Anesthesia E-ssential

AANA Anesthesia E-ssential, April 30, 2020
 
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CRNAdvocacy: Engage in Grassroots on VA Directive on Full Practice Authority

On April 21, Richard Stone, MD, the U.S. Department of Veterans Affairs Undersecretary for Health, issued a memorandum urging VA facilities to amend their bylaws to allow CRNAs to have full practice authority. While this is a great step forward for all CRNAs in the VA system, especially in light of the COVID-19 crisis, the American Society of Anesthesiologists immediately began a grassroots effort to push back.

More than 16,000 physician anesthesiologists have written to their members of Congress asking them to oppose this recommendation. And we're hearing that members of Congress are already delivering their message to Dr. Stone. Here's just a snippet of what Congress is hearing from their anesthesiologist constituents:

"This decision reduces the standard of care in VA and puts the health and lives of our Veterans at risk... Eliminating the clinical involvement of a physician in the care of our Veterans is outrageous and poses serious risks to patient safety."

This false narrative is offensive to all CRNAs and dangerous for our veterans. But because they don't have any evidence to back up their arguments, they have had to resort to scare tactics and outdated attacks. In response to this attack, the AANA is calling on CRNAs to join us in our grassroots effort to make sure our voice is heard loud and clear in the halls of Congress. Study after study has shown that CRNAs provide safe, high-quality care and improve access for our veterans, and no amount of physician grandstanding will change that.

Please follow the instructions below to contact your legislators with the FACTS about CRNAs.
  1. Log in with your AANA username and password.
  2. You will be directed to a pre-written letter that you can personalize.
  3. Click "send letter."
  4. Send any feedback you receive to info@aanadc.com
If you have any questions, please don't hesitate to contact AANA Federal Government Affairs at info@aanadc.com.
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Congress Passes Additional Relief Funding

The U.S. Congress just passed the Paycheck Protection Program and Health Care Enhancement Act, a $484 billion COVID-19 relief package intended to bolster programs created as part of the Coronavirus Aid, Relief, and. Economic Security (CARES) Act. The legislation bolsters funding available for the Paycheck Protection Program (PPP) and funding for the U.S. Department of Health & Human Services (HHS) Relief Funding for hospitals and providers. Following is a breakdown of how the legislation may affect you, based on your employment status.

If You Are A 1099 CRNA or Business Owner
An additional $310 billion has been made available for PPP loans. $60 billion of this funding is set aside for lenders that serve rural and underserved communities:
  • $30 billion set aside for both institutions with less than $50 billion in assets.
  • $30 billion set aside for both institutions with less than $10 billion in assets.
You are eligible to apply for a PPP loan if you own a small business with under 500 employees, including sole proprietorships, independent contractors, and self-employed persons. Note that this includes CRNAs who own an anesthesia group practice.

Given how quickly the original PPP funding well dried up, we encourage any CRNA who is considering a PPP loan to act quickly.

To apply for a PPP loan, a CRNA must follow these steps:
  • Download and complete the SBA PPP loan application. You will need your business information (address, contact info, etc.) as well as your business TIN (EIN, or SSN). You must also certify that your business was in operation prior to February 15, 2020.
  • Determine your Average Monthly Payroll Costs. This will be the basis for your loan amount. For purposes of calculating "Average Monthly Payroll," most applicants will use the average monthly payroll for 2019, excluding costs over $100,000 on an annualized basis for each employee.
  • Answer the eight eligibility questions for you and your business. These require a simple yes or no check mark. Also complete the eight required certifications by simply initialing regarding eligibility and loan use.
  • Once your form is complete, submit your form to your SBA participating lender. You can find SBA participating lenders in your area through the SBA website.
If You Are a W-2 CRNA
W-2 employees are not eligible to apply for a PPP loan. Your employer can still apply for funding to help keep you on the payroll. This funding is forgivable for your employer if they keep you on the payroll. If your employer receives funding from the program and does not rehire you, they will be required to pay back the loan with applicable interest. However, it is important to note that hospitals are currently not eligible to apply for PPP.

