The chief nurse anesthetist leads a team of nurses tasked with administering sedation to pediatric and adult patients undergoing a surgical procedure. She works under the direct supervision of an anesthesiologist and must also ensure her nursing staff is up to date on training and well-versed in medical protocol and procedures. A nurse anesthetist must complete her education through the master's level, though some continue on to receive a doctorate in the field. The chief, or supervisory, nurse anesthetist must also ensure her staff is in strict compliance with hospital, state and national regulations.
Duties Prior to Surgery
The nurse anesthetist must review the patient's medical history prior to administering anesthesia to determine whether the patient has certain allergies or adverse reactions to sedation. This includes review of diagnostic tests and physical examinations. The nurse must order the anesthesia in the correct dosage and obtain informed consent from the patient, which typically requires a discussion of the risks and benefits associated with sedation during surgery. Immediately prior to administration, the nurse must check the patient's airway for obstruction or abnormality as well as ensure all monitoring devices are operational.
Administration of Anesthesia
To administer general anesthesia, the nurse must begin an intravenous line in the patient's arm in which the sedation drugs will flow directly into the blood stream. If a patient experiences anxiety over the notion of sedation, the nurse is responsible for helping the patient relax prior to the procedure. The nurse must explain the anesthesia process as it is happening as well as monitor the patient's immediate response to the drugs and issue additional drugs as necessary to counterbalance any adverse or unexpected reaction.
Monitoring of Patient During Surgery
The nurse anesthetist must remain present during the entire surgical procedure. She must monitor the patient's airway flow to ensure it is not restricted. She must also keep doctors and other nurses informed as to the patient's progress during the procedure. The nurse anesthetist must closely monitor the patient's breathing patterns to ensure the patient is breathing at an appropriate rate given the amount of sedation administered. In addition, the nurse must document the amount and type of anesthesia used in accordance with state law or hospital policy.
A successful transition out of sedation is the nurse anesthetist's primary concern, and she will monitor the patient's vital signs immediately following surgery until the patient is alert and awake. If the patient demonstrates difficulty regaining consciousness, the nurse must immediately communicate this information with the anesthesiologist or surgeon working with the patient. If the patient has regained consciousness but appears to be in a state of delirium, the nurse must initiate safeguards to ensure the patient does not injure herself, as well as communicate these concerns with the medical team and the patient's family. Post-operative delirium is most common in patients with pre-existing cognitive impairments such as dementia or mental retardation.
As the chief of the nurse anesthetist team, the lead nurse is responsible for employee oversight. She is involved in the hiring and termination of employees, including non-supervisory nurse anesthetists and nurse practitioners. The chief nurse is in constant communication with her supervising anesthesiologist regarding compliance with government regulations and recording practices, as well as any issues concerning employees and staff. The chief nurse may also participate in community events on behalf of the hospital or physician's office to enhance community relations.
- Stanford Hospital: Nurse Anesthetist Job Description
- Virginia Commonwealth University: Doctor of Nurse Anesthesia Practice: Objectives
- Bureau of Labor Statistics: Nurse Anesthetists
- Society of Gastroenterology Nurses and Associates: Non-anesthesiologist Administered Propofol
- Richard E. Powers, MD: Practical Management of the Delirious Patient with Mental Retardation by the Nurse Anesthetist
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