Certified Registered Nurse Anesthetists (CRNAs) provide critical care at some of the most significant times in their patients’ lives and are responsible for safely administering anesthesia prior to surgical, obstetrical, and trauma-related medical procedures.
CRNAs are highly respected for their work and, according to the U.S. News & World Report, they rank #8 in best healthcare jobs in 2022. In addition, the CRNA was the highest paid nursing specialty in 2022, earning a median salary of $195K annually, according to the U.S. Bureau of Labor Statistics.
While this role requires extensive education and experience, the work pays off. If this sounds intriguing, a career as a CRNA might be just the path for you. Read on to learn more about the educational and certification requirements, job duties, and advancement opportunities.
Educational requirements
A nurse anesthetist is an RN who specializes in anesthesiology. To become a CRNA, the individual must hold a Bachelor of Science in Nursing (BSN) degree and their registered nurse licensure, which involves successfully passing the National Council Licensure Exam (NCLEX).
Additionally, this person must have a minimum of one year experience working in an acute care setting, such as an emergency room (ER) or an intensive care unit (ICU). They will then have to complete an accredited graduate-level nurse anesthesia program, which generally takes two years, and will need to successfully pass the national certification exam (CRNA).
With more complicated cases on the rise, a need for more education for advanced practice nurses has taken hold. Beginning January 1, 2022, the Council on Accreditation (COA) of Nurse Anesthesia Educational programs (the credentialing body for CRNA programs) determined that all Nurse Anesthesia programs (which are two to three years long) were required to be doctoral programs in order to maintain accreditation.
This means that starting in 2025, all new CRNAs will need either a Doctor of Nursing Practice (DNP) or a Doctor of Nurse Anesthesia Practice (DNAP). However, if an individual is already practicing as a CRNA, they will be grandfathered in and allowed to continue practicing with their master’s level CRNA education; they will not have to obtain their doctoral degree to continue their practice.
To summarize, the steps to become a CRNA take a minimum of seven years to complete.
- Bachelor’s degree in nursing (BSN): Average of four years
- RN licensure: Eligible upon completion of BSN
- Acute care experience: Minimum of one year
- Graduate degree in nurse anesthesia (MSN or DNP): Two to four years
- CRNA Certification: Eligible upon completion of graduate degree
- State licensing: Eligible upon passing CRNA certification exam
DNP vs. DNAP for CRNAs
Raising the education level to a doctorate for CRNAs has been a long time coming and has strong support from nursing organizations.
The trend towards more education for advance practice nurses began in 2004 when the American Association of Colleges of Nursing (AACN) published a position statement advising its member colleges to transition all advanced practice nursing education to the DNP degree.
In 2007, the board of directors of the American Association of Nurse Anesthesiology (AANA) approved a position statement that entry to practice for CRNAs must be a doctorate by 2025.
The two entry-level doctoral degrees approved by the COA are the DNP and the DNAP. The minimum length for entry-into-practice nurse anesthesia programs is 36 months, and all require full-time enrollment. Some programs may allow student registered nurse anesthetists (SRNAs) to work part-time as registered nurses.
The DNP is designed to prepare nurses for leadership roles. It is considered to be a terminal degree, meaning it is one of the highest nursing degrees one can earn. It is rooted in clinical practice and can be earned by any individual who holds an MSN degree. It is obtained through a school of nursing, with the AACN setting its curriculum and accreditation. DNPs who plan to focus on advanced practice registered nursing (APRN) and provide direct patient care must sit for the APRN certification exam.
With a DNP, one can become a clinical or didactic educator or a program director. One does not have to have a degree as a nurse anesthetist, but must have a master’s degree in another nursing-related field, to obtain a DNP.
The DNAP is the highest level professional practice degree that one can earn as a nurse anesthetist. The DNAP program is specifically designed for the nurse anesthetist student and is an advanced doctorate degree specializing in nurse anesthesia. It is approved through the Nurse Anesthetist Council of Accreditation (NACA), and focuses on the utilization of research findings for evidence-based clinical practice, education, and/or administration management related to nurse anesthesia.
Specialty certifications for DNAPs can be obtained through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). To earn this, one must successfully pass an exam with 100 to 170 comprehensive questions. Renewal is required every four years.
The main difference between the DNP and the DNAP is that some institutions do not consider the DNAP to be a terminal degree since its focus is on anesthesia.
This mainly affects individuals who want to work in a university faculty position, as it may influence tenure eligibility. This should not cause concern to any career prospects in which one works in a clinical setting.
Job duties
CRNAs work with surgical teams and are involved in many surgical procedures, both scheduled and unscheduled (i.e., emergency surgery). They work collaboratively with surgeons, anesthesiologists, and other qualified health care professionals to safely administer anesthesia to patients. They can work in a number of positions or places, including:
- Colleges and universities
- Research facilities
- Textbook authors
- Public Health/Government Health Policy and/or Legislation
- Hospital administration
- Medical/Surgical hospitals
- U.S. military medical facilities
- Mobile surgery centers and outpatient care centers
- Doctors’ offices (i.e., plastic surgery, ophthalmology, pain management)
Specific duties include, but are not limited to:
- Identifying possible risks to the anesthetized patient, including potential overdoses and drug allergies
- Performing spinal, epidural, and nerve blocks
- Preparing and administering precise doses of anesthesia in a variety of forms
- Assessing patient response to anesthesia, including monitoring vital signs during and after surgery to prevent and manage complications
- Responding to emergency situations with medication, airway management, or life support techniques
- Educating patient before and after surgical procedure regarding anesthesia
- Developing effective strategies for managing ethical dilemmas related to anesthesia
- Enhancing quality care and improving best practices
- Promoting patient safety
Numerous administrative tasks may be involved in a CRNA’s responsibilities, including ordering medications, managing finances, and training new staff. A CRNA may also act as an instructor for development courses, hold positions with state boards of nursing, or be involved in organizations that set standards for the medical field.
Advancement opportunities and job outlook
To advance as a CRNA or increase earning potential, consider tailoring your education to a specific patient population, surgical subfield, or condition. Specializing can open doors for opportunities to advance, with popular areas of interest including obstetrics, neurosurgery, dental surgery, and pediatrics, among others.
Another option for advancement is to find employment in states that report the highest salaries for CRNAs. Of the top employers, both general medical/surgical hospitals and outpatient care centers list salaries that are above the national average.
Nurse Anesthetists are an integral part of the American healthcare system, as they offer an economically logical alternative when anesthetic care is needed. The need for CRNAs is expected to grow as they are in high demand.
According to the Bureau of Labor Statistics, career growth is expected to increase by 45% from 2020 to 2030. The BLS reports that each year from now until the end of the decade approximately 2,900 new job opportunities for nurse anesthetists will be posted across the country.
