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Certified registered nurse anesthetists (CRNAs) administer anesthesia to more than 40 million patients in the US each year, making them a vital component of today’s healthcare delivery system. Although the CRNA credential made its formal debut in 1956, these advanced clinicians have been valued since the Civil War, when nurses first began volunteering for advanced training in how to administer pre-operative anesthesia and agents for pain management to wounded soldiers.
CRNAs provide all types of anesthesia care, including:
- General Anesthesia
- Regional Anesthesia
- Local Anesthesia
CRNAs serve as highly educated advanced practice registered nurses (APRNs) that possess an average of three and a half years of critical care experience before entering a nurse anesthesia program.
Today’s CRNAs enter the workforce with a minimum of a Master of Science in Nursing (MSN). MSN programs must earn
As of August 2015, there were 115 master’s and doctoral nurse anesthesia programs in the United States that hold accreditation through the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and prepare students for the Certified Registered Nurse Anesthetist (CRNA) credential through the National Board of Certification and Recertification for Nurse Anesthetists.
CRNAs are Both Team Players and Independent Practitioners
CRNAs collaborate with surgeons, podiatrists, anesthesiologists, dentists, and other members of the healthcare team.
When CRNAs administer anesthesia, it is done as a practice of nursing, whereas when it is administered by an anesthesiologist, it is considered a practice of medicine. However, the anesthesia services provided by CRNAs are no different from those provided by physician anesthesiologists. Anesthesiologists and CRNAs can perform the same set of anesthesia services, including the provision of anesthesia during difficult procedures like open heart surgeries and organ transplantations.
CRNAs are found practicing in all settings where anesthesia is necessary. This includes:
- Traditional hospital surgical suites
- Obstetrical delivery rooms
- Critical access hospitals
- Ambulatory surgical centers
- Offices of:
- Dentists
- Podiatrists
- Plastic surgeons
- Pain management specialists
- Healthcare facilities of:
- S. military
- Public health Services
- Department of Veterans Affairs
CRNAs may deliver anesthesia care as independent providers or as part of an anesthesia delivery team. The care models for anesthesia include:
- Care-Team Model: The Care-Team Model consists of supervising physician anesthesiologists that oversee the delivery of anesthesia by resident physicians and non-physician anesthesia providers, like CRNAs.
- MD-Model: The MD-Model is anesthesia care provided by physician anesthesiologists only. The increased staff costs of this model make it less common, generally used in one- or two-room surgery centers.
- CRNA-Model: The CRNA-Model utilizes independently practicing CRNAs, without the involvement of an anesthesiologist. In states that require physician supervision, any licensed physician may oversee the practicing CRNA.
- MD-CRNA Model: The MD-CRNA Model functions much like the Care Team Model. However, CRNAs working under this model work to the full extent of their scope of practice with fewer physician supervision requirements.
The Value of Certified Registered Nurse Anesthetists to the U.S. Healthcare System
The value of CRNAs in the modern healthcare system is evident in:
- Reduced healthcare costs
- A proven track record for patient safety
- Greater access to anesthesia care in medically underserved areas
- Contributions to the healthcare delivery team
CRNAs Provide a Solution to Rising Healthcare Costs
Hospitals, surgical clinics and integrated health systems use CRNAs to control escalating healthcare costs for both patients and insurance companies. A 2010 landmark study found that the most cost-effective anesthesia care model is one in which the CRNA works as the sole anesthesia provider. Further, because many studies have shown no difference between CRNAs and physician anesthesiologists when it comes to the quality of care patients receive, managed care providers recognize CRNAs as a solution to rising healthcare costs.
Congress passed legislation in 1986 that made nurse anesthetists the first nursing specialty to receive direct reimbursement rights under the Medicare program. In addition, the average malpractice premium for self-employed CRNAs in 2014 was 33 percent lower than it was in 1988, which has helped to further reduce barriers to independent practice.
The American Association of Nurse Anesthetists (AANA) has called for Medicare to eliminate the CRNA supervision requirement and allow states and healthcare facilities to make their own decisions based on state laws and patient needs. In the meantime, 17 states have opted out of the federal Medicare requirement calling for physician supervision of CRNAs:
- Iowa
- Nebraska
- Idaho
- Minnesota
- New Hampshire
- New Mexico
- Kansas
- North Dakota
- Washington
- Alaska
- Oregon
- Montana
- South Dakota
- Wisconsin
- California
- Colorado
- Kentucky
CRNAs Deliver Safe Anesthesia Care
According to the Institutes of Medicine, deaths attributed to anesthesia during surgery remain rare in the U.S., occurring approximately once in every 250,000-300,000 cases. Researchers consistently find that CRNA-provided anesthesia care is just as safe as anesthesiologist-provided care.
It comes as no surprise, then, that nearly half of U.S. states do not require physician supervision of CRNAs:
- Alaska
- California
- Colorado
- Connecticut
- Delaware
- Hawaii
- Idaho
- Iowa
- Kansas
- Kentucky
- Minnesota
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Mexico
- North Carolina
- North Dakota
- Oregon
- Rhode Island
- Utah
- Vermont
- Washington
- Washington D.C.
- Wisconsin
- Wyoming
CRNAs Ensure Access to Care in Underserved Communities Throughout the U.S.
According to the American Association of Nurse Anesthetists, CRNAs provide high-quality anesthesia care and are the primary providers of anesthesia care in rural America. Thanks to CRNAs, facilities in many medically underserved areas are able to offer surgical, pain management, obstetrical, and trauma stabilization services. In some states, CRNAs serve as the sole providers in rural hospitals. Because of CRNAs, individuals in rural communities don’t have to travel long distances to receive the care they need. Without CRNAs local hospitals in rural communities would not exist.
CRNA-managed anesthesia care helps eliminate gaps in anesthesia care within communities throughout the U.S., including many medically underserved inner-city communities. They also provide the majority of anesthesia care for the U.S. military and the Veterans Administration.
CRNAs Collaborate with All Members of the Healthcare Team and Often Fill an Important Role Beyond Administrating Anesthesia
CRNAs work alongside all members of the healthcare team, including surgeons, endoscopists, radiologists, nurses, and other operating room personnel. Further, in addition to administering anesthesia, CRNAs are qualified to take on a number of responsibilities, including:
- Overseeing patient safety before, during, and after anesthesia care
- Assessing, identifying, and managing the care of patients suffering from acute and/or chronic pain
- Analyzing situations and responding appropriately in emergency situations