Anesthesia E-ssential

AANA Anesthesia E-ssential, April 2, 2020

Vital Signs

CMS Temporarily Suspends Physician Supervision Requirements for CRNAs

The Centers for Medicare & Medicaid Services (CMS) has temporarily suspended physician supervision requirements for CRNAs!

On Monday, CMS announced an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the pandemic and enabling YOU to practice at full scope. View the AANA news release.

As you know, the AANA has been working tirelessly on your behalf to remove these burdensome restrictions. Earlier this month, AANA CEO Randall Moore, DNP, CRNA, MBA, met with President Trump, Vice President Pence, CMS Administrator Verma, and other key senior administration officials. During that conversation, Moore strongly advocated for this very action.

This suspension of burdensome and unnecessary physician supervision requirements means that CRNAs can contribute their skills and expertise when and where they are needed the most.

On behalf of the AANA Board of Directors and staff, thank you for everything you do. The AANA will continue to be your voice during this crisis, advocating for you, your patients, and the communities you serve.
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Tonight! AANA President and CEO to Answer Membership Questions

The AANA will conduct a tele-town hall meeting Thursday, April 2, at 7 p.m. CT to update the membership regarding AANA's response to COVID-19. AANA President Kate Jansky, MHS, CRNA, APRN, USA LT (ret), and CEO Randall Moore, DNP, MBA, CRNA, will host the meeting.

Moore will be joined by the AANA staff leading the organization's efforts to combat COVID-19. Common questions and concerns expressed by the AANA membership will be discussed during the call.

You will be able to join the meeting here.
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AANA Advocacy: New COVID-19 Resources

We are living through unprecedented times, and in a historic development on March 30, the Centers for Medicare & Medicaid Services temporarily removed physician supervision requirements for CRNAs during the COVID-19 pandemic. This decision presents extraordinary opportunities for CRNAs to use their skills, expertise, and leadership to serve the nation as the number of patients needing care surges in the coming weeks. Below is information to support you, as you continue to navigate the rapidly shifting patient care landscape:
  • The AANA Advocacy team has compiled an FAQ Document on Supervision Removal with the latest information and answers to your questions about how the CMS waiver will affect your practice. Of note: The CMS supervision waiver does not apply to state supervision laws. The COVID-19 State Government Resources page lists enacted state actions taken in response to the COVID-19 crisis. These resources will be updated as new information becomes available.
  • As AANA Senior Director, Education and Practice Brett Morgan, DNP, CRNA, stated in his March 31 email, AANA's new resource, CRNAs as Advanced Practice Providers in Critical Care Settings, defines the roles CRNAs can play in critical care settings. CRNAs can serve as experts in airway management, hemodynamic monitoring, placement of invasive lines and monitors, advanced physical assessment, leading a team of rapid responders, and managing critically ill patients.
  • I urge you to visit the AANA's continuously updated COVID-19 resource page. Featuring a new easy-to-navigate design, the page offers the latest curated resources on Practice, Critical Care, Well-being, Employment, and Education, as well as the latest news.
In the coming weeks and months, the COVID-19 pandemic will bring us challenges, and yes, hardships, that would have been unimaginable a few months ago. AANA is proud of the strength and resiliency our members have shown through this crisis and want you to know that we are devoting all of our resources to helping you meet those challenges and mitigate those hardships.
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Updated Critical Care Resources Available for CRNAs

The AANA recognizes that as the COVID-19 outbreak continues to put strain on hospitals, all healthcare providers can play a critical role in managing the delivery of care. During this time, it is essential for each facility to optimize its healthcare workforce and utilize CRNAs as advanced practice registered nurses. There is no question that during times of emergency and crisis, CRNAs are highly-skilled clinicians who are well-prepared to fulfill a multitude of healthcare-related and leadership roles.

