How to Become a Nurse Anesthetist (CRNA)

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A nurse anesthetist performs a critical component of a patient’s care, administering anesthesia, analgesics, paralytics, and managing complex hemodynamic processes. A Certified Registered Nurse Anesthetist (CRNA) is a nurse anesthetist who has attained an independent license to work in this field. Training to become a CRNA typically requires a four-year degree, current nursing license, and critical care experience. CRNA candidates apply to obtain a master’s or doctoral nursing degree from an accredited university, during which they will receive intensive clinical and didactic training in order to fully understand the complicated responsibilities associated with this career. Finally, prospective CRNAs achieve licensure by passing a national board certification examination.

What Is a CRNA?

CRNAs are master’s or doctoral prepared nurses with special training and licensure in the field of anesthesia and hemodynamic management.

CRNAs are one of the primary administrators of anesthesia in the United States, providing 45 million units of anesthesia to Americans each year. A CRNA is different from an anesthesiologist, or a medical doctor who has completed medical school and residency. The requirements to become a CRNA are different than those for anesthesiologists. However, studies have shown that CRNAs and anesthesiologists administer anesthesia with the same rates of efficacy and safety. Some CRNAs work with anesthesiologists on a daily basis. There is a federal law requiring nurse anesthetists to work under physician supervision. However, 17 states have opted out of this law since 2001, allowing CRNA’s to work as independent practitioners.

What Does a CRNA Do?

CRNAs are qualified to administer anesthesia and provide related care in several different capacities. For example, a CRNA might oversee patient sedation in endoscopy suites, patient recovery in PACU, or a patient’s entire perioperative experience, from admission to discharge.

In the latter context, the CRNA will evaluate and assess patients in order to confirm eligibility and prepare for anesthesia. Not all patients are eligible for anesthesia due to cardiac or other health complications. A tremendously important part of a CRNA’s job is to determine if patients can safely go under sedation or general anesthesia while remaining hemodynamically stable. During assessment, the CRNA also determines whether special patient-specific provisions are required, such as intubation guidance equipment, special medications, or additional monitoring devices. CRNAs must have the courage to tell a surgeon that a patient is not eligible for surgery, using their best nursing judgment and a spirit of patient advocacy. If the patient is eligible, the CRNA will administer anesthesia and monitor its maintenance while the patient is experiencing its effects. Critical points in anesthesia administration are induction (putting the patient to sleep), intubation, and emergence. CRNAs will provide post-anesthesia care as well, which may involve helping patients regain motor control and assisting with pain management.

CRNAs may also have the opportunity to specialize, developing a set of skills which are specific to their particular clinical interests. For example, a CRNA may concentrate on pediatric, obstetric, cardiovascular, dental or neurosurgical anesthesia. Some CRNAs also choose a more administrative specialty such as department director, quality assurance professional, or continuing education specialist. Therefore, whether with patients, colleagues, trainees, or students, it’s important for the prospective CRNA to be well-rounded, possessing both clinical and interpersonal skills.

Where Can a CRNA Work?

CRNAs can practice in any setting where anesthesia is administered, including hospitals, surgical centers, dental clinics, pain clinics, endoscopy suites, and cosmetic surgery clinics.

CRNAs are especially needed in rural areas of the United States. Hospitals in these parts of the country may have experienced difficulty in hiring professionals who specialize in surgical services, obstetrics, pain management, and trauma stabilization. This is because hospitals with less funding may be unable to meet the high salary demands of anesthesiologists. As a result, there are likely to be multiple career opportunities for CRNAs who are willing to relocate to rural areas.

Work Environment

It is essential that prospective CRNAs consider the nurse anesthetist work environment. This profession comes with a significant level of responsibility and CRNAs can expect to experience a potentially exceptional degree of stress while performing their duties. While some nurse anesthetists specialize, all of them are expected to possess an expert level understanding of anesthetic administration and hemodynamic management.

Many employers look for candidates with a firm grasp on the principles of surgery, cardiac critical care, patient care and interaction, difficult airway management, CPR, and postoperative care. As a result, prospective CRNAs should be prepared to multitask, prioritize, and provide many dimensions of care on a given day. The best candidates for this career will thrive in a work environment that frequently combines the routine administration of anesthesia with the unpredictable nature of medical emergencies.

Career Outlook and Demand

The nurse anesthetist job outlook is promising in the United States. An aging population requires medical professionals who are able to perform a wide variety of care, including the administration of anesthesia. Because CRNAs are more cost-effective to employ than anesthesiologists, they are in high demand. This trend is likely to continue, as the United States Bureau of Labor and Statistics estimates that the job market for nurse anesthetists will grow by as much as 31 percent by 2026.

