Certified Registered Nurse Anesthetist (CRNA) in High Demand

Advance practice nurses enjoy some of the highest salaries within the nursing profession. Included in this group are certified registered nurse anesthetists. The nurse anesthetist specialty is also experiencing a shortage of workers due to a growing aging population, more nurses retiring and advances in medicine that allow for a wide range of medical procedures. CRNA expertise and specialization garners a level of respect within the healthcare industry that also commands top pay, at times even competing with physicians’ salaries.

According to Magdy Mahmoud, manager at Everest Medical Services, a New Jersey based medical staffing company, placing certified registered nurse anesthetists in jobs is very easy due to such high demand for this line of nursing work. “When we find them (nurse anesthetists), it is very easy to place them…the pay is a lot higher than normal RNs,” explains Magdy. Increased job security and flexibility in work environments, makes this profession attractive to many RNs looking to enhance their careers. Although RNs need to acquire additional certification and education to become nurse anesthetists, the rewards far outweigh the challenges that one may experience when deciding on returning to school for additional training.

Why Are Nurse Anesthetists Important?

Anesthesia is an important element of medical care for patients undergoing surgical procedures. It involves giving medication to a patient so that they do not feel pain or sensation during surgery. Nurse anesthetists are registered nurses specially trained to administer anesthesia for many different types of surgeries. Since nurses working with anesthesia are required to be certified, they are called a certified registered nurse anesthetist (CRNA).

According to the American Association of Nurse Anesthetists (AANA), each year in the U.S. CRNAs administer 32 million anesthetics to patients and are the primary providers of anesthesia treatment and care in rural areas. Recent advances in healthcare services will provide new challenges and opportunities for the CRNA.

Nurse Anesthetists: A Brief History

Nurse Anesthetists have played an important role in U.S. healthcare for many years. According to the AANA, the area of nurse anesthesia was established in the 1800s and was developed in response to surgeons who needed a solution to high mortality rates related to anesthesia during this period. Surgeons viewed nurses as crucial in being able to give proper attention and care to patients undergoing surgical procedures. Nurse anesthetists were involved in many different types of special surgical procedures and in refining techniques and equipment. The first formal educational programs designed to prepare nurse anesthetists were created in 1909. World War I and II saw an increase in the demand for nurse anesthetists and even more educational programs to train nurses in this area.

In rural America, CRNAs are often the main providers of anesthesia treatment and care which enables medical facilities in underserved areas to offer important surgical obstetrical and trauma stabilization treatment. CRNAs are also the only providers of anesthesia in close to 100% of hospitals in rural areas according to the AANA.

What Exactly do Nurse Anesthetists Do?

A CRNA works with physicians, anesthesiologists, surgeons and other medical professionals to provide anesthesia. A CRNA will work in every setting that anesthesia is administered which includes hospital surgery units, labor and delivery rooms, ambulatory surgical centers as well as in the offices of pain management specialists, dentists, ophthalmologists, podiatrists and plastic surgeons. A CRNA provides patient care before, during and after surgery and assist with pain management and emergency procedures. A CRNA makes sure that patients are comfortable, record their vital signs and monitor their progress. Before patients undergo a procedure, CRNAs conduct a physical examination and provide them with preoperative and postoperative information.

As part of a medical team, certified registered nurse anesthetists usually work under the supervision and direction of the primary surgeon or anesthesiologist. They may assist with gathering equipment and supplies needed for surgery, evaluate pre-surgical tests to determine how anesthesia may affect the patient and ensure that adequate blood supplies are available in the case of an unforeseen emergency. During a procedure, they may be required to administer oxygen, prevent surgical shock or insert artificial airways. They may need to explain a surgical procedure to patients and their families in order to get their cooperation and increase their confidence. Individuals wishing to get into this field need to have good problem solving skills, handle stress and pressure as well as be very knowledgeable in the area of patient care, surgery and medicine. In short, the duties of a CRNA include:

  • Conduct patient assessments
  • Administer anesthesia to patients
  • Participate in preoperative teaching to patients and their families
  • Manage anesthetic treatment and recovery
  • Monitor patient's postoperative progress
  • Work with other healthcare professional such as surgeons, anesthesiologists and dentists.

CRNAs also provide patient care outside of the surgery room since anesthesia services are expanding to include other area such as cardiac catheterization labs, lithotripsy and MRI units. Through patient requests or physician referrals, these healthcare services include implementation and consultation on respiratory care. In addition it may also involve managing and assessing emergency situations which can include cardio pulmonary resuscitation, airway maintenance, tracheal intubation, ventilation, cardiopulmonary care and managing fluid, blood and electrolyte and acid base balances.

