Certified Registered Nurse Anesthetists (CRNAs) work collaboratively with healthcare teams or independently. They administer or assist with administering anesthesia for patients undergoing procedures in various healthcare settings. CRNAs can be present for planned surgical procedures, in emergency settings, in pain management clinics, in dental offices, and in birth centers to name a few.
Nurse anesthetists are responsible for caring for and monitoring a patient’s anesthesiology needs during a procedure, but their work pre- and post-procedure are critical. They will gather medical history, medication information, and assess the patient’s physical and emotional condition when possible. They are constantly looking for and identifying any potential issues that could interfere with plans for anesthesia.
As with other nursing specialties, CRNAs have taken on more responsibility and needed to master increasingly complex healthcare conditions and tech-based equipment. Because of this, changes to the practice entry requirements now require all nurses entering a CRNA program to exit with a doctor of nursing practice (DNP) or a Doctorate of Nursing Anesthesia Practice (DNAP) . Practicing CRNAs aren’t required to return to school for this additional advanced degree if they already have a master’s degree and have been in practice. Although it’s not required, some nurses may find that employment parameters are changing and that the DNP might be a requirement in a new place of employment.
CRNAs have careers that are dynamic and exciting. They can work directly with patients or they may choose to work in administration where they can have an impact on the conditions for patients and nurses. CRNAs also have options to work in government settings or to become active within committees to help shape the policies that surround CRNA work and career expectations. As CRNAs take on more leadership roles, they can use their direct real-world experience to inform the nuances of proposed changes.
As in all nursing specialties, time spent on the job is an excellent way to build skills and empathy for patients. CRNAs will want to continue learning about the rapid changes in the field with certification through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). Certification, which needs to be renewed to stay current, helps you remain informed on the latest developments that impact the duties you perform in your work. By staying up-to-date on the most current techniques and developments, you’ll be able to offer high-quality patient care that will result in better outcomes for your patients and the best performance by your team. Certification is a way to learn about everything from patient care to technological changes in equipment that can change your process.
Celebrate the CRNAs on your team this week and if you’re a CRNA take time this week to reflect on the work you do with your patients and your healthcare team. Be proud of the change you make in each patient’s life as you perform a critical task within the process.
Sponsored by the American Association of Nurse Anesthetists (AANA) , this week of celebration was once known as National Nurse Anesthetists Week. The Additional of “certified registered” helps people understand the rigorous training and continuing education for this specialty.
Nurse anesthetists work closely with a medical team and in some states, they are often the sole anesthetist on a team. According to the AANA, nearly 53,000 certified nurse anesthetists and student nurse anesthetists provide care throughout the country. Career growth in the field continues to attract top talent as the opportunities for lifelong learning and fast-paced advancements offer a dynamic environment. In addition, nurse anesthetists are among the highest paid nurses with a median annual salary of $165,000.
CRNAs have a vital role in patient care at all stages of surgery or a procedure. They assess patients prior to anesthesia, monitor them during the procedure, and continue to watch for any difficulties or problems after they come out of anesthesia. In this role, nurses offer compassion, comfort, and an intense focus on the details of medical care. They must assess visually and with equipment readings to understand how a patient is tolerating anesthesia.
In this career, CRNAs can work with a wide range of medical teams. They can practice in hospitals, stand-alone facilities, dentist offices, trauma teams, surgical facilities, military units, or pain management clinics to name only a few areas. The variety of settings means a CRNA can choose to work in specialties that hold particular interest or match an educational background or a life experience best.
Anyone interested in this field should have the correct path of educational attainment. According to the AANA, “graduates of nurse anesthesia educational programs have an average of 9,369 hours of clinical experience.” Programs for nurse anesthetists can range from 24 to 51 months. Program requirements can vary with the university, but will include essential clinical placements. Certification and recertification are also required to become a CRNA and maintain that professional standing. By 2022, students will be required to enter doctoral programs for this field.
