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Certified Registered Nurse Anesthetist Technical Standards

ADA Guidelines
Definitions
Title III of the Americans with Disabilities Act provides comprehensive civil rights protections for “qualified individuals with disabilities.” An “individual with a disability” is a person who:

  • has a physical or mental impairment that substantially limits a “major life activity,” or
  • has a record of such an impairment, or
  • is regarded as having such an impairment.

The ADA Handbook published by the Equal Employment Opportunity Commission and the Department of Justice states: “examples of physical or mental impairments include, but are no limited to, such contagious and non-contagious diseases and conditions as orthopedic, visual, speech, and hearing impairments; cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, mental retardation, emotional illness, specific learning disabilities, HIV disease (whether symptomatic or asymptomatic), tuberculosis, drug addiction, and alcoholism. Homosexuality and bisexuality are not physical or mental impairments under the ADA.”

“Major life activities” include functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. Individuals who currently engage in the illegal use of drugs are not protected by the ADA when an action is taken on the basis of the recurrent illegal use of drugs.

“Qualified” individuals are defined as follows:

  • A “qualified” individual with a disability is one who meets the essential eligibility requirements for the program or activity offered.
  • The “essential eligibility requirements” will depend on the type of service or activity involved.

The stated mission of the nurse anesthesia program at Samuel Merritt University is to educate and prepare certified registered nurse anesthetists (CRNAs) who can safely perform the full scope of anesthesia-related clinical practice: a) pre-anesthetic preparation and evaluation, b) anesthesia induction, maintenance and emergence, c) post-anesthesia care, and d) peri-anesthetic and clinical support functions. Potential nurse anesthetists are expected to complete all the academic and clinical requirements of an accredited nurse anesthesia program before they are eligible to take the national exam for certification as a nurse anesthetist. The purpose of this document is to delineate the cognitive, affective and psychomotor skills deemed essential to the completion of this program and to perform as a competent certified registered nurse anesthetist. If a student cannot demonstrate the following skills and abilities, it is the responsibility of the student to request an appropriate accommodation. The University will provide reasonable accommodation as long as it does not fundamentally alter the nature of the program offered and does not impose an undue hardship such as those that cause a significant expense, difficulty or are unduly disruptive to the educational process.

Cognitive Learning Skills
The student must demonstrate the ability to:

  1. Assimilate and learn large volumes of complex, technically detailed information to perform clinical problem solving. To synthesize and apply concepts and information from different health professional disciplines in formulating diagnostic and therapeutic judgments.
  2. Learn and perform common diagnostic procedures, e.g., laboratory, cardiographic, radiologic, and to interpret the results, recognizing deviations from the norm and identifying pathophysiologic processes.
  3. Perform physical assessments of the surgical patient during all peri-operative phases and make sound, timely, evidence-based decisions regarding appropriate courses of action/treatment.
  4. Troubleshoot mechanical problems with complex patient monitors, anesthesia machines and adjunct equipment.
  5. Apply critical thinking and problem solving methods that results in independent decision making skills.
  6. Differentiate and prioritize among multiple, simultaneous problems occurring in one patient within the dynamic context of a surgical, obstetric, medical therapeutic, or interventional radiology procedure.
  7. Record examination and diagnostic results clearly, accurately, and efficiently and to communicate them effectively to the patient and colleagues.
  8. Apply quantitative methods of measurement, including calculation, analysis, reasoning and synthesis.
  9. Comprehend three dimensional relationships and to understand the spatial relationship of structures.

