Certified Registered Nurse Anesthetist
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Certified Registered Nurse Anesthetist
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Certified Registered Nurse Anesthetists Fact Sheet
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History: Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years. The Certified Registered Nurse Anesthetist (CRNA) credential came into existence in 1956 and, in 1986, CRNAs became the first nursing specialty accorded direct reimbursement rights from Medicare. In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement.
Prolific Providers : CRNAs are anesthesia professionals who safely administer more than 50 million anesthetics to patients each year in the United States. As advanced practice registered nurses, CRNAs are among the nation's most trusted professions according to Gallup. Nurses have topped Gallup’s Honesty and Ethics list for 20 consecutive years and are ranked second in the 2021 U.S. News & World Report’s “Best Health Care Jobs” report.
Rural America : CRNAs represent more than 80% of the anesthesia providers in rural counties. Many rural hospitals are critical access hospitals, which often rely on independently practicing CRNAs for anesthesia care. Half of U.S. rural hospitals use a CRNA-only model for obstetric care, and CRNAs safely deliver pain management care, particularly where there are no physician providers available, saving patients long drives of 75 miles or more. Anesthesia Safety: Numerous peer-reviewed studies have shown that CRNAs are safe, high quality and cost-effective anesthesia professionals who should practice to the full extent of their education and abilities. According to a 2010 study published in the journal Nursing Economic$, CRNAs acting as the sole anesthesia provider are the most cost-effective model for anesthesia delivery, and there is no measurable difference in the quality of care between CRNAs and other anesthesia providers or by anesthesia delivery model. Researchers studying anesthesia safety found no differences in care between nurse anesthetists and physician anesthesiologists based on an exhaustive analysis of research literature published in the United States and around the world, according to a scientific literature review prepared by the Cochrane Collaboration, the internationally recognized authority on evidence-based practice in healthcare. More recently, a study published in Medical Care (June 2016) found no measurable impact in anesthesia complications from nurse anesthetist scope of practice or practice restrictions. Practice of Nursing: CRNAs provide anesthesia in collaboration with surgeons, dentists, podiatrists, physician anesthesiologists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by a physician 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. Autonomy and Responsibility: As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. CRNAs are qualified to make independent judgments regarding all aspects of anesthesia care based on their education, licensure, and certification. They are the only anesthesia professionals with critical care experience prior to beginning formal anesthesia education. Practice Settings: CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; ketamine clinics; 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. Military Presence: Nurses first provided anesthesia on the battlefields of the American Civil War. During World War I, nurse anesthetists became the predominant providers of anesthesia care to wounded soldiers on the front lines. Today, CRNAs have full practice authority in every branch of the military and are the primary providers of anesthesia care to U.S. military personnel on the front lines, navy ships, and aircraft evacuation teams around the globe. Cost-Efficiency: The all-CRNA model, where anesthesia delivery is staffed and directed by CRNAs avoids duplication of services, promotes efficient utilization of anesthesia providers, and reduces cost. As interests compete for limited resources in healthcare, groups and facilities seeking to minimize the cost of anesthesia services can achieve excellent cost savings as compared to other anesthesia practice models by the implementation of an all-CRNA model. Direct Reimbursement: Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program and CRNAs have billed Medicare directly for 100% of the physician fee schedule amount for services. In 2020, U. S. Congress passed legislation that included a nondiscrimination provision to prohibit health plans from discriminating against qualified licensed healthcare professionals, such as CRNAs and other non-physician providers, solely based on their licensure. Supervision Opt-Out: In 2001, CMS changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria:
To date, 22 states and Guam have opted out of the federal physician supervision requirement, including Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, Kentucky, Arizona, Oklahoma, Utah, Michigan, and Arkansas. Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so. In March 2020, CMS temporarily suspended the supervision requirements for CRNAs to increase the capacity of the U.S. healthcare delivery system during the COVID-19 pandemic. Several governors also removed many barriers to CRNA practice during this crisis. According to a January 2021 CMS report , CRNAs were among the top 20 specialties that served the most beneficiaries in non-telehealth care between March 2020 and June 2020—the height of the COVID-19 public health emergency. Malpractice Premiums: On a nationwide basis, the average 2020 malpractice liability insurance premium for self-employed CRNAs was 36 percent less than it was in 1988. When trended for inflation through 2020, the reduction in premiums was even greater at 71 percent. AANA Membership: Nearly 59,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or more than 85 percent of all U.S. nurse anesthetists). More than 40 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole. Education Requirements: It takes a minimum of 7-8.5 calendar years of education and experience to prepare a CRNA. The minimum education and experience required to become a CRNA include:
Nurse anesthesia programs range from 24-51 months, depending on university requirements. Programs include clinical settings and experiences. Graduates of nurse anesthesia programs have an average of 9,369 hours of clinical experience, including 733 hours during their baccalaureate nursing program, 6,032 hours as a critical care registered nurse, and 2,604 hours during their nurse anesthesia program.