If you have been furloughed by a hospital or seen your hours reduced, you can still apply for assistance. The CARES Act significantly expands existing unemployment benefits in three ways:
  • Recipients receive an extra $600 per week.
  • More workers are eligible for benefits, including self-employed, independent contractors, furloughed workers, and workers affected by COVID-19.
  • Recipients are eligible for an additional 13 weeks beyond the typical 26 weeks offered.
HHS Relief Funding

The CARES Act originally made $100 billion in emergency relief available for facilities and providers. HHS recently announced they would distribute that funding as follows:
  • $50 billion is allocated for general distribution to Medicare facilities and providers.
  • $30 billion of this was already distributed on April 10 to those who bill Medicare, based on provider fee-for-service reimbursements from 2019.
  • The remaining $20 billion will be distributed based on provider's share of 2018 net patient revenue.
  • $10 billion will be distributed to facilities who have a high number of patients suffering from COVID-19.
  • $10 billion will be distributed to rural facilities that operate on especially thin margins.
  • $1 billion will be distributed to providers treating uninsured patients suffering from COVID-19.
  • $400 million will be distributed to Indian Health Service facilities.
  • The remaining funding will be distributed to skilled nursing facilities, dentists, and providers that solely take Medicaid.
  • The legislation just passed by Congress makes an additional $75 billion available for the same fund.
The AANA is aware that many CRNAs will not receive any of the initial $100 billion in relief funding made available by the CARES Act. HHS was given broad discretion in disbursing the relief funding and is open to changing the manner of future disbursements. The AANA Federal Government Affairs team is working closely with HHS to ensure that the remaining $75 billion is made available to every CRNA, regardless of their employment status.
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AANA Sends Letter to Vice President Pence Re: Full-Practice Authority

On Tuesday, the AANA sent a letter to Vice President Mike Pence, chair of the White House Coronavirus Task Force, to express "gratitude for the Department of Veterans Affairs' (VA) recent work on Directive 1899 and the accompanying memo that pointed out the importance of allowing Certified Registered Nurse Anesthetists (CRNAs) to practice to the full extent of their licensure, registration and certification."

The letter went on to stress the importance of CRNAs "permanently be[ing] given authority to practice to the highest level of their education and training within the VA," their vital role in the battle against COVID-19, and providing access to high-quality anesthesia care for the nation's veteran population. Learn more.
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Meet the AANA 2020 Election Candidates

Mark your calendar. The 2020 election for fiscal year 2021 Board of Directors and elected committees (Nominating and Resolutions) will open May 5, 2020, and will remain open until noon (CDT) on May 19, 2020.

Active AANA members will receive their voting credentials and voting instructions on or around May 5, 2020, via email or paper if requested. Watch for your email from noreply@directvote.net (Survey & Ballot Systems); it will include your voting credentials.

Until then, you can get to know the candidates now so you can make an informed decision. Candidates’ information is available on the AANA website. Visit AANA.com/2020Candidates (Member login required).
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TODAY! Listen to Expert Panelist AANA CEO Randall Moore

Newswise, a press release distributor and news services organization, offers a weekly series of COVID-19 expert panels as a Q&A forum between professional experts and members of the media. AANA CEO Randall Moore, DNP, MBA, CRNA, will be a member of the expert panel speaking today at 2 p.m. ET/1 p.m. CT.

Moore will speak about personal protective equipment (PPE), employment issues, and more. Experts from the University of Oxford, America Makes, and Michigan Technological University make up the rest of the panel. Tune in to watch LIVE on Newswise's Zoom channel. Learn more about the expert panel.

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AAAASF Guide to Reopening an AAAASF-Accredited ASC

The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) recently issued AAAASF’s Guide to Re-Opening your AAAASF-Accredited Facility After Closure Due to COVID-19. Because information is changing rapidly, this guidance is subject to change as appropriate. AAAASF cautions that all applicable accreditation standards must be met before an accredited facility can reopen. In addition, facilities cannot provide care under AAAASF-defined Class B, C-M, or C anesthesia until sufficient anesthesia delivery equipment, monitoring equipment, and emergency equipment have been returned or replaced and certified to be in proper condition. The guidance includes a checklist for phases of reopening, including as soon as possible, at least one or two weeks before intended reopening, and one or two days before intended reopening.
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National Nurses Month in May Celebrates Nurses All Month Long

As part of the "Year of the Nurse and Midwife" celebration, the American Nurses Association "will expand National Nurses Week, traditionally celebrated from May 6 to May 12 each year, to a month-long celebration in May."

