Certified Registered Nurse Anesthetists (CRNAs) have made the news for being the Nation’s highest paid nurses. But they are first and foremost nurses. They got in the positions they’re in through stages. They proved themselves as critical care nurses; they’ve been out there in the ICU. Later they competed against other interested critical care nurses – professionally, academically, personally — and then completed several additional years of very rigorous education. They often work in areas where the population depends on them in no small way. One way they may serve: by being on-call for emergencies.
Nurse anesthetists are an integral part of surgery. They also provide an invaluable service in trauma stabilization.
CRNAs may work in operating rooms, ambulatory surgical centers, or the offices of various healthcare providers, for example, ophthalmologists. They practice under supervision in most states. However, some states have opted out of this requirement.
In rural America, it’s nurse anesthetists, not anesthesiologists, who are the main anesthesia providers. One reason they are so fundamental: Many of the hospitals they work for are strapped. Nurse anesthetists may be the highest paid nurses, but they are more affordable than anesthesiologists. So, too, these small hospitals may face recruitment challenges.
This is one of the reasons that during National Certified Registered Nurse Anesthetists (CRNA) Week many communities opted to highlight their role. The Minnesota Association of Nurse Anesthetists reported that anesthesia services are provided solely by CRNAs in more than 60% of the state’s counties (http://www.messagemedia.co/millelacs/community/health/crna-week-sheds-light-on-the-future-of-anesthesia-care/article_d15d51bc-0051-11e8-a63a-d71c6f29c5bb.html).
Nurse anesthetists are also utilized extensively in the military. Nurses have been providing anesthesia since the Civil War. Thankfully, it’s gotten a lot safer in the ensuing time. In fact, the American Association of Nurse Anesthetists (AANA) reports that it’s many times safer than it was in the 1980s (https://www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet).
Many CRNAs do work in urban areas. Rochester, Minnesota has the highest concentration of nurse anesthetists of any metropolitan or nonmetropolitan division in the nation. Next in line are Mobile, Alabama and Charleston, West Virginia. In some settings, they work on teams with anesthesiologists.
The role of the nurse anesthetist extends from pre-operative through post-operative phase (for example, pre-anesthesia assessment and monitoring of post-anesthesia recovery). Technical competencies include attaching invasive and noninvasive monitors and providing airway management and ventilation support; CNRAs sometimes consult on these subjects. Some nurse anesthetists perform pain management services such as nerve blocks. AANA (https://www.aana.com) has provided a sample job description with things that a CRNA might do on the job – it’s a lengthy list.
AANA operates a website that includes CRNA stories (http://www.future-of-anesthesia-care-today.com/CRNA-stories.php). One tells of a CRNA in private practice who got a pilot’s license to facilitate getting from himself hospital to hospital in rural Nebraska. He has assisted with many emergencies, including a person who had accidentally injected himself with what could have been a fatal dose of a medication intended not for humans but cattle; the CRNA’s knowledge of the molecular structure of drugs allowed him to suggest to the emergency room doctor something that might work to counter its effects. Another CRNA, an urban provider, tells of being on the team that performed an historic artificial heart transplant.
Becoming a CRNA
A career in nurse anesthesia builds on a career in critical care nursing; the minimum requirement is one year of experience as a critical care nurse.
A future nurse anesthetist will need to complete a graduate program that is approved by the Council on Accreditation of Nurse Anesthesia Educational Programs. Programs take from two years to about three-and-a-half years (https://www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet). They are heavy on clinical experience.
The profession is transitioning from master’s level to doctoral level. The master’s will no longer be an option for students who enter programs in 2022; all entering students will need to graduate with doctoral degrees. They will have core ‘Doctor of Nursing Practice’ or DNP coursework in addition to comprehensive clinical and didactic preparation in anesthesia-related studies. A 2018 search shows 119 accredited programs, with 74 at the doctoral level (http://home.coa.us.com/accredited-programs/Pages/CRNA-School-Search.aspx).
Nurse anesthetist applicants typically submit several references in addition to their own personal statement. Nursing experience is scrutinized. Academic caliber and scientific aptitude must be high. A 3.0 may be stated as the minimum requirement. The GRE is sometimes required. Some programs will admit RNs who do not hold a Bachelor of Science in Nursing if they hold another appropriate degree at the bachelor’s level. Overall, candidates should expect a highly selective process. OHSU School of Nursing states that for their master’s program, it is not uncommon for the selection rate to be about one in seven (http://www.ohsu.edu/xd/education/schools/school-of-nursing/programs/masters/advanced-practice-nursing/nurse-anesthesia/frequently-asked-questions.cfm).
In order to be credentialed, a person must pass an examination given by the National Board of Certification and Recertification for Nurse Anesthetists, or NBCRNA (https://www.nbcrna.com/initial-certification).
Some CRNAs choose to specialize. Sub-specialties include obstetrics, cardiovascular, pediatric, plastic surgery, dental, and neurological services.
CRNA Salary and Career Outlook
Nurse anesthetists earned an average salary of $160,270 in 2016. There is a good deal of variation from one state to the next, and there may be some surprises (https://www.bls.gov/oes/current/oes291151.htm). Wyoming and Montana employ relatively few CRNAs, but it’s here that wages are highest. Next up is California. The highest paying metropolitan areas are in California.
The Bureau of Labor Statistics groups nurse anesthetists with two other types of advanced practice nurse (nurse practitioners and nurse midwives) for some reporting purposes. This occupational group has been projected to see 31% growth between 2016 and 2026.
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