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, including determining technique, drugs, and dosage, along with managing and monitoring a patient's pain levels and vital functions. This career is categorized as an advanced 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 registered nurses (RNs) and licensed practitioner nurses (LPNs), who do not need to earn graduate degrees. Due to their high level of precision and knowledge, CRNAs operate with high levels of autonomy. This guide will teach you more about how to become a nurse anesthetist.

What Does a Nurse Anesthetist Do?

Before determining and administering anesthesia, a CRNA makes a complete assessment of a patient's health condition and previous reactions to anesthesia. They identify potential risks during the medical procedure, convey those risks to patients, and manage and monitor patients' conditions throughout the procedure and recovery period.

Who Should Consider Becoming a CRNA?

Among all advanced practice nurses, CRNAs enjoy the most professional autonomy. This autonomy comes with great responsibility. Gaining admission to graduate-level CRNA schools can be challenging, and programs that lead to CRNA credentials are notoriously competitive.

Many CRNA programs 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.

CRNAs monitor sophisticated equipment, follow complex protocol, and immediately react when a situation changes. Outside of the operating room, a CRNA is commonly the last clinician to speak with a patient before a procedure, and a calm demeanor is 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 busy operating rooms.

Why Should I Become a CRNA?

Most CRNAs enjoy a significant amount of independence in their practices. They coordinate patient care with other professionals, but overall, they carry out duties as they see fit. Additionally, the Bureau of Labor Statistics (BLS) projects a 31% growth rate for the profession, which is much faster than the average growth rate.

CRNAs also earn a higher median salary than the average U.S. occupation: $113,930 versus $38,640. Professional independence, robust job growth, and high median salaries are all excellent reasons to pursue a career as a CRNA.

What's the Difference Between an Anesthesiologist and Nurse Anesthetist?

Generally, a CRNA needs to complete at least seven years of postsecondary education and training: bachelor's degree (3-4 years), master's degree (2-3 years), and training in critical care nursing (at least one year). As doctors, anesthesiologists complete at least 12 years of postsecondary education before they can practice: bachelor's degree (four years), medical school proper (four years), and residency (four years).

In practice, anesthesiologists can prescribe medication for patients to take after a procedure or discharge from the hospital. In most states, CRNAs can order medication to be used for a specific medical procedure, but they cannot usually prescribe medication. To do so, most states require each CRNA to obtain a specific prescribing license.


Educational Paths to Becoming a CRNA

Although programs may vary from state to state, the CRNA career path is a fairly specific one. Variances are often reflected in state RN licensing requirements. When earning your RN licensure, make sure to check in with your state board of nursing to learn about specific 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, which leads to RN licensure.

With a master's degree as a CRNA requirement, students at this point should begin to prepare for the GRE. Registration, study, and administrative processing can take time. Before applying to CRNA schools, these nurses also need 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 candidates to complete programs on an accelerated timeline.

A working RN who holds a two-year associate degree or diploma must complete the BSN before continuing to a graduate-level CRNA program. Fortunately for these professionals, many 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 can 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 7-8 years of preparation. This period 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 cohorts that begin and finish together. 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: This course examines cardiological and renal anatomical, biological, and physical principles integrated with advanced pharmacological theory, principles, and practice to assess and manage patients.
  • Advanced Pathophysiology for Anesthesia: Students can explore pharmacology and anesthesia, specifically in gastrointestinal, endocrine, and neurologic care. Faculty members integrate current research findings into practice.
  • Role of the Nurse Anesthetist: This course covers the ethical, medical, and legal duties of the nurse anesthetist practitioner and external impacts to the profession. Faculty members review certification exam subject matters.
  • Physics and Chemistry of Anesthesia: Enrollees can examine the physics of solids, liquids, gases, and vapors in addition to inhalation appliances, carbon dioxide absorption, and flammability of gases and vapors. Course materials cover the operating principles of anesthesia delivery devices and patient monitoring systems.
  • Anatomy for Nurse Anesthetists: This course includes cadaver dissection of the human body along with a regional approach to respiratory, circulatory, and peripheral nervous systems. Special emphasis is given to anatomic features of neural blockade.

CRNA Certification and Licensing Requirements

Along with RN licensure, all nurse anesthetists must pass the CRNA exam. The National Board of Certification and Recertification for Nursing Anesthetists (NBCRNA) outlines eligibility requirements, registration processes, exam details, and renewal procedures in its Examination Candidate Handbook.

