Nurse Anesthetist (CRNA)

Lindsay Smith

Last updated at September 16, 2021

Caring for the weak and ill takes both empathy and grit. Life-threatening accidents happen every day, and a CRNA must tend and provide anesthesia to patients in critical condition on a daily basis.

In addition to the right education and training, it takes a specific mindset to succeed as a certified registered nurse anesthetist. Becoming a nurse anesthetist is not the right career choice for everybody.

To become a successful CRNA, being determined to help those in need is only the beginning. You must appreciate greater autonomy in a professional setting and understand you must meet the expectations of patients, coworkers, and the medical institution when delivering anesthesia.

Nevertheless, being a CRNA is highly rewarding. Qualified professionals are in great demand, the pay is among the highest in the industry, and seeing patients restored to good health after surgeries can be very gratifying.

Here's a closer look at Nurse Anesthetists' duties and a detailed career guide to help you determine if the position is truly your calling.

What is a Nurse Anesthetist?

Certified Registered Nurse Anesthetists are Advanced Practice Registered Nurses (APRNs). They are responsible for administering various medications, primarily anesthesia in an acute care setting.

According to The American Association of Nurse Anesthetists, the first Nurse Anesthetists were trained to heal soldiers fighting in the Civil War. However, a CRNA's duties have changed a great deal over the century.

These nurses provide anesthesia care for patients of all ages — from newborns to the elderly. Nurse Anesthetists typically treat patients scheduled for surgery but are also required to administer medication to patients rushed in for emergency surgery due to trauma or a life-threatening accident.

While Nurse Anesthetists have more autonomy than a Registered Nurse (RN), they work under the supervision of doctors in most scenarios. In many states, CRNAs are prohibited from administering medication without the presence of a doctor.

However, in some states, Certified Registered Nurse Anesthetists can work in the absence of a doctor. Keep in mind that medicines are administered in the same manner regardless of state laws.

As the title of the role suggests, Nurse Anesthetists specialize in administering anesthesia. This makes them an essential part of every health care unit. CRNAs are also certified registered nurses. Therefore, the role demands that they use their experience and knowledge to educate patients and their families about the effects of anesthesia. 

A CRNA must observe the state of the patient when they are receiving anesthesia and monitor the patient as they recover from the drug's effects. 

To become a Certified Registered Nurse Anesthetist, you must, at minimum, earn a Master's degree with a focus on anesthesia. You must also have completed extensive medical training and passed the CRNA exam conducted by the National Boards of Certification and Recertification of Nurse Anesthetists.

In the coming years, nurses will need to earn a doctorate before they can work in a hospital or other medical institution as a CRNA.

What Do Nurse Anesthetists Do?

Nurse anesthetists work alongside doctors and other nurses to curate pain management plans for every patient. A nurse anesthetist may choose to administer anesthesia to patients by syringe, using an inhalant, or orally.

Most CRNAs are typically a part of a surgical team. The work hours can vary from institute to institute; however, nurse anesthetists are present during the morning hours (6 am) when most scheduled surgeries take place. A CRNA may need to work till late in the afternoon providing anesthesia during medical procedures and sometimes till the evening, five days a week.

Bear in mind that an emergency can happen anytime, and someone may be rushed in for surgery at any moment. An aspiring CRNA can expect to work evenings, nights, and also on the weekends and holidays.

The primary duties of a CRNA include:

• Educating the patient before and after surgery.
• Administering anesthesia in precise doses.
• Assessing the patient's response to the anesthetics.
• Identifying possible risks like allergies and overdose.

You can expect to spend a lot of time with patients, and in addition to the duties above, you will also need to:

• Provide emergency support.
• Prevent and manage complications.
• Develop anesthetic plans.
• Perform spinal, epidural, or nerve blocks.
• Discuss side effects of anesthetics with the patients and potential caregivers.
• Examine medical histories and request diagnosis if you deem them necessary.