CRNAs are also involved in performing administrative duties within an anesthesia department. Some of these duties include staffing and human resources management, budgeting and financial management, risk management, quality assurance and educational programs. As experts in their field, CRNAs may participate in staff and committee meetings with outside agencies and professional associations.

Their duties require a high degree of responsibility and because of this, CRNAs receive large salaries. An article in CNN Money showed that in 2009, CRNAs were offered an average salary of $189,000 by medical centers compared to only $173,000 offered to physicians based on data acquired by the consulting firm Merritt Hawkins & Associates. This has happened for four consecutive years and is attributed to a high rate of surgeries in the healthcare industry. Also, because their line of work requires specialized training, they usually enjoy more autonomy than many other types of nurses. Since there is a shortage of experienced, skilled CRNAs, the demand for qualified individuals to fill vacant positions will continue to grow.

How to Become a Certified Registered Nurse Anesthetist

To become a CRNA, one must obtain a bachelor's of nursing (BSN) degree and become licensed as a registered nurse (RN). After completing a BSN degree, an RN must complete at least a year of clinical practice in an acute care setting. An acute care setting is a clinical setting where an RN is able to develop their decision making abilities. Examples of acute care settings include the PACU which is the Post Anesthesia Care Unit or recovery room, emergency room (ER) and intensive care unit (ICU). After obtaining clinical experience, an RN would need to enroll in an accredited master's of nursing (MSN) degree program that specializes in anesthesia and pass a certification exam. Completion of an MSN usually takes between 24 and 36 months. Here is a summary of the steps involved in becoming a CRNA:

  • Obtain a bachelor's of science in nursing (BSN)
  • Become licensed as a registered nurse
  • Work in an acute care setting for at least one year
  • Graduate from an accredited master's degree program in nurse anesthesia
  • Complete the requirement of clinical training in a university or large community hospital
  • Successfully pass a national certification exam after graduation

In addition, to maintain certification, CRNAs must take ongoing continuing education courses. In total, it typically takes at least seven years of education plus clinical experience to prepare for a career as a CRNA. According to the AANA, the average student in this field has completed 1,694 hours of clinical work and administers over 790 anesthetics.

Most nurse anesthesia programs include courses in anatomy and physiology, biochemistry, physics, chemistry and pharmacology relative to anesthesia. In addition there is a clinical field work that needs to be completed which provides students with experience in a variety of techniques and procedures involved in anesthesia needed for different types of surgical procedures.

The Nurse Anesthetist Shortage

The U.S. is facing a serious shortage in CRNAs. A report released by the U.S. Department of Health and Human services indicated that there is a nurse anesthetist shortage of over 5,000 within the nation. It also showed that educational programs for nurse anesthesia need to graduate 2,000 students by 2010. The AANA attributes the shortage to fewer resident anesthesiology positions and an increase in surgeries being carried out in places other than hospitals.

In addition, as managed care continues to cut costs, many coverage plans have recognized CRNAs as lower cost alternatives in providing high quality anesthesia care. Utilizing CRNAs has proven to be more cost effective in keeping down medical costs. There are also a growing number of new medical procedures that require anesthesia contributing to the demand.

The current demand exceeds the supply of anesthesia nurses and what is making the situation worse is that many CRNAs are retiring. This combined with an aging baby boomer population who will demand more healthcare services has created a very serious shortage.

A study conducted by the U.S. Department of Health and Human Services in 1990, indicated that educational nursing programs in anesthesia would have to graduate between 1,500 and 1,800 new nurses each year to meet societal demands by 2010. However, just about 1,000 nursing students graduate from anesthesia programs annually.

This poses a problem in providing sufficient healthcare services as CRNAs are usually the only anesthesia providers in about half of all hospitals in the U.S. and over two-thirds in rural hospitals. Important medical procedures such as surgery, trauma stabilization and obstetrical services are not able to be delivered without the care of CRNAs.

The U.S. Nursing Shortage in General

In addition to a shortage in nurse anesthetists, the healthcare industry is also dealing with a shortage of RNs. This poses a problem as nurses are often the first and main point of contact for patients and their families. The shortage of RNs has resulted in a less nurses being available at hospitals where critical care is needed. This often puts a strain on many RNs and medical staff. The Health Resources and Services Administration (HRSA), reports that there will be a nursing shortage in all 50 states by the year 2015.

