CRNA at a Glance

History
Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years. The CRNA (Certified Registered Nurse Anesthetist) credential came into existence in 1956. The title “nurse anesthesiologist,” which is synonymous with the title “nurse anesthetist,” is used by some CRNAs.

Prolific Providers
CRNAs are anesthesia professionals who safely administer more than 49 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2019 Member Profile Survey.

Rural America
CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, pain management, and trauma stabilization services.

Anesthesia Safety
According to a 1999 report from the Institute of Medicine (now the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine), anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.

Practice of Nursing
CRNAs provide anesthesia in collaboration with surgeons, dentists, podiatrists, physician anesthesiologists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by a physician anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

Autonomy and Responsibility
As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.^*

Practice Settings
CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.

Military Presence
Nurses first provided anesthesia on the battlefields of the American Civil War. During WWI, nurse anesthetists became the predominant providers of anesthesia care to wounded soldiers on the front lines; today, CRNAs continue to be the primary providers of anesthesia care to U.S. military personnel on front lines, navy ships, and aircraft evacuation teams around the globe.

Cost-Efficiency
Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.

Supervision Opt-Out
In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt-out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 24 states and Guam have opted out of the federal physician supervision requirement, including Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, Kentucky, Arizona, Oklahoma, Utah, Michigan, Arkansas, Wyoming, and Delaware. Additional states do not have supervision requirements in state law and are eligible to opt-out should the governors elect to do so.

Malpractice Premiums
On a nationwide basis, the average 2018 malpractice liability insurance premium for self-employed CRNAs was 33 percent less than it was in 1988. When trended for inflation through 2018, the reduction in premiums was even greater, at 68 percent.

Direct Reimbursement
Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.

AANA Membership
Over 57,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or nearly 90 percent of all U.S. nurse anesthetists). More than 40 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole.

Education Requirements

• By 2025 all new CRNA’s will hold a doctorate degree from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. As of August 2022, there are 130 accredited nurse anesthesia programs in the United States and Puerto Rico using more than 2300 active clinical sites.
• Nurse anesthesia programs require a minimum of 36 months to complete and can be up to 51 months, depending on university requirements. Graduates of nurse anesthesia educational programs have an average of 9,369 hours of clinical experience.

The minimum education and experience required to become a CRNA include^**:

• A baccalaureate or graduate degree in nursing or other appropriate major.
• An unencumbered license as a registered professional nurse and/or APRN in the United States or its territories and protectorates.
• A minimum of one-year full-time work experience, or its part-time equivalent, as a registered nurse in a critical care setting within the United States, its territories, or a U.S. military hospital outside of the United States. The average experience of RNs entering nurse anesthesia educational programs is 2.9 years.
• Some CRNAs pursue a fellowship in a specialized area of anesthesiology such as chronic pain management following attainment of their degree in nurse anesthesia.

Certification
Before they can become CRNAs, graduates of nurse anesthesia educational programs must pass the National Certification Examination.

CPC Program, formerly Recertification
In 2016, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) launched the Continued Professional Certification (CPC) Program, which replaced the former recertification program. The CPC Program focuses on lifelong learning and is based on eight-year periods comprised of two four-year cycles. Each four-year cycle has a set of components that include 60 Class A credits (assessed continuing education), 40 Class B credits (professional activities), four Core Modules (current literature and evidence-based knowledge; voluntary during the first four-year cycle, required beginning in 2020), a 2-year Check-in at the midpoint of each four-year cycle, and a performance standard assessment (no pass/fail) every eight years.

^*For information about CRNA compensation, please contact the AANA Public Relations Department at (847) 655-1143.

^**Nurse anesthesia educational programs have admission requirements in addition to the above minimums. A complete list of programs and information about each of them can be found at CRNA School Search.

Most recently updated:November 11, 2023.