Certified registered nurse anesthetists (CRNA) are the highest paid nurses in the United States and the demand for CRNAs is predicted to grow considerably over the next decade. CRNA is the oldest nurse specialty in the US and CRNAs became the first advanced practice nurses (APRN) to gain recognition to practice autonomously.
The road to qualifying as a CRNA is, however, a long and tough one – it takes a minimum of seven years of experience and education after obtaining a baccalaureate degree in nursing.
What is a Certified Registered Nurse Anesthetist (CRNA)?
Certified Registered Nurse Anesthetists administer anesthetics for all types of surgery and various other procedures. They are advanced practice nurses prepared at masters or doctoral level and then certified by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) after having passed the examination.
CRNAs are employed in many different healthcare settings, doing the same work as physician anesthesiologists. More than two-thirds of the hospitals in the US use CRNAs, and in rural and other medically underserved areas they are often the only anesthesia providers. In the US Armed Forces, they are the primary providers of anesthesia, including in combat zones since World War I. This may be one of the reasons why more than 40% of nurse anesthetists are men, a considerably higher percentage than the 10% for the profession as a whole.
Nurses were first used to provide anesthesia during the American Civil War. In the earliest hospitals established by religious orders, the sisters were often trained to administer anesthesia. One of them, Agnes Magaw, became highly skilled and was given the title of the “Mother of Anesthesia.”
The first formal education for nurse anesthetists started in 1909, and the American Association of Nurse Anesthetists (AANA) first introduced a certification program in 1945, with 92 candidates taking the examination. Certification became a compulsory requirement in 1978. The AANA was also responsible for organizing a mechanism for accrediting educational programs for nurse anesthesia in 1952.
For many decades the development of the specialty was not without its problems. There were some lawsuits filed by members of the medical fraternity, who were concerned about the competition from nurses. The most significant of these was a case filed in 1934 which eventually went all the way to the California Supreme Court. The court ruled against the medical board, setting a legal precedent for nurses to practice anesthesia.
Today CRNAs are recognized in all 50 states of the US. In most of these states, they work independently and qualify for direct Medicare payments.
What Does a Nurse Anesthetist Do?
During a typical day, the nurse anesthetist will first check on the list of patients for the day and ensure that the equipment and drugs are ready and in order. The next step is to meet with and assess the first patient before developing the anesthesia plan, keeping in mind any potential complications. The assessment includes an interview, examination, and review of all the patient’s medical documents. Further consultations and diagnostic studies might be ordered.
The patient is then accompanied to the operating room where the anesthetist is responsible for administering either general, regional (for example epidural blocks) or local anesthesia. Some procedures, such as cardiac catheterization, require sedation and monitoring only. Throughout the procedure the anesthetist monitors the patient’s vital signs; maintains their airway and physiological balance, and decides what medications the patient needs as the intervention progresses.
Once the procedure is completed, the anesthetist allows the patient to emerge from the anesthesia – the goal being for the patient to recover as soon as possible, peacefully, and with a minimum of pain and other side effects. The anesthetist accompanies the patient to the postoperative recovery area, completes a final evaluation, prescribes further medication as needed – particularly pain medication, and then hands the patient over to the recovery room nurse. Additional follow-up may be needed in the event of complications.
Nurse anesthetists working in hospitals are also frequently part of the teams responding to emergencies requiring basic or advanced cardiac life support.
Although nurse anesthetists work with only one patient at a time, and for a short while, it is during a highly stressful and critical time of their life. The nurse’s communication skills and compassion, as well as her knowledge and technical expertise, can make a meaningful difference in the successful outcome of the procedure.
Where do CRNAs work?
According to figures provided by the AANA, there are nearly 53,000 CRNAs (including student registered nurse anesthetists) employed in the US. And in 2016, they administered more than 43 million anesthetics.
CRNAs are employed in a variety of settings. This includes hospitals where they might work in operating theatres, cardiac catheterization labs, delivery rooms and more. Some are engaged in mobile surgery units as well as in outpatient and clinic settings. Many are found in offices of doctors such as plastic surgeons, dentists, and ophthalmologists. Some CRNAs also have independent practice businesses.
|Industry||Employment||Annual mean wage|
|Offices of Physicians||22,720||$162,430|
|General Medical and Surgical Hospitals||12,820||$184,590|
|Outpatient Care Centers||1,990||$194,440|
|Offices of Other Health Practitioners||1,750||$159,230|
|Colleges, Universities, and Professional Schools||1,140||$148,210|
|Source: US Bureau of Labor Statistics|
In hospitals that employ many CRNAs experienced nurse anesthetists might advance to management positions, and some take on positions at universities that offer nurse anesthetist courses.
What are the personal skills and qualities needed?
Are you considering a career as a nurse anesthetist? Some of the personal qualities and skills you need to succeed in this field are:
- The ability to think critically and problem solve in stressful situations – on the operating table the condition of a patient can change in a matter of seconds.
- Attention to detail – this relates to the equipment used, the patients’ unique circumstances as well as subtle changes in their condition.
- Communication skills – to deal sensitively and compassionately with the patients and their families, as well as collaborate effectively with other healthcare providers.
- Leadership skills – CRNAs are often in positions of authority, especially where they are the only providers of anesthetics.
What are the Qualifications of a CRNA?
The following are the steps and qualifications needed to become a CRNA.