AANA's new resource, CRNAs as Advanced Practice Providers in Critical Care Settings, further defines the roles CRNAs can play in critical care settings:
  • Advanced airway management
  • Advanced ventilator management
  • Advanced hemodynamic monitoring
  • Placement of invasive lines and monitors
  • Rapid advanced physical assessment
  • Leading a team of rapid responders
  • Consultation on the management of critically ill patients
As additional support for our members, AANA has developed a Critical Care Resources webpage of curated content, including webinars and peer-reviewed literature, dedicated to providing references for working in a critical care setting during the COVID-19 pandemic. Topics include ICU preparedness, critical care clinical evaluation, ICU clinical management, and links to template critical care policies.

The AANA continues to monitor the COVID-19 pandemic, and we are committed to providing guidance and resources to support you. Please continue to visit the newly expanded COVID-19 resource page for up-to-date clinical practice, state advocacy, employment, and health & wellness resources and FAQs. Submit any questions not currently addressed in the FAQs through AANA's online form.
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CARES Act: Resources and How it Affects CRNAs

On Friday, March 27, Congress passed the Coronavirus Aid, Relief and Economic Security Act or CARES Act. This bill is the third relief effort passed by Congress to help address both the economic and healthcare effects of COVID-19. The AANA worked hard to successfully advocate for our members as Congress drafted the legislation, ensuring it would include economic relief for CRNAs and other providers, additional funding for hospitals, and means to address the shortage of personal protective equipment (PPE). We are pleased to see a number of items that we advocated for included in the final legislation.

What's in the CARES Act that affects CRNAs:
  • Over $350 billion in low interest loans for small businesses
  • Title VIII Nursing Workforce Development Funding
  • Relief for Students and Student Loan Borrowers
  • Resources for Hospitals and Facilities
Read more about the CARES Act and how it helps CRNAs

To ensure that AANA members have access to all the resources made available by the CARES Act and the federal government at this critical time, we have created a resource page to help members who have questions and want help navigating the relief systems.

Access the AANA COVID-19 resources page

While we view the CARES Act as an important step forward with a number of helpful provisions for CRNAs as well as other healthcare providers and facilities, our advocacy continues. We will persist in pushing for more access to PPE, more grants and funding for rural and critical access hospitals, more resources for our members who face uncertain economic times, and the removal of barriers to practice during this emergency. (See "CMS Temporarily Suspends Physician Supervision Requirements for CRNAs" story.) Please don't hesitate to reach out to the AANA Federal Government Affairs team if you have questions about the CARES Act at

Thank you for all your do for our profession, especially in these difficult times.
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VA/AANA Partnership Brings Employment Opportunities for CRNAs

The AANA has partnered with the U.S. Department of Veterans Affairs (VA) to offer employment opportunities for CRNAs while supporting our nation's veterans during the COVID-19 pandemic.

Through the VA Travel Nurse Corps program, the AANA and the VA have created opportunities for you to work at 157 facilities across the Veterans Health Administration (VHA) in support of COVID-19 operations. Hiring will begin immediately; VA has immediate needs in New York City and New Orleans.

This new partnership between the AANA and VA taps into your unique expertise and skillset to meet the needs of our nation's veterans. The VA needs CRNAs' expertise in rapid systems assessment, airway management, ventilatory support, vascular volume resuscitation, emergency preparedness, and resource management to support their facilities.

CRNAs will be assigned to interested facilities throughout VHA and may be temporarily appointed (not-to-exceed 120 days) on an intermittent, part-time, or full-time schedule in support of the VA facilities across the nation.

For more information, visit
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Putting CRNAs, Patients, and Communities Before Politics

It is deeply unfortunate that the leaders of the American Society of Anesthesiologists (ASA) have chosen to politicize the role of anesthesia professionals in a time of global pandemic. In a March 24 letter to President Trump and Vice President Pence, the ASA makes a predictable attempt to divert attention away from the true issue, the successes we've garnered on the federal and state level, and the efforts that enable you to practice to the fullest extent of your education and training.