National Nurses Month will have four different themes, celebrated by week.
  • Week 1: Self Care (May 1-9, 2020)
  • Week 2: Recognition (May 10-16, 2020)
  • Week 3: Professional Development (May 17-23, 2020)
  • Week 4: Community Engagement (May 24-31, 2020)
Learn more.
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Hot Topics


CANA Web Conference Offers Six Educational Sessions Online

On May 2, 2020, the California Association of Nurse Anesthetists (CANA) will offer its first ever web conference. This one-day, online conference will feature six educational sessions with knowledgeable and engaging speakers as well as the CANA Members Business Meeting.

Topics include: Wellness for CRNAs and SRNAs; Coronavirus: Managing the Critical III Patient in Anesthesia; Emotional Intelligence in Healthcare and Implications for CRNAs; Lessons Learned at the Sharp End of Care: The Aftermath of Adverse Events: Our Voices are Finally Heard!; What Keeps the CEO of the AANA Up at Night?; and Legislative Update and Why CANA Advocacy Matters.

Speakers include Charles Griffis, PhD, CRNA; Anna Lai Mark, CRNA; Tiffany Uranga, DNP, CRNA; Emily J. Marsh, BSN, RN; Garry Brydges, PhD, DNP, MBA, CRNA, ACNP-BC, FAAN; Dianna M. Heikkila, PhD, CRNA; Maria van Pelt, PhD, CRNA, FAAN; Randy Moore, DNP, MBA, CRNA; Kelly MacMillan, Political Solutions; and Monica Miller, Sacramento Advisors.

This program has been prior approved by the American Association of Nurse Anesthetists for 6.00 Class A CE credits. Learn more.
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NewsMaker: SRNA Alyssa Kirk Volunteers with Philadelphia Medical Reserve Corps

As an alumnus and former women's soccer player for Temple University, student registered nurse anesthetist (SRNA) Alyssa Kirk, BSN, RN, CCRN, was recently profiled in a series on the Temple website about "Temple Owls" working to fight the COVID-19 pandemic. Due to her classes being shifted online, Alyssa wanted to find a way to be useful during the COVID-19 pandemic.

As a volunteer with the Philadelphia Medical Reserve Corps, she has worked at local COVID-19 testing sites. "I have been volunteering at the Citizens Bank Park drive-thru testing center, helping to screen patients over the age of 50 who are symptomatic, as well as healthcare providers and first responders," she explained. Learn more.
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NewsMaker: CRNA Kari Rickman a "Modern Hero"

The Midland Daily News (Midland, Mich.) featured Kari Rickman, CRNA, in its Modern Heroes series, which highlights local community members working on the front lines during the coronavirus pandemic. Rickman was nominated by Todd Diederich, her fiancé, for "her selflessness and tenacity with which she tackles her job."

With COVID-19, Rickman is part of a rotating intubation team that is always on hand to help in emergency cases where ventilation is needed. "We're viewed as the 'airway experts' because of our training and how often we regularly intubate patients," says Rickman. She explained the path to becoming a CRNA leads one through working in the intensive care unit (ICU), which has now made the role uniquely qualified to help in the times of COVID-19. Learn more.
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NewsMakers: CRNA Martha Ying Counted Among Hospital Heroes

Martha Ying, CRNA, volunteers at a COVID-19 drive-up testing site at the Michigan State Fairgrounds. MichiganRadio.org caught up with her in an article on hospital heroes. Of particular concern to Ying was the level of testing being done during the pandemic.

"We are not there with testing. We are not there," Ying said. "Our results show that greater than 40% of these tests are positive. There's a little bit of variance, and there are false negatives, too, so that makes it higher." Learn more.
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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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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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Students and CRNAs Needed for the Anesthesia College Bowl!