A 2007 report released by the American Hospital Association estimates that hospitals will need 116,000 RNs to fill vacancies nationwide. This has created a national vacancy rate of 8.1%. Figures like these have prompted a response from healthcare industry analysts, policymakers and specialists to find solutions to the growing shortage.

A shortage in nurse educators at nursing school programs to train a new generation of nurses also makes the situation difficult. Every year, many nursing schools turn away qualified applicants due to not having sufficient faculty to teach new students. Funding from state and federal government programs has been allocated to address these issues in the form of scholarships and recruitment and retention programs. Also, the 2009 American Recovery and Reinvestment Act attempted to address this shortage by providing federal funding towards nurse education and training programs.

Many States are Affected

The HRSA found that certain States will face more of a shortage than others. For instance, Alaska was found to have the largest shortage with only 58% of all nursing positions in that state filled. Hawaii and Connecticut are facing high vacancies also. New Jersey needs to increase the amount of nursing school graduates annually from 2,000 to 6,000 in order to fill the demand for nurses.

Many states are putting money into nursing scholarships in order to get nurses to return to school as well as loan forgiveness programs. An example of this is in Mississippi where in 2006, the state approved salary increases for nurse educators in an effort to attract more nurses into the teaching profession and retain existing instructors. Kansas has also responded to the shortage allocating $30 million in funds to increase the amount of nurses in their state.

The Shortage May Be Affecting The Quality of Patient Care

Decreased staffing means that there are fewer nurses available to work with patients. This impacts job satisfaction and causes work related stress. In some cases it has led to many nurses leaving the profession altogether. A 2010 study published in Health Services Research found that over 75% of RNs feel that the nursing shortage is a huge problem that affects their quality of work as well as patient care and the amount of time that nurses can spend with individual patients.

Solutions to the Nursing Shortage

Many healthcare professionals and lawmakers have come up with a number of solutions to address the nation's current nursing shortage. One area is improving nurse education especially for nurse anesthetists. Experts agree that a major obstacle to the shortage is due to inadequate resources for nurse education and lawmakers have suggested increased funding to recruit and retain nurse educators and provide training facilities and equipment. This includes nursing school scholarships, grants and loan forgiveness programs.

A number of measures have been proposed to improve the working conditions of nurses already in the workforce. This includes increasing nurse salaries, offering better retirement benefits, flexible vacation scheduling and more time off.

Mark Genovese, spokesperson for the New York State Nurses Association says that to address the current nursing shortage, the working conditions of nurses that are already employed needs to be improved. “The most discouraging thing that we have heard from nurses is that they don't feel that they have the resources or support to be able to do their jobs effectively. If we can improve the working conditions, stabilize the workforce and make hospitals a better place to work, then we can encourage more people to come into the field”, he explains.

Many experts also suggest that the nursing shortage is a critical issue that needs to be sufficiently addressed and made known to the public in order to solve the problem. The Center for Nursing Advocacy suggests that the nursing shortage issue receive more media coverage to educate the nation on the seriousness of the shortage and so that public awareness of the problem improves.

Nationwide Efforts to Address the Problem

In response to the shortage, policymakers have enacted new legislation to provide funding for nurse education, recruitment and retention on both the federal and state level. On the federal level, as part of the 2009 American Recovery and Reinvestment act, funds have been allocated to enhance the nation’s healthcare workforce (which includes the nursing profession) by providing funding towards professional training and education. States like Georgia, Colorado, Minnesota, Nebraska and Texas have also made efforts to address the nurse educator shortage. Maryland, Utah, Kansas and Illinois have passed legislation to address the issue of the shortage over the next five to ten years.

In California, nursing organizations are working to provide solutions to improve nurse education including advanced practice nursing. Kathryn Donahue, a spokesperson for the California Nurses Association (CNA) explains that the cost of nursing education is factor affecting the amount of students enrolling in nursing programs each year. “The CNA / National Nurses Organizing Committee has framed legislation, The National Nursing Shortage Reform and Patient Advocacy Act (Boxer) that has multiple components, one of which is funding for nursing education, including a living stipend. This nursing education funding would include advanced practice degrees”, explains Kathryn.

CRNAs are in High Demand

The U.S. Bureau of Labor Statistics (BLS), job opportunities for RNs (which include CRNAs) are projected to be excellent and grow much faster than the national average relative to other occupations. Advanced practice areas which include nurse anesthetists will continue to be high in demand in many underserviced communities including rural and urban areas. Advance practice nurses increasingly provide a lower cost alternative to primary care physicians.

