certified registered nurse anesthetist

How to Become a Certified Registered Nurse Anesthetist: Steps and Requirements

As Dr. Jean Watson put it, ‘Caring is the essence of nursing.’ Indeed, patient comfort and safety is a defining standard of healthcare. And do you know who does most of the heavy lifting in that regard? It’s nurses, of course! Whether it’s in an operating room or a hospital wing, you’ll always find a nurse looking out for patients. Even when patients are at their most vulnerable during medical procedures, nurses are there to ensure their comfort. These specially trained nurses are called certified registered nurse anesthetists or CRNAs. 

If you’re seeking a rewarding and fulfilling nursing career, becoming a CRNA is an excellent option. As a CRNA, not only will you play a pivotal role in healthcare, but you’ll also find yourself constantly learning new things. So, if becoming a nurse anesthetist is on your career development radar, read on. Because we’ve put together a comprehensive guide on all the basics to get you started. 

What is a certified registered nurse anesthetist?

CRNAs are Advanced Practice Registered Nurses (APRNs) who administer anesthesia to patients who need it prior to undergoing a medical procedure. These dedicated healthcare heroes remain by the patient’s side from before the procedure when they are prepping them for anesthesia, all the way through recovery.

CRNAs are an indispensable part of a medical team. Most CRNAs have an extensive nursing background, and their expertise and knowledge is crucial when it comes to monitoring patients before, during and after anesthesia has been administered. As a registered nurse anesthetist, you can be expected to work in operating rooms, clinics, emergency wards and various acute care settings.

Requirements to become a CRNA

The path to becoming a certified registered nurse anesthetist is pretty straightforward And while getting there takes some time and dedication, the rewards are well worth it.

Step 1: Get an undergraduate degree and nursing license

Like most nursing careers, you must complete an accredited undergraduate program to be eligible for an RN license. It is recommended that you pursue a BSN degree as a baccalaureate degree is a must to pursue a doctorate in future. Most nurse anesthesia degrees fall under a doctorate degree.

You must also pass the NCLEX-RN exam or equivalent licensing exam (depends on the applicable laws in your state).

Step 2: Clinical practice in critical care

After completing your training and obtaining your license, you must practice as a RN for at least a year before applying to nurse anesthetist programs. It’s also a good idea for you to gain some hands-on experience in a critical care unit or an acute care role. This experience can be obtained by working in a hospital within the US or a military hospital outside the US.

The Council of Accreditations (COA) defines a critical care area as “where, on a routine basis, the registered professional nurse manages one or more of the following: invasive hemodynamic monitors (such as pulmonary artery catheter, CVP, arterial); cardiac assist devices; mechanical ventilation; and vasoactive infusions.” The most commonly found critical care units include:

  • Surgical Intensive Care
  • Cardiothoracic Intensive Care
  • Coronary Intensive Care
  • Medical Intensive Care
  • Pediatric Intensive Care
  • Neonatal Intensive Care

Experience in critical care is considered valuable because it hones critical thinking abilities, psychomotor skills, patient assessment skills and the ability to interpret and use advanced patient monitoring techniques. Clinical practice in these roles will also expose you to anesthesia procedures that CRNAs need to be familiar with. Plus, you can also interact with other CRNAs and have the opportunity to learn and build rapport with them.

Step 3: Receiving your master’s and/or doctorate degree in an accredited CRNA program

In 2004, The American Association of Colleges of Nursing (AACN) mandated that all nurses pursuing CRNA certifications have a doctorate degree. By 2025, all CRNAs must have a doctorate degree to practice.

You can pursue an advanced MSN degree in Nurse Anesthesia before opting for a Doctorate in Nursing Practice (DNP) or Doctorate in Nursing Anesthesia Practice (DNAP). Pursuing a DNP may be considered wiser as some institutions may prefer it over a DNAP. Alternatively, if you have a BSN, you can skip the MSN altogether and pursue a DNP directly. Many institutions provide direct BSN to DNP programs.

Make sure you do your research about accreditation and other nurse anesthetist program essentials before embarking on your journey to a future as a CRNA. The most common requirements to apply for a nurse anesthesia program are:

  • A GPE of 3.0 or higher
  • A GRE score of approximately 300
  • A valid RN license
  • 1 year of experience in critical care

It’s also important to note that these programs are considered advanced degrees which are typically pursued by working professionals. As such, many institutions offer online CRNA programs. So, factor in your lifestyle and accessibility to resources as well before deciding on a program.

Step 4: CRNA certification

After completing your CRNA degree program, you must pass the National Certification Examination (NCE), administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) to get your CRNA certification.

National Certification Exam

This assessment is a computerized test that is designed to test the skills and expertise required to be an entry-level nurse anesthesia practitioner. It is an adaptive test with 100 questions – 70 from the NCE content outline and 30 random pretest questions, that need to be finished within 3 hours. The question can range from MCQs to calculations to video based. The passing score is decided by NBCRNA every year. The NCE can be taken up to four times in a year.

To be eligible for the NCE, you must have:

  • An active, unrestricted RN license
  • A completed nurse anesthetist program that has been accredited by the Nurse Anesthesia Educational Programs
  • A ‘certification eligible’ status from the NBCRNA after submitting your application and other required documents

The eligibility status notification remains valid for 90 days or until the candidate appears for the examination, whichever happens first.

It is only after passing this exam can you add ‘CRNA’ to your degree credentials.

