What is a Nurse Anesthetist?

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Certified registered nurse anesthetists (CRNAs) play a crucial role in the success of a variety of medical procedures. They work in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other professionals to ensure the safe administration of anesthesia. Some of their responsibilities include providing pain management, assisting with stabilization services, and overseeing patient recovery. These services may be used through all phases of surgery and for diagnostic, obstetrical, and therapeutic procedures as well. Due to their advanced training and the weight of their responsibilities, nurse anesthetists are generally well-compensated professionals.

The American Association of Nurse Anesthetists (AANA) reports that nurse anesthetists first arose during the Civil War to give anesthesia to wounded soldiers. These days, CRNAs are the main providers of anesthesia in rural and medically underserved regions of the U.S., although those aren’t the only places where they work. Nurse anesthetists are also the main providers of anesthesia to men and women in the U.S. Armed Forces, and can work in a variety of settings, explored at length below. These healthcare professionals must have at least a master’s degree and can practice relatively autonomously, depending on their state’s level of CRNA practice authority.

What does a Nurse Anesthetist Do?

According to AANA’s 2016 Practice Profile Survey, nurse anesthetists administer more than 43 million anesthetics each year in the U.S. They are relatively independent professionals who have direct reimbursement rights under the Medicare program. They were the first nursing specialty to have this privilege granted by Congress in 1986.

The AANA details some of the responsibilities of nurse anesthetists:

  • Administering anesthesia during surgical, therapeutic, diagnostic, and obstetric procedures
  • Performing epidural, spinal, or nerve blocks
  • Providing care before, during, and after anesthesia
  • Examining patients’ medical histories for allergies or illnesses to ensure safe provision of pain management
  • Discussing any contraindications or side effects of anesthesia with patients
  • Monitoring vital signs during medical procedures

The Bureau of Labor Statistics (BLS Dec. 2015) and the AANA report that nurse anesthetists work in a variety of settings including:

  • Medical and surgical hospitals
  • Critical access hospitals
  • Mobile surgery centers
  • Outpatient care centers
  • Offices of plastic surgeons, dentists, ophthalmologists, pain management specialists, and other medical professionals
  • U.S. military medical facilities

Also, the AANA notes that when a nurse anesthetist administers anesthesia, it is considered nursing; by contrast, when an anesthesiologist delivers anesthesia, it is considered the practice of medicine. Interestingly, there are no procedural differences between the two.

Skills & Personality Traits of Successful Nurse Anesthetists

According to the AANA (Aug. 2016), more than 40 percent of nurse anesthetists are men, which is significantly higher than the 10 percent of nursing as a whole. The Bureau of Labor Statistics covers a range of skills and personality traits often found in successful nurse anesthetists:

  • Communication skills: The ability to speak informatively (and with appropriate sensitivity) to patients and their families is crucial. Additionally, CRNAs must be able to collaborate well with a range of healthcare professionals.
  • Ability to think critically: Since patient health can be fragile, CRNAs must be able to monitor changes in vital signs and suggest (or provide) appropriate responses.
  • Compassion: As with all medical and nursing specialties, it is important to be kind and understanding in dealing with physically or emotionally distressed patients.
  • Attention to detail: Since the work of nurse anesthetists can significantly impact the health of patients, they must be attuned to even the most subtle changes in patient condition.
  • Leadership skills: CRNAs often work in positions of authority, especially in rural areas where they may be the sole providers of anesthetics. In these situations, they must be able to manage or lead other medical staff effectively.

Education and Experience Requirements for Nurse Anesthetists

Nurse anesthetists are a subgroup of advanced practice registered nurses (APRNs) who must earn a master’s degree from an accredited program which entails both coursework and clinical experience. It generally takes seven years of postsecondary experience and education to become a CRNA.

The AANA lists the requirements for becoming a CRNA in more detail:

  • Pursue a bachelor of science in nursing (BSN) or a similar degree
  • Obtain a license as a registered nurse (RN)
  • Get at least one year of experience as an RN in an acute care setting (e.g., ICU or ER)
  • Earn a minimum of a master’s degree from an accredited nurse anesthesia program which typically take from 24-36 months; the predominant accreditation board is the Council on Accreditation of Nurse Anesthesia Educational Programs, and there were 115 qualifying programs as of August 2016
  • Pass the National Certification Examination through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
  • (Old process) Recertify every two years with proof of 40 hours of continuing education

Please note that CRNAs who certified or recertified in 2016 are now a part of the NBCRNA’s Continued Professional Certification (CPC) program, comprising eight-year periods in two four-year cycles. In addition to maintaining all local credentialing, CRNAs must get at least 100 CE credits every four-year cycle; complete education in four content areas (airway management techniques, applied pharmacology, human physiology and pathophysiology, and anesthesia technologies); and pass a comprehensive exam every eight years. Candidates who recertified in 2017 are the final cohort to recertify with 40 CE hours; in 2018, all CRNAs will recertify with the new CPC program.