Depending on the location and the work environment, a CRNA may be expected to take up administrative duties. You may need to train new staff, order medications for the institution, or manage its finances.

A Nurse Anesthetist may also play the role of an instructor for development courses. They may also get involved with organizations that set the standards for the field of nursing.

The Difference Between A Nurse Anesthetist and An Anesthesiologist

Both anesthesiologists and CRNAs are trained to administer anesthesia. However, the primary difference is in their education.

Anesthesiologists are Medical Doctors (MDs) who need to study for at least four years post-graduation before moving into the role. On the other hand, Nurse Anesthetists have a graduate degree (master's degree) in nursing. They typically need to study for three years after earning a bachelor of science and gaining experience.

Most anesthesiologists treat patients in surgery in work settings like hospitals. However, in addition to working in hospitals, CRNAs can also serve in rural communities.

Both smaller offices and larger hospitals prefer hiring CRNAs over anesthesiologists. Because they provide similar patient care as anesthesiologists at a lower cost, there is a surge in demand for CRNAs.

Some states require CRNAs to be supervised by a doctor when they provide anesthetics. But some states allow CRNAs to practice independently.

Nurse Anesthetist Salary

The Bureau of Labor Statistics (BLS) reports that a Nurse Anesthetist's median salary is $183,580 per year. The top 10% in the field make well over $208,000 annually. 

The salary you make depends on the location and the work environment. Nurse Anesthetists in Oregon, Wisconsin, Wyoming, and Nevada make the highest salaries across the US.

Compared to other Advanced Practice Registered Nurses, a CRNA has a much higher earning potential.

The Bureau of Labor Statistics (BLS) also reports that Advanced Practice Registered Nurses will see a 45% surge in job growth by 2029. This is significantly faster than the average job growth rate of 4%. 

Where Do Nurse Anesthetists work?

A Nurse Anesthetist can work in a variety of settings, including but not limited to:

• Dental clinics
• Outpatient care centers
• Surgery centers
• Medical offices
• Pain management centers
• Plastic surgery centers
• Hospitals

Pain management is a nurse anesthetists' specialty. And you will find these advanced practice registered nurses in any medical setting where patients may experience pain if they are conscious.

Nurse anesthetists mainly provide anesthetics for surgical obstetrical procedures. But besides administering anesthesia for surgical obstetrical procedures, nurse anesthetists may also administer it for trauma care.

How Do I Become a Certified Registered Nurse Anesthetist?

Becoming a Nurse Anesthetist requires patience, determination, and years of learning. 

#1 Earn a Bachelor of Science in Nursing (BSN)

There are several ways to become an RN. You could complete a diploma course or earn an Associate's Degree in Nursing to be eligible to become an RN.

However, if you want to become a Nurse Anesthetist, an ADN or diploma simply won't cut it since you will need a BSN to pursue further education. 

A BSN typically takes four years to complete and will give you the foundational knowledge you need to work as a nurse in a medical setting. You will learn everything a nurse needs to know about human anatomy, pathophysiology, and more. 

Most Bachelor of Science in Nursing (BSN degree) programs incorporate clinical rotations into the course, giving the student a feel for what it's like to work in various health care institutions. 

Keep in mind that studying hard and earning academic achievements right in the beginning will give you a better educational foundation and allow you more work opportunities in the future.

The better your grades are, the higher the chances of you getting recommended by the faculty. Recommendations count for a lot and make you a prime candidate for working in the field. A recommendation will also boost your chances of being accepted into the nurse anesthetist program of your choice.

Aim for a GPA of 3.0 in your BSN since most nurse anesthetist programs have a minimum 3.0 GPA requirement and are becoming increasingly competitive. Next, you must pass the NCLEX-RN exam to get your licensure.

#2 Get Licensed as an RN

After you earn your BSN, you will be eligible for giving the NCLEX-RN exam and get your RN license. The exam is conducted by the National Board of Certification (NCSBN) every few months, and you must pass it to become an RN.

