Male CRNA holding needle

What's the first thing you think about when you're asked to picture the job of a Certified Registered Nurse Anesthetist (CRNA)? Is it sitting in a chair for hours on end watching a patient sleeping? Maybe it's living it up, spending all the money made? There's actually a LOT more to know about a job as a CRNA. Keep reading to find out more about pursuing a career as a CRNA.

RELATED: CRNA Programs

1. CRNAs Work in a Lot of Different Environments

It's true that CRNAs work in surgery centers and large hospitals, but these days there are a lot of other environments where anesthesia occurs. According to the U.S. Bureau of Labor Statistics, the largest number of CRNAs (22,870 CRNAs) work in physicians' offices. Here are a few other places CRNAs work:

  • General medical and surgical hospitals
  • Outpatient care centers
  • Health practitioner offices (such as pain management/ketamine clinics)
  • Colleges, universities, and professional schools

In short, CRNAs practice in a variety of settings. Choosing this profession doesn't limit you -- it opens you up to possibilities.

2. CRNAs Provide Care to Lots of Different Patient Populations

When student nurse anesthetists train, they have the opportunity to do so in different practice disciplines. The job isn't just general anesthesia for adults. CRNAs also provide anesthesia for the following populations:

  • Regional anesthesia for those with chronic pain
  • Obstetrical anesthesia
  • Pediatric anesthesia
  • Cardiac anesthesia for bypass and valve replacements

Some CRNAs choose to focus on a specific practice, especially pediatrics, cardiac, or obstetrics. If a nurse has a specific interest in one of these disciplines, they can potentially continue these interests as a CRNA.

Nurse Anesthetists FAQs

Nurse Practitioners (NPs) and nurse anesthetists are similar in that they are both advanced-practice nurses. However, they do differ in terms of education, job duties/roles, and salary.

Both NPs and certified registered nurse anesthetists (CRNAs) start off in a master’s or doctorate program to earn their advanced-practice degree. After foundation courses are completed, students complete courses pertaining to their specialty “track”. For example, NP students focus on adult or pediatric primary or acute care, women’s health, psychiatry, etc., while the nurse anesthetist students begin a course of study on anesthesia concepts and research.

The roles and duties of an NP versus a nurse anesthetist are quite different.  While both must take a complete history and complete a full assessment, a nurse practitioner, depending on his or her role, is responsible for the care of the patient in either the acute or primary care setting. They may focus on preventive care, or care for the patient during an acute illness. Nurse anesthetists have a different, highly specialized role. They are responsible for administering anesthesia and sedation, monitoring the patient during a procedure, and inserting central lines and epidurals. They must be knowledgeable about the different types of anesthesia medications and be alert to any adverse reactions.

Because CRNAs are in high demand, it is not uncommon for hospitals to begin recruiting students. Depending on the state, some CRNA students can sign contracts while still in school, and employment is contingent on becoming licensed. In other states, licensing is required first.

Many hospitals offer employment contracts with CRNA students, advertising student loan reimbursement, benefits packages, etc. It’s a good idea to read these contracts closely. Sometimes students are dazzled by the loan reimbursement, but realize the pay or benefits aren’t that great. Also, sometimes a length of time of employment is outlined in the contract, and the new graduate decides a specific work area or organization is not a good fit for them - and they are stuck. There may be the possibility to “buy out” of a contract, but it would take time and money out of pocket to do so.

CRNA students should read any contract carefully, and possibly have an attorney advise. Identifying the positive and negative aspects of a contract is a must to determine what component is of most value to the individual. Additionally, CRNA students are strongly encouraged to check their state's board of nursing to see if licensing is needed before signing a contract.

Certified Registered Nurse Anesthetists (CRNAs) are advanced-practice nurses who are certified in administering anesthesia. Due to a widespread physician shortage, advanced-practice nurses are taking a more prominent role in healthcare delivery - including the field of anesthesiology.

While healthcare continuously progresses and evolves, there are still remnants of “old-school” hierarchies that exist between physicians and nurses and yes, male and female providers. Some physicians have difficulty coming to grips with a nurse practicing at an advanced level and performing the same work as medical doctors. Additionally, tensions run high during a surgical procedure. Everything must be precise and organized to allow for the best patient care outcome. The strain of this considerable responsibility often brings the worst out in people- and a hierarchical environment doesn't help matters.

In healthcare, new practitioners sometimes must “prove themselves” to experienced staff to earn respect. There are many anecdotes of nurses and APRNs verbally biting back when they are snapped at by a physician, and the hostility stops. However, it's not acceptable for any verbal abuse or harassment to occur in any setting, including the operating room. It doesn't matter if the culture is "old-school" or not. If discussing the issue directly with the surgeon doesn't end the behavior, it should be reported immediately to a supervisor.

3. "Blame Anesthesia!"

A common misconception when working in the ICU is that CRNAs can do no wrong and there's no arguing with them. Surprise! There are LOTS of people that disagree with CRNAs in their daily job. There's a saying known as "Blame Anesthesia" in the operating room environment.

CRNAs make decisions involving what surgical patients can have surgery that day. CRNAs reschedule surgery due to inappropriate NPO times, or out of medical concerns for patients. Canceling surgeries can quickly make the CRNA a very unpopular person.

Another reason CRNAs take the blame sometimes is because pre-anesthesia procedures take longer than expected. Putting in an arterial line, placing a central line, or inserting an epidural can take longer than expected. This then results in surgery delays that affect the staff and surgeon's timing.

This is why training and professionalism are so important in a CRNAs practice. The amount of education helps keep patients safe and provides a wealth of knowledge to explain concerns.

4. Many CRNAs Have Their Own Independent Practice

If you're a nurse with an entrepreneurial spirit, you may be surprised to learn there are many CRNAs that feel the same. Across the country, there are CRNAs that own their own practices that provide anesthesia services to hospitals, office-based practices, surgery centers, and more.

Some CRNAs use their business to pursue locum tenens jobs -- what most CRNAs call "locums" for short. This is when a CRNA accepts a temporary assignment at a hospital or practice. Many CRNAs love to participate in assignments like this because it provides them opportunities to travel the country and see how anesthesia is practiced in different settings.

Other CRNAs use their businesses to achieve their dream of entrepreneurship and working for themselves while doing a job they love. This path isn't for everyone, but it IS an option for those who are interested in it.

5. CRNAs Have Been Practicing Since the 1800s

The nurse anesthesia practice has its roots in the Civil War when nurses provided anesthesia to wounded soldiers on the battlefield. In 1877, Sister Mary Bernard became the first nurse to specialize in anesthesia at St. Vincent's hospital in Erie, Pennsylvania. Anesthesia has come a long way since this time (no more ether), but nurse anesthetists have been there every step of the way.

In the 100+ years since the idea of a nurse anesthetist began, CRNAs have grown to provide anesthesia in nearly every medical practice setting type. They also are often the sole providers of anesthesia in rural hospitals and for men and women in the U.S. Armed Forces, according to the American Association of Nurse Anesthetists.

Currently, CRNAs have been on the front lines of the COVID-19 pandemic and will continue to find new ways to serve the patients who need them.

Janine Kelbach, RNC-OB

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