Many CRNAs say the direct patient care, the satisfaction of being an essential part of the medical team, and the technical challenges of the work make this an exciting career path. In some states, CRNAs provide the majority, if not all of, the anesthesia care. Anesthesiologists work with patients of all ages and in settings so varied, their days are never the same. But the responsibility of keeping patients safe and being their advocate in a vulnerable time is rewarding.
January 21 through 27 is National CRNA Week, and we’re celebrating by getting up-close and personal with the CRNAs who make the medical world go ‘round! Certified Registered Nurse Anesthetists (CRNAs) safely administer about 43 million anesthetics each year, making surgeries and medical treatments safer. These professionals not only administer anesthesia, but also help ensure patient comfort and security.
CRNAs come from all walks of life and work in a wide range of communities. Interestingly, the American Association of Nurse Anesthetists (AANA) reports that CRNAs are the sole providers in nearly 100% of rural hospitals in some states as well as within the U.S. Armed Forces. Make sure to thank your favorite CRNA during CRNA week and surprise them with something special to say thanks! We love the idea of gifting them a personalized stethoscope with custom engraving as an awesome way to pay tribute.
What Does a CRNA Do Every Day?
What’s life like as a CRNA? Let’s take a closer look. Every day, nurse anesthetists monitor patients during surgery. This requires preparing and administering drugs before anesthesia, managing patients’ airways, and pulmonary status during surgery and closely observing their physical reaction to drugs. They may also perform pre-anesthesia screenings to determine a patient’s risk and administer epidurals in maternity wards.
But there are many other things that CRNAs are responsible for each day, according to Lincoln Memorial University Clinical Coordinator and CRNA Joy Lewis. “We do pre-op and post-op rounds, consults for pain management, place central lines, respond to codes, place and manage labor epidurals, upon consultation implement respiratory and ventilatory management including establish emergency airways,” says Lewis.
Dan Lovinaria, a CRNA with Veterans Affairs at Minneapolis Medical Center, says there’s an emotional aspect to the job, too.
“Being a VA CRNA comes with a tremendous responsibility and a great deal of accountability,” he says. “Patients are often anxious and nervous about their surgical procedures. It is my duty and responsibility to set the tone and make an immediate connection with my patients upon their arrival in the preoperative phase. Something as simple as providing warm blankets to my patients goes a long way. The little things make a significant impact.”
What’s the Schedule Like?
Surgeons have notoriously demanding schedules, whether they’re responding to emergencies or running on a tight, pre-determined schedule. Since CRNAs are required to be present for many of those surgeries, their schedules may be even busier than a surgeon’s.
“Oftentimes our schedules are busier than the surgeons if we work at a hospital with [obstetrics]. Once you place an epidural you may not be able to leave, and they will still want the operation to start on time,” Lewis says.
Lovinaria says he and his team work various shifts, including 8-hour, 10-hour, 12-hour, and overnight shifts.
Who’s Their Boss?
But there’s good news, too. CRNAs operate on a more autonomous schedule—they’re not required to be supervised by an anesthesiologist in any of the 50 states—so their shifts and schedules vary compared with traditional registered nurses. CRNAs may work as part of an anesthesia care team or as individual providers.
Robert J. Gauvin, a CRNA who’s also the president of Anesthesia Professionals, Inc. in Dartmouth, Massachusetts, says owning an anesthesia care business means more work but even more autonomy.
“Because of my unique position as a business owner and practicing CRNA, a typical day involves the 30-plus CRNAs in my group taking care of one to 45 patients in multiple facilities, followed by two to three hours of administrative duties,” Gauvin says. “On a weekly basis, I try to build in dedicated office days that allow me to focus on developing the business side of my practice.”
What About the Education Factor?
Because CRNAs have a much more specialized skill set than traditional RNs, they’re required to have extra education. Most CRNAs start out as RNs and are then required to complete a master’s degree in nursing (MSN), which typically takes about two years. CRNAs must then pass the National Certification Exam (NCE), which covers the knowledge, skills and abilities needed by entry-level CRNAs.
