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What is a Certified Registered Nurse Anesthetist (CRNA)?

The primary role of a Certified Registered Nurse Anesthetist (CRNA) is to manage a patient’s pain during surgery through anesthesia and medicine. This involves preparing patients for surgery, then monitoring them during and after the procedure.

CRNA is a career that has been around since the late 1800s. Surgeons Charles and William Mayo – the founders of the Mayo Clinic – trained nurse Alice Magaw to administer anesthetics to their surgical patients and the job was born. 

Magaw embraced a technique of using a new type of inhaler versus pressing an anesthetic-soaked towel over a patient’s nose and mouth. She also instilled confidence and ensured her patients’ comfort by explaining the process and adjusting their heads during surgery. This patient care is still a large part of what today’s CRNAs do.

Where do CRNAs work?

Sometimes a CRNA will work alongside an anesthesiologist or may work independently. State law dictates regulations and hospitals may have their own guidelines. In some states that may mean CRNAs are working under the direction of a physician whether that’s a surgeon or other medical professional, while in other states they may work autonomously.

CRNAs can work in trauma centers, surgery centers, dentist offices or anywhere that anesthesia is needed. They can work in large group settings, hospitals or in solo practice.

Dr. Derrianne Monteiro is the first CRNA to join the care team at IU Health Ball Memorial Hospital in Muncie, Indiana. At her hospital she said the group works together to give the patient as much care as possible. 

“We want a multidisciplinary cohesiveness amongst the professions, to come together and provide different perspectives for our patients which I think is very important,” she said.

Educational requirements

Becoming a CRNA is demanding in terms of educational requirements. The qualifications to become a CRNA will officially change soon, but most educational institutions have already adapted. Starting in 2025 a doctorate will be required, while previously nurses received a master’s degree

Despite the changes to the academic programs, currently practicing CRNAs with a master’s degree will not be required to return to school for a doctorate to maintain their certification, although some medical facilities may have more stringent job requirements.

Once a nurse graduates from the program, which usually takes three years, he or she will then be required to pass a certification exam. Recertification is required every four years. Anesthetists were among the first nursing specialty to require continuing education. 

Dr. Bradley Stelflung is Director of the DNP Program and Assistant Professor at the Leighton School of Nursing at Marian University in Indianapolis. Steflung said that candidates should thoroughly investigate what the job requires.

“School is extremely difficult, extremely intense,” he said. “It’s a full-time job basically for three years. You have to be committed to this profession.”

Although those interested in applying to a CRNA program must first have at least one year of experience as a registered nurse in critical care, Stelflung said that the minimum requirements are often not enough. Most programs usually require at least two years of ICU or ER experience and many require three or more years. 

Monteiro agreed that having ICU experience was beneficial to becoming a CRNA. It helped her understand the co-morbidities of patients and the effect of medication. She said it can take several years to gain that experience and requires exploring many disciplines.

“The most important part as a registered nurse was the vigilance and the very close monitoring of detail,” she said. “With anesthesia, everything matters. You’re taking care of a patient at the most vulnerable state of their lives.” 

How to choose a CRNA school

CRNA programs help students learn clinical practices, statistics and research in order to gain practical experience. The program also prepares students to pass the certification exam. The current passing rate for first-time takers of the exam is 84.8%. 

Getting accepted into an accredited CRNA school can be very difficult. When looking for a school, consider looking at the requirements for the program and the exam pass rate for its students. A higher rate shows that the students are not only prepared to pass certification but also may be better prepared to go straight into practice. 

Another factor to consider is the range of experience that students receive through clinical rotations. This can also help students be fully prepared for their first day on the job. 

Monteiro suggested finding a school in a location where you’ll have a support system since the three-year program can be very demanding. The time required for the program makes it very difficult to have a job outside of school. 

Because schools are so competitive, Monteiro suggests getting feedback if you don’t get into the program at first. She said that prospective students may then know what areas to improve before applying the next year. 

Benefits of being a CRNA

A CRNA is one of the highest paying careers in nursing. According to the U.S. Bureau of Labor Statistics, a CRNA makes an average of $181,040 annually. 

Stelflung said that the most ideal person to become a CRNA is someone who is confident, motivated, enjoys autonomy and able to make quick decisions. CRNAs must keep their practice evidence-based and stay current with new research.

Monteiro enjoys the ability to advocate on behalf of her patients and the instant gratification that comes from being a CRNA versus other nursing professions. 

“With anesthesia you see the immediate results. You see a person who comes in complaining of so much pain,” she said. “When they wake up, they’re happy.”

Stelflung believes that despite the challenging requirements, it’s a career path enjoyed by those who choose it.

“I just never hear of anyone getting out of nurse anesthesia to do something else,” Stelflung said. “That’s why we all say it’s the greatest profession on earth.”

Challenges to this career path

Burnout and stress are considered relatively common within the health care industry. While studies measuring the level of burnout among the CRNA specialty are rare, the few that exist indicate that CRNAs may have a higher level of burnout than other medical professionals. They self-reported that job-related factors contributed to their stress levels. 

Some stress factors emerged when recent graduates of CRNA programs were surveyed. The most common challenge that they reported relates to practice limitations and not receiving enough autonomy to perform their job. Another stress factor is a lack of orientation, which is common for many graduates. Many going into their first jobs are expected to be autonomous immediately, which is why it can be beneficial to find a CRNA program that promotes a wide range of experiences in clinical rotations.

A CRNA versus an anesthesiologist

The primary difference between a CRNA and an anesthesiologist is the medical background required for each degree. Anesthesiologists complete medical school and go through the same path as a medical doctor. Although CRNAs follow the same path as those in nursing school, their requirements are more rigorous than many other nursing specialties. 

There are currently 31,010 anesthesiologists in the U.S. and 43,570 CRNAs with plenty of demand for each profession. 

There are many reasons that a CRNA might be a better option in a medical setting, whether it’s a need for more patient care or a need to save money. In rural areas more than 80% of the people administering anesthetics are CRNAs.

“I think anesthesiologists are always going to be necessary, but a nurse anesthetist is a perfect solution for cost savings and increased patient safety,” Stelflung said. “They don’t have to be in competition with anesthesiologists.”

Bottom line

A CRNA helps patients prepare for surgery and ensures their pain is managed during and after the procedure. Their focus is patient care and support. Although it’s a high paying field, it’s also a very demanding one both during school and after graduation. It can be a highly stressful nursing specialty. 

Regardless of career path, Stelflung said that CRNAs are all ultimately the same. 

“The interaction with the patient is the same. The priority for patient care is the same. The ideals of the nurse anesthetist are the same,” he said. “It’s about delivering extremely high-quality anesthesia care and treating your patient like that’s your loved one during the procedure.”

“We’re nurses delivering anesthesia – what could be better than that?” he added.

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