How to Become a Nurse Anesthetist

By: Meg Brannagan, RN, BSN

Last Updated: December 19, 2018

Certified registered nurse anesthetists (CRNAs) use their advanced training in pain management to relieve suffering and discomfort due to surgery, trauma, childbirth and illness. After administering anesthetic, they remain at the patient’s side, providing support and adjusting the dosage as needed. CRNAs also care for people before and after surgery and play an important role in ensuring patient safety.

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Nurses have been providing anesthesia care since the Civil War. Today, CRNAs administer 33 million anesthetics annually in the United States. In addition to working in operating rooms, these professionals serve as pain management specialists, first responders and coordinators of emergency care. Depending on state law, CRNAs either practice independently or in conjunction with an anesthesiologist, surgeon, dentist or podiatrist. Nurse anesthetists are sometimes incorrectly called nurse anesthesiologists; the correct term for a nurse practicing in the field is nurse anesthetist.

Nurse anesthetists care for a wide variety of patients, from children to expectant mothers to senior citizens. They begin each case by conducting a preoperative interview with the patient to determine the most appropriate type of anesthesia. Before a procedure, they help patients understand what to expect, answer questions and offer personal support. The care they provide helps to relieve the anxiety associated with surgery and can make an enormous difference in the patient’s experience.

The work of CRNAs has significant social benefits. Nurses are responsible for the vast majority of anesthesiology care in rural areas and other places experiencing a critical shortage of health care professionals. Their assistance allows smaller hospitals to offer comprehensive services close to home, including surgery, obstetrics and trauma care.

Anesthesiology is among the most challenging and rewarding of the nursing specialties. These professionals find great satisfaction in relieving patients’ discomfort and anxiety. They are also proud of the crucial role they play on surgical, emergency response and palliative care teams.

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CRNAs practice in almost every health care setting where anesthesia is needed, including hospitals, outpatient surgery centers and government and public health facilities. They can also be found in the offices of surgeons, dentists, ophthalmologists, palliative care specialists and podiatrists.

Depending on state law, nurse anesthetists either work independently or within a collaborative team of health care professionals. According to The American Association of Nurse Anesthetists (AANA), they are the only anesthesia professionals working in over 60% of rural hospitals and the primary anesthesia providers for members of the U.S. armed forces and pregnant women.

Because most surgeries are performed in the daytime, CRNAs generally work regular business hours. However, they often spend nights, weekends and holidays on call and can be summoned at any time in the event of an emergency.

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Anesthesia care is among the most lucrative nursing specialties. Nurse anesthetists enjoy a median annual salary of $157,140, according to the U.S. Bureau of Labor Statistics. Salaries vary by geographic region and practice setting and are generally best in major metropolitan areas.

According to the Bureau of Labor Statistics Occupational Outlook Handbook, employment of CRNAs is projected to grow by 31% between 2014 and 2024, which is considerably faster than the average for all occupations.

There is currently a shortage of qualified CRNAs in the United States. Because these professionals provide cost-effective services in an era when health care facilities are scrambling to contain rising costs, demand for CRNA services is likely to rise. In addition, nurse anesthetists play an important role in promoting patient safety and increasing health care accessibility for underserved populations.

In the job market, candidates who hold a doctorate have a slight edge over those with a master’s degree.

According to the U.S. Bureau of Labor Statistics, CRNAs must acquire at least a master’s degree, and some choose to acquire a doctoral degree in nursing. Either way, this means years of academic and clinical study beyond the high school level. Typically this begins with earning a bachelor’s degree in nursing and obtaining licensure as a registered nurse (RN). However, some master’s degree programs admit students who have earned an associate’s degree, effectively allowing them to jump from an associate’s to a master’s degree during the course of the program (often called a bridge program).

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Graduate programs admit students who have already earned a bachelor’s degree in nursing (the BSN degree) and have their RN licensure. You must also have at least one year of adult critical care experience as a practicing RN – for instance, in an adult ICU rather than a neonatal or pediatric ICU. You should check and confirm the specific admission requirements of programs you’re interested in, once you’ve qualified as an RN. Your top programs may prefer to admit RNs who have two or more years of critical care experience, rather than the minimum. Some programs may also give preference to nurses who have worked in large medical centers; the operative assumption (valid or not) is that a fast-paced environment provides better preparation for an intensive course of study.

If you’re planning a career as a nurse anesthetist, you’ll need to earn an advanced degree – a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). The core curricula of these programs are identical, with additional research and clinical requirements for doctoral students. Both pathways take 2-3 years to complete. During graduate school, CRNAs complete about 2,500 hours of clinical training and administer approximately 850 anesthetics, according to AANA. By 2025, all programs in the U.S. will be offered at the doctoral level only.

