadership at Veterans Integrated Service Networks facilities, with proper guidance on CRNA practice during the pandemic.

As CRNAs continue to show their utility and the depth and breadth of their education, the AANA believes that all CRNAs should be utilized at the top of their scope and training. We are urging VA facilities to use CRNAs as advanced practitioners in critical care roles such as "managing ventilators, placement of invasive lines and monitors, and overseeing complex hemodynamic monitoring" and urging them to avoid using CRNAs for bedside nursing, which is a massive underutilization of CRNA skills.

The letter also cites recent language from the National Anesthesia Services that stated that it, "does not support the reallocation of Certified Registered Nurse Anesthetists in the VA Healthcare System to function as registered nurses. As care team members, they are indispensable practitioners for the provision of anesthesia services and facility airway management, especially where the threat of coronavirus-induced respiratory failure calls for the most experienced providers to intubate these patients. They are also necessary in operating rooms and non-OR procedural areas to provide anesthesia care for urgent and emergent conditions, which still need to be immediately addressed."

AANA infographic: CRNAs as Advanced Practice Providers in Critical Care Settings
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AANA Requests Medicare Permanently Remove Supervision Requirements for Maternal and Infant Healthcare in Rural Communities

In response to the CMS' request for information regarding maternal and infant healthcare in rural communities, the AANA recommended that CMS permanently remove supervision requirements.

The AANA letter, signed by President Kathryn Jansky, MHS, CRNA, APRN, USA LTC (ret), stated, "CRNAs are the primary anesthesia professionals providing care to the rural and medically underserved populations. CRNAs provide obstetrical anesthesia services with physicians such as obstetricians and family practitioners, and with other APRNs, such as nurse-midwives and nurse practitioners. The AANA's 2019 Member Profile Survey data shows 47.5% of CRNAs report obstetric anesthesia as one of their clinical practice areas...Recognizing CRNAs' strong commitment to safe obstetric anesthesia and analgesia, in 1999 the AANA developed guidelines for the management of the obstetrical patient, which were recently updated as Analgesia and Anesthesia for the Obstetric Patient. These guidelines promote safe and effective anesthesia care for obstetrical patients and provide guidance for anesthesia professionals and healthcare institutions...As part of this policy recommendation, an existing policy barrier we recommend that CMS permanently remove is unnecessary physician supervision requirements as part of the Medicare Conditions of Participation (CoPs). Permanently removing unnecessary supervision requirements is consistent with Medicare policy reimbursing CRNA services in alignment with their state scope of practice."

The comment letter also recommended that:
  • CMS implement policies through this RFI that are evidence-based,
  • CMS promote and Incentivize ERAS® Pathways for Obstetric Patients, and
  • To Promote Access to Care, Medicaid Should Cover CRNA Anesthesia Services.
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Medicare Agency Provides Advanced and Accelerated Payment in Medicare for Providers, Including CRNAs

Per the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Medicare providers, and suppliers, including CRNAs, can receive accelerated and advance Medicare payments during the COVID-19 pandemic that need to be paid back. These payments provide emergency funding and help address cash flow issues based on historical payments during the COVID-19 pandemic. CRNAs may be able to request up to 100 percent of the Medicare payment amount for a three-month period and will have 210 days from the date the accelerated or advance payment was made to repay the balance.

CRNAs can make these requests to the appropriate Medicare Administrative Contractor (MAC) if they meet all of the following eligibility requirements:
  • Have billed Medicare for claims within 180 days immediately prior to the date of the signature on the provider/supplier request form,
  • Not be in bankruptcy,
  • Not be under active medical review or program integrity investigation, and
  • Not have any outstanding delinquent Medicare overpayments.
Qualified providers and suppliers will need to request a specific amount on the request form, available on a provider and supplier's designated MAC website. CRNAs can find their designated MAC here.

For further information, please see the CMS fact sheet.
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This Saturday! Board to Hold Virtual Open Session Meeting

Join the AANA Board of Directors for a virtual Open Session Board Meeting on Saturday, April 18, 2020 at 1 p.m. CDT. Advance registration is required.
More information available at:  https://www.aana.com/governance/governance-resources/agendas
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In-Depth: What to Know About the SBA Coronavirus Relief Options

As a major part of Congress' efforts to help provide relief to small businesses, the CARES Act created four major relief programs through the Small Business Administration (SBA):

Paycheck Protection Program
  • The Paycheck Protection Program is open to small businesses under 500 employees, as well as sole proprietors, independent contractors, and self-employed persons. It provides the option for forgiveness, providing employees are maintained on payroll and at least 75% of the loan is used for payroll. Other allowed uses are mortgage interest, rent, and utilities.
Apply for the Paycheck Protection Program.