In an effort to recruit and retain nursing staff, hospitals may offer more sign on bonuses, flexible work schedules and tuition reimbursement for training. Physician offices will see the most employment growth at 48%, as more procedures once only available through hospitals are able to be carried out in outpatient centers and physician offices and ambulatory care centers. This will provide more job opportunities for CRNAs and RNs in general. Projected growth rates by industry as reported by the BLS are as follows:

  • Physician offices at 48%
  • Home health care services at 33%
  • Nursing care facilities at 25%
  • Employment services at 24%
  • Hospitals both public and private at 17%

A Rewarding Career in Nurse Anesthesia

If you are already an RN looking to specialize, becoming a CRNA may be a great choice. According to a survey released by LocumTenens.com, a recruiting firm, 91% of CRNAs said that they would choose this profession if they had the chance to plan their careers again and 66% said that they have been practicing as a CRNA for over 10 years. Only close to a quarter of survey respondents indicated that they would be changing jobs within the next year.

There are many great reasons to become a CRNA. They include:

  • CRNAs have a unique approach to patient care which allows them to enjoy a high level of autonomy and they command a level of professional respect for the type of work that they do.
  • This rewarding career is one of the highest paid nursing specializations in the nation.
  • CRNAs provide emotional support to patients undergoing surgical procedures while working on a team of other medical professionals to optimize the patient experience.
  • CRNAs are needed in many different surgical specialties including trauma, obstetrics, pediatrics and cardiothoracic.
  • They are needed in many practice areas and in different geographical areas.

BSN: The First Stepping Stone to an MSN Degree

As explained earlier, obtaining licensure as an RN is the first step towards becoming a certified registered nurse anesthetist. There are different ways to become an RN. The first is an associate degree, the second is a three year diploma program and the third is a four year bachelor's degree from a college or university. Even if an individual chooses to obtain an associate’s degree, in order to become a CRNA, one must obtain a BSN degree in order to be accepted into an MSN degree program.

There are many good reasons for obtaining a BSN aside from fulfilling the CRNA prerequisites. A BSN program gives nurses a more in depth study of nursing research and management, physical sciences, social sciences, humanities and community health. Having a broader understanding of healthcare allows students to grow professionally and truly understand the many influences that may impact patient health.

Studies have even show how nursing education relates to improved patient safety and better care. A 2003 study published by the Journal of the American Medical Association found that hospitals that employed higher numbers of RNs with a bachelor's or graduate degree had surgical patients who experienced lower mortality rates. It concluded that education levels are connected to lower levels of patient deaths.

There are more opportunities for CRNAs as the demand for acute healthcare services has increased due to advancements in medicine, improved technology, and faster patient discharges. Therefore, hospitals need skilled, educated and advanced practices nurses to work in these facilities.

An MSN Degree: The Road to Certification as a Nurse Anesthetist

The education provided through an MSN degree allows a nursing student to learn about the field of medicine, similar to that of a physician. MSN educated nurses, which include CRNAs, nurse practitioners, midwives and clinical nurse specialists are in demand especially in underserved communities and allow for low cost primary care services. An MSN program trains students in communication and leadership skills, research, community health and research, which are all necessary to succeed in advanced practice nursing.

According to the AANA, as of February 2008 there are 109 higher education programs in nursing anesthesia and all of them are at the master's degree level and higher. These programs give students clinical experience in anesthesia allowing them to become knowledgeable and competent nurse anesthetists.

Typical coursework in these programs include pharmacology as it relates to anesthesia, anatomy, physiology, basic and advance principles of anesthesia practice and professional aspects of nurse anesthesia. Most of the nurse anesthesia degree programs even exceed the minimum education requirements and provide additional courses specific to preparing CRNAs. Many programs also require that students study scientific inquiry and statistics as well as participate in research projects.

Now Is the Best Time to Enroll in Nursing School

The nursing shortage will continue to fuel the demand for CRNAs. For RNs looking to make a career change, this advanced practice nursing area provides increased job security and a competitive salary. There are a wide variety of degree programs throughout the country to help students obtain an MSN degree in nurse anesthesia. Those wishing to make a career change can enroll in online nursing degree programs or take on campus courses full-time or part-time as a first step toward a nurse anesthesia career path. A career as a nurse anesthetist can provide a wider range of career opportunities and flexibility.

(Sources: The American Association of Nurse Anesthetists, Money Magazine - "Some nurses paid more than family doctors" - Parija Kavilanz, March 23, 2010, CRNA Jobs - "Nurse Anesthetists Seek Flexibility, Financial Rewards" - January, 2006, BLS - CRNA)

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