There are over 100 accredited CRNA programs in the United States, and that number is growing each year. The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) maintains an updated list of approved institutions on its website.

Some institutions offer nurse anesthetist certificate programs for qualifying students who hold a master’s or professional degree in a non-nursing discipline. CRNAs must complete additional post-graduate study to practice in specialties such as pediatrics or obstetrics.

Nurses must be licensed in all states. Upon graduation from an accredited program, nurse anesthetist candidates may sit for the CRNA certification exam through the National Board of Certification and Recertification of Nurse Anesthetists (source: U.S. Bureau of Labor Statistics). The CRNA certification is recognized throughout the U.S. and its territories. To maintain their credentials, practicing CRNAs must participate in continuing education throughout their careers.

Experienced CRNAs often head care teams or take administrative positions within health care facilities. Others start private practices, pain management clinics or other businesses. Nurse anesthetists with a doctorate have the opportunity to teach at the university level or conduct research.

There are several different educational paths you might take toward a degree in nurse anesthesia. Because you need to earn a bachelor’s in order to proceed with graduate training, the BSN-RN is your shortest route to qualification as a nurse anesthetist. If earning a bachelor’s is not feasible for you right away, you can still become a CRNA. Many nursing schools offer “bridge” programs that allow working nurses with a CNA to earn a PN degree; those with a PN to earn an associate degree, or a BSN; and those with an associate degree to earn a BSN.

Whatever your choice, make sure that the undergraduate degree programs you enroll in are nationally accredited, since this will affect your ability to advance your career and pursue graduate studies. Your state’s Nursing Commission is a valuable resource: look for education programs approved by the CCNE (Collegiate Council of Nursing Education) or ACEN (Accreditation Commission for Education in Nursing; formerly NLNAC). You should also check webpages administered by the graduate programs that interest you, and find out what accreditation they require from incoming students’ BSN programs.

A bachelor’s (baccalaureate) degree opens the door to graduate education in nursing, and most forms of advanced-practice certification. This is your route to teaching, research, and leadership positions. Many hospitals prefer to hire BSN-RNs, and encourage AD-RNs to acquire the BSN degree.

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In a traditional BSN program, your studies in nursing science make up your major coursework; these courses are supported by the liberal arts curriculum of a four-year university degree. This means that you’ll take classes in the arts, humanities and social sciences, as well as a series of life-science classes – biology, chemistry, and statistics – that provide the foundation for your nursing specialty. Future nurse anesthetists, take note: do not pass up the chance to take a solid expository writing course!

In general, students begin taking nursing specialty courses in their second year. Your coursework will likely include:

If you’ve already earned a bachelor’s or higher degree in a different field, you may have alternatives to enrolling in a traditional BSN program. You should look for an accelerated BSN (ABSN) degree option, which would allow you to earn your professional degree after a shorter period of study.

Bachelor’s-prepared nurses (BSN-RNs) who want to qualify as a CRNA have two training options at this time: a master’s degree (MSN) in nurse anesthesia, or a doctorate in nursing practice (DNP) with a specialty in nurse anesthesia. You do not need to have an MSN in order to apply for admission to a doctoral degree program, though advanced-practice nurses can enroll and earn their terminal degree in a shorter period of time.

Nurse anesthetists work with a great deal of autonomy – this profession can be an excellent fit for a detail-minded person who thrives on responsibility. The demands of the career path and its required studies also mean that nurse anesthesia degree programs typically have a rigorous admission process, including interviews in which applicants are asked to demonstrate organization and critical thinking in a writing sample. The oral component of interviews explores applicants’ depth of training, leadership potential, and commitment to care.

Many nursing schools are currently phasing out master’s options in nurse anesthesia, and moving to a DNP model. By 2025, all U.S. programs will have shifted to the doctoral degree option. At present, the difference between a master’s and doctoral degree program in this field of specialty amounts to one year of full-time study.

A graduate program in nurse anesthesia incorporates coursework with relevance to many areas of advanced-practice nursing, as well as courses that are fundamental to the specialty, like advanced human physiology and advanced pharmacology. Your studies will include courses like:

Note that if you already have an MSN and you want to earn a post-graduate certificate as a nurse anesthetist, rather than a DNP, this will require at least two years of full-time study. There are currently 25 programs in the U.S. that offer a post-master’s certificate.

• All nurse anesthetists who become certified in/after 2017 will be automatically included in the profession’s CPC (continuing professional recertification) program. Your professional certification remains current for eight years; during this cycle, you must earn at least 100 continuing education credits per four-year period, and complete a number of online educational modules. Every eight years, you have to pass a recertification exam. For more information, visit National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA).
• Continuing education opportunities are crucial for keeping your knowledge of anesthesia practice up-to-date and meeting recertification standards. CE opportunities include seminars, live classes, and online courses.