CRNAs: The Basics

The Definition of A CRNA

Certified Registered Nurse Anesthetists (CRNAs) are highly skilled advanced practice registered nurses who specialize in the field of anesthesiology and pain management. As licensed independent practitioners, CRNAs undergo significant post-graduate education and training averaging 30 months in duration and resulting in a master’s or doctoral degree in nurse anesthesia. They are required to pass the National Certification Examination in order to practice. CRNAs provide the same anesthesia services as physician anesthesiologists, based on a foundation of acute care nursing and graduate education. CRNAs practice in all 50 states and safely administer more than 34 million anesthetics to patients each year in the United States.

What do CRNA's Do?

CRNAs are responsible for the safety of patients before, during and after surgery. They administer every type of anesthesia to all types of patients in any healthcare setting where anesthesia is required. CRNAs provide continuous pain relief and sustain patients’ critical life functions throughout surgical, obstetrical and other medical procedures.

In addition to anesthetic agents, CRNAs select and administer adjunct drugs to preserve life functions; they also use technologically advanced monitoring equipment and interpret a vast array of diagnostic information throughout the course of the anesthetic process. CRNAs are qualified to provide pain care services such as acute pain management after a surgical procedure and chronic pain management in primary care settings within their communities.

A CRNA's Role During Surgery

As anesthesia professionals, CRNAs stay with their patients throughout the entire procedure, administering their anesthesia and monitoring their vital signs to ensure maximum safety and comfort. 

During surgery, the patient’s life often rests in the hands of the nurse anesthetist. This awesome responsibility requires CRNAs to fully utilize every aspect of their anesthesia education and training, nursing skills, and scientific knowledge. In addition to vigilantly monitoring the patient’s vital signs and modifying the anesthesia as needed, CRNAs also analyze situations, make decisions, communicate clearly with the other members of the surgical team, and respond quickly and appropriately in an emergency.

Collaboration with Physicians

Like all anesthesia professionals CRNAs collaborate with other members of the surgical team including surgeons, endoscopists, radiologists, podiatrists, obstetricians and other physician specialists. State laws and regulations vary on requiring CRNAs to be supervised by a physician;

well over half of all states do not require physician supervision.

In any case, nurse anesthetists are always independently responsible for their own actions. Surgeons quite properly defer to nurse anesthetists as the experts in anesthesia care. Under state nurse practice acts or board of nursing rules, CRNAs deliver comprehensive anesthesia care consisting of all accepted anesthetic techniques including general, regional (e.g., epidural, spinal, peripheral nerve block), sedation, local, and pain management.

What's the Difference? CRNA vs. Physician Anesthesiologist.

Like anesthesiologists, CRNAs provide the full range of anesthesia services in collaboration with surgeons, endoscopists, radiologists, podiatrists, obstetricians, and other physician specialists. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals provide anesthesia using the same state of the art techniques and leading edge equipment, resulting in an exemplary safety record.

Numerous studies have demonstrated that there is no difference in outcomes when anesthesia is administered by a CRNA or by an anesthesiologist.

The Safety of Anesthesia

Advances in pharmaceuticals, technology and training for nurse anesthetists and anesthesiologists have contributed significantly to improvements in patient safety.

According to the Institute of Medicine (IOM), AANA, and the American Society of Anesthesiologists, anesthesia care is nearly 50 times safer than it was just 30 years ago, and in a 1999 report the IOM identified anesthesia as one of the safest healthcare specialties. Today, perioperative deaths attributed to anesthesia occur approximately once for every 250,000-300,000 anesthetics provided, representing a dramatic increase in patient safety despite an aging U.S. population and older, sicker patients being treated in operating rooms nationwide. 

CRNAs and the Future of Healthcare

CRNAs are the primary providers of anesthesia care in rural America, affording 10s of millions of rural Americans access to surgical, obstetrical, trauma stabilization, and pain management services without having to travel long distances to receive needed care.

In some states, CRNAs are the sole anesthesia professionals in nearly 100 percent of rural hospitals.

CRNAs also provide a significant amount of anesthesia and related care in urban and suburban healthcare facilities, and are the primary anesthesia professionals in many medically underserved inner‐city areas.

Are CRNAs Accepted by Insurance?

The importance of access to CRNA care has been recognized by the inclusion of “non-discriminatory” language in the Affordable Care Act.

This provision ensures that a group health plan or an insurance issuer will support a competitive, high-quality healthcare marketplace by recognizing CRNAs who provide covered services within their scope of practice. 

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. 

Medical Liability

Nurse anesthetists are responsible for securing their own liability coverage, just as physicians are. In part because the care delivered by CRNAs is getting safer all the time, nurse anesthetist professional liability premiums are 33 percent lower today than 25 years ago (or 62 percent lower when adjusted for inflation). 

The same legal principles that govern the liability of surgeons working with nurse anesthetists apply to surgeons working with anesthesiologists. An examination of relevant case law supports the fact that surgeons are no more liable when working with a CRNA than with an anesthesiologist.

What is the Cost Differential Between A CRNA and a Physician Anesthesiologist?

Yes, there is a cost differential between an anesthesiologist and a CRNA.

The mean annual compensation for an anesthesiologist is about $400,000, nearly two and one-half times that of a CRNA whose median total compensation is about $165,000.

Because Medicare pays the same fee for an anesthesia service whether it is provided by a CRNA, an anesthesiologist, or both working together, the higher cost of the anesthesiologist is borne by someone – the hospital, the healthcare facility, or the patient.