Becoming a Nurse Anesthetist (CRNA)
Certified Registered Nurse Anesthetists (CRNAs) provide critical care to patients in their hour of need. They administer anesthesia before medical procedures while ensuring the comfort and safety of their patients. Given the delicate nature of their work, CRNAs must have extensive education and experience.
Fortunately, their work pays off. Most CRNAs work independently and have the highest earning potential among the advanced practice registered nurses (ARPNS). If you’re interested in being a CRNA and looking to learn about education requirements, duties and responsibilities, certification and licensing, advancement opportunities, among other things, this guide is for you.
In this article:
- What is a nurse anesthetist (CRNA)?
- What do CRNAs do?
- Where do they work?
- Requirements for nurse anesthetists
- Closely related types of nurses
- CRNA nursing careers
- How to become a nurse anesthetist
- Other considerations
What is a nurse anesthetist (CRNA)?
A CRNA is an advanced practice registered nurse trained and certified to administer anesthesia before medical operations, such as surgery, emergency care, pain management, or labor and delivery. A nurse anesthetist provides similar services as an anesthesiologist; however, the latter may provide a collaborative oversight to ensure patients’ best practices.
According to AANA (the American Association of Nurse Anesthetists), most hands-on anesthesia care in the US is provided by CRNAs.
The CRNA profession emerged during the civil war, i.e., when nurses were on the forefront, administering chloroform to injured soldiers. Today, CRNAS are the anesthesia providers in most community-based hospitals in the US and the primary administrators of anesthesia to the US Armed Forces soldiers.
What do CRNAs do?
As a CRNA, you are responsible for numerous tasks, including intubating patients who may need anesthesia, caring for patients under it, monitoring their vital signs, managing ventilators, and administering medications.
In-depth, the duties and responsibilities of a CRNA include:
- Setting up surgical rooms for operation
- Organizing the medications that will be required
- Examining patients’ medical history and requesting diagnostic studies
- Developing anesthetic plans
- Discussing any risks and side effects with the patient and their families
- Prepping and administering anesthesia – in the required form
- Performing epidural, spinal, or nerve blocks
- Offering patient care before, during, and after medical procedures
- Monitoring vital signs during and after medical procedures to avert and manage complications
- Responding to emergencies with life support techniques, medications, or airway management
- Participating in therapeutic or diagnostic procedures
- Diagnosing and delivering chronic or acute pain management
Note, CRNAs can also be tasked with administrative duties, including managing finances, ordering medications, and training new staff. They may also hold positions with state nursing boards, act as instructors in course development, or be part of organizations that set medical standards.
Bottom line, a CRNA works in varied and exciting settings – and go home knowing they’ve advocated, cared, and probably helped patients live to their fullest.
CRNAs and other nurses are in demand
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Where do they work?
A report from AAMC (Association of America Medical Colleges) projects that the nation will face a shortage of 54100 – 139 000 physicians by 2033. With such deficits, the demand for CRNAs will keep increasing across the United States. Thus, a certified CRNA is needed in different healthcare environments, including:
- Medical and surgical hospitals
- Outpatients surgery care centers
- Dental offices
- Plastic surgery centers
- Pain management centers
- Public health centers, and other medical offices, and
- The United States military facilities
Requirements for nurse anesthetists
Currently, you require a master’s degree in nursing (MSN) and national certification to become a CRNA. However, this is bound to change in 2025; for then, a doctoral degree will be the prerequisite to joining the field. The recent directives by the Council on Accreditation of Nurse Anesthesia (COACRNA) Educational Programs require all nurse anesthesia degree programs to include doctoral degrees by 1st January 2022. They will also need all the students pursuing nurse anesthesia’s MSN programs at the time to transition to doctoral programs.
Enrolling into a CRNA degree program requires you to:
- Be a registered nurse (RN)
- Have a BSN (Bachelor of Science in Nursing) degree
- Have a 1+ year of experience in the Emergency room (ER), intensive care unit (ICU), or other acute care settings
Note, these requirements may vary depending on your preferred nursing school. Some institutions require a Resume/CV, letters of recommendation, minimum GRE scores, minimum GPA requirements, and sit-in interviews. Also, CRNA degree programs are competitive, and thus, you may consider pursuing specialty certification as a CCRN (critical care registered nurse) to better your odds.
When applying, ensure that the COACRNA approves your selected program – for you must graduate from an accredited MSN program to take the licensing certification test. To that end, be prepared to study the following areas:
- Chemistry, biochemistry, and physics
- Anesthesia pharmacology
- Pain management
- Statistics and research
- Anesthesia technology and equipment
- Anatomy, physiology, and pathophysiology
- Legal and professional aspects of CRNA practice
Once done with the education program, you’ll have supervised clinical practice, working in community-based or university-based hospitals – to apply techniques and theories learned in class. As per AANA statistics, the average CRNA student administers about 850 anesthetics and complete about 2500 during their clinical training.
After graduating from the MSN program, you must pass your NCE (National Certification Examination) as offered by the NBCRNA (i.e., National Board of Certification and Recertification for Nurse Anesthetists).
NCE test comprises 100 – 170 computerized questions across various topics, including 30 random questions. It costs $725.
To obtain the certification, the graduate should apply for the NCE exam, pay the fee, provide appropriate documentation to NBCRNA, and then schedule to take the examinations at their convenient testing center.
Note, a test taker has a total of 3 hours to complete the NCE exam whose questions relate to:
- 25% of basic sciences
- 15% of equipment, technology, and instrumentation
- 30% of the basic principles of anesthesia
- 30% of the advanced tenets of anesthesia
Note, the NBCRNA website has practice exams and tutorials to help prepare. Also, according to NBCRNA reports, 84% of graduates pass the NCE exam on their first try, after which, they can recertify through the CPC (Continued Professional Certification) program every four years.