Nurse anesthesia educational programs have admission requirements in addition to the above minimums. A complete list of programs and information about each of them can be found at CRNA School Search . Certification: Before they can become CRNAs, graduates of nurse anesthesia educational programs must pass the National Certification Examination. CPC Program, formerly Recertification: The Continued Professional Certification (CPC) Program, which replaced the former recertification program, focuses on lifelong learning and is based on eight-year periods comprised of two four-year cycles. Each four-year cycle has a set of components that include:
The CPC Assessment component is only required in the second 4-year cycle and can be taken during any testing windows in that second cycle. For complete information on all components of the CPC Program, visit NBCRNA/CPC . * Effective January 1, 2022, all students matriculating into an accredited program must be enrolled in a doctoral program. As of January 1, 2025, all students graduating from an accredited program must be awarded a doctoral degree. Updated: October 5, 2022
AANA® is a registered trademark of the American Association of Nurse Anesthesiology
RegisteredNursing.org Staff Writers | Updated/Verified: Aug 24, 2022
A certified registered nurse anesthetist (CRNA) is an advanced-practice nurse who is certified in anesthesia. According to the American Association of Nurse Anesthetists ( AANA ), nurses first gave anesthesia to wounded soldiers during the Civil War. Today, nurse anesthetists work in a variety of settings such as:
The difference between certified registered nurse anesthetists and anesthesiologists is that CRNAs are graduate degree-level nurses, and anesthesiologists are medical doctors. In many states, CRNAs can practice without physician supervision. According to the AANA, when anesthesia is administered by a certified nurse anesthetist, it is considered nursing practice. If administered by an anesthesiologist, it is considered practicing medicine. However, anesthesia is administered the same way by both professionals.
Certified registered nurse anesthetists are valuable members of the health care team. Not only do they work in busy hospitals in metropolitan areas, but they can also serve as primary anesthesia providers in rural and underserved communities. Their presence in these communities allows for improved access to treatments while providing competent, quality care.
Nurse anesthetists also help reduce health care costs. Since they do not always require physician supervision, depending on the state in which they practice, they are sometimes the only anesthesia provider available. Organizations compensate CRNAs less than anesthesiologists, which reduces the cost to the organization as well as insurers, thereby reducing the cost to the patients.
Certified registered nurse anesthetists start off as registered nurses. A significant role of the RN is to provide education. CRNAs thoroughly educate patients and families about specific anesthesia and treatments, including side effects and recovery. Comprehensive education can enhance recovery and lead to higher patient satisfaction.
Nurses interested in becoming nurse anesthetists should value autonomy and independence. They should be able to:
CRNAs are advanced practice registered nurses who have completed a Master's of Science in Nursing ( MSN ) or doctoral degree program ( DNP ). Currently, the AANA plans to require all CRNA programs to change from MSN to DNP programs by 2025 .
To advance to a master's degree, a student must first complete an accredited nursing program and obtain a bachelor's degree in nursing ( BSN ). Successful completion of the NCLEX-RN is needed for licensure. The length of time to become a Certified Registered Nurse Anesthetist (CRNA) may vary depending on the program. However, these are the minimum requirements:
Nurse anesthesia programs are accredited by the Council on Accreditation of Nurse Anesthesia Education Programs ( COA ). There are currently 121 accredited nurse anesthesia programs in the US and Puerto Rico.
A nurse anesthesia program ranges anywhere from 24-51 months, depending on the university, and includes clinical experience as well as didactic classroom hours. On average, it takes a minimum of 7 to 8.5 years of experience and education to become a CRNA.
