The Advanced Practice Nurse is responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. Assesses, plans, implements and evaluates care based on age-specific components. Assumes responsibility for the coordination of care focused on patient transition through the continuum of care, patient and family education, and supporting factors that impact customer satisfaction. The Advance Practice Nurse: 1) Establishes a medical diagnosis based on comprehensive assessment 2) Makes advanced clinical decisions 3) Uses prescriptive authority, procedures, referrals, treatments and therapies in accordance with state and federal and laws and regulations 4) Is credentialed as a provider in accordance with the regulations of the VA system 5) provides leadership in coordination of multidisciplinary health care for an integrated delivery of care of the veteran, 6) facilitates/coordinates use of systems/community resources to implement and enhance care across the continuum 7) Analyzes outcomes (related to organizational care delivery and populations served) to make recommendations for improvements in care delivery systems across the care settings 8) Conducts, critically appraises or synthesizes research that discovers, examines and evaluates knowledge, theories, criteria and creative approaches to improve health care practices 9) Provides leadership in developing care models to manage chronic care issues 10) Develops and implements education programs for veterans, staff and other health care providers. Duties and responsibilities include, but not limited to: 1. Preanesthetic Evaluation - Obtain an appropriate health history. - Conduct an appropriate physical exam. - Request pertinent diagnostic studies. - Select, obtain, order and administer preanesthetic medications. - Obtain informed consent for anesthesia, anesthesia induction, maintenance, and emergence. - Document informed consent along with preanesthetic evaluation in the Hines VAH electronic records system. 2. Preoperative and Intraoperative Care, including Operating Rooms and Out of Operating Room Procedures - Obtain, prepare and use all equipment, monitors, supplies and drugs for the administration of anesthesia, performing and ordering safety checks, as needed. - Select, obtain, or administrate the anesthetics (General, MAC, Regional), adjuvant drugs, accessory drugs, fluids and blood products as necessary to manage the anesthetic. - Perform all aspects of airway management. - Perform BLS/ACLS management. - Insert peripheral and central venous catheters. - Insert arterial catheters and performing arterial punctures to obtain arterial blood samples. - Insert pulmonary artery catheters. - Perform and manage regional anesthesia techniques including, but not limited to subarachnoid, epidural, major and peripheral nerve blocks, intravenous regional anesthesia, trans-tracheal, topical, local infiltration blocks, and bilateral superior laryngeal nerve blocks. - Provide appropriate invasive and non-invasion monitoring modalities utilizing current standards and techniques. - Recognize abnormal patient responses during anesthesia, selecting and implementing appropriate corrective action and requesting consultation from the assigned supervising attending anesthesiologist, as needed. - Evaluate patient response during emergence from anesthesia and instituting pharmacological or supportive treatment to insure patient stability during transfer. 3. Postoperative Care - Provide post anesthesia follow-up and evaluation of the patient's response to anesthesia and surgical experience and notifying the attending anesthesiologist, as needed. - Deliver a full report to the recovery room nurse. - Select and prescribing medication, and writing postoperative orders related to the care of the patient as necessary, in consultation with the attending anesthesiologist. - Initiate and administer respiratory support to ensure adequate ventilation and oxygenation in the post-anesthesia period. - Initiate and administer pharmacological or fluid support of the cardiovascular system during the post anesthetic period to prevent morbidity and mortality, in collaboration with the attending anesthesiologist. Additional responsibilities which are within the expertise of the individual CRNA and are appropriate and relevant to the practice setting as determined by the Chief of Anesthesia, Chief CRNA, or the Clinical Director Attending Anesthesiologist. These duties include, but are not limited to the following: a. Covering all the Intensive Care Units/Wards for emergency intubations; offsite, emergency and scheduled cardioversions; off site, emergency and scheduled ERCPs; offsite epidural pain management; preoperative or postoperative visits on the wards are required to support proper level of functioning for the OR schedule, and the needs of the Hines VA Department of Anesthesia b. CRNA schedule will be determined by the needs of the Hines VAH Department of Anesthesia d. The call schedule will be made and reflect the needs of the Hines VAH Department of Anesthesia e. CRNAs will also actively participate in the QA process at Hines VA Hospital as mandated by the VA, JCHO, or any other regulatory agency Work Schedule: Monday thru Friday, 7:00 am to 3:30 PM Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.