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Certified registered nurse anesthetists (CRNAs) are nationally certified as having the competencies necessary to administer anesthesia and related care, and state licensed as advanced practice registered nurses (APRNs).
Although the CRNA scope of practice is ultimately structured according to state statutes and regulations and/or institutional policy, it generally includes providing patient care in the following categories:
- Anesthesia induction
- Clinical support functions
- Maintenance and emergence
- Peri-anesthetic care
- Post-anesthesia care
- Pre-anesthetic preparation and evaluation
CRNAs are licensed, independent practitioners who practice both autonomously and in collaboration with a multidisciplinary healthcare team. The main focus of the CRNA job is to provide high-quality, evidence-based anesthesia and pain care services at all acuity levels, for all patients, and for a number of different reasons in a variety of settings:
- Surgical
- Obstetrical
- Diagnostic
- Therapeutic
- Pain management
Although CRNAs are primarily focused on the clinical aspect of their job, these graduate-educated advanced clinicians also serve as researchers, educators, mentors, advocates, and administrators.
What to Expect from a Career in Nurse Anesthesia: The CRNA Job Description
The most comprehensive definition of the certified registered nurse anesthetist job description can be found in two practice statements published by the American Association of Nurse Anesthetists (AANA), which together detail all CRNA services, duties, and responsibilities:
- Scope of Nurse Anesthesia Practice
- Standards for Nurse Anesthesia Practice
Scope of Nurse Anesthesia Practice
The AANA’s Scope of Nurse Anesthesia Practice defines the CRNA scope of practice as including:
- Performing comprehensive health histories and physicals
- Conducting pre-anesthesia evaluations
- Obtaining informed consents for anesthesia
- Overseeing the development of a patient plan of care
- Prescribing, and administering drugs and controlled substances (where permitted)
- Selecting/inserting both invasive and noninvasive monitoring modalities
- Providing acute, chronic, and interventional pain management services
- Providing critical care and resuscitation services
- Ordering and evaluating diagnostic tests
- Requesting consultations
- Performing point-of-care testing
- Planning and initiating anesthetic techniques, including general, regional, local and sedation
- Utilizing anesthetic techniques such as ultrasound, fluoroscopy, and other technologies to improve diagnosis and care delivery and improve patient safety and comfort
- Responding to emergency situations using airway management and other techniques
- Facilitating emergence and recovery from anesthesia
- Providing post-anesthesia care, including medication management
- Conducting post-anesthesia evaluations
- Performing discharge services
CRNAs should be skilled in:
- Pre-anesthesia medications
- General anesthesia and adjuvant drugs
- Regional anesthesia techniques:
- Subarachnoid
- Epidural
- Caudal
- Upper extremity
- Lower extremity
- Diagnostic and therapeutic nerve blocks
- Local infiltration
- Topical
- Periocular block
- Transtracheal
- Intracapsular
- Intercostal
- Acute and chronic pain therapy
- Airway management techniques
- Blood, blood products, plasma expanders
- Central venous catheter placement
- Fluid, electrolyte, acid-base management
- Invasive and noninvasive monitoring
- Mechanical ventilation/oxygen therapy
- Peripheral intravenous/arterial catheter placement
- Pulmonary artery catheter placement
- Sedation techniques
CRNA Job Duties Beyond the Operating Room
In addition to services provided inside the operating room, CRNAs provide a number of valuable services in other settings, such as cardiac catheterization labs and MRI units. They often provide ventilatory and respiratory care and manage emergency situations that may call for initiating or participating in airway maintenance, CPR, tracheal intubation, ventilation, and cardiopulmonary support.
Many CRNAs take on administrative roles in which they oversee the overall functioning of an anesthesia department, with a particular focus on the efficiency and quality of anesthesia services. Their job scope in the administrative role may include one or more of the following:
- Personnel and resource management
- Financial management
- Quality assurance
- Risk management
- Continuing education/staff development
Nurse anesthetists also continue to serve important roles as investigators, collaborators, interpreters, and consultants in research settings. According to the AANA, an increasing number of CRNAs regularly sponsor and consult in research activities, often serving as project directors and principal investigators for funded research in university settings.
Standards for Nurse Anesthesia Practice
The AANA’s Standards for Nurse Anesthesia Practice serves as a common foundation for ensuring the quality of CRNA practice, and gives insight into what CRNA jobs entail. The AANA identifies 11 standards of CRNA care:
- Standard I: Perform and document a pre-anesthesia assessment and evaluation
- Standard II: Obtain informed consent from the patient or legal guardian for the planned anesthesia services
- Standard III: Design and implement a patient plan of anesthesia care
- Standard IV: Implement the plan of anesthesia care based on the patient’s physiologic status and continuously assess the patient’s response to anesthesia, procedure, or surgical intervention
- Standard V: Monitor and evaluate the patient’s physiologic condition based on the type of care and the patient’s needs; this includes monitoring:
- Oxygenation
- Ventilation
- Cardiovascular
- Thermoregulation
- Neuromuscular
- Positioning
- Standard VI: Document all information related to the administering of anesthesia on the patient’s medical record
- Standard VII: Evaluate the patient’s status and determine when it is safe to transfer the responsibility of care to another qualified healthcare provider
- Standard VIII: Minimize risk of fire, explosion, shock, and equipment malfunction by adhering to appropriate safety precautions
- Standard IX: Ensure that all infection control policies and procedures exist in the practice setting so as to minimize the risk of infection to the patient, the CRNA, and other healthcare personnel
- Standard X: Participate in the review and evaluation of anesthesia care
- Standard XI: Respect and maintain the basic rights of patients
State Regulations, Laws, and Practice Requirements that Govern CRNAs
Individuals who want to become nurse anesthetists must meet a number of requirements to legally practice in the U.S.:
- Complete a Bachelor of Science in Nursing (BSN) and RN license
- Complete a Master of Science in Nursing (MSN) or higher from a nurse anesthetist program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
- Earn national certification as a Certified Registered Nurse Anesthetist through the National Board of Certification and Recertification for Nurse Anesthetists to qualify for state licensure as an APRN-CRNA.
Because nurse anesthetists earn licensure at the state level, their scope of practice varies according to state laws rules and regulations. CRNAs are named in the APRN Consensus Model, a national initiative to standardize APRN titles, scope of practice, accreditation, certification, education, and the ability to practice and prescribe independently.
As of 2015, the following states adhere to the APRN Consensus Model, which allow CRNAs to practice independently, without the need to enter into a physician supervision agreement:
- 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
Further, CRNAs have independent prescriptive privileges in the following states:
- Alaska
- Colorado
- Connecticut
- Delaware
- Hawaii
- Idaho
- Iowa
- Minnesota
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Mexico
- North Dakota
- Oregon
- Rhode Island
- Utah
- Vermont
- Washington
- Washington D.C.
- Wyoming
The Future of Nurse Anesthetist Jobs
The US Bureau of Labor Statistics projects that the number of jobs for nurse anesthetists will increase by 31 percent during the ten-year period leading up to 2024. The increased demand is largely being driven by the fact that the Affordable Care Act (ACA) has made healthcare more accessible to millions of Americans, all while the nation’s aging baby boomer population continues to demand higher levels of care.
Certified registered nurse anesthetists remain a critical link to high-quality healthcare services for rural and inner-city Americans living in underserved areas that have been identified as health professional shortage areas (HPSAs). According to the American Association of Nurse Anesthetists, CRNAs continue to be the sole anesthesia providers for more than two-thirds of rural hospitals in the U.S., providing some 70 million rural Americans with access to anesthesia over the years.