“Pursuing my studies as a CRNA demanded my efforts and abilities in many ways: mentally, physically, emotionally, financially, and so on,” says Mary Nguyen, a CRNA at Lourdes Hospital in Paducah, Kentucky. “My whole world was completely changed. With that being said, I’d do it all over again to have the privilege to work in my position as a CRNA.”
Nguyen also emphasized the importance of the CRNA certification exam. “The best advice that I can give to others is: ‘Respect the Test!’ The National Certification Exam (NCE) requires a level of thinking and comprehension of anesthesia that is only attained after rigorous clinical experiences paired with thorough reading and studies,” she says.
And then, of course, CRNAs must put a significant amount of time and money into continued education in order to keep their certification active. According to CRNA Bruce Schoneboom, the Senior Director of Education and Professional Development with the AANA, CRNAs must regularly become re-certified.
“The National Board of Certification and Recertification for Nurse Anesthetists’ new recertification program is called the Continued Professional Certification (CPC) Program and consists of eight-year periods. Each period is comprised of two four-year cycles. Every two years CRNAs will check in through a simple, online process known as the ‘two-year check-in,’” Schoneboom says. CRNAs must complete 100 additional education credits in an eight-year period.
Is It as Rewarding as They Say?
Talk to any nurse, and he or she will tell you that there’s a certain pride in putting on a pair of scrubs every morning. But is being a CRNA just as fulfilling as the traditional RN track? Yes, say CRNAs. And the proof is in the pudding: CRNA is a career with one of the highest job satisfaction ratings within nursing.
“There are so many rewarding moments being a CRNA. The one-to-one patient/CRNA interaction is a very valuable experience, and so is engaging the vets’ caregivers or significant others about the anesthesia plan of care,” says Lovinaria, adding that it’s the critical thinking component of the job and its dynamic changes that keep him on his toes.
Nguyen agrees: “I can honestly and wholeheartedly share that even on my worst day, doing what I love is better and more rewarding than a single day doing something else. I would choose this profession over any other option available,” she says.
Make sure to give your favorite CRNA plenty of props during CRNA Week this year!
During this year’s CRNA Week (#crnaweek), there are many nurse anesthetists who are remembering why they got into the profession, and even more are reflecting on how the face of the profession is changing.
John Bing, BSN, CRNA, American Association of Nurse Anesthetists (AANA) Region 6 director, and national AANA board of directors member, says one of his steadfast missions is to make sure the field continues to attract top nurses, but that it is especially welcoming to aspiring minority nurse anesthetists.
Bing knows first-hand how hard it is being a minority in the field. When he first started out, he was often the only African American in the OR, he says. At times, people assumed he was part of the housekeeping staff. Although he laughs about it now, Bing has made it a direct part of his mission to attract more minorities into this field.
He even takes on leadership positions with the primary goal of making sure he is representing the minorities in the field. “You need to see that in leadership,” he says. “If others don’t see that, they won’t see a place for them. I make sure they see it.”
“Many times you would go in and you were it,” he says of when he started out. “Maybe you were the only one in the hospital or the department. Now you go in and you see a fair amount [of minorities].”
One of Bing’s specific approaches is to make sure he talks to patients as the anesthesia takes effect. He finds out what they like so they can chat about it—sports, cooking, books, kids—anything that helps them relax. “That’s like a sedative,” he says. “It calms them down and they remember that.”
And while he’s monitoring a patient, Bing does exactly what he teaches his students—he assesses his patient over and over and over. “You must rely on your instinct,” he says. During travels with students to countries like Nicaragua, Bing teaches students that not every machine is calibrated the same or even correctly.
“The machine is a guideline,” he says. “You are ultimately responsible for anything that happens. You can’t blame the machine for anything. Look at the patient.”
Bing says that while he’s checking blood pressure every five minutes or so, he is constantly “circling the block,” as he calls it. All the machines are incredibly helpful, but they should only confirm what a nurse anesthetist is seeing, hearing, smelling, and touching.
