About CRNAs

Nurse anesthetists have been providing anesthesia care to patients in the United States for nearly 150 years.

The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer more than 32 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2010 Practice Profile Survey.

CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.

According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.

CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.

CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.

Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East. Nurses first provided anesthesia to wounded soldiers during the Civil War.

Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.

Nationally, the average 2009 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (62 percent lower when adjusted for inflation).

Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.

 

Education and experience required to become a CRNA include:                                           

• An earned Bachelor of Science in Nursing (BSN)

• Licensure as a registered nurse (RN) in at least one U.S. state or in Puerto Rico

• A minimum of one year of acute care nursing experience as an RN

Master’s-level programs currently range from 24 to 36 months and are composed of both academic and clinical study. However, as programs transition to doctoral-level preparation of nurse anesthetists, programmatic length is anticipated to increase to a minimum of 36 months.

 

The academic curriculum consists of formalized graduate study in the following content areas specific to anesthesia:

• Advanced anatomy, physiology, and pathophysiology

• Chemistry and biochemistry

• Advanced pharmacology

• Basic and advanced principles of anesthesia practice including physics, equipment, technology,

and pain management

• Research methodology and statistical analysis

• Research or other scholarly endeavor

Additional academic content related to the discipline of the graduate degree being earned (e.g., nursing, biology, health science, etc.) is required. The clinical component of a nurse anesthesia educational program provides supervised direct patient care experiences for students during which time they are able to learn and apply a broad variety of anesthesia techniques and monitoring modalities, test theory, hone critical thinking skills, and apply evidence-based knowledge to clinical problems.

Each graduate is required to complete a minimum of 550 cases encompassing a wide variety and diversity of anesthesia experiences; however, based on 2009 transcript data the average graduate actually delivers more than 1,700 hours of hands-on clinical anesthesia care for more than 850 individual cases. Students gain experience with patients of all ages who require surgical, medical, obstetrical, dental, and podiatric interventions.

In order to be recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

Examples of the scope of practice of CRNAs includes, but is not limited to, the following:

~ Performing and documenting a preanesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, and administering preanesthetic medications and fluids; and obtaining informed consent for anesthesia.

~ Obtaining, preparing, and using all equipment, monitors, supplies and drugs used for the administration of anesthesia and sedation techniques, performing and ordering safety checks as needed.

~ Selecting, obtaining , or administering the anesthetics, adjuvant drugs, accessory drugs, fluids and blood products necessary to manage the anesthetic.

~ Performing all aspects of airway management, including fiberoptic intubation.

~ Performing and managing regional anesthetic techniques including, but not limited to, subarachnoid, epidural and caudal blocks; plexus, major and peripheral nerve blocks; intravenous regional anesthesia; transtracheal, topical and local infiltration blocks; intracapsular, intercostal and ocular blocks.

~ Providing appropriate invasive and non-invasive monitoring modalities utilizing current standard techniques.

~ Recognizing abnormal patient response during anesthesia, selecting and implementing corrective action and requesting consultation whenever necessary.

~ Evaluating patient response during emergence from anesthesia and instituting pharmacological or supportive treatment to ensure patient stability during transfer.

~ Providing postanesthesia follow-up and evaluation to the patient’s response to anesthesia and surgical experience, taking appropriate corrective actions and requesting consultation when indicated.

~ Initiating and administering respiratory support to ensure adequate ventilation and oxygenation.

~ Discharging patients from a postanesthesia care area according to facility policy.

~ Inserting peripheral, central intravenous, pulmonary artery catheters, and arterial catheters.

~ Managing emergency situations, including initiating CPR or emergency intubation.

CRNAs practice autonomously as the sole provider of anesthesia in every type of procedure or surgery. This includes, but is not limited to,  minor procedures, inserting and managing epidurals for labor and delivery, and “open-heart” surgeries.