Psychomotor Skills

The student must demonstrate the ability to:

  1. Sitting: Maintain an upright posture.
  2. Standing: Maintain upright posture
  3. Locomotion: Ability to:
    1. Get to lecture, lab and clinical locations, and move within rooms as needed for changing groups, partners and work stations, and perform assigned clinical tasks;
    2. Physically maneuver in required clinical settings, to accomplish assigned tasks.
    3. Rapidly get to locations within hospitals that may have limited access and space (e.g., responding to calls for emergency airway management during “code blue” situations, or “Code C” in the obstetric suite)
  4. Manual tasks:
    1. Maneuver or move an individual's body parts or clinical equipment from side to side, forward and backward, or from a lower to higher position.
    2. Maintain an object in a constant position for an extended period.
    3. Connect a variety of types of tubing via adapters, sometimes in complex configurations
    4. Competently perform cardiopulmonary resuscitation (CPR) and all ACLS protocols using guidelines issued by the American Heart Association or the American Red Cross.
    5. Pushing/pulling ability to exert force against a small or large object to move it closer or further away.
  5. Reaching:
    1. Ability to extend arm(s) over and under individuals and equipment as required by each clinical setting.
  6. Small motor/hand skills:
    1. Legibly record/document evaluations, patient care notes, referrals, etc. in standard medical charts in hospital/clinical settings in a timely manner and consistent with the acceptable norms of clinical settings.
    2. Legibly record thoughts for written assignments and tests.
    3. Document communications in written form in charts, compose reports and correspondence.
    4. Apply a firm grasp, as well as a flexible grasp (e.g., threading catheters over guidewires, endotracheal tubes over stylets or tube exchangers)
    5. Operate a push-button telephone and a computer keyboard (for automated record keeping, and retrieval of patient information from a computer terminal)
    6. Perform precision movements, i.e., venipuncture, arterial puncture, peripheral and central intravenous line placement, IV regulation, use of an array of airway management equipment, fiberoptic intubating scope, administration of subarachnoid blocks, epidural catheters, peripheral nerve blocks).
    7. Elicit data from patients via palpation, auscultation, and percussion.
    8. Manipulate a blood pressure cuff, stethoscope, insert NG tubes; perform injections and adjust IV drips or other equipment as required.
  7. Visual acuity to:
    1. Legibly record/document evaluations, anesthesia care notes in standard anesthesia records in hospital settings in a timely manner and consistent with the acceptable norms of clinical settings.
    2. Perform the precision movements delineated in number 6.
    3. Identify tiny markings and inscriptions (i.e., on syringes, thermometers, IV bags, etc.).
    4. Identify color changes and coding systems.
    5. Identify waveforms and digital readouts from monitors
  8. Hearing or ability to receive and:
    1. Effectively respond to verbal requests from patients and team members, especially in noisy operating rooms
    2. Interpret the language used to communicate lectures, instructions, concepts, narratives, questions and answers.
    3. Auscultate and percuss for internal body sounds, e.g., heart, bowel, lungs.
    4. Respond in a timely manner to a variety of machine alarms, and changes in sounds from monitoring equipment (e.g. esophageal/precordial stethoscope, pulse oximeter)
  9. Communication ability:
    1. Effectively and sensitively communicate with team members in both verbal and written formats and in an effective, efficient and appropriate manner.
    2. Should be able to speak, to hear, and to observe patients in order to elicit information, perceive non-verbal communication, and describe changes in mood, activity, posture, color, and physical presence
    3. Communicate on the spot to other students, teachers, patients, peers, other staff and personnel to ask questions, and explain conditions and procedures within a reasonable time period.
  10. Self Care ability to:
    a.  Maintain general good health and self-care in order not to jeopardize the health and safety of self and individuals with whom one interacts in the
         academic and clinical settings.
    b. Arrange transportation and living accommodations for/during off-campus clinical assignments to foster timely reporting to the classroom and
        clinical center.

 

Affective learning skills
The student must be able to:

  1. Maintain composure and emotional stability during periods of high acute stress as well as periods of chronic stress.
  2. Possess and maintain the emotional health required for the full utilization of his/her intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients, and the development of mature, sensitive and effective relationships with patients.
  3. Tolerate physically and intellectually demanding workloads (averaging 50 - 60 hours/week).
  4. Adapt to constantly changing environments, display flexibility, and learn to function in the face of uncertainty or ambiguity.
  5. Demonstrate the personal qualities of compassion, integrity, concern for others, openmindedness, self-discipline, focus, and self-motivation.