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According to the American Association of Nurse Anesthetists (AANA), more than 49,000 nurse anesthetists held active licenses in the US as of 2015, routinely administering anesthetics to some 40 million Americans every year. Their high level of expertise allows them to administer anesthesia for all types of surgical cases, from dental surgery and common outpatient procedures to the most complex in-patient surgical procedures. Not surprisingly, CRNAs are also recognized as earning the highest salaries among all advanced practice registered nurse (APRN) roles.
Though they most often work as part of an anesthesiologist-led team in hospital surgical units and for integrated health systems, nurse anesthetists also play a vital role as independent providers of anesthesia care. In states with large rural populations living in counties and townships designated as health professional shortage areas, nurse anesthetists often serve as the sole providers of anesthesia care in rural hospitals. They are just as often found working in hospitals in inner-city areas similarly designated as having a shortage of healthcare professionals, and commonly work with active service members in the U.S. military and in Veterans Administration hospitals.
RNs interested in becoming certified registered nurse anesthetists can look forward to a tremendous amount of respect within the healthcare community, a high demand for their unique expertise, the freedom to work independently in a variety of settings, and top salaries.
How to Become a Nurse Anesthetist: Education, Certification, and Licensure Requirements
Registered nurses with licenses in good standing would take these steps to become a certified registered nurse anesthetist (CRNA):
Step 1. Earn a Master of Science in Nursing (MSN) or Higher Degree in Nurse Anesthesia
Nurse anesthetists are prepared for clinical practice through a graduate-level education, earning a Master of Science in Nursing (MSN) or higher degree. As of August 2015, there were 115 accredited nurse anesthesia educational programs in the U.S., including MSN degree programs, post-graduate certificate programs, and doctoral programs.
MSN-Nurse Anesthesia programs have a number of things in common:
- All programs must be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).
- Programs range from 24 to 36 months in length.
- Programs consist of both didactic (coursework) and clinical components.
MSN degree programs provide students with a graduate-level scientific, clinical, and professional foundation. COA standards govern the didactic curricula of nurse anesthesia programs to ensure students receive the advanced education necessary to support safe clinical practice.
The COA requires the academic curriculum and prerequisite courses of nurse anesthesia programs to include:
- Anatomy, physiology, and pathophysiology
- Basic and advanced anesthesia practices
- Professional aspects of nurse anesthesia practice
- Pharmacology of anesthetic agents and adjuvant drugs within the concepts of biochemistry and chemistry
- Research
- Clinical conferences
- Radiology and ultrasound
Clinical experiences should provide students with the opportunity to:
- Apply knowledge to clinical problems
- Test theory
- Learn anesthesia techniques
Clinical rotations allow students to gain experience with patients of all ages that may be in need of medical, surgical, obstetrical, dental, and pediatric interventions. According to AANA statistics, the average nurse anesthetist student completes nearly 2,500 clinical hours and administers about 850 anesthetics in the course of their clinical training.
The AANA reports that most programs exceed the COA’s minimum requirements, and many also require study in methods of scientific inquiry and statistics, as well as active participation in student-generated and faculty-sponsored research.
Admissions Requirements
Admission into a Nurse Anesthetist MSN program requires, at a minimum, a Bachelor of Science in Nursing (MSN), an RN license, and usually at least a year or two of experience working in a critical care nursing setting.
However, admission into a Nurse Anesthesia MSN program can be a competitive endeavor, with institutions often requiring candidates to possess:
- Minimum GPA requirements
- Minimum GRE scores
- Resume or CV
- Letters of recommendation
According to the AANA, because so many candidates for CRNA programs have similar credentials with regard to undergraduate degrees and GPAs, many institutions require candidates to sit for an interview, and many prefer “career-tested” nurses who can easily make the transition into advanced nurse anesthesia practice.
Step 2. Become Board Certified as a CRNA through the National Board of Certification and Recertification of Nurse Anesthetists (NBCRNA)
Graduates of MSN-Nurse Anesthesia programs must take and pass the National Certification Examination (NCE) offered through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) to earn CRNA certification and qualify for state licensure as an APRN-nurse anesthetist.
According to the NBCRNA, in FY2015, a total of 2,983 candidates took the nurse anesthesia certification examination, with an overall pass rate of 81 percent.
The NCE is a variable-length, computerized test consisting of between 100-170 test questions (includes 30 random, non-graded test questions). The cost of the exam is $725.
Once applicants have applied to take the NCE, paid the fee, and provided the NBCRNA with the appropriate documentation (including proof of education and clinical experience), they may schedule to take the exam through Person VUE, which administers the NCE at testing facilities throughout the U.S. Candidates can locate testing centers here.
Test takers have a total of three hours to complete the exam, which includes questions related to:
- Basic sciences (25 percent)
- Equipment, instrumentation, technology (15 percent)
- Basic principles of anesthesia (30 percent)
- Advanced principles of anesthesia (30 percent)
Step 3. Apply for State Licensure as an Advanced Practice Registered Nurse (APRN)
All U.S. states, with the exception of New York and Pennsylvania, require CRNAs to be state licensed as APRNs. (Although CRNAs are not recognized as APRNs in New York and Pennsylvania, they are still required to hold an RN license and national certification as a CRNA.)
To qualify for state licensure, candidates must provide their state board of nursing with a completed application, application fee, and proof that they have earned CRNA certification and completed an accredited nurse anesthesia program.
Depending on the state’s practice requirements, candidates may also need to submit an application for prescriptive authority and physician supervision form.
CRNA practice authority remains inconsistent throughout the U.S. While some states follow the APRN Consensus Model and recognize CRNAs as independent providers with full prescriptive authority, other states still require CRNAs and other APRNs to practice under the supervision of a physician. Still other states limit a CRNA’s ability to prescribe medication.
As of 2016, 25 states and the District of Columbia grant CRNAs the authority to practice independently, which means there is no requirement for a written collaborative agreement between a CRNA and a physician:
- 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
However, 26 states do NOT allow CRNAs to practice without operating under the direct supervision of a physician:
- Arizona
- Alabama
- Arkansas
- Florida
- Georgia
- Illinois
- Indiana
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Mississippi
- Missouri
- New Jersey
- New York
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- South Dakota
- Tennessee
- Texas
- Virginia
- West Virginia
The following states allow CRNAs full prescriptive authority:
- Alaska
- Colorado
- Connecticut
- Delaware
- Idaho
- Iowa
- Hawaii
- Minnesota
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Mexico
- North Dakota
- Oregon
- Rhode Island
- Utah
- Vermont
- Washington
- Washington D.C.
- Wyoming
While 11 states do not grant prescribing authority to CRNAs:
Step 4. Keep Your CRNA Certification and State APRN License in Good Standing
CRNAs must maintain their CRNA designation by renewing it through the NBCRNA every two years. To qualify for renewal, CRNAs must:
- Hold a current and unencumbered RN license
- Complete at least 40 continuing education credits
- Show proof that they have been engaged in the practice of anesthesia during the certification period
- Verify they do not have any mental, physical, or other problems that could interfere with the practice of anesthesia
CRNAs must also maintain their state license to practice as a CRNA. While some states recognize the maintenance of the CRNA credential as fulfilling practice/continuing education requirements, other states require CRNAs to complete additional continuing education for renewal.