Find an eligible lender.


Economic Injury Disaster Loan (EIDL)
  • The EIDL program is open to small businesses under 500 employees, as well as sole proprietors, independent contractors, and self-employed persons. It has the option of receiving up to $10,000 from your loan as an advance to help cover immediate shortfalls, though this loan has a lower limit than the Paycheck Protection Program.
Apply for the EIDL.


Express Bridge Loans
  • The Express Bridge Loan Program is only open to small businesses who have a pre-existing relationship with the SBA. These loans offer quick access to up to $25,000 to help businesses with immediate needs and serve as a bridge for larger EIDL loan funding.
Express Bridge Loan Program Guide.


SBA Debt Relief
  • The SBA is offering debt relief for borrowers who took out loans prior to the pandemic. The SBA will automatically pay the principal, interest, and fees of current 7(a), 504, and microloans for a period of six months. Additionally, it will provide automatic deferrals to disaster loans that were already in service prior to March 1, 2020.
It's important to note that applicants cannot receive loans from multiple programs at the same time. With demand for loans high, prioritizing lenders that you already have a financial relationship with may be important and you may need to contact multiple lenders in order to find one who can accept your application. Anyone needing extra assistance may visit the SBA's local assistance page to find additional help for these loan programs.
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In Memoriam: Bonnie Winters, CRNA, ANP (1940-2020)

Bonnie Winters, CRNA, ANP, of Parker, Colo., passed away on Friday, April 10, 2020. She was born Bonnie Jean Tomlinson in Chicago, Ill., on November 20, 1940, to Albert E. Tomlinson and Violet L. Tomlinson (nee Smith).

A CRNA for 47 years, Bonnie’s career as a clinician served as a vehicle to make a significant impact on the way nurse anesthetists are viewed in the Veterans Administration (VA). Learn more.

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Tonight! Webinar: CRNA Employment Issues During COVID-19

This important webinar will focus on addressing some of the commonly asked questions by CRNAs who are navigating the changing employment environment during the COVID-19 pandemic. Join us on Facebook Thursday, April 16, 2020, at 5 p.m. CT.

Speakers:
  • Margo Wolf O’Donnell, Co-Chair, Labor & Employment Practice Group, Benesch Law
  • Anna Polyak, Senior Director, State Government Affairs and Legal, AANA
Join us at the AANA Facebook page.
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Tomorrow! COVID-19 Infection Prevention Pearls Webinar

Friday, April 17, 2020, at 4-5 p.m. CT
Earn 1.0 Class A CE Credit

Attend a free webinar to help you stay informed on the latest infection prevention practices specific to the anesthesia care of patients infected with the coronavirus. Topics will cover PPE recommendations and review conservation methods, and discuss infection control from pre-care to post-care.

Learning outcomes:
  • Discuss the status of the COVID-19 pandemic.
  • Describe infection control practices specific to the anesthesia care of the patient infected with coronavirus.
Speakers:
  • Charles A Griffis, Ph.D., CRNA, Assistant Clinical Professor, UCLA School of Nursing Faculty, USC Doctor of Nurse Anesthesia Practice Program;
  • Cormac O'Sullivan, Ph.D., CRNA, Associate Clinical Professor and Director, DNP Program in Nurse Anesthesia, University of Iowa.
Register Today to reserve your spot!
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Monday! Acute Respiratory Distress Syndrome (ARDS): What You Need To Know Today

Monday, Apr. 20, 2020, 5 p.m. CDT, Pending CE Approval

A free webinar on Acute Respiratory Distress Syndrome (ARDS) management will discuss recent findings related to ARDS and the current COVID-19 pandemic.

Speakers John J. Gallagher, DNP, RN, CCNS, CCRN-K, TCRN, RRT, and Andrew Rice, MSN, CRNA, APRN, ACNP-BC, will review current literature, physiology, patient profiles, and at-risk groups. The webinar also will cover COVID-19 and how it can tie into sepsis, and it will identify critical diagnosis, therapies, and best practices for treatment.

