Certified Nurse Anesthetist (CRNA)

• Assesses and monitors the client pre-operatively, intra- operatively and post- operatively.
• A pre-anesthetic check list shall be performed before the first case and before each additional case of the day.
• Always evaluates the client's current mental and physical status.
• Always identifies any historical adverse re-action(s) to anesthesia.
• Always reviews anesthetic history to include family's anesthetic history and potential problems.
• Proactively advocates for customers who should not be anesthetized.
• Conducts history and physical assessment as per professional standards.
• Always reviews current diagnosis of the client and proposed surgical procedure.
• Identifies and documents the client's current medications.
• Always reviews all pertinent laboratory data and takes appropriate action.
• Assures informed consent has been obtained from client during interview.
• Always evaluates the client for major system abnormalities.
• Always verify allergies, Anesthetic problems, NPO status and other pertinent information.
• Discusses the proposed anesthetic technique and alternative anesthetic techniques in a calming, patient focused and professional manner.
• Appropriately discusses the risks and complications associated with Anesthesia, including but not limited to reactions, intubation, oral and dental damage and possible death.
• Assembles drugs including emergency and routine anesthetic drugs, labeled and dated. Drugs and dosages are weight and age appropriate.
• Prepares equipment, selecting type of equipment and quantity as per type of procedure, as appropriate for the age and size of the patient, i.e. neonates, pediatrics, adolescents, adults and geriatrics.
• Prepares an appropriate anesthesia plan of care, as observed by Supervisor/random chart audit.
• Continues patient oversight through anesthesia discharge.
• Prepares for and provides anesthesia procedures in remote locations as per established protocols.
• Utilizes disconnect alarm as per established procedures.
• Utilizes carefully considered judgment in deciding which monitoring techniques are to be used on each client, based on physical diagnosis, to verify adequate ventilation and circulation. Utilizes ASA standards for basic intra- operative monitoring.
• Plan of care includes post anesthesia care and completes follow up post op visit and care as needed
• Provides individualized pre-medication, meeting each client's unique requirement and the provider’s preference.
• Client's vital signs and condition upon arrival to the recovery unit using the Par's scoring system.
• Adheres to appropriate safety precautions during all procedures to minimize the risk of fire, explosion, electrical shock and equipment failure.
• Documents presence of a nurse anesthetist during the course of the anesthetic.
• Documents Blood pressure and EKG monitoring on all surgical clients (general, regional and local anesthetics).
• Documents the client’s response (acceptance or refusal) to the explanation of the proposed anesthetic.
• Records Anesthesia plans; utilizes ASA classification, documents appropriate plan and interventions via information system.
• Completes and accurately documents pertinent information on client's record per WRHS policy/procedures.
• For the Induction phase always documents: Drugs, dosages and times of administration; technical difficulties during the induction period; and verification of airway control as well as frequency of ventilation in adverse airway situations and Anesthetic technique used.
• For the Intra-operative phase always documents: client's physiological responses to Anesthesia; monitoring modalities; all intra-operative events/problems; Communications regarding client's concerns to other health care providers; Position changes and pulse verification. Anesthetic techniques and methods of drug administration; total amount of all drugs, fluid/blood loss and replacements.
• For the Emergence phase always documents: reversal of Anesthetic Agents as needed; Airway management during emergence; Condition of client prior to being transported to the post-Anesthesia care units.
• PACU Note - Documents either on the anesthetic record or the PACU record depending on the disposition of the patient.
• Entries are legible.
• Documents patient events/occurrence reports accurately and completely.
• Does not use unapproved abbreviations.
• Documents all charges in an appropriate and timely manner.
• Reports patient/visitor/employee incidents according to WRHS policy.
• Immediately responds to code and takes appropriate equipment.
• Always remains calm in a crisis.
• Able to diffuse high stress situations.
• Able to evaluate situations in seconds and respond appropriately. Must be able to effectively interact with others.
• Demonstrates competence in allaying patient fears.
• Thoroughly performs machine checks in compliance with FDA recommendations.
• Adheres to appropriate safety precautions during all procedures to minimize the risk of fire, explosion, electrical shock and equipment failure.
• The anesthetic machine is always inspected by CRNA according to established guidelines before use. The CRNA assure readiness, availability, cleanliness and working condition of all equipment to be utilized in the administration of the anesthesia care.
• Documentation on client record always includes verification of that the anesthetic machine and equipment were checked and documents what adjunct equipment is being used for each patient.
• Orders and tracks all supplies. Evaluates new equipment and supplies and makes recommendations.
• Promptly reports malfunctioning equipment, or equipment needing repair, to appropriate personnel.
• Ensures that preventative maintenance is performed according to regulatory requirements. Notifies supervisor immediately if there are lapses.
• Stocks Rooms - Replaces outdated drugs and supplies in the work area.
• Attends facility and other departmental meetings, as required. Reads minutes and demonstrates knowledge of content.
• Delegates tasks appropriate to patient condition and team member skills and are flexible to meet unit needs. Anticipates issues and consistently takes appropriate action.
• Demonstrates problem solving skills with employees, other departments, visitors and others as indicated
• Consistently demonstrates leadership and organizational skills that provide for a safe environment for the patient.
• Consistently promotes teamwork.
• Provides support and direction to staff to facilitate quality patient care.
• Consistently demonstrates empathy in interactions with patient/families.
• Appropriately communicates unit needs regarding equipment/supplies. Reports equipment in disrepair/needing replacement immediately.
• Manages practice according to AANA standards and recommended practices.

• Education: Graduate from an approved program of nurse anesthesia accredited by the Council of Accreditation of Nurse Anesthesia Educational Programs/Schools or its predecessor.
• Experience: Insurable by an appropriate medical malpractice insurer for the limits required by this institution or state. Demonstrates competency in those clinical responsibilities for which the candidate applies.
• License Requirements: Holds a current certification in the State of North Dakota. Is currently certified or currently re-certified by the Council on Re-certification of Nurse Anesthetists or its predecessor. Holds current state licensure as a registered nurse in the state of North Dakota, and comply with any applicable state statutory or regulatory requirements concerning the advanced practice nursing. Must complete the credentialing process as identified by WRHS Medical Staff by- laws.​​​​​​​

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