Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years. The CRNA (Certified Registered Nurse Anesthetist) credential came into existence in 1956.
CRNAs are anesthesia professionals who safely administer approximately 43 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2016 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, pain management 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.
Practice of Nursing
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.
Autonomy and Responsibility
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. 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.
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 (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 17 states have opted out of the federal physician supervision requirement, most recently Kentucky (April 2012). Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so.
Nationally, the average 2016 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (65 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.
More than 50,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or, 90 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.
The minimum education and experience required to become a CRNA include*:
- A baccalaureate or graduate degree in nursing or other appropriate major.
- An unencumbered license as a registered professional nurse and/or APRN in the United States or its territories.
- A minimum of one year full-time work experience, or its part-time equivalent, as a registered nurse in a critical care setting.
- Graduation with a minimum of a master’s degree from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. As of August 2016, there were 115 accredited nurse anesthesia programs in the United States utilizing more than 2,100 active clinical sites; 46 nurse anesthesia programs are approved to award doctoral degrees for entry into practice. Nurse anesthesia programs range from 24-42 months, depending on university requirements. Programs include clinical settings and experiences.
- Pass the National Certification Examination following graduation.
* Note: Programs have admission requirements in addition to the above minimums. A complete list of nurse anesthesia programs and information about each of them can be found at CRNA School Search.
CRNAs who certified or recertified in 2016 are now part of the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) Continued Professional Certification (CPC) Program. The CPC Program consists of eight-year periods, with each period comprised of two four-year cycles. In addition to practice and licensure requirements, the program requires CRNAs to attain a minimum of 100 continuing education credits per 4 year cycle; complete educational modules in four content areas, including airway management technique, applied clinical pharmacology, human physiology and pathophysiology, and anesthesia equipment and technology; and pass a comprehensive examination every eight years.
For CRNAs recertifying in 2017, the recertification requirements remain the same as previous recertification periods: 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. After recertification in 2017, all CRNAs will be in the NBCRNA CPC Program.