Learning outcomes:
  1. Identify current trends in the clinical management of ARDS during the COVID-19 pandemic.
  2. Make recommendations for caring for patients with ARDS during the COVID-19 pandemic.
Register Today to reserve your spot!
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Hot Topics


AANA and NRHA: CRNAs Respond to COVID-19 in the Rural Setting

The AANA partnered with the National Rural Health Association (NRHA) to promote and release the AANA infographic, CRNAs in the Rural Setting: APRN Leaders with the Expertise and Skills to Respond to COVID-19. This document describes how CRNAs can help rural facilities prepare for and meet the challenges of COVID-19, including directing, managing, and providing anesthesia-related services for urgent surgeries and procedures and providing life-saving critical care management for patients impacted by COVID-19. Rural facilities are encouraged to discuss with their CRNAs how CRNAs can lead and contribute value-added services and capabilities to the COVID-19 response. CRNAs also may use this infographic in discussions with rural facility leaders to support the CRNA role during the COVID-19 crisis.
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Podcast: SRNAs Discuss Wellness on From the Head of the Bed

Current and past student reps from the AANA Health & Wellness Committee discuss Student Registered Nurse Anesthetist (SRNA) wellness in light of the COVID-19 pandemic with From the Head of the Bed’s Jon Lowrance, MSN, CRNA. Find this podcast and other CRNA-produced wellness material at www.AANA.com/COVIDWellness
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CRNAs: Balancing and Incorporating Wellness During the COVID-19 Pandemic

CRNAs are essential to the healthcare workforce and they give back to their communities in many ways. Ever wondered how to practice mindfulness while wearing an N95 mask? Do you need suggestions on how to stay well during the COVID-19 pandemic? Are you an SRNA who wants to move forward after having been furloughed? See www.AANA.com/COVIDWellness for these and other well-being resources.
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COVID-19 Federal Resources

In an effort to keep our members up to date with the fast pace of developments coming out of D.C., we have compiled a list of federal resources to help CRNAs with issues ranging from practice to reimbursement, to small businesses and student loans:
Find all of AANA's COVID-19 Resources on our website.
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Interested in Serving on a FY2021 AANA Committee? Application Deadline Extended

Deadline Extended: June 30, 2020
The deadline to apply for a position on a FY2021 AANA Committee has been extended! More information is available on the AANA Committee page. The application deadline is June 30, 2020.
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ADCE 2021 Call for Abstracts - Deadline Extended!

You are invited to submit an abstract for consideration to present at the 2021 Assembly of Didactic and Clinical Educators (ADCE) and the ADCE portion at the 2021 Annual Congress. Present your idea to hundreds of CRNA faculty, clinical preceptors, program directors, and students, and help shape the future of nurse anesthesia education.

Topics
Submissions should include educational topics that will develop the effectiveness of CRNAs in their roles as program administrators, didactic educators, and clinical educators in diverse settings.

AANA will accept up to two submissions per presenter.

Submission Deadline
May 12, 2020 – Visit the abstract submissions page for more information.
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Deadline Extended: June 30, 2020 - FY2021 CRNA-PAC Committee

Deadline: June 30, 2020
CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the AANA 2021 fiscal year are encouraged to submit an application through the AANA online committee submission form located on the aana.com committee page

Responsibilities of Committee members include:
  • Setting the CRNA-PAC income and expenditure policy;
  • Participating in fundraising duties;
  • Reviewing open-seat and challenger candidates for federal office; and
  • Volunteering at CRNA-PAC events and national meetings.
Committee members are expected to attend two in-person meetings per year (Joint Committee Conference in September 2020 and Mid-Year Assembly in April 2021) and conference calls on an as-needed basis.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at charris@aanadc.com or call (202) 741-9087.

Disclaimer
The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax-deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest, and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a U.S. Citizen.

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Nominate an SRNA for the Education Committee Student Excellence Award

One student will receive the Education Committee Student Excellence Award at the 2020 AANA Annual Congress. The winner will be recognized at the Student Luncheon. The submission deadline is April 20, 2020.

The award will be presented to a student in good academic standing who demonstrates:
  • Outstanding leadership and professionalism during their nurse anesthesia program,
  • Participates in activities that foster a positive public image of nursing,
  • Participates in activities that foster high-quality healthcare to consumers, or
  • Engages in volunteer activities of community service or support of healthcare.
The student must be nominated by their program administrator or the program administrator’s faculty designee. All SRNAs who are a student at the time of the submission deadline are eligible.

