A Certified Registered Nurse Anesthetist (CRNA) is an advanced practice nurse, with extensive education credentials and clinical training to administer anesthesia and pain management treatment. Often, CRNAs are the only providers of anesthesia.

This career is not only very rewarding, it is also competitive. We have spoken to two CRNAs about why they have chosen this specialty as a career and about their own experiences.

Greg Clopp MSN, CRNA/APRN, currently works in a practice in Northwestern, WA, and has given us a full overview of his experience as a CRNA in New Jersey and his current practice. He also discusses the amount of training and education that CRNAs need to practice:

In order to enroll in a graduate program for CRNA training, a nurse must possess, at least, a BSN, 3.0+ GPA and one year of experience in Critical Care Nursing. Rutgers requires a CCRN certification to apply, but not the GRE. (Some programs require GRE, while others don’t require certification.) Everyone in my cohort at Rutgers far exceeded every minimum – for example, none of us had less than 5 years experience as an RN nor less than 2 years in critical care areas.

While I cannot quote the exact numbers, Rutgers gets hundreds of applications every year and interviews approximately 80 candidates to fill 20 seats in a cohort.

Currently programs are either 28 month masters (MSN) degree programs (about 70-75 graduate credits) or 36 month doctoral (DNP or DNaP) programs with 85+ graduate credits. Soon all graduates will be required to obtain a doctoral degree to be eligible to take the board exam.

All CRNAs are trained to administer all types of anesthesia independently (general, regional, spinal, epidural).

When I first graduated, I practiced in New Jersey—a state where CRNAs are Advanced Practice Registered Nurses (APRN) with full Prescriptive Authority per the board of nursing and are required to have a collaborative agreement with a physician in order to practice. Please note – a collaborative agreement does not mean that the physician dictates the anesthetic nor supervises the care delivered by the APRN. While a collaborative agreement could be with any physician in any specialty, the NJ Department of Health stipulates that a CRNA must be directly supervised by an anesthesiologist in order to practice within a doctor’s office, surgery center or hospital. (And also, a physician doesn’t need to be board certified to practice in any specialty in any state.)

Additionally, in order for a hospital to bill medicare, CRNAs must be supervised by a physician (of any specialty) unless the state’s governor has opted out of said supervision requirement. To date, 17 states have done so.

In my day-to-day practice in NJ, there was always a physician anesthesiologist assigned to work with me, but just like how your supervisor doesn’t dictate your actions neither does a supervising anesthesiologist in an Anesthesia Care Team. I would perform a full preoperative assessment, determine the anesthetic plan and discuss it with the patient, obtain consent, prepare the anesthesia equipment, medications and supplies, and make sure the anesthesiologist of the day agreed with the plan. The physician anesthesiologist and I would induce anesthesia together (one of us would push meds, the other would manage the airway) and then I would work with the OR team to finish positioning the patient for surgery. I’d remain with the patient the entire case, treating their blood pressure, heart rate, and signs of pain while adjusting the depth of anesthesia independently. At the end, I’d get the patient breathing spontaneously, make sure they were waking up and wean them off of ventilator support and remove the ETT/LMA before escorting them to PACU and giving a full report to the PACU nurse. At some point, the anesthesiologist would see the patient in PACU and sign them out when they are ready. I also administered sedation for GI procedures, placed epidurals for labor and administered spinal anesthesia for c-sections and other surgeries.

Currently I practice fully autonomously in a group that’s about 50/50 physician anesthesiologists and nurse anesthesiologists in Northwestern, WA. In WA (like NJ and nearly all other states), CRNAs are APRNs will full prescriptive authority. Furthermore, there are no other regulatory restrictions on practice here and WA is an opt-out state for medicare billing. Of course, I still have bosses. Our department has a physician anesthesiologist as chairman and a CRNA as vice chair/chief CRNA. And we all answer to the customer (not only the patient, but the hospital too). At our shop, CRNAs do all cases and all types of anesthesia.

Just as before, I’m involved in all phases of care, and here I do regional anesthesia as well. CRNAs can sign patients out of PACU since the group does not have to meet any regulations dictating when a physician has to be involved. Furthermore, in our group, the CRNAs independently handle Obstetric Anesthesia with no physician involvement—we do 100% of the labor epidurals and c-sections as well as advise the obstetrical team on the antepartum and postpartum management of complex patients. We handle any and all perinatal emergencies, including anesthesia for emergency c-sections and postpartum hemorrhages.

James Stockman MSNA, CRNA, works within a group of CRNAs and has given us some insight on the history of nurse anesthesiology. He also tells us just how rewarding this specialty has been for him:

United States-trained Certified Registered Nurse Anesthetist, or Nurse Anesthesiologist (as we are sometimes called), is the oldest nursing specialty, and from the start, nurse anesthesiologists have been trained to provide all manner of anesthesia care for the betterment of our patients. The Nurse Anesthetist profession dates back to the Civil War and some of the earliest pioneers of anesthesia were Nurse Anesthetists. For instance, Alice Magaw, known as the mother of anesthesia, provided anesthesia for the famed surgeons Drs. William and Charles Mayo of the Mayo Clinic. Continuing the trend from the professions early days in the Civil War, the U.S. military utilizes CRNAs to provide the bulk of anesthesia care to our soldiers on the front lines, and in hospitals on military bases around the globe.

The training of CRNAs is immense and we are trained to deliver all aspects of anesthesia care and management. In the United States, CRNAs practice in a variety of practice models, from models in collaboration and coordination with Physician Anesthesiologists, to models completely independent of Physician Anesthesiologist involvement. In the all-CRNA anesthesia practice, I work in our group of CRNAs provide anesthesia care in collaboration with the operating physician without the involvement of a Physician Anesthesioloigst. In a typical day, our group can be called to provide anesthesia care for anything, from critically-ill trauma patients, to pediatrics, to obstetric anesthesia for new mothers. In our county hospital we are considered the airway experts so we are often called to provide emergency airway management in different areas of the hospital. Our practice can be summed up by the statement that we never know what our day may bring. No two patients are the same and that is something I think we all love about our profession. The challenging nature is one of the most rewarding aspects of both independent practice and the profession as a whole.  

Choosing a career in this profession is one of the most rewarding things I have ever done. The training itself is challenging and will require you to draw upon your experience as a critical care RN to grow into a strong CRNA. Anyone who is considering a career as a CRNA will first have to obtain a Bachelors in Nursing undergraduate degree and then work for a minimum of one year as an RN in a critical care setting. Although, I must stress, the average critical care experience for a CRNA is two and a half years. Once you apply to a CRNA training program there is a lengthy interview and review process. If you are selected, programs last anywhere from twenty eight months to thirty six months. Currently all CRNA programs are transitioning to three year long, doctorate programs by the year 2025. This will have the end result of CRNA students graduating with a Doctorate of Nurse Anesthesia Practice or DNAP degree.

Anyone choosing this profession must know that they are joining the ranks of a long and proud profession, who has contributed greatly to the amazing safety record that surgery and anesthesia care boast today. It is this commitment to excellence in patient care that has allowed the CRNA profession to flourish the last two hundred years and is the reason it will continue to do so into the future.

Want to know more about being a CRNA? Visit the American Association of Nurse Anesthetists to learn more about this rewarding and competitive specialty.