Jennifer L.W. Fink, RN, BSN is a professional freelance writer with almost a decade of experience as a Registered Nurse. She's worked in both hospitals and nursing homes as a med-surg, geriatric and transplant nurse. Her national publication credits include Parents, RN, Ladies' Home Journal, Nursing Spectrum, Pregnancy and Journal of Christian Nursing.
A certified registered nurse anesthetist (CRNA) provides anesthesia services before, during and after surgery, childbirth or other medical procedures. While their training is somewhat different from that of an anesthesiologist, a medical doctor who specialized in the administration of anesthesia, CRNAs and anesthesiologists provide the same services.
Nurse anesthesia is the oldest nurse specialty in the United States, dating back to the Civil War. Today, there are well over 30,000 CRNAs in the United States. CRNAs currently deliver approximately 65 percent of the anesthesia given annually, according to the American Association of Nurse Anesthetists.
To become a CRNA, one must first have a BSN, a RN license and at least one year of experience in an acute care setting. Nurse anesthesia is a master's degree program and is often extremely competitive. The CRNA program generally lasts 24 to 36 months and includes coursework in pathophysiology, physiology and pharmacology. Upon graduating, the prospective nurse anesthetist must pass a certification exam to become licensed as a CRNA. Some nurse anesthetists eventually decide to pursue a Doctor of Nurse Anesthesia (DNAP), a practice-focused doctoral degree.
CRNAs practice in a wide variety of settings, including hospitals, ambulatory surgical centers, pain clinics and physicians' offices. Over 70 percent of the anesthesia delivered in rural healthcare facilities is delivered by nurse anesthetists. Many CRNAs practice in inner city environments as well. The degree of supervision varies according to the state. Some states allow CRNAs to practice independently, while other states require some form of physician supervision.
Nurse anesthetists assess patients and provide appropriate patient and family education prior to any anesthesia-related procedures. CRNAs administer anesthetic agents and remain with the patient throughout the entire procedure, monitoring the patient's temperature, blood pressure, heart rate and oxygenation for any sign of difficulty. CRNAs also adjust the flow of anesthesia based on the patient's vital signs and pain control. CRNAs deliver general, spinal, regional and local anesthesia, as well as nerve blocks. They can also administer sedation, intubate and place central lines. CRNAs monitor patients' recovery from anesthesia as well.
Generally speaking, CRNAs are paid the most of any advanced practice nurses. A CRNA, on average, earns over $185,000 per year (according to CNN).
On March 3rd, 2011, we conducted a live blog event in cooperation with the American Association of Nurse Anesthetists (AANA). The Q&A was led by:
- Debbie Malina, President-Elect, AANA
- John Preston, Director of Education and Professional Development,
The transcript is below. Please see the bottom of the page for a replay of the event.
Choosing a CRNA program:
Q: What advice do you have for evaluating the quality of CRNA programs?
The single most important thing for you as an applicant to do is visit your prospective schools. Do your best to set up a meeting with a faculty member, hopefully the program director. Ask that person questions about the program, students, educational experiences and opportunities. Explore the expectations for individuals who successfully complete their programs. That is the best information you can get!
Q: Is it too early to seek out a CRNA school before you have your minimum of one year of Intensive Care Unit (ICU) experience?
It is never too soon to start looking at programs you are interested (or potentially interested) in attending. Remember, though, students are typically admitted based on competitiveness. If you have more experience, you will be more competitive.
Q: Are there any CRNA programs that admit applicants without a BSN?
You must have a BSN or other appropriate bachelor's degree. Your best bet is to check directly with the programs you are interested in, though.
Q: I am considering changing careers and becoming a CRNA. What steps will I need to take and how long will it take?
The first step - seek out a school administrator in a nurse anesthesia program for advise/counsel. There are many answers to your question, and many people have found themselves in the same position. First, you have to become an RN, preferably with a BSN.
Applying to a CRNA program:
Q: What are some of the requirements for entry into a CRNA program?
You must first obtain a bachelor's degree in nursing.
A minimum of one year, full-time experience as an RN in a critical care area is required. Personally, I believe more experience is better, so I'd recommend two or more years.
At the same time, too many years of critical care experience may work against you in some situations. My reasoning is that when you have worked in one area for many years, you might become less willing to change and adapt. If you can prove this statement wrong, longevity in ICU should not be a problem.
Q: Do you need to be working currently in an ICU to apply to CRNA programs?
This is really best left to each individual program. Current critical care experience is ALWAYS going to be acceptable to all programs; other experience will depend on the program.
The best applicants from an experience perspective are those who have received their acute care in a high acuity area/unit/hospital.
Q: Are there areas within hospitals, in addition to the ICU, that would provide excellent preparation for CRNA programs?
Applicants are required to have "current acute care experience as an RN." Programs are also allowed to define what constitutes "acute care." The take home message is that Adult ICU always works. For all other areas, check with the programs you are interested in.