Simply put, the ASA does not define your role as a CRNA. At this time, we are successful in removing barriers to facilitate the life-sustaining work that you are doing every day. We are a profession that puts patients first, and it's clear that the ASA has chosen to do otherwise.

Through direct relationships with HHS Secretary Azar, state leaders, and most recently with the Trump administration, the AANA continues to work hand in hand with federal and state lawmakers to remove barriers to practice for CRNAs. (See "CMS Temporarily Suspends Physician Supervision Requirements for CRNAs" story.) Recognizing necessary, nonpartisan improvements, the work has been swift, particularly in Arizona, Maine, Maryland, New York, Ohio, Tennessee, and West Virginia. The AANA has been in communication with the National Governors Association, which has offered states "Strategies for Health Care Workforce and Facility Capacity"—guidance that strongly encourages governors to allow you to practice at the top of your license.

The guidance is also consistent with Secretary Azar's letter to all U.S. governors to encourage the removal or relaxation of scope of practice barriers in an effort to expand the capacity of states' current healthcare workforces to combat the COVID-19 pandemic. Secretary Azar's recommendations include allowing health professionals to practice across state lines and suspending restrictive supervisory and collaborative scope of practice requirements.

In addition to our robust federal and state advocacy, the AANA has also fostered important partnerships, notably with the U.S. Department of Veterans Affairs, to secure employment opportunities for our members.

As an association that deeply cares for you and the patients you serve, we're choosing to focus on being part of the solution and continue advocating for our members and the communities impacted by the COVID-19 pandemic.
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Learn from Experience: Medtronic Virtual Roundtable on COVID-19 Care

Listen in as physicians from China, Europe, and the U.S. on the frontlines of care for COVID-19 patients tell you what they have learned. Join the Medtronic Virtual Roundtable on April 7, 8 a.m. EST. Panelists include:
  • Professor Bin Du, the ICU Director at Peking Union Medical College Hospital;
  • Professor Xiangdong Chen, professor and chair of the Department of Anesthesiology at Wuhan Union Hospital in Wuhan, China;
  • Professor Finn Radtke, senior physician and head of research in the Department of Anaesthesiology and Intensive Care at Nykoebing Hospital, University of Southern Denmark; and
  • Associate Professor Ashish Khanna, a staff intensivist and anesthesiologist, associate professor of anesthesiology and section head for research with the department of anesthesiology, section on critical medicine at Wake Forest University School of Medicine, Winston-Salem, N.C.
The roundtable will be moderated by Karen Phillips, anesthesiologist, adult intensivist and senior medical director, Medtronic, an AANA corporate partner.

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The Joint Commission Calls for Action at the Federal Level to Address Shortages of Critical Medical Supplies

The Joint Commission recently issued a public statement on shortages of critical medical equipment that strongly supports emergency efforts at the federal level to dramatically increase the production and distribution of PPE and other necessary medical equipment and supplies, as well as the availability of telehealth services.

Joining with five other organizations, The Joint Commission stated, “PPE is needed immediately to protect the caregivers who are risking their own health to care for patients in the most need. Shortages of ventilators and intensive care facilities threaten the lives of the sickest patients.”
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The Joint Commission Supports Staff Use of Their Own Personal Protective Equipment During COVID-19

On March 31, The Joint Commission released a statement supporting the use of personal face masks/respirators provided from home during COVID-19. This statement notes The Joint Commission is “painfully aware of the current shortages of PPE” and says it is acceptable to bring this PPE from home “when health care organizations cannot provide access to protective equipment that is commensurate with the risk health care workers are exposed to amid the COVID-19 pandemic.”