Salary – How Much Can a Certified Registered Nurse Anesthetist (CRNA) Make?

Certified registered nurse anesthetists (CRNAs) perform a variety of functions to ensure the safety of pain management and stabilization services for patients. Due to the weight of the responsibilities involved and the length of training, this work is relatively well-paid.

The Bureau of Labor Statistics (BLS May 2016) reported that there were 39,860 nurse anesthetists employed in the United States. They made an average hourly wage of $78.86, or approximately $164,030 annually. This is more than three times the mean annual salary for all occupations in the U.S.: $49,630.

The BLS (May 2016) lists the percentile annual salary estimates for nurse anesthetists nationwide:

  • 10th percentile: $107,960
  • 25th percentile: $137,800
  • 50th percentile (median): $160,270
  • 75th percentile: $189,880
  • 90th percentile: >$208,000*

These are the same percentiles expressed as hourly wage estimates:

  • 10th percentile: $51.91
  • 25th percentile: $66.25
  • 50th percentile (median): $77.05
  • 75th percentile: $91.29
  • 90th percentile: >$100.00*

*The BLS does not have precise figures for these percentile estimates.

Salaries For CRNAs by Industry

The amount of money a nurse anesthetist makes varies by industry. According to the BLS (May 2016), the following were the top-paying industries in the field by average annual salary:

  • Outpatient centers: $181,800
  • Specialty hospitals (except psychiatric and substance abuse facilities): $175,800
  • General medical and surgical hospitals: $174,980
  • Federal executive branch: $162,590
  • Offices of physicians: $159,250

It is important to note that while outpatient centers and specialty hospitals offer the highest annual mean wage to nurse anesthetists, they also have lower levels of employment than some other industries. According to the BLS, the five top-employing industries for CRNAs in the U.S. were the following:

  • Offices of physicians: 21,460 jobs
  • General medical and surgical hospitals: 11,850 jobs
  • Outpatient care centers: 1,820 jobs
  • Offices of other health practitioners: 1,650 jobs
  • Federal government: 980 jobs

Salaries for CRNAs by State and Metropolitan Area

The salaries for nurse anesthetists also vary by state and region. According to the BLS (2016), the five top-paying states by average annual salary for CRNAs were:

  • Montana: $242,140
  • Wyoming: $233,400
  • California: $215,530
  • Oregon: $199,860
  • Nevada: $192,330

Notably, four of the five top-paying metropolitan areas by average annual salary for nurse anesthetists were in California:

  • San Diego-Carlsbad, CA: $241,670
  • San Jose-Sunnyvale-Santa Clara, CA: $238,860
  • San Francisco-Redwood City-South San Francisco, CA: $224,310
  • Spokane-Spokane Valley, WA: $221,720
  • Oakland-Hayward-Berkeley, CA: $219,050

It’s important to note, however, that some states and metropolitan areas have higher employment for CRNAs than others. The top-employing states for nurse anesthetists were:

  • Texas: 4,700 jobs
  • Ohio: 2,510 jobs
  • North Carolina: 2,440 jobs
  • Pennsylvania: 2,310 jobs
  • Florida: 2,300 jobs

The top-employing metropolitan areas in the United States for nurse anesthetists were:

  • Houston-The Woodlands-Sugar Land, TX: 2,040 jobs
  • Minneapolis-St. Paul-Bloomington, MN and WI: 1,200 jobs
  • Pittsburgh, PA: 770 jobs
  • Boston-Cambridge-Newton, MA: 690 jobs
  • Birmingham-Hoover, AL: 680 jobs

While these are the most recent employment figures from the BLS, becoming a nurse anesthetist may be a wise career choice since demand for these specialists is growing very quickly in the U.S. The BLS (Dec. 2015) projected that between 2014 and 2024, there would be a 19 percent increase in positions, much more robust than the expected average growth of all occupations in the country during that same decade (6.5 percent).

How To Become a CRNA

Becoming a certified registered nurse anesthetist (CRNA) can be rewarding for a number of reasons, including personal satisfaction, benefits to society, and relatively generous compensation. CRNAs perform similar work to anesthesiologists including giving local and general anesthetics; performing epidural, spinal and nerve blocks; providing twilight sedation; and facilitating pain management for patients. Currently, hundreds of self-reporting nurse anesthetists have given their profession a perfect score in job satisfaction in a Payscale (2017) report. It is easy to see why working as a nurse anesthetist can be a competitive and highly desirable line of work.

So how does someone become a nurse anesthetist? According to the American Association of Nurse Anesthetists (AANA), it generally takes a minimum of seven years postsecondary education and experience to become a certified registered nurse anesthetist (CRNA). An average student will complete approximately 2,500 clinical hours and administer 850 anesthetics before obtaining his or her certification. The general requirements and more detailed steps to becoming a nurse anesthetist are presented below.