Please visit the AANA website for complete details under Education Opportunities for Educators.
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Education Committee Student Writing Contest

Submissions are now being accepted for the annual Student Writing Contest. SRNAs must submit an essay of no more than 1,500 words (including references) on a topic pertinent to education, professional practice, and development, wellness, healthcare, or health policy.

Potential essay topics include, but are not limited to: leadership; case reports; health policy; professional development; quality improvement; student wellness; diversity; interprofessional collaboration; community service; work-life balance; simulation; innovative use of technology in education; ethics; and generational issues. Citations must follow AMA format. The submission deadline is April 20, 2020.

The winner will be recognized during the Student Luncheon at the 2020 AANA Annual Congress. There also is an opportunity for the winning essay to be published in the AANA NewsBulletin as a Student News column.

Please visit the AANA website for complete details under CE & Education > Education > Opportunities for Students
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Students and CRNAs Needed for the Anesthesia College Bowl!

The spirited Anesthesia College Bowl will be held at the 2020 AANA Annual Congress on Monday, August 17, 2020. Six teams of students play each other, answering questions about anesthesia that have been submitted by nurse anesthesia program directors. The winning student team faces off against a team of six CRNAs to determine the ultimate winner of the College Bowl. The winners hold bragging rights until the following year! Applications for both students and CRNAs are due May 4, 2020.

Students wishing to play must inform their program administrator, who can submit a maximum of two students to participate. CRNAs must submit the Challenge Team sign-up form. Please visit the AANA website for complete details under CE & Education > Education > Opportunities for Educators
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Accepting Applications: Student Representative to the Education Committee

The AANA Education Committee supports the professional development of nurse anesthesia didactic and clinical educators and students. The committee includes a student representative, elected annually, who serves for one year. This student functions as an information source for students and enhances communication between the student body and the committee. In addition to participating in the above activities, the student representative facilitates the AANA Connect SRNA Community, contributes content to the AANA for SRNAs Facebook page, and writes the Student News column for the AANA NewsBulletin.

The student representative is elected by the students attending the AANA Annual Congress. The student representative participates in Education Committee meetings and conference calls. Please visit the AANA website for complete details under Education Opportunities for Students. Note that your expected graduation date must be August 2021 or thereafter. The deadline for submission is May 4, 2020.

Primary activities of the Education Committee include planning the Assembly of Didactic and Clinical Educators (ADCE) meetings and the Student Session at Annual Congress. The committee also hosts the Student Luncheon and Anesthesia College Bowl at Annual Congress.

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NewsMaker: CRNA McCarthy Recounts Her Vietnam Experiences

Jane McCarthy, Ph.D., CRNA, FAAN, was a young nursing student in the late 1960s, and like most young people at that time, she was affected by the war in Vietnam. "I remember standing there at the grave-site of one of my high school friends and saying to a friend of mine, Craig, 'I can't keep doing this, just coming home to these funerals! I've got to do something.' And here I was, studying to be a nurse, and I thought, what could be more meaningful than to go into the Army to take care of these friends, guys, that had to go?" Recently, McCarthy wrote of her experiences for AANA's Voices of Vietnam. Learn more.
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Discover the April 2020 AANA Journal Issue

The April 2020 AANA Journal features articles on laryngospasms, bronchoscopy, airway management for deep sedation, ventilation during general anesthesia, and other fascinating topics. Below, Editor-in-Chief Chuck Biddle, Ph.D., CRNA, introduces each article in the latest issue.

Repeated Postanesthetic Laryngospasm in a Male Adult
This article offers a troubling, challenging, and perplexing problem that few of us may ever see to the extent that the case report details: a man with repeated episodes of laryngospasm in the immediate (1 hour) period following extubation. This is a fascinating opportunity to avail yourself of the value of the case report in transferring knowledge of an experience from one practitioner to us all.

Anesthetic Considerations for Automated High-Frequency Jet Ventilation During Electromagnetic Navigation Bronchoscopy
The authors illuminate challenges associated with diagnostic bronchoscopic procedures during computed tomography referenced and computerized 3-dimensional imaging. The unique anesthetic considerations are nicely detailed with special emphasis on the management of ventilation. A credit to the anesthesia team to provide superb care under the most demanding conditions to achieve procedural success.