Applications Deadline: May 4, 2020
The spirited Anesthesia College Bowl will be held at the 2020 AANA Annual Congress on Monday, August 17, 2020. Six teams of students compete against 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 Opportunities for Educators
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Student Representative to the Education Committee - Deadline: May 4

Applications Deadline: May 4, 2020
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 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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Meetings and Workshops


Upcoming Webinars: Stay Current with the Latest COVID-19 News and Resources

This webinar series is supported, in part, by an educational grant provided by AANA Corporate Partner Medtronic and Johnson & Johnson.

Peer Support, Self-care, and Resilience for Health Care Providers during COVID-19
(Replay of a previous webinar)
Monday, May 4, 2020, at 6 p.m. CDT, 1.0 Class A CE Credit
The fear and anxiety caused by COVID-19 that healthcare professionals are experiencing can be overwhelming and can cause strong emotions. Learn insight and wisdom on how best to take care of yourself and support your fellow care professionals. Presenters: Maria Van Pelt, PhD, MSN, MS, CRNA, FAAN; Josh Lea, DNP, MBA, MS, CRNA; Lauren LaChance, RN. Earn 1.0 Class A CE Credit. Register here.

New! Webinar: Pediatric Anesthesia during the COVID-19 Pandemic
Wednesday, May 6, 2020, at 6 p.m. CDT, CE Pending
Learn about the latest anesthetic management practices in caring for pediatric patients during the COVID-19 Pandemic, and reduce the risk for SARS-CoV-2 transmission. Register here.

Impact of Drug Shortages During the COVID-19 Pandemic (Replay of a previous webinar)
Thursday, May 7, 2020 at 5 p.m. CDT, 1.0 Class A CE Credit
Learn of the causes and implications of current drug shortages and how they impact clinical practice, particularly for drugs needed in the critical care of ventilated COVID-19 patients. Presenters: Erin R. Fox, PharmD, BCPS, FASHP; Daniel Kistner, PharmD; David J. Margraf, PharmD, MS; Brian D. Berry Jr., CRNA, MBA, MS; and Lorraine Jordan, PhD, CRNA, CAE, FAAN. Register here.

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Foundation and Research


AANA Foundation Open Submission: Dean Hayden Student Research & Evidence-Based Practice Grant

This grant is open to student registered nurse anesthetists (SRNAs) who are nurse anesthesia students in good academic standing and an associate member of the AANA. Visit the Foundation’s Applications and Program Information webpage to learn more and apply.
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AANA Foundation: ADCE Thank You Video

Thanks to all who attended the AANA Foundation’s fundraiser at the Assembly of Clinical and Didactic Educators (ADCE) – Uncork & Unwind. We appreciate your support. Check out this video for great photos of those in attendance.
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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 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 Foundation: Call for Board of Trustees Candidates - Deadline June 1, 2020

The AANA Foundation is seeking candidates for its Board of Trustees. If you are interested, review the criteria and apply by June 1, 2020. Thank you.
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AANA Member Benefits


Members, Take Advantage of Free Class A and Pharmacology Credits!

Earn up to 9.5 Class A CE and 1.75 pharmacology credits with exclusive AANA Learn® courses, including topics like enhanced recovery, respiratory compromise, and multimodal pain management. Free to AANA members and associate (student) members—just log in and add the course(s) to your cart. Get started today!
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New System Verifies Catheter Placement Within Seconds

Milestone Scientific’s CathCheckTM has been validated and integrated into the CompuFlo® epidural system. Using CathCheck, anesthesia providers can monitor the placement of a catheter to determine the presence or absence of a pulsatile waveform (heartbeat), providing new information that can be used to determine if the catheter is in place or has become dislodged from the epidural space. This can be performed within seconds by measuring the pulsatile waveform within the epidural space. It is used with both obstetric patients and COVID-19 patients to manage their pain and also reduce the number of times the patient is touched. Learn more.
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Medtronic and Johnson & Johnson Show Their Support For CRNAs

We are excited to announce that AANA Corporate Partner Medtronic and Johnson & Johnson have provided financial support for the COVID-19 Webinar Series through a medical educational grant. With their support, the AANA can continue to provide members with essential tools and clinical resources during this challenging time. This complimentary webinar series is a resource for all CRNAs working to update their skills and knowledge related to managing patients with expected or confirmed COVID-19 infections. Earn up to 4 AANA Class A credits with this series.