If you pass, your certification’s verification is sent to your state board of nursing, where you’ll complete additional steps as needed to be a state-licensed CRNA.
All the USA states (except Pennsylvania and New York) require CRNAs to be licensed as APRNs (advanced practice registered nurse).
To qualify for the state licensure, a candidate must provide a completed application, associated fee, and proof of CRNA certification and program completion; to their state board of nursing. Based on the state requirements, the candidate may submit their physician supervision form and apply for prescription authority.
Additional requirements for CRNAs
To maintain their designations, CRNAs must renew their national certification via the NBCRNA every 2 or 4 years. To qualify for renewal, you must:
- Complete 40+ continuing education credits
- Hold a current, unencumbered RN license.
- Prove you have engaged in anesthesia during the certification period
- Verify you don’t have physical, mental, and other problems that could interfere with anesthesia practices
In 2 years, the CRNA must complete an online-check-in to maintain their state license.
In 4 years, you must complete:
- 60 Class A credits on tasks directly linked to improvement or delivery of anesthesia care.
- 40 Class B credits on activities related to anesthesia practice or professional development subjects, such as research, public education, and patient safety.
- Four core modules: Physiology, applied clinical pharmacology, airway management, pathophysiology, and anesthesia technology and equipment.
At the end of 8 years, the CRNA must take a CPC test comprising 150 questions, designed to test knowledge in the four core modules of CRNA practices.
Closely related types of nurses
In their line of work, CRNAs are likely to work with their fellow APRNs, including mental care nurses, primary care nurses, preventive care nurses, and mid-wife nurses.
More closely, CRNAs can work with perioperative nurses or surgical nurses in charge of pre-and-post-operation patient care. Also, CRNAs can work with nurse-midwives with a specialization in caring for pregnant women. Nurse-midwives also help out in labor, delivery, prenatal appointments, and after-delivery counseling.
CRNA nursing careers
As a CRNA, you can advance your career through specialization. That is, tailoring your education and expertise toward a specific condition, population, or surgical subfield. Specializing is known to increase earning potential and offer more opportunities. The popular concentrations include pediatrics, cardiovascular, obstetrics, neurosurgery, and dental surgery.
Alternatively, find work in locations or settings that report high CRNAs’ salaries. For instance, outpatient care centers and general surgical/medical hospitals list salaries higher than the national average. Also, some states pay better than others. According to BLS (bureau of labor statistics), Wyoming, Montana, Oregon, Wisconsin, and California states pay their CRNA over $200,000 annually.
Else, you can go to medical school and study to become a doctor.
Salary career outlook
According to BSL, the average hourly pay for CRNAs was $97.50 as of 2nd November 2020. Of course, the salary is dependent on your state and the type of facility you’re working in. Regardless, nurse anesthetics have a relatively higher earning potential in the nursing arena compared to other APRNs.
How to become a nurse anesthetist
To become a nurse anesthetist, you must:
- Earn a bachelor degree in nursing (BSN) from a regionally accredited university or college
- Complete a master of science in nursing (an MSN program)
- Obtain RN licensure by completing and passing the NCLEX-RN (National Council Licensure Examination)
- Pursue specialization as an RN in critical or acute care settings
- Get admitted to an accredited CRNA program.
- Earn a DNP in anesthesia practices – this will be a prerequisite to becoming a CRNA as of 2025
- Obtain certification from NBCRNA after passing the national certification examination
- Obtain an advanced practice nurse-practitioners state licensure – that’s specific to your state.
- Find entry-level employment in the nurse anesthesia field, more so in specialized areas.
- Re-certify through the CPC (Continued Professional Certification) program every four years.
When pursuing to be a nurse anesthetist, take the following into considerations.
The time it takes one to be a CRNA depends on the education path they choose to follow.
Obtaining a BSN degree takes about 4 years, after which, the candidate is eligible to apply for registered nurse (RN) licensure upon completion. Next, the graduate must have a minimum of one year to specialize in acute care or pursue CCRN.
Obtaining MSN and DNP in nurse anesthesia will take another 4 to 6 years – after which, the candidate can get their CRNA certification. With the national certification, the candidate can finally apply for state APRN licensing.
However, the graduate can opt for an accelerated program, where a BSN-to-DNP can take around 3-4 years.
The cost of CRNA programs varies depending on whether it’s a public or a private program. Here, take into account the tuition, program, and loan fees, as well as the cost of books, materials, equipment, healthcare insurance, food, lodging, transportation, and other utilities.
The working conditions of a nurse anesthetists have negative and positive aspects. Expect a significant amount of stress. For instance, a CRNA must be on guard always – which can be draining. Patients with chronic pain resistant to treatment can be challenging to care for, and the same goes for patients who experience unexpected reactions to anesthesia.
You’ll also be on your feet for long hours – assisting in life-saving surgeries and other medical procedures. Or work in risky areas, exposing yourself to chemicals, bloodborne pathogens, and workplace violence.
However, CRNAs have a fulfilling career, from relieving pain to providing patient care. Yes, there is something rewarding about helping patients live life to the fullest.
As for shifts, a CRNA can work during the day, night, holiday, weekend, and on-call shifts.
Final word on nurse anesthetists
In conclusion, while it takes time and massive dedication, being a CRNA is rewarding. For one, you get to work independently while getting paid to do what you love – providing care. To make the process easier and more exciting, Incredible Health helps you find your dream job as well as manage your career. We provide 100% free resources to help continue your education, in addition to exclusive events and community support. Sign up to get started.