Requirements to Take the NBCRNA Exam:

  • Hold an active RN license in your state of employment.
  • Hold a graduate degree from a nursing anesthetist program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs.
  • Submit a completed application form along with all supplemental materials.
  • Acknowledgment that one does not suffer from ailments that would prohibit work as a CRNA, such as drug or alcohol abuse.
  • Have 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 ability to practice.
  • Prospective CRNAs should also note that the National Council of State Boards of Nursing 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 have been vetted by a neutral agency. This process ensures a standard of academic rigor can be reasonably expected at these schools. Accreditation occurs on the national, regional, or program level, or even all three, but each of these accreditations hold different weights.

National accrediting bodies are focused on a type of education, such as technical or vocational. Regional accreditation is more focused on academic rigor and carries more prestige than national accreditation, 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 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 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 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. The BLS projects an astounding 16% increase in jobs from 2016-2026 for nurse anesthetists. 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.

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 Salary
Offices of Physicians CRNAs working in the offices of private practice physicians are typically in charge of patient's well-being before, during, and after medical procedures requiring the administration of mild to moderate anesthesia. They review a patient's complete medical history to make sure the anesthesia will not produce any adverse effects while still being adequate for the procedure to be performed. $159,250
General Medical and Surgical Hospitals CRNAs working in hospitals usually coordinate patient care with other medical professionals involved with the patient. Working with an anesthesiologist or on their own, they order the type of anesthesia to be administered and monitor the patient closely during and after the procedure. $174,980
Outpatient Care Centers These care centers provide diagnostic and treatment services, such as MRI scans and chemotherapy sessions. CRNAs working in this type of environment often administer sedatives to ease a patient's discomfort during procedures. They also instruct patients in the dosage and proper administration of any painkillers they are prescribed. $181,800
Offices of Other Health Practitioners CRNAs can work in dental offices where they provide general anesthesia or deep sedation services. They do not assist dentists in any procedure; instead, they focus on the patient and monitor their condition throughout the procedure. CRNAs also instruct patients in pain management after dental procedures. $151,250
Colleges, Universities, and Professional Schools CRNAs can teach a variety of undergraduate classes in subjects like pharmacology, regional anesthesia administration, and anesthesia machine technology. In some states, a CRNA must acquire a license to teach in postsecondary institutions. CRNAs with doctorate-level education and training can also teach master's-level coursework. $80,380

Source: Bureau of Labor Statistics

CRNA Salary

As the table above demonstrates, the country's top five CRNA employers deliver lucrative nurse anesthetist salaries. When viewed from a more regional slant, BLS data reveals that the top paying states for CRNA salaries are Montana, Wyoming, California, Oregon, and Iowa. CRNAs also enjoy salaries that grow as they gain more experience, as illustrated below.


Conclusion

Depending on the clinical environment, a nurse anesthetist job description may include predictable schedules with respectable amounts of paid leave. This is more likely to be the case in private practices or 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 providers in rural areas, which is common for APRNs, may find themselves frequently called to the hospital with no regard for their personal need for rest. Even in large, well-staffed hospitals, on-call shifts can exhaust the most energetic of CRNAs.

In 2015, the 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.

It stops short of recommending a maximum number of CRNA work hours per week, but 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.


Additional Resources for Nurse Anesthetists


American Association of Nurse Anesthetists

Supporting almost 53,000 members throughout the country, AANA certification programs, continuing education opportunities, and advocacy efforts on behalf of the profession itself. The AANA Foundation awards education and research funding opportunities to CRNA practitioners, students, and faculty. AANA implements academic and practice standards to ensure professional integrity within the field.


Anesthesia Patient Safety Foundation Grant

APSF co-administers the mentored research training grant with the Foundation for Anesthesia Education and Research. The assistance amount comes to a total of $300,000 dispensed over a two-year period ($150,000/year). Grant applicants must be current faculty members within 10 years of their first teaching appointments and performing research focused on patient safety topics.


Global Humanitarian Outreach - American Society of Anesthesiologists

GHO seeks to enhance and support the safe practice of anesthesia on a global scale. CRNAs and other anesthesiology practitioners can participate in international volunteer and disaster relief efforts, apply for funding opportunities, such as the Resident International Anesthesia Scholarship Program, and sign up for overseas training programs.


Nurse Anesthetist Traineeship Program

Although individual RNs cannot apply for this program, those looking for financial assistance for their CRNA degrees should seek out educational opportunities in institutions or agencies that participate in this federal program. The Health Resources and Services Administration maintains the NAT program, which covers full or partial tuition costs, books, and reasonable living expenses for CRNA trainees.


Society for Pediatric Anesthesia

SPA supports anesthesiology practitioners who specialize in the care of underage patients, including infants and teenagers, in operative, out-patient, and other types of healthcare facilities. The website features online courses, a job board, training webinars, and fellowship opportunities for academic and practice research projects. SPA sponsors both national conferences and regional meetings for its members.