Past topics have included:
  • Impact of Drug Shortages During the COVID-19 Pandemic
  • COVID-19 Infection Prevention Pearls
  • Acute Respiratory Distress Syndrome (ARDS): What You Need to Know Today
  • Peer Support, Self-Care, and Resilience for Health Care Providers during COVID-19
  • Pediatric Anesthesia during the COVID-19 Pandemic (1.0 CE Credit available)
Watch this space for upcoming webinars!
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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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New CRNA Opportunity: Envision Physician Services, Connecticut

Envision Physician Services has an exciting, new CRNA opportunity offering top pay! Join our thriving team in the highly desirable New London, CT area and work with a well-established group of 11 physicians and over 20 passionate CRNAs. The practice covers Lawrence Memorial Hospital in New London as well as 2 surgery centers in the region. The New London area is located on the coast in southeastern Connecticut and is centrally located between Boston and New York City.

Opportunity Details:
  • Top Pay!!! $240,000+Earning Potential!
  • Flexible Scheduling with a variety of shifts.
  • Great work-life balance!
  • Ability to do Regional.
  • Case mix includes: OB, Orthopedics, Spinal, GYN, Healthy Pediatrics, General Surgery, GI.
Highlights:
  • Competitive compensation.
  • 100% paid malpractice insurance with tail coverage.
  • Generous paid time off.
  • Robust benefits plan including medical, dental, vision, and 401K with employer contribution, effective day 1!
SRNAs: take advantage of our Earn While You Learn program and receive monthly stipends senior year! Learn more.
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Faculty CRNA: WellSpan Health, Pennsylvania

WellSpan Health, a sophisticated medical community in south central Pennsylvania is seeking a full-time faculty member to join the staff of our Nurse Anesthetist Program at York College. Employment with WellSpan Medical Group allows you to enjoy a fulfilling career in an organization with strong physician leadership, a culture of support and low turnover. WellSpan Health is a top rated integrated health system with a focus on high-quality patient care.

About the Opportunity
  • Participates in didactic instruction, simulation laboratory and clinical instruction.
  • Works collaboratively with the clinical and didactic faculty of the Nurse Anesthetist Program and the York Hospital CRNA Clinical Coordinator in maintaining school activities and policies.
  • Participates on program, college, hospital and other committees as required.
  • Assists with coordination of all aspects of the program, academic and clinical, ensuring patient safety.
  • Participates in the admissions procedures including recruitment interviews and selection of students.
  • Performs continuous evaluation of the clinical aspect of instruction at York Hospital.
  • Master’s degree required; PhD or DNP preferred.
  • Graduate of an accredited program of nurse anesthesia with certification to practice anesthesia; 2-3 years clinical experience required, didactic experience preferred.
Learn more.
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CRNA: Banner Health, Nebraska

Come Home to the clean air quality of life in rural 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.

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, Operating Room: University of Virginia, School of Medicine, Virginia

Administer anesthesia and anesthesia-related care in collaboration and consultation with attending anesthesiologists in the main OR and satellite areas.
  • Participates in pre-anesthetic preparation and evaluation.
  • Formulates a patient-specific plan for anesthesia care in collaboration with attending anesthesiologist.
  • Implements monitors and adjusts patient's physiologic condition as appropriate for type of anesthesia and specific patient's needs.
  • Transfers the responsibility for care of the patient to other qualified providers post-operatively to assure continuity of care and patient safety.
  • Supports operating room procedures.
  • Participates in additional areas of responsibility which are within the expertise of the individual CRNA.
  • Assumes responsibility for professional development of self and contributes to and assists with the professional development of others.
  • In addition to the above job responsibilities, other duties may be assigned.
Position Compensation Range: $64.00 - $98.50 Hourly

MINIMUM REQUIREMENTS

Education: Master of Science in Nursing from accredited nursing program.
Experience: No experience required.
Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. Licensed to practice as a Nurse Practitioner in the Commonwealth of Virginia required. Certified Registered Nurse Anesthetist in the Commonwealth of Virginia required. American Heart Association (AHA) Health Care Provider BLS certification required.

