Certified Registered Nurse Anesthetist

Position Summary

The Certified Registered Nurse Anesthetist (CRNA) provides safe, efficient, high-quality anesthesia care to patients having outpatient orthopedic procedures at Capital Orthopaedic Surgery Center and District Surgery Center, a Maryland-licensed freestanding ambulatory surgical facility. Cases include arthroscopy, sports medicine, hand and upper extremity, foot and ankle, spine, and outpatient total joint replacement. The CRNA practices in collaboration with an anesthesiologist under Maryland Board of Nursing regulations and works as part of an anesthesia care team with surgeons, nursing staff, and center leadership in a fast-paced, high-throughput setting.

Essential Duties and Responsibilities

Clinical Care

• Perform pre-anesthesia assessments, including review of medical history, labs, and diagnostics, and communicate findings and concerns to the collaborating anesthesiologist.
• Develop and carry out anesthesia care plans in collaboration with the anesthesiologist, including general anesthesia, monitored anesthesia care (MAC), and sedation, and assist with or perform regional and neuraxial techniques as privileged.
• Manage airways, including endotracheal intubation and supraglottic airway placement.
• Prepare, check, and maintain anesthesia machines, monitors, airway equipment, and emergency supplies before each case.
• Monitor patients continuously during procedures, and manage hemodynamic, airway, and other intraoperative events, escalating to the anesthesiologist as appropriate.
• Support multimodal and opioid-sparing analgesia protocols and enhanced recovery after surgery (ERAS) pathways for total joint and other orthopedic cases.
• Give handoff reports to PACU nursing staff, and help manage postoperative pain, nausea, and complications.
• Respond to emergencies, including malignant hyperthermia, local anesthetic systemic toxicity (LAST), airway emergencies, and cardiac events, and take part in patient transfers when needed.

Collaboration

• Practice in collaboration with a designated anesthesiologist, licensed physician, or dentist, as required by COMAR 10.27.06, and maintain a current collaboration agreement on file with the Maryland Board of Nursing for [Center Name].
• Work within the anesthesia care team model and center policies on anesthesiologist medical direction.
• Exercise independent professional judgment, including the right and obligation to decline a delegated act that is outside scope or unsafe for the patient, and escalate concerns through the appropriate channels.
• Work with surgeons and perioperative staff to keep schedules on time, reduce delays, and maximize OR efficiency.
• Communicate clearly with patients and families about anesthesia care and recovery expectations.

Quality, Safety, and Compliance

• Take part in the center's quality assurance and performance improvement program, peer review, and infection control activities.
• Support readiness for Maryland Office of Health Care Quality (OHCQ) licensure and complaint surveys, CMS surveys, and accreditation surveys (AAAHC).
• Maintain complete, accurate, and timely anesthesia records in the electronic health record.
• Follow all federal and Maryland requirements for controlled dangerous substance (CDS) handling, storage, documentation, count reconciliation, and waste.
• Help review anesthesia policies, protocols, and equipment standards.

Administrative

• Take part in staff meetings, in-services, and committees as requested.
• Support accurate anesthesia billing documentation, including start and stop times and medical direction documentation.
• Maintain credentialing and clinical privileges at the center.

Qualifications

Required

• Graduate of a nurse anesthesia program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), with a master's or doctoral degree (DNP or DNAP)
• Current certification (or recertification) by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
• Current, unrestricted Maryland RN license or multistate (compact) RN license
• Current certification by the Maryland Board of Nursing to practice as a nurse anesthetist
• Collaboration agreement filed with the Maryland Board of Nursing naming a collaborating anesthesiologist or physician for Capital Orthopaedic Surgery Center and District Surgery Center.
• Current ACLS, BLS, and PALS certification
• Maryland CDS registration and DEA registration (Preferred, not required)
• Ability to obtain and maintain clinical privileges at Capital Orthopaedic Surgery Center and District Surgery Center

Nurse Anesthetist Graduates (if considered)

• Recent graduates awaiting NBCRNA certification may be considered with Maryland Board of Nursing approval to practice as a nurse anesthetist graduate. Graduates must practice under the supervision of an anesthesiologist or CRNA who is on site and immediately available until certified.

Preferred

• One or more years of CRNA experience in an ambulatory surgery center or high-volume outpatient orthopedic setting
• Experience with ultrasound-guided peripheral nerve blocks
• Experience with outpatient total joint replacement and ERAS protocols
• Experience in an anesthesia care team model

Knowledge, Skills, and Abilities

• Sound clinical judgment in managing outpatient anesthesia, including patients with obstructive sleep apnea, obesity, and cardiovascular disease
• Efficient, organized workflow suited to a quick-turnover environment
• Excellent communication and teamwork skills with anesthesiologists, surgeons, nurses, and patients
• A commitment to patient safety, a positive patient experience, and a team-based culture
• Comfort with electronic health records and anesthesia information systems

Physical Requirements and Working Conditions

• Ability to stand for long periods, and to bend, reach, and assist with patient positioning and transfers
• Ability to lift and move up to [50] pounds with assistance
• Manual dexterity and visual acuity to perform airway management and invasive procedures and operate monitoring equipment
• Possible exposure to bloodborne pathogens, anesthetic gases, radiation (fluoroscopy), and hazardous materials; appropriate PPE required
• Typical schedule is weekday daytime hours with no overnight call; occasional early starts or late cases depending on the surgical schedule