Continued Professional Certification Assessment (CPCA)

Every certified CRNA needs to take the CPCA every eight years. The CRNA credential is renewed every four years. This is a skill assessment exam without any pass or fail components. With 150 questions that need to be answered over 3 hours, the test is more of a self-assessment to identify areas that need to be revised. The score is measured against a performance standard. It is designed to test the knowledge of practicing CRNAs in four broad areas:

  • Airway Management
  • Applied Clinical Pharmacology
  • Applied Physiology and Pathophysiology
  • Anesthesia Equipment, Technology, and Safety

This test can be taken any time of the year. The only deadline is that it must be taken at least six months before credential renewal. The test can be taken in-person and online. For in-person assessments, the candidate must find a nearby PearsonVue center and schedule an appointment. A preliminary performance report is given immediately after the test. After the assessment is verified by the NBCRNA, an official score report is provided within 1-2 business days.

Step 5: Apply for State Licensure as an Advanced Practice Registered Nurse (APRN)

All states in the US, except New York and Pennsylvania, require CRNAs to hold an APRN state license. To be considered eligible for an APRN license, a candidate must have:

  • A RN license
  • Completed an accredited nurse anesthesia program
  • A CRNA certification

As laws of practice vary from state to state for CRNAs, they might also need to submit a prescriptive authority and physician form. Some states give APRNs the right to prescribe medications while some stated mandate them to practice under a physician. Among the former, some states also limit their ability to prescribe medicine, if not take it away altogether.

Requirement Checklist

To summarize, to become a CRNA requires the following:

  • A BSN degree
  • A valid RN license
  • Clinical experience in critical care
  • An MSN/ DNP/ DNAP degree
  • NCE certification
  • An APRN license

Scope of Practice for a CRNA

In the US, the Scope of Practice for CRNAs depends on state laws governing the practice. From the qualifications required to have a CRNA license to the process of obtaining the license, all of it is outlined in a state’s nurse practice act. CRNAs also follow the CRNA Code of Ethics to maintain a standard of quality and ethical anesthesia practice.

CRNAs commonly provide anesthetic care to specialties like:

  • General surgery
  • Obstetrics
  • Trauma
  • Cardiac
  • Orthopedics
  • Dental
  • Gastrointestinal
  • Plastic surgery

The scope of practice for CRNAs can range from settings like hospitals, ambulatory care (surgical or otherwise), non-operating areas that require anesthetic care to even office-based settings.

In the US, nearly one third of the hospitals in cities and two thirds of the hospitals in rural areas are dependent on CRNAs for anesthesia procedures. Additionally, military units and population with limited access to healthcare solely depend on CRNAs to provide anesthesia.

Responsibilities of a CRNA

As a CRNA, you can typically expect to perform the following duties on a regular basis: 

  • Putting together and executing anesthesia plans for diverse scenarios ranging from surgery to labor and delivery 
  • Reviewing and documenting patient histories to identify allergies and other potential risk factors to patient safety and communicating and educating patients on anesthetic procedures 
  • Requesting and assessing diagnostic tests 
  • Preparing necessary anesthesia equipment in the operating room 
  • Coordinating with the surgical team throughout the procedure 
  • Managing and adjusting anesthesia levels as required throughout the procedure 
  • Tracking patient vitals during procedures 
  • Monitoring patients before, during and after procedures 
  • Providing post-operative care 
  • Coordinating with other healthcare professionals for effective pain management  
  • Staying updated on the latest findings and research

Why should you become a CRNA? 

Pursuing a career as a CRNA can be very rewarding, especially now, with the demand for nurse anesthetists predicted to increase in the coming years. The BLS estimates a 38% job growth rate for APRNs by 2030. This path is also financially rewarding since CRNAs are one of the highest paid nursing specializations. The median wage for CRNAs was estimated at $125,900, with experienced nurses earning well over $250,000. 

While having job security and a higher earning potential, you also get to play an impactful role in healthcare. You can choose to further specialize in pediatric anesthesia, cardiovascular anesthesia, or obstetric anesthesia to further enhance your career prospects. This will give you professional fulfilment while allowing you to contribute significantly to the healthcare community. 

FAQs 

1. How long does it take to become a CRNA?

 Considering all the degrees and medical training, it can take up to eight years to become a CRNA. 

2. Is it necessary to have an MSN to become a CRNA?

Since the AACN mandated that the minimum requirement for nurses to be eligible for CRNA certification is to have a DNP, it is not necessary to have an MSN.  

3. What is the highest salary for a CRNA?

CRNA salaries can vary according to factors like experience and the region they practice in. The highest salary offered to a CRNA (as of May 2022) was $246,510, in California. Other states that have higher salaries for CRNAs (above $230,000) include Connecticut, Illinois, Kentucky, New Jersey, New York, and Wisconsin. 

4. Is experience in acute care necessary to become a CRNA?

Yes, experience in acute care is crucial to become a CRNA. In fact, it is a requirement to have 1-2 years of acute care experience to even be eligible for enrolling to a nurse anesthetist program. 

5. Is it necessary to have an APRN license to practice as a CRNA?

All US states, except New York and Pennsylvania, require nurses to have APRN licensure to practice as a CRNA.   

 6. Can CRNAs prescribe medication?

The laws on prescriptive authority for CRNAs vary from state to state. As of 2023, 21 out of the 50 US states allow CRNAs to prescribe medication. These include: 

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