PHYSICAL DEMANDS

Job requires sitting for prolonged periods, frequently bending/stooping, reaching (overhead, extensive, and repetitive); Repetitive motion: (squeezing an ambu bag). Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull 50 - 100lbs and lift/push/pull > 100lbs. May be exposed to fumes, chemicals, cold, heat, blood/body fluids and infectious disease.

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.

Mitigation Strategies for COVID-19

The Anesthesia Patient Safety Foundation (APSF), in the interest of helping anesthesia providers protect themselves and their patients, has released a series of perioperative considerations during the coronavirus pandemic. Such guidance is critical, the organization notes, because these health care professionals are among those most at risk, due to the potential for direct contact with respiratory droplets during intubation and extubation. At the forefront of the recommendations is hand hygiene, which APSF considers the single-most important measure to prevent cross infection. Therefore, it says, alcohol-based gels should be placed on or near every anesthesia workstation. Personal protective equipment (PPE) is also key, especially N95 masks, fluid-resistant long-sleeved gowns, disposable caps and beard covers to avoid possible contamination to hair exposed to infected droplets, and goggles and/or full-face shields. Specifically in terms of airway management, APSF recommends preparing and disposing of equipment directly beside the patient, in order to limit how far contaminated equipment may travel; administering prophylactic antiemetics to curb the risk of viral transmission via patient vomiting; and keeping patients with confirmed or suspected cases of COVID-19 in operating rooms designated for that purpose, instead of post-anesthesia care units or other holding areas. Additionally, anesthesia providers are advised to double glove, avoid fiber-optic intubation, preoxygenate patients to help avoid manual ventilation and potential aerosolization of the virus, and perform rapid sequence induction or modified rapid sequence induction, among other steps.

From "Mitigation Strategies for COVID-19"
Anesthesiology News (04/27/20) Vlessides, Michael

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Enhanced Recovery Protocols Lower Opioid Use After C-Section

Study findings indicate that Enhanced Recovery After Surgery (ERAS) protocols lower post-surgical opioid consumption in mothers who deliver via cesarean section. The retrospective investigation included 1,463 women who underwent C-section according to an ERAS pathway consisting of transversus abdominis plane (TAP) blocks and multimodal analgesia, with narcotic analgesics provided only when these measures failed to control pain. Outcomes were compared with those of 2,109 counterparts who received standard perioperative care for C-section. Only 341 women in the ERAS cohort required postoperative opioids versus 1,766 women in the control group. Meanwhile, when ERAS patients did require opioids, their utilization fell to just 803 opioid units from 8,082 opioid units. Additionally, ERAS patients stayed in the hospital for a shorter amount of time and incurred lower costs. The research team from Saint Barnabas Medical Center, a teaching hospital in Livingston, N.J., reported their results in Obstetrics and Gynecology.

From "Enhanced Recovery Protocols Lower Opioid Use After C-Section"
MedPage Today (04/27/20) D'Ambrosio, Amanda

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Low-Dose Normal Saline Washout May Not Reverse Phrenic Nerve Blockade After Shoulder Surgery

Washout with normal saline does little to reverse phrenic nerve blockade after shoulder surgery, researchers have found. Patients undergoing shoulder operations with ultrasound-guided interscalene nerve block were randomly divided into two groups. One set of participants received three doses of 10 mL normal saline washouts through an in situ nerve block catheter after postoperative local anesthetic bolus. The other set received sham washouts. Researchers evaluated pain on a numeric scale rating, used ultrasonography to measure diaphragmatic thickness, and performed brachial plexus motor and sensory exams on all patients. They observed no between-group differences in those endpoints. "Although 10-mL normal saline washouts did not reverse diaphragmatic paralysis from interscalene nerve blocks, it also did not diminish the block's analgesic effect," said lead investigator Lynn Ngai Gerber, MD. "Furthermore, more patients in the washout group showed an improvement from full to partial paralysis, suggesting that a larger bolus dose of normal saline may be needed to completely reverse diaphragmatic paralysis. In clinical practice, use of saline washouts may reduce the overall degree of phrenic nerve blockade and thus diaphragmatic paralysis while preserving the block's analgesic effect, but further dose-finding studies are needed."

