What is a Certified Registered Nurse Anesthetist (CRNA)?

History of Nurse Anesthesia
Nurse anesthesia is the oldest clinical nursing specialty beginning in the late 1800's. In order to reduce morbidity and mortality, surgeons chose nurses as a group of professionals who could give their full attention to patients under anesthesia during surgical procedures. Alice Magaw, the most famous nurse anesthetist of the nineteenth century, documented over 14,000 anesthetics without a single complication related to anesthesia. In 1909, the first formal nurse anesthesia programs were developed. Since World War I, nurse anesthetists have been the predominating anesthesia care providers in the combat zones. As the profession grew, nurse anesthetists accepted positions in the public sector, private sector, military service, and academic health centers. In academic health centers, nurse anesthetists were frequently responsible for the education of nurses, medical students, as well as physicians. As more nurses entered the specialty of nurse anesthesia, need for standardized education and credentialing became apparent. The formation of the predecessor to the American Association of Nurse Anesthetist (AANA) in 1931 provided an organization for nurse anesthetists and educators to develop curriculum for the specialty.

CRNA Practice
There are nearly 28,000 nurse anesthetists practicing in the United States. Nurse anesthetists administer 65% of the 26 million anesthetics given each year. In addition, nurse anesthetists administer approximately 85% of anesthesia given in rural settings. Nurse anesthetists work as sole practitioners or in collaboration with surgeons, anesthesiologists, obstetricians, dentists, podiatrists, or other qualified healthcare professionals. In 1994, survey data revealed 41% of CRNAs were hospital employees, 34% worked in groups composes of CRNAs and anesthesiologists, 12% were self-employed or CRNA-group-employed, and 13% were in other types of practices. There has been a trend away from hospital employment in recent years. Managed care plans recognize the value of CRNAs in providing high-quality care with reduced expense. In 1986, CRNAs became the first nursing specialty to receive direct reimbursement from Medicare. Male nurse anesthetists comprise 42% of the nation's nurse anesthetists. The high percentage of men in the nurse anesthesia profession is attributed to use of nurse anesthetists in the military and the higher level of compensation for this nursing specialty. The average annual income for a CRNA in 1999 was approximately $105,000 based on an AANA survey.

Scope of Practice
The practice of anesthesia is recognized by nursing and medicine specialties. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing. When anesthesia is administered by an anesthesiologist, it is recognized as the practice of medicine. Anesthesia is the art and science of rendering a patient insensible to pain by the administration of anesthetic agents, drugs, and procedures. CRNAs ultimately practice according to their expertise, state statutes and regulations, and institutional policy. Anesthesia care is provided by CRNAs in four categories: 1) pre-anesthetic evaluation and preparation, 2) anesthesia induction, maintenance, and emergence, 3) post-anesthesia care, 4) peri-anesthetic and clinical support functions. CRNAs working alone routinely perform all of these functions. CRNAs working with anesthesiologist in an "anesthesia care team" develop practice patterns within the individual work setting.

Nurse Anesthesia Education
The education of CRNAs is conducted in around 83 accredited programs in the United States and Puerto Rico. In 1998, the Council of Accreditation of Nurse Anesthesia Programs (COA) required all nurse anesthesia programs to be at the graduate level. Nurse anesthesia programs are in or in association with institutions of higher education and range from 24 to 36 months of integrated academic and clinical study. The anesthesia component of the curriculum must include: advanced anatomy, physiology, and pathophysiology, biochemistry and physics related to anesthesia, advanced pharmacology, principles of anesthesia practice, research methodology and statistical analysis, and finally research or other scholarly endeavor. In addition to didactic work, the anesthesia student is required to complete a minimum of 450 cases using a variety of anesthesia techniques. Admission requirements stated by the COA include a Bachelor of Science in Nursing, license as a registered nurse, and a minimum of one year of acute care nursing experience. After completion of an accredited school of nurse anesthesia, the nurse anesthesia student must pass a national certification examination to become a CRNA. The CRNA must complete 40 hours of continuing education credits and re-certify every two years.

References
American Association of Nurse Anesthetists. (2000). "American Association of Nurse Anesthetists Resource Site." http://www.aana.com [2000, Sep 18].

Hamric, A. B., Hanson, C. M., & Spross, J. A. (1996). Advanced Nursing Practice: An Integrative Approach. Philadelphia: W.B. Saunders Company.