I say the more experience you have, the better; however, from a guideline standpoint, ICU is the minimum requirement for application.
Q: What should I focus on during my BSN to help prepare me for CRNA programs?
Your BSN program will provide you the education and experience to become a generalist. Really get a good grasp of biology, chemistry, anatomy, physiology and pathophysiology. What you can do is observe the role of the CRNA when you do your surgery rotation. If you do an SICU rotation, observe the CRNAs when they bring the patients in from surgery. Observe them if they participate in codes. Once you are out of school, you might want try to get into an ICU internship. See if you can shadow a CRNA on your days off to figure out if it's the career for you.
Q: If my bachelor level science course grades were average, do you recommend taking graduate science courses before entering a CRNA program?
GPA is certainly a very important part of the application for all nurse anesthesia programs. Before you repeat any courses, you need to identify two or three schools you would be interested in applying to, and then speak to each respective school's program administrator. Share your transcripts with them, and ask for their opinions and advice. What they tell you will not be binding, but it will be the best information you can get as far as taking measures to improve your potential for selection/admission.
Q: Should I take chemistry?
I entered nursing with a BSN many years ago. Chemistry was part of my undergraduate degree. Nursing curriculums are increasingly removing chemistry from the plans of study. My opinion (and it is what I told applicants when I was a program director) is to seriously consider taking at least one chemistry course, even if it's not required. If you get a choice, focus on biochemistry and/or organic chemistry. General chemistry, while important, will be less directly applicable.
Q: If you earn a BSN outside of the United States, will it affect admission to American CRNA programs?
You have to have an RN license from one of the US states to be eligible for a nurse anesthesia program. In order to get an RN license, you have to have successfully passed the NCLEX or completed equivalency measures as defined by each state's board of nursing. If you meet these requirements, I would anticipate that the location of your education will not be an issue.
Q: Do specialized second degrees look favorable to admissions committees?
Any and all additional education cannot hurt, but the admissions committee will look at the complete package a potential student brings with him or her. A strong grasp of the sciences is highly regarded.
Q: Is there an age limit in applying to CRNA programs?
Q: When applying for a CRNA program, what can I do to make my application stand out?
Stellar experience, grades and GRE scores will stand out. There is also usually an intense face-to-face interview.
Q: Is it wise for a student to shadow a CRNA?
I definitely recommend shadowing someone. How else do you know what the job entails? I cannot speak for all programs, but the one I am affiliated with requires shadowing before interview.
Q: What types of questions should you expect during the in-person interview for a CRNA program?
Every institution has its own requirements and own way of interviewing. Some will have you meet multiple faculty members; some have you meet with students. Others may have you take a short test - chemistry, biology, or pharmacology, for example. It is as varied as the 111 programs that exist.
***From one of our readers***Questions could include: clinical experience and ICU knowledge, as well as personal information like how you plan on paying for school.
Q: Do you have any tips for the essay portion of the application?
Simply carefully read and follow the directions for each essay. Different schools want you to address different things. If you copy and distribute a boiler-plate essay, it can be a death certificate for your application.
Completing a CRNA program:
Q: How long on average does it take someone to go from a BSN program to becoming a CRNA?
Once you have graduated and successfully obtained your license, you must have a minimum of one year of acute/critical care experience just to be considered for entrance to a CRNA program. You also may not be accepted the first time around.
Once accepted, programs vary in length from around 28-36 months. They are full-time. Most do not allow you to work. All programs are at the master's degree level. Some offer you the opportunity to obtain a practice doctorate, which takes approximately three more semesters.
Q: Is it important to receive acute care training and complete a CRNA program in the state where I hope to be employed?
If you get your master's from a regionally accredited university, it should not be an issue. Given the choice, I would encourage you to carefully assess the program you are interested in. Evaluate the degree offerings and credentials of the school you are considering attending.
Nurse anesthesia programs do not care where you have obtained your acute care experience, but my personal philosophy is that you obtain more enriching experiences by working somewhere other than where you got your education.
Q: Since most CRNA programs don't allow you to work, how do you suggest paying for school/housing?
First, you need to plan ahead. Save up some funds, reduce your debt before entering school, and get your affairs in order. Student loans will help, and some people survive on them alone, but many discover they are in a bad place before they are finished with their program if this is their sole source of funding.
Q: Do you receive a pass/fail score after taking your CRNA board exam or do you have wait for the notice?
You receive the pass/fail score immediately, but other things are required before you can be a CRNA. You need: verification of academic requirements, state licensure, and unencumbered right to practice. Only after those requirements are met is your certification released. You must then recertify every two years.
Starting a CRNA career:
Q: Could you talk a bit about your experiences when starting out?
I started out as a nurse's aide, became an LPN, and then a two-year degree RN. I worked in an ICU for many years and obtained my BSN. Then I shadowed a CRNA at work for three months on my days off. By the time I went to anesthesia school, I was ready. My many years of experience prepared me not only for the educational part of nurse anesthesia, but gave me the life skills to be successful.
Q: I have seen that some colleges are offering doctorate programs for nurse anesthesia. Is that the future?
The AANA has mandated that all CRNA graduates will graduate with a practice doctorate by 2025. Programs that do not offer the practice doctorate by 2022 (for graduation in 2025) will no longer be accredited. Right now, there are six programs that offer a BSN to DNP (or equivalent) in anesthesia. Post-masters programs number around seven. Just because the program you might be interested in does not offer a practice doctorate at this time does not mean you should not consider it. Many programs offer distance learning for their post-master's degrees, and new programs are opening all the time.
CRNAs who do not have a practice doctorate by 2025 will most likely be grandfathered in.
Q: How are the proposed health care changes going to affect the practice of anesthesia in the US?
The proposed (and developing) health care changes will have many effects on practice for all health care professionals. Health care in the US is in a constant state of reform and change. The most recent changes will provide many new and exciting opportunities for advanced practice nurses, including CRNAs.
Additionally, the recent Institute of Medicine (IOM) report highlighted the role that advanced practice nurses should play in the future. It is projected that advanced practice nurses will have a major role in closing the gap on access to care for the American public.
Q: What do you see for the future of CRNA careers? Has the market become saturated?
Our best data (which is never perfect) indicates that there are still a sizable number of openings for CRNA positions. Even so, there are areas of geographic saturation, especially in some larger metro areas. While the number of educational programs has increased over the last few years, so has the number of graduates, patients, and surgical procedures being performed annually.
There are currently 111 programs. The last workforce survey the AANA did three years ago indicated a 12 percent CRNA shortage (healthy is five to six percent). Shortly after the economy took a nosedive, those who were planning to retire didn't. Health care reform is going to bring 37 - 40 million people into the market. If CRNAs are not there to provide anesthesia services, someone else will have to fill the slot.
As for salaries - who knows? But as reimbursement falls, I think we can anticipate we will not see the dramatic increases of the past.
Q: Anesthesia is just such an awesome responsibility. Do you have any advice on how to get over the fear having that much responsibility?
Anything new is a little scary. I would say that there is nothing you have done in nursing that will prepare you for the intense freedom and responsibility that you will experience as a nurse anesthetist. As with everything else, your educational program will build on your experience until you acquire the knowledge and skills required to assume care of anesthetized patients.
Nurse anesthesia is not for everyone. It is something that individuals have to decide for themselves.
Q: How does a CRNA work in tandem with an anesthesiologist? What differs between a CRNA and an anesthesiologist?
CRNAs can work independent of or together with anesthesiologists. The practice arrangements depend on many factors including individual preference, facility preference and state practice laws. While both a CRNA and an anesthesiologist are highly educated anesthesia professionals, the difference boils down to the fact the one is a graduate-level prepared nurse who specializes in anesthesia care and the other is a medical school graduate who completed a residency in anesthesia care. There are many more similarities than differences.
Q: I found it very difficult to find a job in this economy. Many advertised jobs were for anesthesiologists. Do you have any recommendations?
It may boil down what jobs are available. You may have to be willing to move to the job rather than expecting to find the ideal position where you want to live. Every job market has fluctuations in supply and demand. While supply is higher presently, I anticipate it will swing the other way as the economy improves and more people are able to retire.
Q: Are independent contractor CRNA jobs still around?
In addition to being an educator, I have been an independent contractor for over seven years. There are good and bad things about it. No work means no pay. You must pay your own taxes, retirement, vacations, social security, continuing education, licenses, and certification, etc. You must be willing to move to the job, and understand that it may only last a few days, weeks, or months.
The upside is that you have time off when you want/need it, and the freedom to change jobs often.
Independent contractors can work in major medical centers or small, one-man facilities. Generally, new grads may find work as contractors, but not in small or one-man facilities.
Q: What does the recertification consist of?
You can go to www.nbcrna.com to see what is required.
Q: In order to be re-certified is it necessary to continue your education or is practice enough?
Practice is not enough. You must obtain 40 continuing education units (CEUs) every two years. They must be approved CRNA education units. Competency testing is coming in the future.
Q: What will competency testing entail?
It has not been completely defined yet, but it has to be more than just participating in traditional Q&A or classroom-type continuing education. It will require engaging in activities that require demonstration of critical thinking and simulation, along with some sort of objective evaluation.
Q: Can you speak any to the advantages and disadvantages of becoming a CRNA versus a nurse practitioner?
Each profession is totally different. Only you can decide. If you are unsure, shadow a CRNA and an NP for equal lengths of time to help you decide. In either case, you need to get some experience as a nurse first.
Q: What are the requirements/experience needed to become a chief CRNA?
It depends on what your employer's requirements are. Certainly, you will need experience as a staff CRNA and leadership skills.