Steps to Becoming a Nurse Anesthetist

Nurse anesthetists require several years of experience and schooling prior to becoming certified. The AANA provides one possible path to become to becoming a CRNA:

Step 1: Pursue a bachelor of science in nursing (BSN) or a similar degree – 4 years

The road to becoming a certified nurse anesthetist typically begins as an undergraduate. Students take courses such as physiology, anatomy, pharmacology, pathophysiology, and health assessment. Although a BSN is not required for becoming a RN, students who complete these undergraduate programs may have an edge in the highly competitive application process to accredited nurse anesthetist programs. Students are also required to complete clinical rotations in major health departments such as women’s health, surgery, and pediatrics. While pursuing a BSN or other qualifying degrees, it is advisable to get good grades. The accredited nurse anesthetist programs often require applicants to have maintained a GPA of 3.0 or higher, particularly in science courses. This criteria and the application prerequisites are covered in more detail below.

Step 2: Obtain a license as a registered nurse (RN) – less than 1 year

After completing an undergraduate program, registered nurses must become licensed. These requirements may vary by state, but they generally involve passing an approved training program and the National Council Licensure Examination for Registered Nurses (NCLEX-RN). These exams are given by the National Council of State Boards of Nursing (NCSBN), and cover topics such as health assessment, physiological integrity, and infection control. Since requirements and licensure may vary by state, it is important to check with local NCBSN Member Boards prior to registering for the exam.

Step 3: Get experience as an RN in an acute care setting – 1-3 years

Prior to applying to an accredited nurse anesthesia program, candidates typically complete at least one year of work in a clinical setting such as an intensive care unit (ICU), cardiac care unit (CCU), or emergency room (ER). At this phase, some RNs choose to pursue a Critical Care Registered Nurse Certification (CCRN), a specialization that may improve one’s chances of getting acceptance to a nurse anesthetist program. Eligibility for a CCRN includes having a valid RN license, passing an exam, and completing at least 1,750 hours of direct critical care within the previous two years. Other prospective CRNAs choose to shadow a practicing nurse anesthetist, an experience that some programs advise prior to applying for admission.

Step 4: Gain admittance to an accredited nurse anesthesia program – less than 1 year

The AANA estimates that as of August 2018, there were 121 accredited nurse anesthesia programs and more than 1,799 active clinical sites. Admission to these programs can be highly competitive. For example, the nurse anesthetist program at Kansas University has the following requirements for applicants:

  • Two years of experience as an RN
  • One year of full-time ICU experience
  • Proof of valid RN license
  • Bachelor’s degree in an appropriate discipline
  • Completion of prerequisites: chemistry (2 courses), human anatomy, physiology, microbiology, and statistics
  • 3.0 overall GPA in college coursework
  • 3.0 GPA in 5 science prerequisites
  • Graduate-level writing abilities
  • Shadow experience with a CRNA or an anesthesiologist
  • Three references
  • College transcripts
  • ACLS/BLS/PALS certifications
  • Resume
  • Goal statement (personal essay)
  • Background check (after admission)

Prior to applying to nurse anesthetist programs, review the admission requirements carefully. The Council on Accreditation of Nurse Anesthesia Programs (COA) has the most up-to-date list of accredited programs for nurse anesthetists.

Step 5: Graduate from the accredited nurse anesthesia program – 2-3 years

All nurse anesthetists must complete an accredited program which generally takes 24-36 months. While these students graduate with a minimum of a master’s degree, a growing number of the 115 programs across the U.S. award a doctoral degree. All nurse anesthesia programs have courses such as:

  • Anesthesia pharmacology
  • Geriatric anesthesia
  • Obstetric anesthesia
  • Pain management
  • Anesthesia biology
  • Anesthesia pathophysiology

Additionally, nurse anesthesia programs include clinical practice in university-based or large community hospitals where students are exposed to a range of procedures requiring anesthesia such as pediatric, plastic, and open-heart surgeries.

Step 6: Pass the National Certification Examination through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) – less than 1 year

Upon completion of an accredited program, nurse anesthetists must pass the National Certification Examination (NCE) to become a CRNA. This computer exam typically takes three hours. Each student must answer between 100 and 170 questions. The responsive design of the exam adjusts the tested material depending on the test-taker’s answers to previous questions. For the complete information about the exam, visit the NBCRNA Exam Handbook.

Step 7: Get a job as a CRNA

After certified nurse anesthetists graduate from an accredited program and pass the exam, they are eligible for entry-level employment. Some employers seek individuals who can work among several major departments, whereas others seek CRNAs with more specialized qualifications and experience to work in specific departments such as obstetrics, pediatrics, or endoscopy.

Step 8: Maintain certification – recertify every 4 years, retest every 8 years

Finally, as mentioned above, CRNAs who certified or recertified in 2016 are now a part of the NBCRNA’s Continued Professional Certification (CPC) program, comprising two four-year cycles. To maintain their certification, CRNAs must complete 100 units of continuing education every four years in several areas: airway management techniques, applied pharmacology, human physiology and pathophysiology, and anesthesia technologies. Additionally, they must pass a comprehensive examination every eight years.