Acknowledging the incredible challenges healthcare workers are facing, the statement affirms, “We must protect those who are working so heroically to care for people afflicted with COVID-19.” Read Joint Commission Statement on Use of Face Masks Brought From Home, which includes an evidence assessment and policy analysis.
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Hot Topics

CPC Update: Certification Renewal Deadline Extended Four Months to November 30

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) recognizes the extraordinary impact the COVID-19 pandemic is having on every individual, business and family, while creating unprecedented challenges for the CRNA community. The NBCRNA has made the following adjustment to the Continued Professional Certification (CPC) Program timeline and deadlines to provide some relief from the many timing constraints everyone is currently facing:
  • The NBCRNA is extending the July 31, 2020, certification renewal deadline by four months to November 30, 2020, allowing additional time to fulfill the CPC requirements.
We will continue to monitor the impact of the crisis and will continue to communicate essential information as quickly as possible. Read the full statement.
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Meet the Candidates

The introduction of the 2020 slate of candidates and Board of Directors candidates’ position statements will not take place live this year. However, candidates for the Board of Directors have been asked to present their position statements via video. This information, along with other candidates’ information, i.e., photo, biographical sketch, position statement, etc. will be available on the AANA website shortly before the voting cycle begins on May 5, 2020.
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Last Call for Abstracts! Don’t Miss Out on a Chance to Speak at 2021 ADCE and the ADCE Portion at the 2021 Annual Congress

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.

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
April 14, 2020 – Visit the abstract submissions page for more information. 
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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 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 AANAConnect 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 CE & Education > 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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AANA Journal App: Simpler, Easier, More Functionality at Your Fingertips

Stay current with the latest CRNA research and industry news using the new AANA Journal mobile app! You’ll get the same great AANA Journal content, quickly and conveniently across your mobile devices.
  • Listen to Articles - All articles will include narrated audio.
  • Watch Videos - Video resources can be viewed in the app.
  • Easily Navigate - View external resources and pages online directly from the app.
AANA members – Download the App Today:
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NewsMaker: CRNA Dana Standridge-Kissel and Daughters Show Appreciation for Hospital Staff During Difficult Days

Dana Standridge-Kissel, CRNA and former ICU nurse, and her daughters came up with the idea to place carnations with thank-you notes on the cars of employees at Eastside Medical Center in Snellville, Ga.

According to Gwinnett Daily Post, "Tucked under [the employees'] windshield wipers were carnations wrapped with 'thank you' notes attached. It was a way for the daughters of Standridge-Kissel and Dr. Michael Kissel, Eastside's chief of staff, to offer some appreciation to 125 hospital employees for the work they are doing during the outbreak of the coronavirus disease known as COVID-19." Learn more.
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AANA Meetings: Refresh Your Knowledge and Make New Connections

Postponed to October: Spinal Epidural with Obstetric Essentials Workshop

The AANA has been carefully monitoring the evolving situation surrounding the COVID-19 Pandemic. To ensure the safety of our members and staff, the AANA has decided to postpone the Spinal Epidural with Obstetric Essentials Workshop that was scheduled for April 30-May 2, 2020 at AANA headquarters in Park Ridge, Ill. The new dates will be October 15-17, 2020.

Your registration will be automatically transferred to the new dates. If you are unable to attend in October, please contact and we will issue a refund in full to the original form of payment. Please allow 10-14 business days for the refund to appear on your credit card statement. Also note that participants are responsible for cancelling any other travel arrangements made, such as hotel and airfare.
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Foundation and Research

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 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 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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CRNACareers - 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, 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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CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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CRNA: Banner Health, Nebraska

Nebraska isn't for everyone, but if you enjoy unique adventures, beautiful scenery, calm pace of life, and a solid compensation package, this opportunity is just right for YOU!

Banner Health is one of the largest non-profit healthcare systems in the country with 28 hospitals, six long-term care centers and an array of other services, including family clinics, home care services and home medical equipment, in six Western states.

We have an excellent opportunity for a dynamic CRNA to join our highly trained team!
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB.
  • Experience preferred.
  • One week on, one week off, one week call.
Ogallala Community Hospital (OCH) is an 18-bed critical access hospital committed to meeting the health care needs of western Nebraska and was one of four Banner Health facilities named HealthStrong™ Top 100 Critical Access Hospitals scoring best among critical access hospitals on the iVantage Health Analytics’ Hospital Strength Index™. The Hospital Strength Index is a comprehensive rating of critical access hospitals, and results recognize the Top 100 Critical Access Hospitals that provide a safety net to communities across rural America. Service area 15,653.