Does Ultrasonographic Measurement of Gastric Content Influence Airway Management Decisions?
The presence of gastric content before induction of general anesthesia is the primary modifiable risk factor in the prevention of pulmonary aspiration. The purpose of this project was to determine if ultrasonography could be routinely used to measure gastric content and assign aspiration risk in patients undergoing general anesthesia.

Cut to Air
The authors review the last-ditch effort to ventilate a patient when a “cannot ventilate, cannot intubate” scenario unfolds: cricothyrotomy. What are the lapses and the strengths of our educational programs and continuing education enterprises in this regard? Are you able to perform this task should you be confronted with it? Mandatory reading for sure!

Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results
This article uses a survey and a study to shed light on an increasingly common clinical practice: deep sedation, and how the airway is managed. Deep sedation means different things to different people though there are published clinical hallmarks that help to establish what is defined as deep sedation. Which strategies are available and what are their limitations are covered. A very interesting read, and relevant, indeed.

Recognition and Management of Subcutaneous Emphysema as a Complication of Robotic-Assisted Laparoscopic Surgery: A Case Report
The case report presents a healthy female, an elective routinely performed procedure, then a significant complication. Lessons to be learned for sure in the diagnosis, management and prevention of a massive subcutaneous emphysema. Read, vicariously learn from the excellent case report and gain from the experience of others. It will help empower you to be a safer anesthesia provider.

Anesthesia Implications of Patient Use of Electronic Cigarettes
The authors do a follow-up on a previous article from the AANA Journal (by other authors) on a common and much needed current concern: patients using electronic cigarettes. Because the devices are fundamentally a kind of metered nicotine delivery system, there are important anesthetic considerations and risks, all nicely outlined in this fine paper.

Prevention of Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: Are We Doing Enough?
This article provides us with an up-to-date review of how to prevent and manage postoperative nausea and vomiting (PONV), a very common complication occurring in bariatric surgery patients. PONV continues to be a major concern for patients, a complication that can otherwise cloud a successful anesthetic, and presents a real challenge for the care giver. This paper provides insights and strategies directed at this common and disturbing complication.

AANA Journal Course: Update for Nurse Anesthetists—Optimizing Mechanical Ventilation During General Anesthesia
Wright and his colleagues provide us with a much-needed update on optimizing mechanical ventilation. Great effort on behalf of bench and clinical researchers provide an opportunity to see translational research in action. This latest installment of the AANA J course provides the reader with just that, and more: 1 hour of Class A credit!

And don’t miss our exclusive online content. 

This month, two nurse anesthetists with a long and admirable record of scholarly contributions to the accreditation specialty take on a monumental historical task in their two-part article, the first being: A Commitment to Quality: The History of Nurse Anesthesia Accreditation Part One: 1930-1982. Their careful and meticulous research of historical documents demonstrates that the Council on Accreditation evolved into a well-known accreditation agency recognized by both governmental and non-governmental organizations, that served the purpose of elevating the standards of anesthesia education.
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Foundation and Research


AANA Foundation: Grant Applications – Due May 1, 2020

The mission of the AANA Foundation is to advance the science of anesthesia through education and research. Grants are awarded to CRNAs only and the applicant must be an AANA member. The AANA Foundation sets a broad research agenda that includes healthcare policy, science of anesthesia, education, practice/clinical, and leadership. Visit the AANA Foundation website to learn more and apply. Grant applications are due May 1, 2020.
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AANA Foundation: ‘State of the Science’ Oral and General Poster Sessions Application Now Available – Due May 1, 2020

The ‘State of the Science’ Oral and General Poster Sessions offer CRNAs and SRNAs an opportunity to present their research findings and innovative educational approaches at the AANA Annual Congress in San Diego, Calif., August 14-18, 2020. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Access the applications on the AANA Foundation website. Apply today!
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AANA Member Benefits


Coronavirus (COVID-19) Response: Federal Aid Program vs Refinancing

At Laurel Road, we understand the uncertainty and questions that surround the spread of the Coronavirus. Our focus is the safety of our borrowers, team, and wider community. We continue to see strong interest in refinancing right now with consistent growth among the healthcare community. While refinancing during this time brings borrowers certain benefits, including historically low rates, applicants who are looking to refinance federal loans also should consider the benefits they will be waiving under those loans. To help you understand the implications of refinancing federal loans to private student loans, we’ve curated some useful content highlighting what would be different, and what would remain the same. Learn more.
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Jobs



CRNACareers

CRNACareers.com - What are your next steps?

Whether you’re graduating soon and researching employers, are a seasoned professional interested in advancing your career or looking to supplement your work with locum tenens options, CRNACareers.com is the place to help get you started:

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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CRNAs: Mary Washington Healthcare, Virginia

We are still hiring. CRNAs: $15,000 Sign-On Bonus. New Grads Welcome

Full-time opportunities for CRNAs (day & night shifts) in both inpatient and outpatient settings.

Mary Washington Healthcare – ranked #2 in the Washington, DC area by U.S. News and World Report, has excellent opportunities for CRNAs to join our experienced team of surgeons who perform everything from complex abdominal surgeries to minor outpatient procedures.

Ideal candidates will have a valid VA Nursing license, valid VA licensure as a Nurse Practitioner in Anesthesia and current certification as a Nurse Anesthetist by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). If pending initial certification, evidence of graduation from an accredited nurse anesthesia program and of eligibility for board exam is required.

Our fast-growing healthcare system provides a level of surgical excellence that is unsurpassed in our region, and we have opportunities at three different locations, including:
  • Magnet®-designated Mary Washington Hospital – our Level II Trauma Center, with 15 operating rooms and 1 Cysto room – performs Cardiac, Thoracic, General/Vascular, Ortho, Neurology, Plastics, and EENT.
  • Stafford Hospital – our 100-bed community hospital that provides high-quality care from a patient's initial visit through diagnosis, treatment, and post-surgical follow-up.
  • Fredericksburg Ambulatory Surgery Center (FASC) – the only tertiary-level outpatient surgery facility in the region.
Learn more.
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CRNA Opportunities: Sanford Health, North Dakota/South Dakota

Sanford Health’s Department of Anesthesia is looking for CRNAs to join their teams in Bismarck, North Dakota; Fargo, North Dakota; & Sioux Falls, South Dakota. Sanford Health is one of the largest health care systems in the nation, with 44 hospitals and nearly 482 clinics in 26 states. Sanford is dedicated to the integrated delivery of health care, genomic medicine, senior care and services, global clinics, research and affordable insurance. Nearly $1 billion in gifts from philanthropist Denny Sanford have transformed how Sanford Health improves the human condition.

BISMARCK, ND PRACTICE DETAILS:
  • High-volume practice with continual growth and a referral network spanning to Western North Dakota, Eastern Montana, and Southern Canada.
  • Join 25 CRNAs and 10 anesthesiologists - a care team that provides over 13,000 anesthesia cases per year.
  • Variety of cases to challenge your clinical skills including Neuro, Ortho, General, Peds, GI, ENT, Cardiothoracic, Bariatrics, Urology, Robotics, Interventional Radiology, and Electro-physiology.
  • Work in an anesthesia care team that is truly team focused with great relationships between all providers.
  • A great environment to practice for both new graduates and those with years of experience.
FARGO, ND PRACTICE DETAILS:
  • Region’s only Level I Trauma Center + Joint Commission accredited Comprehensive Stroke Center.
  • Region’s only Level II Pediatric Trauma Center w/65 board certified pediatric subspecialists.
  • Excellent working relationships with the physician anesthesiologists.
  • Department provides anesthesia for approximately 28,000 cases per year at two hospitals as well as a freestanding ASC.
  • All specialties are represented, with the exception of heart or liver transplants.
  • The Joint Commission recognizes Sanford Health as an Advanced Comprehensive Stroke Center.
  • Department practice is the Anesthesia Care Team model.
  • Family Birth Center epidural service is CRNA managed 24/7
  • Supportive environment for new graduates.
SIOUX FALLS, SD PRACTICE DETAILS:
  • Sanford USD Medical Center is seeking CRNAs to join their team.
  • Become part of a team dedicated to service excellence with a passionate commitment to care.
  • Level II Pediatric Trauma Center.
  • 35 Large, state-of-the-art surgical suites.
  • Join 70 CRNAs and 20 anesthesiologists - a care team that provides 30,000 anesthesia cases per year.
  • Variety of cases to challenge your clinical skills including Ortho, General, Cardiothoracic, Neuro, ENT, GI, Vascular, Pediatrics, Urology, and Robotics.
Sanford Health offers a competitive compensation & benefits package as well as paid malpractice insurance, relocation allowance and much more. Learn more.
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CRNA: Banner Health, California

Banner Health, a Top 5 Large Health System and one of the country's premier non-profit health care networks is expanding its team of advanced practice providers and is seeking an experienced CRNA to join our highly trained surgical team where you’ll enjoy a smaller hospital setting and become part of the fabric of the community.