Besides passing the National Board of Certification exam, you will also need to complete a criminal background check to earn your licensure. Some states demand you to meet additional requirements, so ensure you know what needs to be done before signing up for the exam.

#3 Gain Experience As An ICU Nurse

Once you get your RN licensure, you can work in any medical setting as a nurse. However, nurse anesthetist programs prefer taking in candidates with experience in the intensive critical care unit (ICU).

One of the best things you can do to boost your chances of being accepted into a top program is to gain at least one year of experience working in the adult ICU as an RN.

In addition to gaining one year of experience, earning certifications such as a Critical Care Registered Nurse Certification is another great way to show off your commitment. Besides enhancing your resume, getting certified will make you an attractive candidate to whoever reviews your application to a nurse anesthetist program.

Shadowing a nurse anesthetist is another way you can show your commitment to the field. It is also one of the best ways of gaining insight into your future as a CRNA.

#4 Enroll Into An Accredited Nurse Anesthesia Program

Nurse Anesthetist Programs or CRNA programs are graduate degree programs that prepare you to become a Nurse Anesthetist.

There are over 100 CRNA programs you can apply to. However, you must make sure that you only enroll in a course recognized by the Council on Accreditation of Nurse Anesthesia Educational Programs. 

If you accidentally enroll in a program that isn't accredited, you will not be eligible to give the NBCRNA exam. You can check whether a course is accredited or not on the American Association of Nurse Anesthetists website.

While there are dozens of programs you can apply to, you must note that every nurse anesthesia program has a unique focus. Also, the requirements for every program are different. 

However, most nurse anesthesia programs will require you to have:

• A Bachelor's degree in nursing.
• Minimum GPA indicated in college transcripts.
• A valid Registered Nurse's license.
• At least two years of work experience as an RN.
• At least one year of work experience in an acute care setting.

Most nurse anesthesia programs also require you to submit some references, and top-notch communication skills are a must.

Change In Required Education Level

Historically, registered nurse anesthetists (CRNAs) have only needed to earn an MSN before working in a medical institution. However, this is set to change soon.

While a few programs still offer master's degrees that meet the certification criteria, these programs will cease to exist after 2022 on the orders of the Council on Accreditation. By 2022, every CRNA program will be required to award a doctoral degree. 

Furthermore, after 2025, nurse anesthetists must have a doctoral degree to practice. If you enroll in a CRNA program before 2022, you will be able to get a job as a CRNA without needing a doctoral degree since CRNAs with master's degrees will be grandfathered in. You will save yourself two years and a lot of effort if you beat the deadline and get the same position.

Raising the education level for CRNAs has been under discussion for years. It is by no means a snap decision since the move has gained strong support from nursing organizations over the years.

Even the American Association of Colleges of Nursing, which represents public and private nursing schools across the nation, welcomes the change. An ACCN spokesman revealed that the institution first called for doctoral preparation for all APRNs in 2004.

It is important to note that the COA does not specify which doctorate a candidate must pursue. While there are many options like Doctor of Philosophy, Doctor of Education, and Doctor of Nursing Science, the most prominent choice will likely be Doctor of Nursing Practice (DNP).

#5 Pass The National Certification Examination 

After you earn your graduate degree, passing the National Certification Exam (NCE) is the final step you need to take to become a CRNA. 

It is administered by the NBCRNA and conducted on a computer. The exam is three hours long, consists of 100 questions, and will evaluate your knowledge and skill, testing what you learned in the program. Sometimes, the test has up to 170 questions, so it can gauge your abilities deeply and determine if you've passed.

Once you pass, the state board of nursing will receive a verification of your certification. You can then complete any other formalities required to begin working as a CRNA.

Post getting certified, you will also need to maintain your certification. You must recertify yourself every four years and take the NBCRNA every eight years to remain eligible to work as a Nurse Anesthetist.