Ogallala, Nebraska, is home of the incredible Lake McConaughy with more than 100 miles of shoreline, a forward-thinking school system, low crime rate, and a multitude of recreational activities. This friendly community is inviting to all! Ogallala offers an immediate sense of belonging, and exceptional quality of life – living & working where others play!

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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CRNA Sought: Eau Claire Anesthesiologists (ECA), Wisconsin

Eau Claire Anesthesiologists (ECA) Seeks CRNAs to join their established practice.
  • ECA is committed to the team approach to anesthesia.
  • The schedule typically has one anesthesiologist starting two operating rooms with two CRNAs.
  • Staffing usually continues in a 1 to 2 or 1 to 3 model but will occasionally be a 1 to 4 model on very busy days.
  • Monday-Friday schedule with secondary call coverage only 5-6 weekends a year.
  • CRNAs are normally involved with all types of cases except pain blocks, epidurals and most cardiac cases.
  • 25 operating rooms among 3 different facilities in use each day on average.
  • ECA currently has 22 physicians, 35 CRNAs and 5 IVRNs.
  • Approximately 22,000 cases a year.
  • Compensation of 200k-210k a year, 30k signing bonus, fully funded 401k, 6k contribution to HSA, potential student loan payments and other comprehensive benefits.
Eau Claire is a University community in western Wisconsin and rated one of the best small towns in the U.S. It is known for Indie music festivals, craft beer, and a Brooklyn-Austin-Portland vibe. Only 90 miles from Minneapolis/St. Paul and all the amenities there. Learn more.
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Hospital-Employed CRNA Opportunity: Carle Physician Group, Illinois

Carle Physician Group is seeking an additional CRNA to join our team of 50 CRNAs at our main campus in Urbana, Illinois.

Position Details Include:
  • Join an autonomous and team-centered department of 50 CRNAs that perform over 19,500 cases annually at an established research and teaching hospital.
  • Call 1:20 (call included in 40-hour work week).
  • Three subgroups of 10 CRNAs cover OB, Pediatric, and Heart cases.
  • Perform a wide variety of cases and procedures to include: General, Spinal, Epidurals, IV Regionals, CVP, PA Invasive Monitors and A-lines.
Education Requirements:
Master's or Doctorate degree in Nurse Anesthesiology

Licensure/Certification Requirements:
Current Illinois CRNA license
Learn more.
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Full-Time CRNA Opportunity: Envision Healthcare, Arizona

Envision Physician Services has a full-time CRNA opportunity in our collaborative and well-respected Care Team at Havasu Regional Medical Center in Lake Havasu City, Arizona. Live and work in a very desirable location of beautiful Arizona and experience 300 days of sunshine per year! Learn more about the opportunity, why CRNAs choose us, and all of the wonderful benefits of becoming a part of the Envision Physician services family.

Opportunity Highlights
  • Competitive compensation and robust benefits starting day 1.
  • Anesthesia Care team is comprised of 8 CRNAs and 6 physicians.
  • Practice a wide variety of cases including regional blocks, epidurals, spinals, ortho, GI.
  • This practice covers 6 ORs, L&D, 1 Cardiac OR, and a 2 room ASC.
  • Reasonable schedule and call; if you are seeking a work-life balance, this is your opportunity!
  • CRNAs have a wide range of autonomy and are well respected.
Why CRNAs Choose Us:
  • Clinician-led practice on the local, regional and national level.
  • Leadership and mentoring opportunities.
  • Collegial environment that supports autonomy and work-life balance.
  • Long-term stable contracts at well-recognized coast-to-coast hospitals and ambulatory surgery centers.
Envision Physician Services offers a competitive compensation and benefits plan, bonus structure, CME, generous time off, 401K and paid malpractice with tail coverage. 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.

