Certified Registered Nurse Anesthetist (CRNA)

What is a Certified Registered Nurse Anesthetist (CRNA)?

Certified registered nurse anesthetists (CRNAs) are responsible for the entirety of the anesthesia procedure, from determining technique, drugs, and dosage, to managing and monitoring a patient’s pain levels and vital functions. This career is categorized as an advance practice registered nurse (APRN) role because it requires graduate-level educational and clinical training. CRNAs spend 2-3 more years in school than many nursing professionals, such as RNs and LPNs, who do not need to earn a graduate degree. Due to the high level of precision and knowledge demanded of them, CRNAs operate with high levels of autonomy.

Common Responsibilities for a CRNA:

  • Assesses patient health and responsiveness to anesthesia
  • Identifies potential risks of anesthetizing a patient, including allergies and overdose
  • Calculates precise dosage and titration of anesthetic medicines
  • Manage vital functions throughout sedation
  • Carefully and clearly communicates with patients before, during and after administering anesthesia
  • Support trauma stabilization procedures during and after procedures

Who Should Consider Becoming a CRNA?

Among all advanced practice nurses, CRNAs enjoy the most professional autonomy out of all their nursing peers. This autonomy comes with great responsibility, however, and aspiring CRNAs must be ready to work hard. Gaining admission to graduate-level nursing programs can be challenging, and programs that lead to CRNA credentials are notoriously competitive. Many expect a minimum GPA of 3.4 or higher, often with the stipulation that full-time employment among students is prohibited. Ideal candidates for nurse anesthetist degree programs must be prepared for personal, social, and financial sacrifice in pursuit of the degree.

In the field, an effective nurse anesthetist must be a leader comfortable with independent decision-making — while CRNAs function as part of a team in the operating room, the CRNA is often the sole individual managing a patient’s pain relief. The ability to think critically under pressure cannot be overstated, as these professionals are responsible for the lives of their patients. Not only must CRNAs monitor sophisticated equipment and follow complex protocol, they must also immediately react when a situation changes. Outside of the OR, it’s not unusual for a CRNA to be the last clinician to speak with a patient prior to a procedure, and a calm demeanor is a key when soothing a nervous patient. Good communication skills are essential in this scenario, much as they are when collaborating with physicians, nurses, and other clinical staff. Lastly, aspiring CRNAs must be able to stay focused on difficult tasks in the midst of a busy operating room.


Educational Paths to Becoming a CRNA

Although programs may vary from state to state, the CRNA career path is a fairly specific one. These variances are often reflected in state RN licensing requirements.

What Education is Needed to Become a CRNA?

To reach this credential, an aspiring CRNA must begin with a bachelor’s degree from an accredited college and, most often, this degree is a Bachelor of Science in Nursing (BSN). The four-year BSN qualifies its graduates for the NCLEX examination, a test that leads to RN licensure. Because a master’s degree is a CRNA requirement, students should begin to prepare for the GRE exam at this point — registration, study, and administrative processing can take time, and students should plan a realistic timeline. Before applying to nurse anesthesia programs, these nurses must also gain at least a year of experience in an acute care clinical setting. Typical clinical environments include emergency rooms, intensive care units, or cardiac care units. After meeting all of these requirements, professionals are prepared to apply to an accredited nurse anesthetist degree program.

RN tO CRNA Bridge Programs

Bridge programs are designed to enable a working student to either change to a new industry entirely or earn a higher degree in their current field. All bridge programs are based on a degree the student already holds, often allowing students to complete a program on an accelerated timeline. Working RNs who hold two-year associate degrees or diplomas must complete the BSN before continuing on to a graduate-level CRNA program. Fortunately for these professionals, a variety of RN-to-BSN bridge programs are available. Many RN-to-BSN programs are offered exclusively online and can be earned without taking time off work.

How Long Does It Take to Become a CRNA?

Individual experiences differ based on the educational route that any given student may take on the path to a nurse anesthetist job. However, the CRNA credential is generally granted after seven to eight years of preparation. This time frame includes the minimum time necessary to complete the BSN, one year of full-time employment, and a nurse anesthetist degree program. Nursing school students generally progress through graduate-level curricula in groups that begin together and finish together, called cohorts. Depending on the school, some BSN programs also teach upper-level nursing courses in cohort groups.

What Will I Learn in an Online CRNA Certification Program?

  • Foundations of anesthesia practice: Cardiological and renal anatomical, biological, and physical principles integrated with advanced pharmacological theory, principles and practice to assess and manage the patient.
  • Advanced pathophysiology for anesthesia: Pharmacology and anesthesia specifically in gastrointestinal, endocrine, and neurologic care. Integration of current research findings into practice.
  • Role of the nurse anesthetist: Ethical, medical, and legal duties of the nurse anesthetist practitioner, and the study of external impacts to the profession. Review of certification exam subject matter.
  • Physics and chemistry of anesthesia: Physics of solids, liquids, gases and vapors. Inhalation appliances, carbon dioxide absorption, and flammability of gases and vapors. Operating principles of anesthesia delivery devices and patient monitoring systems.
  • Anatomy for nurse anesthetists: Cadaver dissection of the human body. Regional approach to respiratory, circulatory, and peripheral nervous systems. Special emphasis given to anatomic features of neural blockade.

CRNA Certification and Licensing Requirements

All nurse anesthetists must pass the CRNA exam: The National Board of Certification and Recertification for Nursing Anesthetists outlines eligibility, registration processes, exam details and renewal procedures in its Examination Candidate Handbook.