Banner Lassen Medical Center (BLMC), built in 2004, in Susanville, California, has a growing younger population with four seasons and a short winter and is located just 90 minutes from Reno, Nevada.

This represents an excellent opportunity for a passionate and energetic CRNA to join a well-respected surgical team providing Orthopaedic, General Surgery and Scopes.
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB.
  • 3 years’ experience preferred.
  • 2 weeks on, 1 week off.
  • SIGN-ON BONUS.
Banner Health offers a competitive salary and recruitment incentives along with an industry leading benefits package that provides security for you and your family:
  • Comprehensive medical, dental, vision and pharmacy plans.
  • Paid time-off plans.
  • Eligible for benefits coverage within 30 days.
  • Financial savings resources.
  • Career advancement and optimal work-life balance.
  • Employee Discounts.
Learn more.
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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Effects of Perioperative Administration of Acetaminophen on Postoperative Shivering

A study out of Japan examined whether intravenous acetaminophen, delivered perioperatively, reduces the incidence of severe postoperative shivering. The sample population included women undergoing gynecological laparotomy over a two-year period. Each participant was randomly assigned to the intervention group, which received IV acetaminophen for 15 minutes following induction of general anesthesia, or to the control group, which received a saline placebo. Researchers were interested primarily in postoperative shivering observed during the half-hour that patients spent in the post-anesthesia care unit. The main endpoint—defined as a shivering score greater than two—occurred in 22.2 percent of the 18 women in the acetaminophen group and in 73.7 percent of the 19 controls. Body temperature (BT) from the axilla, a secondary outcome, was found to be significantly lower in the acetaminophen patients than in the control patients. Together, the findings suggest that suppressing the postoperative increase in the BT set point—rather than dropping the threshold for shivering—could explain the prophylactic effect of perioperative acetaminophen administered to women undergoing gynecological laparotomy.

From "Effects of Perioperative Administration of Acetaminophen on Postoperative Shivering"
Anesthesia & Analgesia (04/20) Vol. 130, No. 4, P. 983 Kinjo, Takehiro; Tadokoro, Takahiro; Tokushige, Akihiro; et al.

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Steps to Manage OR Use and Safety During PPE Shortages

Operating room (OR) optimization until now has not been studied in the context of a shortfall of personal protective equipment (PPE), such as with the COVID-19 crisis. Researchers at the University of Iowa tackled the topic, with a goal of achieving the lowest possible infection risk when handling patients with undetermined COVID-19 status at the time of anesthesia. They developed a four-pronged approach, which they published in Anesthesia & Analgesia. The first recommendation is for longer staff shifts—such as for 12 hours—as a way to curtail the number of surgical masks used, limit the potential for COVID-19 exposure, and reduce the number of clinicians in contact with patients. The second recommendation limits use of the OR to just one case per day per OR, providing the necessary time to deep clean each room—including terminal cleaning with the use of ultraviolet-C light. Skipping the post-anesthesia care unit (PACU) is a third recommendation, with recovery instead taking place in the same OR where the surgery was performed. This strategy keeps the risk of contamination at bay and also preserves surgical masks. Anesthesia providers could also select anesthetic drugs that shorten recovery times. Lastly, the authors emphasize the need for optimized communication that maintains throughput while minimizing potential exposure to the virus.

