Nurse anesthetists have been providing care in the U.S. for over a century. Most notably, they first began work during the American Civil War. In 1986, they were the first advanced practice registered nurses (APRNs) to receive direct reimbursement from Medicare.
The relationship between certified registered nurse anesthetists (CRNAs) and the military is strong. Since World War I, CRNAs have been the primary anesthesia providers to soldiers on the front lines.
We discuss a CRNA's scope of practice and how to join the ranks of a CRNA. First, let's hear about the challenges and rewards from a practicing CRNA and the advice she offers to nurses who want to specialize in the field.
Q&A With Certified Registered Nurse Anesthetist
Jenny Finnell, MSN, CRNA, has seven years of clinical anesthesia experience in several settings, including open heart, obstetrics, and outpatient surgery. She now works at a level one trauma children's hospital and burn center. Along with her clinical experience, Finnell has a passion for connecting with students through her mentoring program CRNA School Prep Academy and meeting them where they are within their CRNA journey.
Finnell serves the anesthesia community by providing resources and opportunities for aspiring students and current nurse anesthesia residents. This includes a CRNA Scholarship Foundation called Pay It Forward CRNA.
1. Why did you choose to become a CRNA?
I decided to become a CRNA because of these factors:
- Unique, life-saving, hands-on skills
- Critical thinking through complex situations
- Using pharmacology and pathophysiology daily
- Variety of patient populations that I could serve as a CRNA
- More control over my patients' outcomes
- Knowledgeable on how to safely eliminate anxiety and pain
- Work-life balance was more favorable for having a family (little to no nights, weekends, or holidays)
- Much higher earning potential than any other advanced practice role
- High job satisfaction among CRNAs
- High demand with plenty of job opportunities
2. Over the past two years, you created the mentoring program CRNA School Prep Academy. Why is mentorship important in nursing?
When you decide to become a nurse, the most common reason is to help others. Nurses are inherently compassionate. They are givers — what better way for us to give than through mentoring our peers.
Sometimes nurses get lost in providing for their patients, but we forget that we equally need to care for one another. Our community is stronger when we connect and grow with one another. We can make a bigger impact, show up better, and feel more fulfilled in our careers.
Mentorship does not have to be a big task like starting a mentoring program or coaching program. Mentorship is simply a mindset that you can adopt into your life. This mindset will naturally allow you to mentor in your daily interactions with your peers.
This is what I teach my community, so I know I am building a community of fellow mentors. Once you experience the impact of mentorship, you naturally desire to do the same for others. Because we all want to help, that is why we are nurses.
3. While no day is the same, what is a 'typical' day like for a CRNA?
Yes, no day is exactly the same. A lot depends on the "type" of CRNA you desire to be.
You could work at a facility or hospital that can shape your daily routine. I spent the first year of my CRNA career doing a lot of obstetrics such as spinals for C-sections, labor epidurals, and working 24-hour shifts.
I [left] obstetrics and worked on an open heart team where I did hearts, lungs, and big vascular cases while my CRNA peers did not do these types. I now work at a pediatric hospital where I mostly work with children for various procedures.
I also have experience working at an outpatient orthopedic surgery center where the CRNAs rotate out of the operating room (OR) for a day to provide regional peripheral nerve blocks for various patients throughout the day.
Depending on where you work, you will have a set amount of hours for the week, but from my experience, you can adjust your schedule as you need. Typically, nights are not an option for most staff because we do not run full OR schedules all night long — Thank goodness! Nights are reserved for emergent cases.
4. What are some of the greatest challenges of being a CRNA?
Working under pressure is a fair statement for a challenge. It definitely might not be for everyone. I encourage you to shadow a CRNA to observe this and see how that feels to you.
Also, working in a high-acuity intensive care unit will give you a good insight into if a high-pressure environment sits with you well. Patients can decompensate quickly; it is on you to help stabilize them for the operation and wake them up safely.
Other challenges may be that you need to be OK with delegating and being in charge of the room. I say that this is a challenge because, for me, I am naturally more shy and reserved. But I now have built a strong "mama bear" voice in the OR when necessary. It took time.
Other minor things but worth mentioning. Breaks can be unpredictable or nonexistent depending on how well staffed your OR is. You can also not have a predictable end of shift if your CRNA staffing is short or your surgeons run the OR schedule long versus wide.
5. What are some of the greatest rewards of being a CRNA?
Waking a patient up after surgery with little-to-no discomfort. Getting them through a life-saving operation. Being that smiling reassuring face they see before they close their eyes.