Requirements to take the NBCRNA exam:

  • Hold an active RN license in one’s state of employment
  • Hold a graduate degree from a nursing anesthetist program accredited by the COA
  • Submit a completed application form along with all supplemental materials
  • Acknowledgement that one does not suffer from ailments that would prohibit work as a CRNA (drug or alcohol abuse)
  • A clean RN license record without instances of suspension, restrictions, or disciplinary action

CRNA recertification requirements:

  • Obtain a minimum of 40 hours of approved continuing education every two years
  • Document substantial anesthesia practice
  • Maintain current state licensure
  • Certify that one has not developed any conditions that could adversely affect their ability to practice
  • Prospective CRNAs should also note that the National Council of State Boards of Nursing (NCSBN) is taking steps to standardize APRN licensure across the U.S. However, not all states have adopted these guidelines yet, so it is important for nursing anesthetist candidates to check their state’s current status and examine the proposed model for regulation.

Accreditation

When any academic program is accredited, its curriculum and admissions process has been vetted by an neutral agency. This process ensures a standard of academic rigor can be reasonably expected that these schools. Accreditation occurs on the national, regional, or program level, or even all three, but each of these accreditations means something different.

National accrediting bodies are focused on a type of education, such as technical or vocational. Regional accreditation is more focused on academic rigor; regional accreditation carries more impact than national accreditation does, especially when it comes to graduate school admissions. Program-specific accreditation is especially useful for evaluating the academic offerings in certain fields; the Commission on Collegiate Nursing Education (CCNE) approves nursing education programs at all levels, representing the gold standard of the nursing industry. Additionally, the Council on Accreditation of Nurse Anesthesia Educational Programs further monitors programs to ensure that they meet nurse anesthetist requirements.

Although the federal government’s role in accreditation is limited, the U.S. Department of Education does provide oversight of the accreditation process and it maintains a database of accredited schools. Similarly, the Council for Higher Education Accreditation is an independent association of accredited degree-granting institutions that administers a database of accredited schools.


Career Outlook

As a whole, the nursing sector is growing at a tremendous scale that is only projected to continue into the foreseeable future. According to the U.S. Bureau of Labor Statistics, nurse anesthetists can anticipate an astounding 31% increase in jobs through 2024. This explosive growth is the combined result of an aging population, the medical profession’s increased reliance on preventive care as treatment, and legislative changes in the healthcare landscape.

Source: BLS

Work Environments

CRNAs enjoy an array of employment options. Factors that may influence a CRNA’s choice of employer include flexibility in scheduling, on-call requirements, and whether they prefer a solo or group practice. Below we’ve listed some of the most popular employers for graduates of CRNA programs, as well as the median certified registered nurse anesthetist salary.

Average Hourly Rate for CRNAs by Workplace Environment

Environment Description Average Hourly Rate for CNA
General Hospital Acute care facility where patients are recovering from surgery, disease, or trauma. May be small community hospitals (~75 beds) or large regional hospitals (~1500 beds). $147,734
Ambulatory Care/Surgery Center Outpatient setting that delivers high-level care without hospital admission. Care delivery includes same-day surgery, dialysis treatment, radiologic testing, blood testing, and chemotherapy and hematology therapy. $145,127
Military Direct care facilities for military service personnel and their family members, located on military bases and posts throughout the U.S. and across the globe. $170,000
Physician’s Office/Private Practice Office where individual or a group of physicians see patients for non-acute follow-ups. Often adjacent to a hospital complex. Physicians, RNs, and CNAs perform routine checkups and assessments; care delivery may include minor surgical procedures, injections, blood testing, measurement of vital signs, and long-term care plan management. $170,000
Other Dentist or oral surgery clinic or private practice. Care provided for surgical treatment of diseases, injuries, and defects of hard and soft tissues of the jaw and face. $122,500

Source: Payscale

CRNA Salary

As the table above demonstrates, the country’s top five CRNA employers deliver quite comfortable nurse anesthetist salaries. When viewed from a more regional slant, the same U.S. Bureau of Labor Statistics (BLS) data reveal that the top paying states for CRNA salaries are Texas, Ohio, North Carolina, Pennsylvania, and Florida. CRNAs also enjoy salaries that grow as they gain more experience, as the table below indicates.

Source: Payscale

Depending on the clinical environment, a nurse anesthetist job description may include predictable schedules with respectable amounts of paid leave. This is likely to be more true in private practices or in small freestanding surgical or ambulatory care centers. Matters may be different at public and private hospitals. Many CRNAs who work in hospitals are subject to extremely long shifts, heavy caseloads, and irregular hours. Nurse anesthetists who serve as the primary provider in rural areas, which is common for APRNs, may find themselves frequently called to the hospital with no regard to their personal need for rest. Even in large, well-staffed hospitals, on-call shifts can exhaust the most energetic of CRNAs.

In 2015, American Association of Nurse Anesthetists (AANA) published official guidance on the topic of fatigue in the workplace, citing patient safety as a major concern when anesthetists are overly fatigued by the demands of work. While fatigue is somewhat accepted as an industry norm, the guidance states that it can adversely affect the nurse anesthetist’s ability to be vigilant, and vigilance is non-negotiable in this profession. While it stops short of recommending a maximum number of CRNA work hours per week, the AANA does advise that nurse anesthetists work no more than 16 consecutive hours without adequate breaks for meals and respite.

For more information, read about the different paths to becoming a nurse.