Certified Registered Nurse Anesthetists (CRNAs) at a Glance
The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer more than 49 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2019 Member 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.
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 supervision requirement. 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 2018 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (68 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 54,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or, greater than 90 percent). 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 Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
A current unencumbered license as a registered nurse and/or APRN in the United States or its territories and protectorates.
At least one year of experience as a registered nurse in an acute care setting.
Graduation with a minimum of a master’s degree from an accredited nurse anesthesia educational program. As of August 2019, there were 121 nurse anesthesia programs in the United States utilizing approximately 1,870 approved clinical sites; 91 nurse anesthesia programs are approved to award doctoral degrees. These programs range from 24-51 months, depending upon university requirements. By 2025, all nurse anesthesia programs will award graduates a doctoral degree for entry into practice.
All programs include clinical training in university-based or large community hospitals. Graduates of nurse anesthesia educational programs have an average of 9,369 hours of clinical experience.
Some CRNAs pursue a fellowship in a specialized areas of anesthesiology such as chronic pain management or acute pain management following attainment of their degree in nurse anesthesia.
Graduates of nurse anesthesia programs must pass the National Certification Examination following graduation.
In 2016, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) launched the Continued Professional Certification (CPC) Program, which replaced the former recertification program. The CPC Program is based on eight year periods comprised of two four year cycles. Each four year cycle has a set of components that include 60 Class A credits (assessed comtinuing education), 40 Class B credits (professional activities), four Core Modules (current literature and evidence-based knowledge; and a performance standard assessment (no pass/fail) every eight years.