Swabbed PPE Worn During COVID-19 Patient Care Test Negative for Virus

A study out of Singapore found that personal protective equipment (PPE) tested negative for coronavirus even though the wearers had cared for infected patients. The researchers conducted the one-day study in an effort to gauge the per-contact risk of PPE contamination with the virus. They used sterile swabs to collect samples from the goggles, N95 respirators, and shoes of 30 doctors, nurses, and other personnel. The samples were taken as the staffers exited the rooms of 15 patients who had tested positive within the previous 48 hours. The median duration of exposure was six minutes, which was spent doing everything from administering medications and cleaning to performing physical examinations and collecting respiratory specimens. None of the 90 samples taken came back positive for SARS-CoV-2, a finding that the investigators acknowledged contradicts previous research findings that coronavirus remains viable on some PPE. Despite some limitations to their own work, they find optimism in the results. “This provides assurance that extended use of N95 [respirators] and goggles with strict adherence to environmental and hand hygiene while managing [patients with] SARS-CoV-2 could be a safe option," they write in Infection Control & Hospital Epidemiology.

From "Swabbed PPE Worn During COVID-19 Patient Care Test Negative for Virus"
Healio (03/26/2020) Stulpin, Caitlyn

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More Than 5,000 Surgery Centers Can Now Serve as Makeshift Hospitals During COVID-19 Crisis

Underscoring the gravity of the coronavirus pandemic, the Centers for Medicare & Medicaid (CMS) is waiving a number of rules in order to accommodate the treatment of a growing number of infected patients. As part of the move, many medical patients who are not infected with COVID-19 will be directed to ambulatory surgery centers as well as inpatient rehabilitation hospitals, hotels, and even dorms in order to take the pressure off of overtaxed hospitals and health systems. There are an estimated 5,000 outpatient surgery centers in the country—a good many of which suspended business after being advised not to perform nonessential operations. However, these facilities have the space, equipment—including ventilators or anesthesia gas machines that could be repurposed as ventilators—and willing staff to help during the public health crisis. Before CMS relaxed the rules, outpatient centers could care for patients for no more than 24 hours; but, now, they will be able to treat heart attack survivors, cancer patients, and trauma victims. "This is a great step in fighting this pandemic," says Adam Schlifke, MD, an anesthesiologist and clinical assistant professor at Stanford University.

From "More Than 5,000 Surgery Centers Can Now Serve as Makeshift Hospitals During COVID-19 Crisis"
Kaiser Health News (03/30/20) Szabo, Liz; Anthony, Cara

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Propofol TCI Reductions Do Not Attenuate Significant Falls in Cardiac Output Associated with Anesthesia Induction and Knee-Chest Positioning in Spinal

Researchers wondered if lowering propofol concentrations at targeted intervals would mitigate hemodynamic changes that usually occur with anesthesia induction and knee-chest position. Chief among those changes is a drop in cardiac output (CO), which can influence patient outcomes. The two-part study included 20 patients undergoing lumbar spinal surgery. For the first phase, target-controlled infusion propofol anesthesia was adjusted to keep bispectral index between 40 and 60. Propofol target concentration was reduced at two different points during the second leg of the study—immediately following loss of consciousness and again before positioning. The investigators calculated that anesthesia induction caused CO to drop 25.6 percent from baseline level in the first phase of the study and by 19.8 percent in the second phase. Knee-chest positioning pushed the total CO reduction from baseline 10 minutes after positioning to 38.4 percent and 46.9 percent, respectively, for phases one and two. The findings indicate that planned reductions in propofol concentration do not attenuate a decrease in CO triggered by anesthesia induction and knee-chest position. Rather, the researchers suggest, clinicians may want to rely on minimally invasive CO monitors to inform management of anesthetized patients in the knee-chest position.

