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 valuable members 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, including side effects and recovery. Comprehensive education can enhance recovery and lead to higher patient satisfaction.
Nurses interested in becoming nurse anesthetists 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 to become a Certified Registered Nurse Anesthetist (CRNA) may vary depending on the program. However, these are the minimum requirements:
- A Bachelor of Science degree in nursing (BSN) or another related field from an accredited program
- An unrestricted license as a registered nurse
- A minimum of one year (full-time or part-time equivalent) experience as an RN in a critical care setting
- Completion of, at minimum, a master’s degree from an accredited nurse anesthesia educational program
Nurse anesthesia programs are accredited by the Council on Accreditation of Nurse Anesthesia Education Programs (COA). There are currently 121 accredited nurse anesthesia programs in the US and Puerto Rico.
A nurse anesthesia program ranges anywhere from 24-51 months, depending on the university, and includes clinical experience as well as didactic classroom hours. On average, it takes a minimum of 7 to 8.5 years of experience and education to become a CRNA.
Recertification and continuing education for CRNA’s is different than other APRNs. The recertification program for nurse anesthetists is called the Continued Professional Certification (CPC) Program and is administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). The requirement for continuing education (CE) credit is robust; CRNA’s must meet 60 general CE credits and an additional 40 CE credits covering four content areas including airway, pharmacology, physiology and pathophysiology, and anesthesia equipment along with a comprehensive certification exam every eight years.
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 (Updated Jan 5, 2021) 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 the 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 the 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