Certified Registered Nurse Anesthetist (CRNA

Certified Registered Nurse Anesthetist (CRNA)

Tripler Army Medical Center, Hawaii

Salary Range $180.00 - $190.00 Hourly Position Type Full Time Category Health Care

The work to be performed under this contract will be at Tripler Army Medical Center (TAMC). HCWs shall receive notification two weeks prior to the reassignment to another location.

Hours of performance may include shift work. The work schedule may include rotating 8.5 to 12 hour shifts, 7 days per week including nights, weekends and federal holidays. Over-time is allowed for each labor category work schedule.

The Military Treatment Facility provides services 24 hours a day, 365 days a year (366 days during leap years) including holiday. Clinics and units have designated operating hours.

Overtime is authorized. Overtime hours shall be coordinated with the COR or their designee, and approved, prior to being worked.

The work schedule may include shift work (see hours of performance). Work will not exceed 12 hours in a 24-hour period and 80 hours in a consecutive 14-day period.

Specific days, hours, and shift length will be scheduled by the designated government representative. The specific schedule for each two-week period will be provided one month in advance. At the mutual agreement of the Contractor and the Government, alternative schedules may be implemented such as a compressed work schedule. Any changes in the schedule shall be coordinated between the HCW and the Government. Any planned absences of the HCW shall be communicated to the Government supervisor in advance of the absence in order to ensure that clinical operations are not adversely affected. The Government reserves the right to change shift hours with a five day notice to accommodate patient care needs and mission requirements.

Contract HCWs will be required to work on federally recognized holidays.

Each HCW shall demonstrate competency as required in the contract and as follows: The contractor shall ensure that all contract HCWs providing services under this contract shall be able to read, write, and speak English well enough to effectively communicate with all parties and other health care providers. In addition, if the position requires the use of computers, the contract HCWs shall be computer literate and be able to type a minimum of 40 words per minute.

HCW(s) shall complete all MTF-specified orientation program(s), initial and annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF.

As a prerequisite to performance under this contract, all Certified Registered Nurse Anesthetist performing services must be privileged by the MTF Director. Compliance with the privileging requirements as stated in this contract is essential to performance under the contract. Any failure to meet these requirements is considered non-performance and the basis for termination for cause.

The Contractor shall provide documentation certifying health requirements such as immunizations, annual vaccinations, medical testing (i.e., tuberculosis, N95 particulate respirator duckbill mask fitting) and physical examination when required at the time of initial placement.

The HCW shall be required to obtain documentation of required physical testing or a report of a physical examination.

A two-step Tuberculin Skin Test (TST) is required within 12 months of reporting to TAMC. The requirement for a two-step TST depends on prior TST screen history as explained below. A single negative Interferon Gamma Release Assay (IGRA) result within 12 months of reporting to TAMC will be accepted in lieu of a two-step TST. In those areas where there is a higher risk of transmission of tuberculosis, contracted HCW(s) may be tested frequently as directed by the MTF policy. A single TST must be performed within 12 months of reporting to TAMC for personnel who have had two consecutive annual negative tests with the most recent test within one year of the new TST placement date OR who have documentation of a negative two-step TST within one year of the new TST placement date. In other circumstances, a two-step TST will be required within 3 months of reporting to TAMC. Positive TST results of 10mm or greater or a positive IGRA result will require results of chest x-ray screening performed on or after the date of the positive TST or IGRA as well as a medical provider assessment documenting absence of signs and symptoms of active TB disease. Chest x-rays completed outside of TAMC must be completed within 3 years of reporting to TAMC. Chest x-rays completed at TAMC must be completed within 5 years of reporting to TAMC.

Core Duties:

• Manage patient anesthesia experience, perform preoperative evaluations and preparations, administer monitored anesthesia care, regional and general anesthesia, monitor and manage patient reactions to anesthesia and surgery, manage fluid therapy, perform and manage invasive monitoring, and perform post-operative evaluations as privileged by the MTF Credentials Committee.
• Perform a pre-anesthetic assessment and evaluation of the patient. This includes obtaining an informed consent from the patient, requesting consultations and/or diagnostic studies and ordering pre-anesthetic medications.
• Develop and implement an anesthetic plan of care.
• Perform an assessment immediately prior to induction of anesthesia of the patient. This shall include a review of the medical record with regard to completeness, pertinent laboratory data, time of administration and dosage of pre-anesthesia medication, together with an appraisal of any changes in the patient's condition from that noted on previous visits. This note shall include any previous anesthetic experiences and complications thereof noted in the medical record.
• Maintain the patient's physiologic homeostasis and corrects abnormal responses to the anesthesia and/or surgery.
• Collect and interpret patient physiological data by selecting, applying or inserting noninvasive monitoring modalities.
• Manage the patient's airway and pulmonary status.
• Manage the patient's emergence and recovery from anesthesia by maintaining homeostasis, providing relief from pain and anesthesia side effects and preventing and managing complications through selecting, obtaining, ordering and administrating medications, fluids or ventilator support.
• Record all pertinent events taking place during the introduction of, maintenance of and emergence from anesthesia, including the dosage and duration of all anesthetic agents, other drugs, intravenous fluids and blood or blood components on all patients that have received anesthesia care.
• Record post-anesthetic visits, including at least one note describing the presence or absence of anesthesia related complications of the procedure.

HCW Duties : The duties for the HCW are as follows:

• Monitoring anesthesia care, management of patient anesthesia experience, and performing preoperative evaluations and preparations; administering Spinal, Epidural, Bier Block, Axillary Block, and other regional anesthesia, and general anesthetics; monitoring patient reactions to anesthesia and surgery, managing fluid therapy, and performing post- operative evaluations.
• Contract CRNAs routinely provide independent anesthesia care for American Society of Anesthesiologists (ASA) physical status classification 1 and 2 patients. They are responsible and accountable for determining when a physician (anesthesiologist, if available) will be consulted for the delivery of anesthesia care to ASA 1 and 2 patients. Consultation will be requested, as necessary, regardless of the patient's ASA classification. For patients in ASA physical status classification 3, 4, 5 or 6, CRNAs will collaborate with a physician (anesthesiologist, if available) or oral surgeon before induction of anesthesia. This collaboration may be face to face or by telephone.
• Advising anesthesiologist or attending physician of adverse reactions necessitating non- delegated medical decisions; takes appropriate actions as directed or required.
• Maintaining all required records. Using the composite health care system for keeping records, ordering of ancillary procedures, ordering of medications, entering orders, and performing other required patient record functions.
• Adhering to the Centers for Disease Control guidelines concerning universal precautions and the MTF infection control program at all times while providing services under this contract. Ensuring cleanliness and maintenance of anesthesia equipment.
• Indicating responsibility for the contents and correctness of all prepared reports/forms by affixing his/her signature to the documents and validating their contents.
• Attending professional staff conferences/meetings and other appropriate professional activities as requested by the Chief, Anesthesia Services. Meetings will be held during scheduled work hours.
• Complying with all safety requirements of the MTF and OSHA.
• May serve as adjunctive clinical instructors/faculty members in the Phase II U.S. Army Nurse Anesthesia Program.
• Prepare service reports and collect data.
• As a prerequisite to performance under this contract, all Certified Registered Nurse Anesthetist performing services must be privileged by the MTF Director. Compliance with the privileging requirements as stated in this contract is essential to performance under this contract. Any failure to meet these requirements is considered non- performance and the basis for termination for cause.