Nurse Anesthetist (CRNA)
A certified registered nurse anesthetist (CRNA) is an advanced-practice nurse who is certified in anesthesia. According to the American Association of Nurse Anesthetists (AANA), nurses first gave anesthesia to wounded soldiers during the Civil War. Today, nurse anesthetists work in a variety of settings such as:
- Operating rooms
- Obstetric care
- Outpatient surgery centers
- Plastic surgery centers
- Dental offices
- Pain management centers
- Public Health centers
The difference between certified registered nurse anesthetists and anesthesiologists is that CRNAs are graduate degree-level nurses, and anesthesiologists are medical doctors. In many states, CRNAs can practice without physician supervision. According to the AANA, when anesthesia is administered by a certified nurse anesthetist, it is considered nursing practice. If administered by an anesthesiologist, it is considered practicing medicine. However, anesthesia is administered the same way by both professionals.
Why Are Certified Registered Nurse Anesthetists So Important?
Certified registered nurse anesthetists are a valuable member of the health care team. Not only do they work in busy hospitals in metropolitan areas, but they can also serve as primary anesthesia providers in rural and underserved communities. Their presence in these communities allows for improved access to treatments while providing competent, quality care.
Nurse anesthetists also help reduce health care costs. Since they do not always require physician supervision, depending on the state in which they practice, they are sometimes the only anesthesia provider available. Organizations compensate CRNAs less than anesthesiologists, which reduces the cost to the organization as well as insurers, thereby reducing the cost to the patients.
Certified registered nurse anesthetists start off as registered nurses. A significant role of the RN is to provide education. CRNAs thoroughly educate patients and families about specific anesthesia and treatments, to include side effects and recovery. Comprehensive education can enhance recovery and lead to higher patient satisfaction.
Nurses interested in becoming a nurse anesthetist should value autonomy and independence. They should be able to:
- Pay close attention to detail
- Work well under pressure
- Work collaboratively with different personality types
- Be flexible, and adapt to changing situations
- Prioritize responsibilities
What Are the Education Requirements for Nurse Anesthetists?
CRNAs are advanced-practice registered nurses who have completed a Master's of Science in Nursing (MSN) or doctoral degree program (DNP). Currently, the AANA plans to require all CRNA programs to change from MSN to DNP programs by 2025.
To advance to a master's degree, a student must first complete an accredited nursing program and obtain a bachelor's degree in nursing (BSN). Successful completion of the NCLEX-RN is needed for licensure. The length of time it takes to earn an MSN depends on the nurse's starting point:
- Nursing students enrolled in a BSN program complete in about four years
- RN to BSN takes about two years
- BSN to MSN takes about two years
- BSN to DNP takes three to four years
- MSN to DNP takes one to two years
Additionally, both online programs and classroom programs are available to accommodate students. Both types have pros and cons depending on students' needs, therefore researching individual schools is encouraged.
Some graduate programs require nurses to gain a few years' clinical experience before enrollment, and some allow nurses to work concurrently during the program. Regardless, one of the requirements for nurse anesthetists is to obtain at least one year of full-time employment (or part-time equivalent) as an RN in a critical care setting.
Master's degree programs require completion of general advanced-practice courses, as well as courses specific to the nurse anesthetist track. General advanced-practice courses include concepts such as:
- Health promotion and maintenance
- Advanced pathophysiology
- Pharmacology for advanced practice nurses
Depending on the school, the curriculum for CRNAs can vary slightly, but core concepts include:
- Advanced pathophysiology in anesthesia
- Advanced health assessment for nurse anesthesia
- Principles of anesthesia
- Clinical anesthesia
Are Any Certifications or Credentials Needed?
After graduating from an advanced-degree program, nurses can become credentialed as CRNAs. The National Board of Certification & Recertification of Nurse Anesthetists (NBCRNA) offers certification by examination. The exam is of variable length and designed to ensure the competency of entry-level CRNAs. The NBCRNA provides a handbook outlining detailed eligibility requirements to take the exam. General requirements include:
- Hold an active, unrestricted RN license
- Hold a graduate degree from an accredited nurse anesthetist program
- Submit a record of academic and clinical experience which must:
- Be submitted by the nurse anesthesia educational program administrator
- Be signed by both the administrator and candidate
- Accurately show the minimum requirements have been met
Licensure and certification are different-certification means the CRNA is competent to deliver anesthesia in a health care setting; licensure means they are legally permitted to practice in their state of residence. State nursing boards list the requirements for testing and can vary from state to state. The CRNA can, after meeting the specified requirements, apply to the state board for licensure.