Salary

According to the U.S. Bureau of Labor Statistics, the median annual salary for a CRNA was $167,950 in 2018, making it the best paid nursing specialty. Individual CRNA salary is determined by experience, educational qualifications, institution type, and location. For example, a nurse anesthetist with a doctorate will likely earn a higher salary than a nurse anesthetist with a master’s degree, and a nurse anesthetist in California may have a higher salary than one in Florida.

Education Requirements

The education and experiential requirements to become a nurse anesthetist are rigorous. First, a candidate must obtain a Bachelor of Science in Nursing (BSN). Next, a prospective CRNA must have acquired nursing licensure by passing the National Council Licensure Examination (NCLEX). This qualifies an individual to practice as a licensed registered nurse. CRNAs are also required to have 1-2 years of clinical experience, which can include emergency, ICU, PACU, and other specialty areas, and depends on individual state and school requirements.

Schools that train CRNAs are accredited by the Council on Accreditation of Nurse Anesthesia Education Programs (COA). Some CRNAs choose to practice at the master’s level, but pursuing a doctoral degree is becoming increasingly popular. The total time spent on CRNA education, including undergraduate work, will amount to approximately eight years for most nurse anesthetists.

Applying to Nursing Schools

Nurse anesthetist school requirements vary according to the particular curriculum of a given program, but there are certain CRNA prerequisites shared by most. In order to qualify for enrollment, students must already hold a Bachelor of Science in Nursing (BSN) as well as a current nursing license in their state. Experiential requirements are another component. For example, applicants may be expected to possess at least one year of experience working as a registered nurse in critical care. This ensures that nurse anesthetist students will already be acquainted with the basics of the medical field. For the same reason, many universities require applicants to hold certifications in Basic Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support.

Continuing Education

CRNA continuing education is both encouraged and expected in the nurse anesthetist field. It is a requirement for CRNAs to complete continuing education credits for license renewal according to guidelines from the CRNA licensing authority, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). This organization has issued a set of guidelines that CRNAs can consult to maintain active license status with continuing education.

Four Core Modules are required during a CRNAs second four-year term of practice. Core Modules are classes recognized by the American Association of Nurse Anesthetists to provide adequate preparation for working in as a CRNA. They are also excellent preparatory courses for candidates who haven’t yet taken their licensure exam.

Licensure

When an aspiring nurse anesthetist has met all of the educational CRNA requirements, licensure can be considered. Even if an individual has acquired the knowledge and skills necessary to practice in the field, licensure must be completed with the guidelines set forth by the NBCRNA.

New CRNAs are required to pass the NBCRNA board's examination before they can practice. Nurse anesthetists are then required to recertify every two years to maintain licensure. The board has recently updated its recertification process and given it the name: Continued Professional Certification (CPC). Recertification itself is now known as the 2-Year Check-In. This involves completing at least 40 hours of continuing education credits. Additionally, a full CPC Assessment is required every eight years.

Frequently Asked Questions About CRNAs

How Many Years Does It Take to Become a Nurse Anesthetist?

An aspiring nurse anesthetist can expect to spend up to eight years in school. This period of time comprises four years in the pursuit of an undergraduate nursing degree (BSN), as well as four additional years in the pursuit of a master's or doctoral degree. As mentioned previously, nurse anesthetist graduate programs require at least one year of nursing critical care experience, adding a considerable amount of time to the process. Finally, candidates for CRNA careers should allow additional time to study for licensure and to pass their exams.

What Is the Difference Between Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners?

Nurse anesthetists, nurse midwives, and nurse practitioners are all graduate-level, advanced practice nurses. Nurse midwives and nurse practitioners have prescribing authority, while this varies for nurse anesthetists by state and individual qualifications. All three have a much greater scope of practice than registered nurses. Nurse midwives are women's health providers who work in a variety of clinical settings, providing obstetric, gynecologic, and postpartum care. Nurse practitioners work in a multitude of specialties with varying levels of autonomy in care provision depending on state. There is some degree of overlap in the duties between these three positions, but a nurse anesthetist is specifically responsible for the administration of anesthesia.

What Is the Difference Between a Nurse Anesthetist and an Anesthesiologist?

An anesthesiologist is a medical doctor who has graduated from medical school and completed residency. Like CRNAs, anesthesiologists administer anesthesia, but anesthesiologists have a greater level of autonomy, are always independent practitioners, and often oversee CRNAs. They are trained in the medical profession, which is different than the training of a nurse, though the nuances of these differences vary among settings. It is also typically more costly to employ an anesthesiologist.