Recertification and continuing education for CRNA's is different than other APRNs. The recertification program for nurse anesthetists is called the Continued Professional Certification (CPC) Program and is administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). The requirement for continuing education (CE) credit is robust; CRNA's must meet 60 general CE credits and an additional 40 CE credits covering four content areas including airway, pharmacology, physiology and pathophysiology, and anesthesia equipment along with a comprehensive certification exam every eight years.
Depending on the school, the curriculum for CRNAs can vary slightly, but core concepts include:
After graduating from an advanced-degree program, nurses can become credentialed as CRNAs. The National Board of Certification & Recertification of Nurse Anesthetists (NBCRNA) offers certification by examination . The exam is of variable length and designed to ensure the competency of entry-level CRNAs. The NBCRNA provides a handbook outlining detailed eligibility requirements to take the exam. General requirements include:
Licensure and certification are different—certification means the CRNA is competent to deliver anesthesia in a health care setting; licensure means they are legally permitted to practice in their state of residence. State nursing boards list the requirements for testing and can vary from state to state. The CRNA can, after meeting the specified requirements, apply to the state board for licensure.
Certified registered nurse anesthetist is a specialty in and of itself. There is no further delineation in practice per se, other than focus areas. For example, there is no specific "Pediatric Certified Registered Nurse Anesthetist" or "Obstetric Certified Registered Nurse Anesthetist" and so on. However, CRNAs can complete clinical rotations in various care areas to gain skills. For example, they may work in:
Post-graduate CRNAs can also participate in accredited fellowship programs (Updated Jan 5, 2021) that focus on certain populations, for example:
The NBCRNA offers a voluntary sub-specialty certification in nonsurgical pain management . CRNAs who obtain certification are competent in neural or neuraxial blocks, alternative techniques for the management of acute and chronic pain (pharmacologic and non-pharmacologic). Criteria for examination include:
Nurse Practitioners (NPs) and nurse anesthetists are similar in that they are both advanced-practice nurses. However, they do differ in terms of education, job duties/roles, and salary.
Both NPs and certified registered nurse anesthetists (CRNAs) start off in a master’s or doctorate program to earn their advanced-practice degree. After foundation courses are completed, students complete courses pertaining to their specialty “track”. For example, NP students focus on adult or pediatric primary or acute care, women’s health, psychiatry, etc., while the nurse anesthetist students begin a course of study on anesthesia concepts and research.
The roles and duties of an NP versus a nurse anesthetist are quite different. While both must take a complete history and complete a full assessment, a nurse practitioner, depending on his or her role, is responsible for the care of the patient in either the acute or primary care setting. They may focus on preventive care, or care for the patient during an acute illness. Nurse anesthetists have a different, highly specialized role. They are responsible for administering anesthesia and sedation, monitoring the patient during a procedure, and inserting central lines and epidurals. They must be knowledgeable about the different types of anesthesia medications and be alert to any adverse reactions.
Because CRNAs are in high demand, it is not uncommon for hospitals to begin recruiting students. Depending on the state, some CRNA students can sign contracts while still in school, and employment is contingent on becoming licensed. In other states, licensing is required first.
Many hospitals offer employment contracts with CRNA students, advertising student loan reimbursement, benefits packages, etc. It’s a good idea to read these contracts closely. Sometimes students are dazzled by the loan reimbursement, but realize the pay or benefits aren’t that great. Also, sometimes a length of time of employment is outlined in the contract, and the new graduate decides a specific work area or organization is not a good fit for them - and they are stuck. There may be the possibility to “buy out” of a contract, but it would take time and money out of pocket to do so.
CRNA students should read any contract carefully, and possibly have an attorney advise. Identifying the positive and negative aspects of a contract is a must to determine what component is of most value to the individual. Additionally, CRNA students are strongly encouraged to check their state's board of nursing to see if licensing is needed before signing a contract.
Certified Registered Nurse Anesthetists (CRNAs) are advanced-practice nurses who are certified in administering anesthesia. Due to a widespread physician shortage, advanced-practice nurses are taking a more prominent role in healthcare delivery - including the field of anesthesiology.
While healthcare continuously progresses and evolves, there are still remnants of “old-school” hierarchies that exist between physicians and nurses and yes, male and female providers. Some physicians have difficulty coming to grips with a nurse practicing at an advanced level and performing the same work as medical doctors. Additionally, tensions run high during a surgical procedure. Everything must be precise and organized to allow for the best patient care outcome. The strain of this considerable responsibility often brings the worst out in people- and a hierarchical environment doesn't help matters.
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