Certified registered nurse anesthetist is a specialty in and of itself. There is no further delineation in practice per se, other than focus areas. For example, there is no specific "Pediatric Certified Registered Nurse Anesthetist" or "Obstetric Certified Registered Nurse Anesthetist" and so on. However, CRNAs can complete clinical rotations in various care areas to gain skills. For example, they may work in:
- Children's hospitals
- Obstetric/ labor and delivery units
- Cardiothoracic care areas
Post-graduate CRNAs can also participate in accredited fellowship programs that focus on certain populations, for example:
- Trauma/critical care
- Acute surgical pain management
- Advanced pain management
The NBCRNA offers a voluntary sub specialty certification in nonsurgical pain management. CRNAs who obtain certification are competent in neural or neuraxial blocks, alternative techniques for management of acute and chronic pain (pharmacologic and non-pharmacologic). Criteria for examination include:
- Unrestricted RN/APRN license
- Current CRNA certification
- At least two years of nurse anesthetist clinical experience
- Attestation of being actively engaged in nurse anesthesia practice
- Evidence of completion of education in specific pain management areas
- Provide three letters of support from colleagues who have observed the practitioner's techniques
- Successful completion of a simulation course
- Successful completion of the certification exam
Nurse anesthetists have a vital role in the delivery of anesthesia. Medications used for anesthesia can be risky. CRNAs must use their nursing skills and knowledge of the medications to maintain patient safety as well as achieve the desired effect of the drug. Specific duties may include:
- Performing a physical assessment
- Taking a patient history
- Educating patients and families on the anesthetics used: the desired effect, common side effects, and potential adverse reactions
- Obtaining informed consent before procedures
- Administering the anesthetic, which may be:
- Monitoring patients during administration to include:
- Cardiovascular status (including fluid balance)
- Neuromuscular status
- Utilizing adjunctive medications, fluids, and other treatments to maintain cardiorespiratory status and fluid balance if needed
- Maintaining/managing patients' airways using intubation, mechanical ventilation, and pharmacological support
- Inserting peripheral or central lines
- Inserting epidurals for obstetric patients
- Recovering patients from anesthesia
What Are the Roles and Duties of a Nurse Anesthetist?
The overall responsibilities of CRNAs include:
- Developing, implementing, and evaluating an anesthetic plan of care
- Recognizing emergent situations and responding rapidly and appropriately
- Implementing and evaluating response to chronic/acute pain management techniques
- Discharging patients and educating them on follow up anesthesia care
- Acting as a liaison between various departments, such as:
- Post-anesthesia care units
- Intensive care units
- Collaborating with physician regarding treatment plans and anesthesia efficacy
- Maintaining patient safety during treatment
- Following strict infection control policies and procedures
Nurse Anesthetist Working Conditions
The working conditions of CRNAs have positive and negative aspects. There can be a significant amount of stress involved. For example, patients who suffer from chronic pain and who fail to respond to treatments can be emotionally draining to providers. Patients who experience an unexpected adverse reaction to anesthesia can also cause stress. Certified nurse anesthetists must "expect the unexpected" and be able to act quickly. The constant requirement to be on guard can be draining.
However, CRNAs have a rewarding job. They can relieve a patient's pain. Pain relief may seem like it's easily achieved, but for many suffering from chronic pain, that is not always the case. Nurse anesthetists can help patients go from a poor quality of life to living life to the fullest. They help new mothers experience childbirth without being distracted by the pain. They help patients through sometimes life-saving surgeries.
CRNAs may work in high-risk areas that may expose them to workplace violence, blood borne pathogens, and chemicals. Safety precautions and policies and procedures must be followed to maintain the health and safety of the CRNA as well as patients. Additionally, CRNAs sometimes spend a lot of time on their feet, assisting during long surgeries or procedures.
As far as work hours, CRNAs can work in various settings, many times in acute care. Hours vary but may require night, weekend, holiday, and on-call shifts.
Nurse anesthetists have had a long, robust history that has evolved into a highly respected and in-demand career. They are commonly the only anesthesia providers in less populated communities, which leads to higher access to care and therefore, improved patient outcomes.
Certified registered nurse anesthetists are one of the highest paid advanced-practice nurses. According to Payscale, salary can range from $96,175 to 184,547. The median salary is $139,838 per year. The top-paying states for CRNAs are:
Salary is dependent on city and state of residence, years of experience, and the organization of employment
According to the Bureau of Labor Statistics, the projected employment of CRNAs is expected to grow 19% by 2024, which is a faster-than-average growth. Currently, the states with the highest level of employment for CRNAs are:
- North Carolina