To get recertified, you must complete 100 units of continuing education. Your areas of study will likely include pathophysiology and anesthesia technologies.

To learn more about the registration process, the exam, and the renewal procedure, visit the NBCRNA website or go through the Examination Candidate Handbook.

Continuing Education and Recertification for Nurse Anesthetists

As mentioned earlier, you will need to pursue continuing education to maintain your national certification. You must ensure that you take up activities according to the NBCRNA's Continued Professional Certification (CPC) Program.

To get recertified every four years, you must:

• Earn 60 Class A credits by doing activities directly related to anesthesia delivery or improvement of care.
• Earn 40 Class B credits on development topics or anesthesia practice.

Some of the many development topics for certification and recertification for nurse anesthetists you could take up include patient safety, public education, and research. You also have core modules such as airway management, physiology, pathophysiology, and more.

In addition to meeting these requirements, you will need to complete an online check every two years. This is necessary to confirm your state license and ensure that you're continuing your practice.

Every eight years, you will need to take an assessment test. It will comprise 150 questions and will test your understanding of the core modules of nurse anesthesia.

There is no pass/fail criterion in this assessment. However, if the NBCRNA finds that you do not meet performance standards, you will need to pursue additional continuing education to keep practicing.

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How Long Does It Take To Become A Nurse Anesthetist?

Earning a BSN degree takes four years, after which you will need to get your RN license. The next step involves gaining experience in the field. You can get your minimum of one year of work experience and move on, or choose to work for up to three years as an RN.

Completing the nurse anesthesia program can take you between two and three years, post which you must take the NCE and get licensed by your state.

In total, becoming a CRNA can take you between seven and ten years, sometimes more.

Advancing Your Career After Becoming A CRNA

Specializing in one of the best ways to advance your career after you become a CRNA. If you intend to specialize, try and tailor your education to a specific surgical subfield, condition, or population.

Currently, the most popular specializations include neurosurgery, pediatrics, and obstetrics, among others. Working with organizations for these specialties is an excellent way to network and get the best opportunities.

You could also try to find work in locations and settings that report the highest salaries. Your location can make a big difference to your annual salary. CRNAs that work at hospitals and outpatient centers have the highest annual salary.

FAQs

What Would Happen If I Don't Renew My APRN License?

If you don't maintain your APRN license, you will be barred from practicing medicine as an APRN — regardless of what state you're in. The renewal requirements vary from state to state, but most CRNAs are required to practice a specific number of hours yearly and pursue continuing education if they want to keep their license valid.

Can I Become a CRNA After Enrolling In An Unaccredited Program?

For you to be eligible for a nurse anesthetist license, you will need to have completed a CRNA program accredited by the COE. These are only conducted at regionally accredited universities.

To check if a program is accredited, you can visit the AANA website and search for the college/university. If you have enrolled in an unaccredited program, your only option is to leave the program and enroll in an accredited program.

Can I Get A DNAP Without a Master of Science in Nursing?

You do not need to earn an MSN degree before enrolling in a DNAP program. You can enroll in an MSN-to-DNAP program. These programs help candidates advance into a doctoral program and earn their master's degree without having to enroll in separate programs.

Is it Hard to Become a Nurse Anesthetist?

You will need to work hard for a long, long time before you can become a CRNA — and that's only the beginning. Taking care of patients in emergencies and scheduled surgeries, maintaining your licensure, and taking up administrative tasks can get hectic.

That being said, there aren't as many jobs that are as gratifying as being a CRNA. In addition to earning a great living, you will also get the satisfaction of seeing people recover back to health almost every day.

And now that you know how to become a nurse anesthetist, you're one step closer to having a fulfilling career.

Lindsay Smith

Lindsay is an Adult-Gerontology Primary Care Nurse Practitioner with Nephrology Associates in Nashville, Tennessee. She is passionate about working with patients with End-Stage Renal Disease (ESRD) to maximize their function and wellness.