From "Steps to Manage OR Use and Safety During PPE Shortages"
Anesthesiology News (04/10/20) Vlessides, Michael

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Suture-Method Versus Through-the-Needle Catheters for Continuous Popliteal-Sciatic Nerve Blocks

Researchers hypothesized that a novel perineural catheter design would work just as effectively as the traditional method, which has barely evolved in the past 70 years. While the basic design has always introduced the catheter through or over a straight needle, regulators sanctioned a new design whereby the catheter is attached to the back of a suture-shaped needle. The inserted needle moves along the arc of its curvature, pulling the catheter past the target nerve before exiting the skin at a second location. To compare this new technique with the established standard, investigators designed a randomized clinical trial. Participants included 70 patients scheduled for painful foot or ankle surgery with continuous supraparaneural popliteal-sciatic nerve block. Postoperative outcomes demonstrated the novel catheter to be noninferior to the conventional approach. At two days post-procedure, study participants assigned to the suture design boasted lower average pain scores than those assigned to the through-the-needle design. Moreover, none of the suture-style catheters became completely dislodged, while the tips of three traditional catheters were found outside of the skin before they were removed as planned on postoperative day three.

From "Suture-Method Versus Through-the-Needle Catheters for Continuous Popliteal-Sciatic Nerve Blocks"
Anesthesiology (Spring 2020) Vol. 132, No. 4, P. 854 Finneran, John J.; Swisher, Matthew W.; Gabriel, Rodney A.; et al.

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Video Laryngoscopy FPS Rate

Researchers compared the efficacy of video laryngoscopy (VL), which increasingly is being used within the anesthesiology field, with that of direct laryngoscopy (DL), the longtime standard. They recruited more than 2,000 patients undergoing elective surgery with endotracheal intubation for the multinational trial. Per randomized assignment, some participants underwent traditional DL while others received VL with the McGrath MAC system. The primary outcome was rate of first-pass success (FPS), which the investigators predicted would be greater with VL. FPS was achieved 82 percent of the time with DL and 94 percent of the time with VL—even better than the researchers had expected. Although time for intubation was a second faster for DL, chief investigator Rudy Noppens, MD, PhD, dismissed the difference as clinically unimportant. "Based on these results, video laryngoscopy using a Macintosh-shaped blade can be recommended as a first choice instrument in elective surgery patients," he asserted. The study findings were presented at last year's World Airway Management Meeting.

From "Video Laryngoscopy FPS Rate"
Physician's Weekly (04/13/20) Rice, Rebecca

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Measuring the Risk Among Clinicians Who Intubate Patients with COVID-19

Developers in the United Kingdom have created intubateCOVID, a global registry aimed at tracking exposures and outcomes specifically among the anesthesia providers who place breathing tubes. The goal of the database—which is being populated with U.S. data by a team at the University of Pennsylvania—is to curb the spread of coronavirus to these clinicians, who may be exposed to aerosols and droplets from the patient's airway. Clinicians tasked with airway management are encouraged to document every intubation they perform on patients with confirmed or suspected COVID-19, providing details such as the techniques used and the personal protective equipment (PPE) worn during each encounter. In the days and weeks to follow, they can then add whether they have experienced new symptoms or tested positive for the virus. "Our goal is to rapidly capture and analyze large-scale data to identify whether these providers are at an elevated risk and, if so, whether the use of specific techniques or PPE helps to reduce that risk," explains Penn's Mark Neuman, MD, the U.S. lead for intubateCOVID.

From "Measuring the Risk Among Clinicians Who Intubate Patients with COVID-19"
Brinkwire (04/09/20)

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Use of Pectoral Nerve Blocks for Pacemaker or ICD Placement in Pediatric Patients

Investigators conducted a retrospective study to better understand the value of pectoral nerve blocks (PECS) in children who have undergone pacemaker (PM) or implantable cardioverter defibrillator (ICD) placement. The research included 20 pediatric patients who received PECS and 54 who received usual analgesic care. The patients in the PECS group generated lower pain scores than the controls at 1, 2, 6, 18, and 24 hours after implantation. While they also had lower pain scores at 4, 8, and 12 hours, the between-group differences were not statistically significant. In addition to better alleviating pain, PECS was associated with lower total opioid use in the 24-hour period following device placement. "In our cohort, pectoralis nerve blocks reduced postoperative pain scores, lowered total opioid use, and did not increase rates of complications in children undergoing pacemaker or ICD placement," the study authors reported in Heart Rhythm. "[Pectoral nerve blocks] should be considered at the time of transvenous PM or ICD placement in children."

From "Use of Pectoral Nerve Blocks for Pacemaker or ICD Placement in Pediatric Patients"
Cardiology Advisor (04/09/20) Meissner, Morgan E.

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News summaries © copyright 2020 SmithBucklin



Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

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April 16, 2020
COVID-Advocacy