What does a CRNA do?

Certified nurse anesthetists are specialized nurses who care for patients before and after surgery. They manage a patient's pain and administer anesthesia, functioning much like anesthesiologists. A CRNA performs a physical assessment of a client prior to surgery and determines the type of anesthesia required in each patient's case. The CRNA administers the anesthesia during the surgery, stays with the client throughout the entire procedure and closely monitors the body functions along with the effects of the anesthetic. The goal is to ensure each client receives the highest level of safety and comfort during a procedure. The nurse must constantly monitor a patient's vital signs and adjust the amount of medication while coordinating with the other members of the surgical team. The post-operative care responsibilities include overseeing the client recovery from anesthesia.

What are some of the general CRNA responsibilities?

The practice of CRNAs is dependent on their level of experience, state regulations, as well as on the policies and procedures enforced by the institution which hires them. According to the American Association of Nurse Anesthetists, CRNAs administer anesthesia and provide patient care in the following main categories: pre-anesthetic preparation and evaluation; anesthesia induction, maintenance and emergence; post-anesthesia care; and peri-anesthetic and clinical support functions.

In addition to providing anesthesia services in the operating room environment, CRNAs may also work in other areas such as MRI units, cardiac catheterization laboratories, and lithotripsy units. The responsibilities of a CRNA in these type of environments may include: provide respiratory and ventilatory care; identify and respond to emergency situations such as cardiopulmonary resuscitation; provide airway maintenance, ventilation, or tracheal intubation; assist with pharmacological support or manage a client's blood and electrolyte balance. Certified nurse anesthetists may hold administrative and teaching positions or be involved in academic research and consulting activities.

What is a CRNA's scope of practice?

A complete list of CRNA functions and practice parameters may be found in the AANA Scope and Standards of Nurse Anesthesia Practice. The following functions are a summary of a CRNA's scope of practice:

  • Prior to a procedure perform and document a client assessment, which may include consultations and diagnostic studies; select, obtain, order, or administer preanesthetic medications and fluids; obtain informed consent for giving anesthesia.
  • Develop and implement an anesthetic plan for each client.
  • Select and begin the anesthetic technique outlined in the client's anesthetic plan. This technique may include general, regional, and local anesthesia as well as intravenous sedation.
  • Choose, obtain, or administer the anesthetics, as well as other drugs and fluids required to manage the anesthetic.
  • Choose an appropriate way to collect and interpret a client's physiological data.
  • Manage a client's airway and pulmonary status using an appropriate technique such as: endotracheal intubation, mechanical ventilation, pharmacological support, respiratory therapy, or extubation.
  • Manage the patient's emergence and recovery from anesthesia and prevent any complications.
  • Release or discharge clients from a post-anesthesia care unit, and provide post-anesthesia follow-up evaluation and care.
  • Order, initiate or modify pain relief methods. Select appropriate drugs, regional anesthetic techniques, or epidural analgesia to manage pain.
  • Respond to emergency situations by providing: airway management, administration of appropriate fluids or drugs, or using cardiac life support techniques.

What should I know about the educational requirements for nurse anesthetists?

Nurse anesthesia programs are known for providing students with a rigorous education. Acceptance into a CRNA program is competitive. It requires strong letters of recommendation and the completion of specific criteria prior to admission. An interview is a mandatory part of the admission process. According to the American Association of Nurse Anesthetists, there are over 110 nurse anesthesia programs in the United States. These educational programs are closely associated with and operated by universities and other academic institutions.

CRNA programs take a minimum of twenty-four months to complete but many of them require about thirty-six months of study. Nurse anesthesia degrees are master's or doctoral degrees. Accreditation of these educational programs is given by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) upon a careful and systematic evaluation. To work as a nurse anesthetist in the United States one must pass a national certification exam, and re-certify every two years by completing a mandatory number of continuing education hours.

Is there work collaboration between nurse anesthetists and anesthesiologists?

Anesthesia is recognized as a specialty in two professions: nursing and medicine. About eighty percent of Certified Registered Nurse Anesthetists (CRNAs) work with physician anesthesiologists as members of the same care team for a given patient. The other twenty percent of CRNAs function as the only anesthesia providers in a team which includes surgeons and other licensed physicians.

The American Association of Nurse Anesthetists (AANA) believes that anesthesia results are excellent in both practice models and these positive outcomes are documented by multiple independent research studies. CRNAs and anesthesiologists must have forthright and collaborative relations when they are part of the same care team. Regardless if they work as sole anesthesia providers or not, CRNAs are responsible for their actions when caring for a client and need to practice in accordance with their licensure, certification, and level of experience.

Does the work of a nurse anesthetist involve performing research?

In addition to administering anesthesia, nurse anesthetists may take on various roles such as investigators, collaborators, consultants, interpreters and users of research findings. Nurse anesthesia educational programs have been focusing on providing graduate students with the basic skills for conducting research. Furthermore, an increasing number of graduate level CRNA teachers have decided to act as sponsors and directors for research projects conducted by universities and schools of nursing.

