So You Want to be
a CRNA ...
Nurse anesthetists thrive on the challenges and rewards of their specialty
By
Toni Inglis, MSN, RN
May 13, 2002
A 17-year-old boy went into full cardiac arrest 27 years ago in the emergency
room of a rural hospital in Missouri. Respiratory therapist Sally Bass
Witkowski was on duty that evening, and the incident would change her
life.
"In 1975, my career goal was to teach respiratory therapy at the
college level. I was working full time and close to graduating with a
BS in respiratory therapy when this kid arrested.
"The on-call nurse anesthetist was called. She walked in the room,
started his IV, intubated him and saved his life. She did it all effortlessly
and quietly. I could tell it was no big deal to her. When I saw her do
that, I knew that was what I wanted to do, what I wanted to be.
"She was a quiet, well-trained country woman. Her name was Margaret
Ryan. I've wanted to tell her many times how much I admired her, how she
changed my life, but that was 27 years ago."
Witkowski became a certified registered nurse anesthetist 18 years ago
and has worked as a staff anesthetist for an anesthesia group in Austin,
Texas, since 1984. "Our anesthesia group covers several hospitals,
and we do every kind of surgery imaginable, from total hip to neonatal
open heart."
Witkowski described the mechanics of her job. "We [CRNAs] interview
patients, review charts and physical history, do preoperative teaching
and develop an anesthesia plan in collaboration with the anesthesiologist.
While the patients are in surgery, we assure their safety and comfort
by administering anesthesia while at the same time monitoring vital signs,
anesthesia depth, blood loss, body temperature and positioning. We assure
that the patient gets from surgery to the recovery room or ICU stable
and comfortable.
"Patient safety is the No.1 priority for nurse anesthetists. We minister to the patient's physical and emotional needs, offer reassurance and comfort, and stay right by the patient's side throughout the surgery."
National shortage of anesthesia providers
Despite the critical need for CRNAs, a national protracted shortfall
of anesthesia providers threatens to limit the growth of surgical activity.
CRNAs practice in every setting in which anesthesia is delivered, including
traditional hospital surgical suites, obstetrical delivery rooms, physicians'
offices, ambulatory surgical centers and the military, said Ira Gunn,
MLN, CRNA, FAAN. "We have so decentralized where we perform that
people are spread out all over. Those who work in outpatient surgery centers
reduce the number of nurse anesthetists available to take call and work
round-the-clock. We just can't cover it all."
Another factor contributing to the shortage is an aging population, as
elderly patients have an inpatient procedure rate about three times that
of the general population. The burgeoning field of pain management, as
well as advances in diagnostic and operative procedures, have grown out
of proportion to the supply of active anesthesia providers, and the proportion
of nurse anesthetists nearing retirement age is increasing.
Educational capacity is a problem. "We need more accredited nurse
anesthesia programs in this country. There aren't enough student slots,
and faculty are difficult to recruit. For our entering class of August,
we had 312 applicants for 85 slots," said Kay Sanders, MHS, CRNA,
director of the graduate program of nurse anesthesia at Texas Wesleyan
University, the largest nurse anesthesia program in the United States.
On the positive side, the shortage has resulted in higher pay for CRNAs.
In 1999, the national average salary of CRNAs was about $102,000, finally
jumping the six-figure hurdle, according to the American Association of
Nurse Anesthetists.
"Besides comfortable pay, nurse anesthesia is satisfying work,"
Gunn said. "Most CRNAs were critical care nurses first. With nurse
anesthesia, you have far more control over your work. And the one-on-one
focus with your patient is priceless."
To become a CRNA, a licensed registered nurse must complete an accredited
nurse anesthesia program (earn a master's degree), then pass a certification
exam. Requirements for admission are a bachelor's of science of nursing
or another appropriate baccalaureate degree and a minimum of one year
of acute care nursing experience.
"The average length of work experience for CRNA school candidates
is four to five years, although a fair number have had quite a few years
of experience. Critical care experience is what's needed, preferably adult
intensive care or emergency nursing," said Gunn, who has practiced
anesthesia for nearly 50 years and has worked extensively with state legislatures,
Congress and administrative bodies regulating the nurse anesthesia profession.
"Most nurse anesthetist programs are located within schools of nursing,
and the average program length is 24 to 36 months. Texas Wesleyan is 27.5
months," Sanders said. "The first year is classroom with graduate-level
classes in the basic sciences, advanced anatomy and physiology taught
by Ph.D. physiologists, pharmacology, pathophysiology-many of the same
classes you'd find in medical schools. The second year consists of clinical
residencies where a student is assigned to a hospital with hands-on general
and regional anesthesia, and acute and chronic pain management."
CRNAs have provided anesthesia care for more than 100 years and legally
administer 65 percent of the 26 million anesthetics delivered in the United
States each year, according to the AANA. They are the sole anesthesia
providers in 65 percent of rural hospitals. For more information about
this subject or in becoming a CRNA, visit the association's Web site at
www.aana.com.