We have a huge responsibility and not one to take lightly. Patients are putting their life in a stranger's hands. They are rendered helpless and at your mercy to care for and speak for them. It is extremely rewarding and so humbling.
One of the most rewarding things is that you get to be one-on-one with your patient so you can give all your attention to them.
6. What advice would you give to those looking to pursue a career as a CRNA?
Research this career path and possible schools early — as early as possible, even if you are a prenursing major. Shadow early and often, attend open houses, and get involved in leadership roles.
Seek out mentorship! Pursuing this career path is hard; I am not going to sugarcoat it. Seek out support from your peers and surround yourself with others pursuing the same goal.
Most importantly, surround yourself with positive role models that will keep you encouraged and moving forward. Be persistent, learn from the challenge ahead, be adaptable, and you will find success!
What Does a CRNA Nurse Do?
A nurse anesthetist plans and delivers anesthesia. They can also prescribe pain management and specialize in pain control. A CRNA functions autonomously within the healthcare system. They may provide anesthesia during labor and delivery, surgery, trauma stabilization, or in pain management clinics.
A CRNA works together with the patient and other healthcare professionals to provide patient-centered care. They focus on holistic, evidence-based, and cost-effective healthcare. They may be the sole anesthesia professional delivering care, especially in rural and underserved areas.
"One of the most rewarding things is that you get to be one-on-one with your patient so you can give all your attention to them."
- Jenny Finnell, MSN, CRNA
A nurse anesthetist may work in hospitals, outpatient surgical centers, office-based settings, or nonoperating room anesthesia areas. A CRNA has several primary responsibilities in patient care and essential skills to function optimally. These skills include:
- Selecting, ordering, and administering pre-anesthesia and anesthesia
- Preparing the procedure or operating room with the right equipment
- Providing regional anesthesia, such as epidurals
- Managing the airway, such as intubation
- Monitoring anesthesia during the procedure
- Selecting, ordering, and administering controlled substances
- Counseling and educating patients
- Selecting and prescribing pain management medication
- Conducting pre-anesthesia assessments
- Getting consent for anesthesia
- Administering intravenous or intramuscular medication
- Managing recovery from anesthesia
- Navigating emergency complications during procedures
- Planning for and managing early emergence from anesthesia (unexpected wake up)
How to Become a Certified Registered Nurse Anesthetist
A nurse anesthetist is an APRN role. Most nurses who become a nurse anesthetist start by earning a bachelor of science (BSN) degree. This degree takes four years to complete. You may choose to start with an associate degree in nursing (ADN), which is a two-year degree.
Nurses with an ADN may then move on to a nursing bridge program that continues their education through an RN-to-BSN program. Some master of science in nursing (MSN) programs also have a bridge program for nurses with an ADN.
Nursing candidates who hold a bachelor's degree in another field may transfer some credits and complete the BSN in 2-3 years. After graduation, the candidate must pass the National Council Licensure Examination for RNs (NCLEX-RN). The state uses the NCLEX exam to demonstrate competency for your state license.
Most nurse anesthetist programs prefer candidates who have at least 2-3 years of experience at the bedside before enrolling in the program. Beginning in 2022, all graduating CRNAs must hold a doctor of nurse anesthesia practice or a doctor of nursing practice (DNP) to practice. Most nurse anesthetist programs require a 3.0 GPA, but many prefer students with a 3.5 GPA or higher.
After completing the program, the candidate must be certified and get a nurse practitioner state licensure to practice. The National Board of Certification and Recertification for Nurse Anesthetists gives the certification examination. The credentials validate the nurse anesthetist's knowledge and competency to practice.
CRNAs must take a Continued Professional Certification Assessment examination every eight years. The test is to recertify as a CRNA. This is not a pass/fail examination. It tests knowledge in airway management, applied pharmacology, physiology and pathophysiology, and anesthesia equipment, technology, and safety.
After completing and passing the national certification examination, the candidate must also earn their license in the state where they practice. The requirements of licensure vary by state.
How Much Do Nurse Anesthetists Make?
Nurse anesthetists are some of the highest-paid advanced practice nurses on average. According to the U.S. Bureau of Labor Statistics (BLS), the mean annual salary was $189,190 in 2020. However, many factors can influence your salary both positively and negatively.
For example, your annual salary estimate will depend on your geographical location. The lowest average salary, according to BLS data, is in Utah at $127,130, and the highest average salary is found in Oregon at $236,540. That is over $100,000 difference per year in base salary.
You have control over other factors that affect your nurse anesthetist salary. Years of experience, work setting, and additional certifications can impact how much you are offered at a new job.
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