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Certified Registered Nurse Anesthetist (CRNA)

Tripler Army Medical Center, Hawaii

Place of Performance: 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: The performance hours of the MTF are as follows:

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 provide 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.

Scheduling: The schedule or scheduling process is as follows:

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.

Registered Nurse, Emergency Department Registered Nurse, Neonatal Intensive Care Unit Registered Nurse and Certified Registered Nurse Anesthetist may be authorized to work overtime.

Closures: During a planned closure of the facility due to training, holiday or unplanned closure due to unusual and compelling circumstances (e.g., natural disasters, military emergencies, severe weather), the Contractor will only be compensated for the actual hours the HCW provided services.

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

New Year's Day, January 1st; Martin Luther King's Birthday, 3rd Monday in January; President's Day, 3rd Monday in February; Memorial Day, Last Monday in May; Juneteenth, June 19th; Independence Day, July 4th; Labor Day, 1st Monday in September; Columbus Day, 2nd Monday in October; Veteran's Day, November 11th; Thanksgiving Day, 4th Thursday in November; Christmas Day, December 25th.

Computer Skill Competency: 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.

MTF Training: Additional training requirements are as follows:

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.

MTF Standards: Specific policies, procedures, and instructions/regulations for the place of performance are as follows:

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.

HCW Health Requirements: 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.

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

Tuberculosis Screening: The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows:

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.

Qualifications

• Degree/Education: Degree: Master's degree in nursing.
• Education: Graduate from an approved anesthesia program accredited by the Council on Accreditation of Nurse Anesthetist Education Program Schools or its predecessors.
• Certification: Certified as a Registered Nurse Anesthetist from the American Association of Nurse Anesthetists (AANA) or the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).Be certified every 4 years by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

• Possess and Maintain current Basic Life Support (BLS),Advanced Cardiovascular Life Support (ACLS) and one of the following pediatric certifications: Neonatal Resuscitation Program (NRP) or Pediatric Advanced Life Support (PALS). Online certification is unacceptable.
• Experience: Certified Registered Nurse Anesthetist (CRNA) - minimum three years of experience as a licensed, board certified CRNA with continuous experience during the last (12) months. Have current experience (1 year or more in the past 3 years) providing epidural anesthesia (labor epidurals). Have experience in the delivery of and monitoring of all types of anesthesia utilized in the delivery of obstetrical and surgical anesthesia (general endotracheal, subarachnoid block and epidural, and IV regional techniques).
• Licensure/Registration: Have and maintain a valid, unencumbered state license, with no limitations, stipulations, or pending adverse action, in any state in the United States, District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands.