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Quick Facts :
What Is a Certified Registered Nurse Anesthetist (CRNA)?
According to the American Association of Nurse Anesthetists (AANA), CRNAs anesthetize approximately 40 million patients each year in the United States. The four primary types of anesthesia are conscious sedation, general, local and regional. The nurse anesthetist provides a specific type of anesthesia based on the orders from the patient’s surgeon.
The Different Types of Anesthesia
The purpose of anesthesia is to put the patient to sleep during surgery or, at the very least, relax him or her. Depending on the type of anesthesia, the patient will not remember anything from the actual surgical procedure. Research indicates that increased patient comfort has a direct correlation to the amount of time necessary for recovery.
General anesthesia comprises the use of a combination of inhaled and injected drugs to induce a state of total unconsciousness. Surgeons typically restrict its use to highly invasive procedures or those types of surgery that require the patient to be completely relaxed. As expected, this type of anesthesia also carries the highest degree of risk. It’s up to the CRNA to monitor the patient carefully before, during and after surgery. General anesthesia travels to the brain quickly, producing unconsciousness and temporary immobility of the spinal cord and nerves.
In procedures involving local anesthesia, the nurse anesthetist injects drugs into a specific area of the patient’s body to cause temporary numbness. This type of anesthesia is especially common in dentistry. During a dental procedure, anesthesia prevents patients from feeling pain without rendering them completely unconscious.
The major difference between regional and local anesthesia is the amount of body surface each one covers. Both types block the patient’s nerves to reduce or eliminate pain. Regional anesthesia is commonly used in labor and delivery in the form of an epidural injection. It’s also an appropriate choice for patients who experience chronic pain in their lower body.
As the name implies, patients receiving conscious sedation remain conscious during the surgery. However, they feel no pain and will have no memory of the procedure later. Surgeons use conscious sedation when patient cooperation is vital, but the surgery is not invasive enough to justify the use of general anesthesia. All types of anesthesia have a place in the medical setting. It’s up to the CRNA to ensure that the anesthesia the patient receives fulfills its intended purpose.
Typical Duties and Responsibilities of a Nurse Anesthetist
As a nurse anesthetist, you can find employment in a wide variety of healthcare settings and earn a high salary ‒ all while helping others and earning a good income. Although hospital operating rooms are the most common employment environment, patients also require the assistance of a CRNA in outpatient surgery centers, physician offices, oral surgery centers and pain clinics. As a nurse anesthetist, you may be able to practice independently, as part of a group, or in a collaborative effort with other health care providers. Those who work independently contract with hospitals or physicians’ offices.
According to the AANA, as a career, the position of nurse anesthetist has existed since the late 1800s; in fact, it was the first developed specialty in the field of clinical nursing. The organization estimates that some 49,000 nurse anesthetists work in various health care settings across the United States. Some specific duties include:
- Performing a physical assessment of each patient prior to surgery
- Participating with the surgeon, medical doctor and other nurses in pre-operative education to ensure successful outcomes
- Preparing the type of anesthesia ordered by the surgeon
- Administering anesthesia to the surgical patient to reduce or eliminate pain, so he or she can remain as relaxed and comfortable as possible during the procedure
- Monitoring the effects of anesthesia throughout the surgery
- Helping the patient wake after the surgery and continuing to monitor his or her progress in the recovery room
Steps to Become a Nurse Anesthetist
1. Obtain an Associate’s or Bachelor’s Degree
As one of the best-paid nursing specialties, the CRNA must be both highly educated and experienced. Preparation begins with earning a general degree in nursing, where you can apply your aptitude for science. Since working as a nurse anesthetist requires at least a master’s degree, earning a bachelor’s degree prior to applying for a graduate program is necessary at some point. However, future nurses have the option of earning a two-year associate’s degree in nursing (ADN) and passing their state exam to obtain an entry-level role as a registered nurse (RN). This gives you the opportunity to gain some direct experience in nursing before returning to school to pursue a bachelor’s degree.
You should be able to find a number of nursing programs in your area. Several hundred colleges across the country offer an accelerated degree option called the “registered nursing to bachelor of science in nursing” (BSN) bridge program. In this program, the student receives credit for previous nursing coursework and experience. Direct enrollment in a BSN program is an option as well. Some of the courses you can expect to complete at the associate’s level include nursing fundamentals, anatomy and physiology, and microbiology. The ADN also includes several liberal arts courses and requires supervised nursing practice toward the end of the program.
The typical BSN program includes coursework in nutrition, health assessment, evidence-based practice, nursing trends and public health. Compared to the AND degree, which primarily prepares you for hands-on nursing duties, the BSN teaches critical thinking and leadership skills that will afford you additional career opportunities.
2. Pass the NCLEX-RN Exam
After successful completion of an associate’s or bachelor’s degree, the next step is to take the National Council Licensure Examination (NCLEX-RN), the registered nurse edition. All 50 states and territories of the United States require passage of this exam to begin working as an RN. The NCLEX-RN, which is administered and scored by the National Council of State Boards of Nursing, contains eight separate sections. It has between 75 and 265 questions that change in category and difficulty based on the way the student answers the first several questions. However, only 60 of the first 75 questions are actually scored.
The computer-generated NCLEX-RN exam stops when the computer assumes you’ve answered 95 percent of the questions correctly. You will receive notification of your pass or fail score by mail, which can take up to several weeks in some states. If you didn’t pass, your results will indicate your areas of strengths and weaknesses on the exam as well as when you are eligible to test again. All students who pass the exam have their names forwarded to a state registry. To qualify for employment as an entry-level nurse, you must have an official registration number.
3. Enroll in a Graduate Program for Advanced Practice Nursing
A practicing RN who wants to work as a nurse anesthetist must enroll in a master’s degree program to acquire advanced nursing practice. The most common way that current nurses fulfill this requirement is by enrolling in a BSN to master of science in nursing (MSN) bridge program. Like its RN-to-BSN bridge equivalent, these programs are fast-paced and give students credit for prior learning related to nursing, and they also have a liberal arts component.
Colleges that offer the BSN-to-MSN bridge program require applicants to have a current RN license as well as a specific number of years of experience as a nurse in a critical care unit. Most also require a minimum grade point average and completion of certain courses to gain admittance. Some of the competencies that you can expect to learn in a master’s degree program include:
- How to evaluate patients before, during and after surgery
- Preparation and management of anesthesia during all points of patient contact
- Develop anesthesia plans for patients representing a wide range of ages and surgical requirements
- How to recognize emergency situations in patients preparing for surgery as well as during and after a surgical procedure
- Treating emergencies and complications, including those not related to anesthesia
- How to prevent, recognize, evaluate and treat complications in anesthesia
After successful completion of a master’s degree program, the next step is to pass the Certified Registered Nurse Anesthetist exam. This test contains a minimum of 100 and a maximum of 170 questions. Of these, 30 are for the purpose of pre-testing and potential inclusion on future CRNA exams. The time limit for this exam is three hours. One-third of the test covers human anatomy, physiology, and specific diseases. The remaining two-thirds covers basic principles of anesthesia, procedural questions, and treatment of potential complications of anesthesia.
The initial certification is valid for two years. During that time, you should have worked full-time as a CRNA and completed 40 hours of continuing education in anesthesia topics. You also must submit proof that you have no physical or mental limitations that would prevent the safe administration of anesthesia. As a nurse anesthetist, you will need to apply for recertification every two years for the remainder of your career.
According to the AANA, nurse anesthetists were one of the first specialty nursing practices to require continuing education credits. The organization also states that it takes a total of seven calendar years and 2,500 hours of supervised clinical practice to prepare to work as a CRNA. While still a student, you can expect to administer approximately 850 doses of anesthesia during your clinical practice hours.
CRNA Salary and Career Outlook
As a nurse anesthetist, you will earn a very good living wage for you and your family. In May 2015, the Bureau of Labor Statistics (BLS) released a report that the median salary for all people who worked as a CRNA that year was $160,250 annually. This is equivalent to full-time wages of about $77 per hour. Percentiles listed on this report include average salaries such as:
- 10th, annual salary of $105,000, with an hourly equivalent of $51
- 25th, annual salary of $133,000, with an hourly equivalent of $64
- 75th, annual salary of $186,000, with an hourly equivalent of $90
- 90th, annual salary greater than $187,200, with an hourly equivalent greater than $90
Private physicians employed the highest number of nurse anesthetists in 2015, followed by general medical and surgical centers, other health practitioners and outpatient surgery centers. In terms of salary, those who worked as a CRNA in an outpatient surgical clinic earned the most, and nurse anesthetists whose employer fell into the “other health care practitioners” category earned the least.
In 2015, states with the highest number of jobs for a CRNA, as related to population, were Florida, Texas, North Carolina, Ohio and Pennsylvania. In terms of salary, states where nurse anesthetists earn the most are Montana, New Hampshire, Wyoming, Wisconsin and California. The median salary in the latter five states ranges from $206,150 to $243,550 per year.
As a nurse anesthetist, you will always be able to find employment. Combined with nurse practitioners and nurse midwives, the BLS predicts an annual growth rate for a nurse anesthetist at 31 percent through 2024. This is nearly four times higher than the projected growth for all occupations and twice as high as that of a regular RN. An increase in demand for health care services, the aging baby boomer population, an emphasis on preventive care, and more people having access to insurance coverage are the factors for the exceptionally high projected growth.