# Nurse anesthetist

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy. Nurse anesthetists provide all services of anesthesia for patients before, during, and after surgery. Certified Registered Nurse Anesthetists, (CRNA) are dedicated to the safe administration of anesthesia delivery and work within a diverse team. They are dedicated to patient advocacy, safety and professional development. In some localities, nurse anesthetists provide anesthesia to patients independently; in others they do so under the supervision of physicians. In the United States, the physician may be an anesthesiologist, surgeon, or podiatrist. The International Federation of Nurse Anesthetists was established in 1989 as a forum for developing standards of education, practice, and a code of ethics.

## History of CRNAs

In the United States, nurse anesthetists are called Certified Registered Nurse Anesthetists (CRNAs). CRNAs account for approximately half of the anesthesia providers in the United States and are the main providers of anesthesia in rural America.
Nurses have been providing anesthesia care to patients since the American Civil War. Nurse anesthetists are considered an essential role to the health care workforce. They provide pain management and emergency services, including airway management and blood and fluid resuscitation, which was very important to patients in the Civil War. Depending on the local system of healthcare, they participate only during the operation itself, or may also be involved before and after (for preanesthetic assessment and immediate postoperative management). The National Association of Nurse Anesthetists professional association was established by Agatha Hodgkins in 1931. It was renamed the American Association of Nurse Anesthetists in 1939. The group established educational institutions for nurse anesthetists in 1952, and established the CRNA certification in 1957. AANA continuing education was established in 1977. As of 2011, some 92% of CRNAs in the U.S. were represented by the AANA.
Scope of practice rules vary between healthcare facility and state. Before 2001, Medicare required that physicians supervise CRNAs in the administration of anesthesia. In 2001, Medicare's rules changed, allowing individual states to decide whether CRNAs may administer anesthesia without physician supervision. In the absence of a state requirement that physicians supervise CRNAs, individual healthcare facilities decide. CRNA organizations have lobbied in many states for the ability to practice without physician supervision; these efforts are opposed by physician groups. In 2011, sixteen states granted CRNAs autonomy, allowing them to practice without physician oversight. In 2017, there were 27 states in which CRNAs could independently practice (that is, "without a written collaborative agreement, supervision or conditions for practice"). In 2020, there was no physician supervision requirement for nurse anesthetists in ambulatory surgical facilities in 31 states In states that have opted out of supervision, the Joint Commission and CMS recognize CRNAs as licensed independent practitioners. In states requiring supervision, CRNAs have liability separate from supervising practitioners and are able to administer anesthesia independently of anesthesiologists.

## Education

A nurse anesthetist will need to complete two to three years of higher education, beyond the bachelor's of nursing degree.
Before becoming a nurse anesthetist, one must complete a Bachelors of Science in Nursing degree. A minimum of one year of full-time work experience as a registered nurse in a critical care setting is required before applying to CRNA school. The average experience of RNs entering nurse anesthesia educational programs is 2.9 years. Nurse anesthetists are required to attend accredited educational programs covering all areas of anesthesia. This education provides training about the anesthetics needed for patients in any type of procedure or surgery. After completing an accredited program, CRNAs must pass a national certification exam to acquire this designation. It is important to have the best education for this field for the significance of anesthesia. By 2025 the Council on Accreditation, the organization which accredits nurse anesthetist programs, will require all graduating CRNAs to be doctorate prepared.

## Salary

According to the U.S. Bureau of Labor Statistics, a CRNA salary is around $181,040. Salaries within the US vary by state. Overall employment for nurse anesthetists and other medical professions is projected to grow 45 percent from 2020 to 2030.

## Work environment

CRNAs typically work in healthcare settings such as emergency rooms, intensive care units, and operating rooms. Their environment is with medical and surgical teams with procedures that can occur anytime. Some partnerships they work with are anesthesiologists, dentists, surgeons, and other medics in serving patients who need of receiving anesthesia. Nurse anesthetists are an essential part of everyday medical facilities. The need of CRNAs is anticipated to grow.

## Skills and procedures

Nurse anesthetists work with anesthesiologists, surgeons, anesthesiologist assistants, anesthesia technicians, and others. CRNAs communicate with the surgeon and interdisciplinary team to design an anesthesia plan for a patient. Some procedures that nurse anesthetists offer include:
* Evaluation of the patient prior to anesthesia
* Physical assessment and pre-operative teaching before the anesthesia
* Administering anesthesia
* Airway management

## Roles and responsibilities

CRNAs have important roles when it comes to patient care. They need to meet all the patients' standards and help ensure the patient is in good condition before receiving an anesthesia plan.Some of the roles and responsibilities a CRNA need to require for this position include:
* Bedside manner
* Record-keeping skills
* Communication skills
* Teamwork with other nurses and doctors
* Inhaled anesthesia administration
* Administration of blood and medication
* Epidural placement
* Placement of arterial and central lines
The CRNA profession requires an understanding, accurate, and responsible attitude to work this position. You must have strong communication skills with the patient and your team to become a CRNA. The freedom of a nurse anesthetist is expanded compared to an RN that allows you to oversee the patient and with your team.

## Nurse anesthetist vs. anesthesiologist

Nurse anesthetist and physician anesthesiologists have certain distinctions, however they share many similarities. Certified Registered Nurse Anesthetists are nurses who have specialized training to perform anesthesia. In comparison, an anesthesiologist is a trained physician who specializes in anesthesia.

## Terminology

The AANA recognizes Certified Registered Nurse Anesthetist, CRNA, nurse anesthetist, and nurse anesthesiologist as equivalent titles. The use of nurse anesthetist is substantially more common than the use of nurse anesthesiologist; terms anesthesia nurse and anesthetist nurse are unheard of.
Use of the term nurse anesthesiologist has been criticized by those who argue that the term anesthesiologist should be limited to medical doctors. For example, groups representing anesthesiologists and other medical doctors, such as the American Medical Association (AMA) and American Society of Anesthesiologists (ASA), oppose the use of this phrase to describe CRNAs and call it misleading.
In 2021, after a year-long rebranding effort, the American Association of Nurse Anesthetists changed its name to the American Association of Nurse Anesthesiology. The name change was condemned by physician groups, including the AMA, ASA, American Board of Anesthesiology, American Board of Medical Specialties, and American Osteopathic Association. Physicians' organizations said that the name change was "title misappropriation" that was deceptive, misleading to patients, and cause confusion in care settings.
In 2021, the New Hampshire Supreme Court upheld a decision by the New Hampshire Board of Medicine that blocked nurse anesthetists from identifying themselves as anesthesiologists and limited use of the title to MDs and DOs specializing in anesthesiology.