1. Obtain a BSN degree.
As with other Advance Practice Registered Nurses (APRNs) like CRNA, one must first be a registered nurse with a valid license to practice. Earning a bachelor’s degree is necessary for becoming a CRNA. Another option is to earn a two-year associate’s degree in nursing (ADN) and pass the state exam to obtain an entry-level role as a registered nurse (RN). This path gives you the opportunity to gain some direct experience in nursing before returning to school to pursue a bachelor’s degree.
2. Pass the NCLEX-RN
After successfully completing your BSN, the next step is to take the National Council Licensure Examination (NCLEX-RN) and pass it.
3. Enroll in a nurse anesthesia programs
Once you’ve earned your BSN degree and license to practice, you can attend an accredited nurse anesthesia programs. In the US, there are 121 nurse anesthesia programs accredited by the Council on Accreditation of Nurse Anesthesia Programs (COA) – you can find an up-to-date list of all the approved programs on their website. Eighty of these accredited programs offer a doctoral degree as entry into practice. The courses include extensive experience in clinical settings and the duration varies from 24 to 51 months.
Each program has its stringent admission requirements, and you are advised to carefully review the requirements of the program that you want to apply for.
All the programs require at least one year of experience in critical care nursing – in other words, you need to work in an intensive care unit or emergency care setting. Voluntary specialty certification as a Critical Care Registered Nurse (CCRN) is also often required or will improve your chances to be admitted. To obtain this certification, you need to have completed at least 1,750 hours of direct critical care within the previous two years and pass the examination conducted by the AACN Certification Corporation.
Job shadowing a nurse anesthetist, to make sure that this is really the job for you, is also strongly recommended before applying to a program.
4. Pass the CRNA certification exam
On successful completion of your university program in nurse anesthesia, you need to pass the National Certification Exam which is conducted by the NBCRMA before you can practice as a CRNA. You might also have to obtain specialty licensure status in your particular state. The exam is a variable-length computerized test that contains a minimum of 100 and a maximum of 170 questions. In 2018, a total of 3,053 National Certification Examination (NCE) exams were administered, with a pass rate for first-time takers of 84.3%. The total number of candidates who took the NCE and were certified during 2018 was 2,448.
5. Recertification every two years
You will need to maintain your certification credentials throughout your career. The Continued Professional Certification program is based on eight-year periods with two four-year cycles. In each of the cycles, a specified number of continuing education credits in different areas are required, and a comprehensive exam is written at the end of every eight years.
What is the Salary Range for Nurse Anesthetist?
CRNAs are some of the highest paid RNs in nursing. According to the U.S. Bureau of Labor Statistics 2018-19 Occupational Outlook Handbook, the median national annual salary for CRNAs is $165,120. The bottom 10% is earning about $110,520 annually, with the top 10% earning as much as $208,000.
The actual salaries do, however, vary according to the type of employment setting, the particular state, years of experience and some other factors. The top five US states with the highest annual mean wages for CRNAs are:
|State||Employment||Annual Mean Wage|
|Source: US Bureau of Labor Statistics|
What are the Pros and Cons of working as a Nurse Anesthetist?
Hundreds of nurse anesthetists gave their job a perfect score in a recent Payscale survey. The job offers the opportunity to practice independently, and the pay is excellent. There are employment opportunities everywhere, and at a projected growth of 31% by 2022 the demand for these specialized nurses is growing at a much faster pace than the 6.5% average growth for all jobs in the US.
Nurse anesthetists feel that they are doing something meaningful for others. “I genuinely love being a CRNA and find joy and purpose in being able to care for people when they are most vulnerable. As CRNAs, we have an incredible responsibility, but with that comes the greatest reward. Words simply cannot describe the love and passion I have for this profession,” said Ryan Pettit, who holds a Ph.D. and works in a private hospital.
CRNAs also enjoy the fact that they are always learning. “The ongoing, ever-changing needs of healthcare mean that I will always be challenged to educate myself so I may be equipped with the best techniques and strategies for my patients,” explained CRNA Mary Nguyen.
Every patient is unique and every day is different – which keeps the work interesting. ”I can truly say that hundreds of patients later, I have never tired of the reassurance I am able to give someone at one of the most vulnerable times in their lives,” said Gloria Spires, who first started working as a CRNA in 1975.
The job can, however, be very stressful and emotionally demanding at times, especially in emergencies. The stress level is considered to be highest of any of the nurse specialties because the risk of something going wrong is always just around the corner.
Nurse anesthetists work long hours on their feet, mostly work alone, and could be on call 24 hours a day. There is limited opportunity for promotion – although this might not be much of a disadvantage considering the excellent salaries.
Certified Registered Nurse Anesthetist (CRNA) Organizations
If you’re interested in becoming a nurse anesthetist and want to learn more, check out these websites and resources:
- American Association of Nurse Anesthetists (AANA). This is a national organization which has contributed greatly to the growth and recognition of this specialty since it was founded as early as 1931. Its comprehensive website offers information on its advocacy roles, news, educational information and some other resources for its members. There are AANA associations in each State which are listed on the website together with the relevant links.
- National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). This board is responsible for determining the certification and recertification requirements for nurse anesthetists and conducting the examinations.
- Council on Accreditation of Nurse Anesthesia Programs. This Council sets the standards and minimum requirements for the masters and doctoral programs for nurse anesthesia. Universities wishing to introduce a program have to apply to this council to have their educational program approved. Approved programs are communicated by the Council to the US Department of Education.
- International Federation of Nurse Anesthetists. The 43 members of this body, founded in 1989, are representatives of associations in those countries where nurses are educated in and practice this specialty. It aims is to advance the educational standards and practices of nurse anesthetists to enhance the quality of anesthesia care worldwide