From "Propofol TCI Reductions Do Not Attenuate Significant Falls in Cardiac Output Associated with Anesthesia Induction and Knee-Chest Positioning in Spinal"
Journal of Neurosurgical Anesthesiology (Spring 2020) Vol. 32, No. 2, P. 147 Chaló, Daniela; Pedrosa, Sara; Amorim, Pedro; et al.

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Rates of Fentanyl Positivity in Neonatal Urine Following Maternal Analgesia During Labor and Delivery

While many pregnant women receive fentanyl for labor pain and delivery, little is known about fetal exposure to the drug via the placenta. Researchers at Brigham and Women's Hospital in Boston tackled the subject through a medical record review of 96 newborns who underwent urine toxicology screening between January 2017 and September 2018. Tests came back positive for fentanyl in 29 percent of cases where the mother received fentanyl-based analgesia. A positive result was more likely the longer the duration of maternal exposure to labor analgesia, with the odds increasing four-fold for every five hours of pain intervention. The investigators emphasized, however, that neonatal outcomes were comparable whether babies had a positive or negative urine fentanyl screen. The findings nonetheless suggest a strong association between maternal fentanyl analgesia and positive urine fentanyl screens in newborns, which they say support possibly increased use of these laboratory tests going forward.

From "Rates of Fentanyl Positivity in Neonatal Urine Following Maternal Analgesia During Labor and Delivery"
Journal of Applied Laboratory Medicine (03/20) Novikov, Natasha; Melanson, Stephanie E. F.; Ransohoff, Jaime R.; et al.

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Exposure to Surgery with General Anesthesia During Adult Life Is Not Associated with Increased Brain Amyloid Deposition in Older Adults

Investigators explored a possible association between surgery with general anesthesia (GA) in older adults and amyloid-ß (Aß) deposition, which is implicated in the Alzheimer's disease (AD). The research took place in the Mayo Clinic Study of Aging, with a sample population of 2,563 patients between the ages of 70 and 97. Of those individuals, 585 underwent positron emission tomography (PET) scans to measure brain Aß. Researchers performed separate analyses related to surgical GA exposure after age 40 and in the 20 years before neuroimaging. The findings indicated that while exposure to surgery/GA correlated to a modestly higher risk of abnormal cortical thinning, there were no significant associations observed between exposure and neuroimaging. Therefore, the Mayo researchers conclude, the cortical thinning seen with adult exposure to surgery/GA is likely caused by a process or processes other than AD pathology.

From "Exposure to Surgery with General Anesthesia During Adult Life Is Not Associated with Increased Brain Amyloid Deposition in Older Adults"
British Journal of Anaesthesia (03/20) Sprung, Juraj; Warner, David O.; Knopman, David S.; et al.

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Use of IV Ibuprofen Can Reduce Opioid-Related Side Effects

Intravenous ibuprofen received regulatory approval for pain management more than a decade ago, but today's shift away from perioperative opioids could push it to the forefront of analgesic care. Stephen Southworth, MD, MBA, chief investigator for Cumberland Pharmaceutical's Caldolor drug application in 2007, notes that IV ibuprofen has "definitively" curtailed—and even eliminated, in some cases—postoperative opioid consumption. "IV ibuprofen is truly a 'Goldilocks' drug," he says. "It has been very helpful in our mission for a no-opioid surgery experience." Used primarily as part of a multimodal analgesic model, it also is lauded for reducing adverse effects associated with opioids—such as vomiting and nausea. Cumberland now intends to offer Caldolor in a premixed IV bag, making it even more attractive by eliminating the step of diluting the drug or preparing it under a hood in the pharmacy department. IV ibuprofen is an option for most surgical procedures and for patients no younger than 6 months old. Except in the case of individuals with aspirin-based asthma or other rare conditions, or patients who are recovering from coronary bypass or myocardial infarction, Southworth reports that IV ibuprofen is also very safe.

From "Use of IV Ibuprofen Can Reduce Opioid-Related Side Effects"
Anesthesiology News (03/27/20) Kronemeyer, Bob

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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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