The American Association of Nurse Anesthetists Foundation is a strong promoter and facilitator of research. The foundation encourages both teachers and students to actively participate in research projects, cooperate, as well as share ideas and knowledge. Certified Nurse Anesthetists share their research at national and international conferences with nurses, pharmacists, physicians, and physiologists. The research is typically funded by governmental grants as well as private organization sponsorship. The AANA Foundation is one of the nonprofit organization well known for funding CRNA and nurse anesthesia student research.

Do I need a bachelor's degree in nursing in order to enroll in a CRNA program?

The majority of CRNA programs do require applicants to have a bachelor's degree in nursing from a nationally accredited program. However, some CRNA programs may also consider registered nurses with a baccalaureate degree in another field. Additional course work may be required from those who have a two-year degree in nursing and a bachelor's degree in some other field. Because each school of nursing has its own admission rules, you are encouraged to find out the particular CRNA program requirements at the university of your choice.

What prerequisite coursework do I need to take before applying to a CRNA program?

It is best to contact the school of nursing where you plan to apply and ask what coursework is required of CRNA program applicants. The following courses are typically mandatory for nurses interested in completing a nurse anesthesia program: organic and inorganic chemistry; biochemistry; physics; statistics. Prospective students need to submit official school transcripts of all academic and professional courses they completed before admission. The minimum GPA a potential student must receive in these prerequisite courses is 3.0 but in general future CRNA students achieve an average GPA of 3.4 or higher.

How much work experience as a registered nurse do I need prior to applying to a CRNA program?

Having the required clinical background is essential to ensure your success in a CRNA program. Nurse anesthesia programs require that prospective students have a minimum of one year of intensive care unit experience although some programs require two years. Most programs conduct admission interviews once a year.

Registered nurses looking to enroll in CRNA programs must have their intensive care experience by the time of the interview. Even though only one year of ICU experience is mandatory, most applicants work as registered nurses in intensive care for two to three years before they decide to pursue a master degree in anesthesia.

Each school has its own definition of what constitutes acceptable intensive care experience but in general the following hospital units qualify towards meeting the critical care requirement: surgical intensive care including: trauma, post-cardiovascular surgery and neurosurgical specialty units; coronary care, pulmonary care, and other medical sub-specialty units; pediatric and neonatal intensive care units.

You need to consider if your present work place provides enough experience to make you successful in a nurse anesthesia program. Prospective students should look for jobs at academic teaching hospitals where they can increase and sharpen their skills. Candidates who lack enough clinical experience are typically advised to obtain a CCRN certificate before they reapply for admission the following year.

Besides education and work experience, what other type of requirements should I be aware of?

The list of CRNA admission requirements might seem extensive for some prospective students. Aside from educational and work experience requirements, individuals interested in enrolling into a CRNA program may need to complete a minimum of two days of clinical shadowing experience with a certified registered nurse anesthesia or a physician anesthesiologist. Shadowing with a CRNA is the preferred path, but if a CRNA is not available, the applicant may shadow a physician anesthesiologist. While not all schools of nursing ask for a shadowing experience, they all highly recommend it as an excellent learning experience.

Because sometimes it might be difficult to find a CRNA to shadow, it is a good idea to set up a shadowing experience with the CRNA employed at the hospital where you work as a registered nurse. In addition to shadowing a nurse anesthetist, prospective students might have to write a goal statement or an essay which explains academic and professional readiness for attending the CRNA program. Describing the goals one hope to achieve by pursuing a career in anesthesia might also be one of the questions asked during the CRNA program admission interview.

CRNA salaries depend on: number of days/hours required to work; mandatory on call or weekend work; years of experience; state; size of employer; responsible party for the job offer: private practice, recruitment agency, hospital. Sometimes private practice groups may pay a significantly higher salary than hospitals or recruitment agencies.

What factors are important to consider before choosing a CRNA job?

The following seem to be important criteria to consider when looking to sign a work contract as a CRNA: salary; benefits; location; hours of work per week; mandatory call; location; type of anesthesia required by the position. To ensure you obtain a competitive salary, compare offers from several potential employers in the area.

Recruitment agencies, anesthesia groups, hospitals, and private practice groups may offer significantly different salaries for individuals with the same experience. Job benefits can be extensive for a nurse anesthesia and may include: health and dental insurance coverage, a retirement package, and overtime pay when applicable. Benefits are a substantial contribution to a CRNA's annual income and should be considered carefully.

It is common for hospitals and private anesthesia groups to require a nurse anesthetist to be on call for a specified number of days. It is smart to find out how often you will be required to be on call and if there are different levels of call. Some very attractive CRNA positions may be offered in a different state than the one you live in. Are you willing to relocate or will you settle for a job that is less attractive but close to where you currently live? Employers are usually very specific about the type of anesthesia the CRNA needs to perform for a given job. They may choose not to use a CRNA's services for procedures such as heart or head surgery or they may require extensive experience in certain areas such as obstetrics.