From "Low-Dose Normal Saline Washout May Not Reverse Phrenic Nerve Blockade After Shoulder Surgery"
Healio (04/27/2020) Tingle, Casey

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The Sooner Hip Replacement Patients Can Get Up and Walk After Surgery, the Faster They Can Recover at Home

Although bupivacaine is a popular choice for spinal anesthesia, new evidence suggests that using mepivacaine instead gets hip replacement patients up and moving sooner. Researchers at Philadelphia's Thomas Jefferson University recruited 154 patients for a prospective clinical trial, randomizing some to spinal anesthesia with long-acting hyperbaric or isobaric bupivacaine and others to spinal anesthesia with intermediate-acting mepivacaine. Return to ambulation at 3.5 hours after hip arthroplasty was more common among the study participants who received mepivacaine. The mepivacaine group also benefited from a shorter length of stay and more same-day discharges compared to the bupivacaine patients. However, they also reported higher pain levels and used more postoperative opioids—although this finding was only true in the post-anesthesia care unit. The study was due for presentation this month at the 45th Annual Regional Anesthesia and Acute Pain Medicine Meeting, which was canceled because of COVID-19.

From "The Sooner Hip Replacement Patients Can Get Up and Walk After Surgery, the Faster They Can Recover at Home"
Newswise (04/20/20)

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A Comparison in Outcomes of Preoperative Single-Shot vs. Continuous Catheter Fascia Iliaca Regional Anesthesia in Geriatric Hip Fracture Patients

A prospective study observed outcomes in elderly patients receiving fascia iliaca nerve block via single-shot administration, versus continuous catheter, for hip fracture surgery. The sample population included 66 participants in the single-shot category and 41 in the continuous block category. Investigators assessed for morphine milligram equivalent consumption and visual analog scale (VAS) pain scores preoperatively and at days 0, 1, and 2 postoperatively. Both block approaches curtailed preoperative opioid demand, with no between-group differences evident during any of the prespecified postoperative intervals. VAS pain scores did not vary significantly at any point between the two treatment arms. Secondary endpoints—including opioid-related adverse events, length of stay, and readmission rates—also were comparable regardless of whether patients received single-shot fascia iliaca block or continuous catheter. The researchers say more study is needed to determine if one approach is more cost-effective or clinically meaningful than the other.

From "A Comparison in Outcomes of Preoperative Single-Shot vs. Continuous Catheter Fascia Iliaca Regional Anesthesia in Geriatric Hip Fracture Patients"
Injury (04/19/20) Stephan, Stephen R.; Garlich, John M.; Debbi, Eytan M.; et al.

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Epidural Anesthesia May Be Associated with Increased Postoperative Complications in the Elderly Population Undergoing Radical Cystectomy

Elderly patients who undergo radical cystectomy may be at greater risk for major complications with the use of epidural anesthesia, according to analysis. Investigators pulled 2014-2016 data from the National Surgical Quality Improvement Project, focusing specifically on length of stay, 30-day complications, and demographic traits. The analysis covered 6,448 patients who underwent radical cystectomy during the study period, including 5,064 who received general anesthesia (GA) alone for the procedure and 1,384 who received general anesthesia in combination with epidural anesthesia (GEA). Major complications occurred at a rate of 17.8 percent in the GA-only patients compared with 18.5 percent of patients who received GEA. Based on subgroup analysis, major complications were more likely in patients older than 75 years who received GEA instead of GA—possibly due to end-organ effects from the hemodynamic changes associated with epidural anesthesia, which are not well tolerated in older populations. More research is needed, the authors conclude, to identify the effects of epidural anesthesia on individual surgical procedures.

From "Epidural Anesthesia May Be Associated with Increased Postoperative Complications in the Elderly Population Undergoing Radical Cystectomy"
World of Urology (04/20) Patel, Sephalie Y.; Ackerman, Robert S.; Boulware, David; et al.

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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 30, 2020