What is a Nurse Anesthetist?

Nurse anesthetists have been providing anesthesia care in the United States for over 125 years. Nurses first provided anesthesia to wounded soldiers during the Civil War. More than 90% of this country’s nurse anesthetists are members of the American Association of Nurse Anesthetists (AANA).

Certified Registered Nurse Anesthetists (CRNAs) are anesthesia professionals who personally administer approximately 27 million anesthetics each year in the United States.

CRNAs are the sole anesthesia providers in approximately two thirds of all rural hospitals in the United States, enabling these healthcare facilities to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100% of the rural hospitals.

According to a 1999 report from the Institute of Medicine, anesthesia care today is nearly 50 times safer than it was 20 years ago.

CRNAs provide anesthetics to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine.

As advanced practice nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.

CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. Military, Public Health Services, and Department of Veterans Affairs healthcare facilities.

Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.

Across the country, nurse anesthetist professional liability premiums are 39% lower than 15 years ago.

Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.

Approximately 49% of the nation’s 34,000 nurse anesthetists who work full-time are men, compared with 8% in the nursing profession as a whole.

Education and experience required to become a CRNA include:

• A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
• A current license as a registered nurse.
• At least one year of experience as a registered nurse in an acute care setting.
• Graduation with a master’s degree from an accredited nurse anesthesia program. As of February 2006, there were 99 nurse anesthesia programs with more than 1,000 affiliated clinical sites in the United States. They range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.
• Pass a national certification examination following graduation.

In order to maintain their recertification, CRNAs must obtain a minimum of 40 hours of continuing education every two years.

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Q&A

What are Certified Registered Nurse Anesthetists (CRNAs)?
Nurse anesthesia is an advanced clinical nursing specialty. As anesthesia specialists, CRNAs administer approximately 65% of the 26 million anesthetics given to patients in the United States each year.

How Does a Nurse become a CRNA?
A nurse attends an accredited nurse anesthesia education program to receive an extensive education in anesthesia. Upon graduation, the nurse must pass a national certification exam to become a CRNA.

What does a Nurse Anesthesia Education Program Include?
A program will include 24 to 36 months of graduate course work including both classroom and clinical experience with:

• The classroom curriculum emphasizing anatomy, physiology, pathophysiology, biochemistry, chemistry, physics and pharmacology as related to anesthesia.
• The major clinical component providing experience with a variety of anesthesia techniques and procedures for all types of surgery and obstetrics.

All nurse anesthesia education programs offer a master’s degree. Depending on the particular program, the degrees are in nursing, allied health, or biological and clinical sciences.

What are the Requirements for Admission to a Program?
The requirements for admission are:

• A bachelor’s of science in nursing or another appropriate baccalaureate degree. (Each program determines "appropriate" degrees and "approved" programs.)
• A license as a registered nurse.
• A minimum of one year of acute care nursing experience. (Each program determines what constitutes "acute care" nursing.)

Is Financial Aid Available for an Individual to Attend a Program?
Financial aid is available and varies by program. It is suggested that you contact several programs and ask them about the availability of tuition assistance, as well as the specific admission criteria. There is no financial aid available through AANA for those entering a nurse anesthesia education program.

What is the Role of An Individual CRNA?
A CRNA takes care of a patient’s anesthesia needs before, during and after surgery or the delivery of a baby by:

• Performing a physical assessment
• Participating in preoperative teaching
• Preparing for anesthetic management
• Administering anesthesia to keep the patient pain free
• Maintaining anesthesia intraoperatively
• Overseeing recovery from anesthesia
• Following the patient’s postoperative course from recovery room to patient care unit.

CRNAs provide services in conjunction with other healthcare professionals such as surgeons, dentists, podiatrists, and anesthesiologists.

Where do CRNAs Practice?
CRNAs practice in a variety of settings in the private and public sectors and in the U.S. military, including traditional hospital operating rooms, ambulatory surgery centers, pain clinics, and physicians’ offices. They practice on a solo basis, in groups and collaboratively. Some CRNAs have independent contracting arrangements with physicians or hospitals.

What Employment Opportunities Exist for CRNAs?
CRNAs are in demand and therefore have many opportunities for general or specialty practice throughout the United States.

Reflecting the level of responsibility, CRNAs are one of the best paid nursing specialties. The reported average annual salary in 2003 was approximately $129,000.

Past, Present, Future of CRNAs
Nurse anesthesia is no longer the best kept secret in healthcare. Established in the late 1800s as the first clinical nursing specialty, nurse anesthesia developed in response to the growing need surgeons had for anesthetists. Certified Registered Nurse Anesthetists (CRNAs) and the American Association of Nurse Anesthetists (AANA) have played significant roles in developing the practice of anesthesia. Today, more than 36,000 Nurse Anesthetists provide cost-effective, high-quality patient care that is essential to America’s healthcare system.

What Is the Role of the Individual CRNA?
Nurse anesthetists, pioneers in anesthesia, have been administering anesthesia for more than 100 years.

As anesthesia specialists, CRNAs take care of patients before, during and after surgical or obstetrical procedures. Nurse anesthetists stay with their patients for the entire procedure, constantly monitoring every important body function and individually modifying the anesthetic to ensure maximum safety and comfort.

How do CRNAs Impact Healthcare?
CRNAs are the sole anesthesia providers in more than two-thirds of all rural hospitals in the United States, affording some 70 million rural Americans access to anesthesia. CRNAs provide a significant amount of the anesthesia in inner cities as well.

CRNAs are qualified and permitted by state law or regulations to practice in every state of the nation.

Meeting the Needs of Tomorrow
CRNAs have a proud history of meeting the challenges of changing healthcare trends. The recent acceleration of managed healthcare services will provide additional opportunities and new challenges for these advanced practice nurses. CRNAs will continue to be recognized as anesthesia specialists providing safe patient care.

CRNAs Fully Use Their Training
During surgery, the patient’s life often rests in the hands of the anesthesia provider. This awesome responsibility requires CRNAs to fully utilize every aspect of their anesthesia education, nursing skills, and scientific knowledge. CRNAs vigilantly monitor the patient’s vital signs, regulate the anesthetic as necessary, analyze situations, make decisions, communicate clearly with the other members of the surgical team, and respond quickly and appropriately in an emergency.

"The future looks bright for CRNAs," according to 1999 AANA President Linda R. Williams, CRNA, JD. "CRNAs are a glowing example of how advanced practice nurses can be used to provide affordable, high-quality healthcare to the citizens of this country."

The shortage of CRNAs in the marketplace spells job opportunities. With hospitals and other healthcare facilities scrutinizing their bottom lines, CRNAs offer an attractive option for providing anesthesia care. Also of interest is the fact that approximately eight nurse anesthetists can be educated for the cost of one anesthesiologist. Competitively, this gives CRNAs an advantage over anesthesiologists in a scenario where manpower supply and costs to the government and society are issues.

It is not the policy of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), nor the American Association of Nurse Anesthetists, to rank nurse anesthesia educational programs. All accredited programs of anesthesia follow the same accreditation standards, policies and procedures as set forth by the COA. Once they are accredited, they have to maintain the accreditation through periodic reviews to ensure they are following the standards.

*Reprinted with permission from the American Association of  Nurse Anesthetist.