And getting stale in this profession is not an option, he says. “I say to my students, ‘Tell me how this patient could die today,’” he says. That forces students to look at the big picture and not just look for complications, but to look for other factors that could impact that patient on that day.
Bing clearly enjoys working with his students, but he understands first-hand how sometimes they are not the ones who chose the profession. “The last thing I thought I would be was a nurse,” he says with a laugh. As an African-American, there were few role models that looked like him.
A chance look at a jobs list that revealed six pages of nursing jobs, convinced Bing, an athlete in high school and college, to take a look. Bing says he turned to his buddy he was working out with and said, “We get to be around girls and have a great job!” But he still didn’t expect to land in this field. Eventually, nurses in the recovery room where he worked nudged him to give it a try.
Now, Bing’s mission is to attract minorities into nurse anesthesiology. He speaks to kids in schools, paying special attention to making the field appealing to boys and young men. As it is, 49 percent of nurse anesthetists are male, he says, which is a high number considering less than 10 percent of all nurses are male.
But Bing lets kids know that there are chances to be out on a helicopter go team or even in the midst of trauma situations. “Men like that kind of stuff,” he says and it certainly gets the attention of younger kids who don’t know those possibilities exist.
Add in the good salary, the camaraderie, and the fair amount of autonomy, says Bing, and a career as a CRNA shows kids who might not initially consider a nursing career that the path is open to more possibilities than they ever imagined.
John Bing, BSN, CRNA, AANA Region 6 director, and national AANA board of directors member, says most people don’t quite understand what a nurse anesthetist does and, in fact, there are not very many of them.
Many people believe a nurse anesthetist puts them to sleep, leaves, and then returns to wake them. Far from it, says Bing. “The job of a nurse anesthetist is always assessing,” he says. They are with the patient all the time, from the moment they greet the patient, through the entire procedure or surgery, and when they are brought out of anesthesia.
The job, says Bing, is like no other. “We are there pre-, inter-, and post-op,” he says. But he understands why the job is mysterious to some. Even Bing’s mom thought he just gave people a pill to make them go to sleep, he says with a laugh.
But nurse anesthetists appear happy with their jobs. On the just-released 2017 U.S. News and World Report Best Jobs list, a nurse anesthetist’s job placed fifth on best health care jobs and placed sixth on the best jobs overall. The reported salary median salary is $157,140.
Bing says he appreciates being able to develop a relationship with a patient in such a short amount of time. Being present through the entire procedure gives nurse anesthetists the ability to monitor every nuance of the patient’s reactions and behavior, he says. And the interactions before the anesthesia is administered means nurse anesthetists have the chance to build up trust and get to know a patient as a person. The patients remember that, says Bing, and you get to know them as a person.
And this field rarely gets stale, he says. CRNAs have to be recertified every four years, so continued learning is mandatory. One of the special draws for nurse anesthetists is the ability to work with people from the moment they are born until the day they die, says Bing. These nurses work with all ages and have to know the intricacies of how the human body reacts to the anesthesia at each age and with virtually any condition. “We get everybody,” says Bing. “And it is all acute.”
As a group, nurse anesthetists stick together, says Bing. With as high as 89 percent reporting approval for their job satisfaction, he says, they enjoy the work. And the AANA doesn’t encourage sub groups, he says. The group acts as one. “Eighty-five percent of our professional nurse anesthetists belong to our parent professional organization,” says Bing. “We don’t want to go out and have splinter groups. We are better together.”
The AANA is urging nurses to spread the word during National CRNA Week and suggests things like career days in schools, inviting legislators to a breakfast or coffee gathering, or even casual and formal public speaking opportunities to let people know about the profession. And use #crnaweek to spread the word o a wider audience.
It’s also a good time to celebrate what nurse anesthetists do. “In this country 100,000 people give anesthesia,” he says. “That means there are 3.5 million people per anesthetist. That makes [them] pretty special.”
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