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Nurse anesthetists are among the most highly sought-after health professionals today, benefiting from a higher profile in the field and a growing workload.

As a certified nurse anesthetist in rural Nebraska, Steve Wooden, MS, CRNA, travels quite a bit. But he doesn't always hit the road.

Instead, his services are in such high demand in remote areas of the state, he takes to the cockpit of his private plane to pilot himself to various operating rooms.

"I do a lot of traveling, as much as 100 miles or more to do a case or two. Without CRNAs, small hospitals would have a hard time providing surgery services, or even staying in business," said Wooden, of Anesthesia Services of Nebraska in Broken Bow.

On a typical day, Wooden may administer anesthetic for a toddler's spinal tap, fly to another town for a major surgery or for a birth, and head back to Broken Bow to give a local or spinal analgesia for a patient's chronic back pain.

Nurse anesthetists are among the most highly sought-after health professionals today, benefiting from a higher profile in the field and a growing workload. CRNAs administer about 65 percent of the anesthetics given in this country each year, working collaboratively with physicians to care for patients before, during and after surgery. The percentage of anesthesia given by CRNAs has increased from about 49 percent in 1971.

Hot commodity

Why the surge in demand? CRNAs are cost-effective providers of anesthesia service at a time when numbers of inpatient and outpatient surgeries are rapidly increasing, reported Allied Consulting Inc., a Texas professional staffing firm. With a concurrent nationwide shortage of anesthesiologists and managed care's imperative to reduce costs, CRNAs represent a savings to hospitals.

"We perform [a lot of] the same clinical functions as an anesthesiologist," said Rodney Lester, Ph.D., CRNA, nurse anesthesia division director and associate professor of clinical nursing at the University of Texas-Houston Health Science Center School of Nursing. "Day surgery and short surgical procedures have increased, so a CRNA may be able to do 10 to 12 anesthetics per day as opposed to six or seven. We have enough CRNAs to take care of everyone, but patients for elective surgeries may have to wait a little later in the day."

About 80 percent of CRNAs work as partners in care with anesthesiologists, while the remaining 20 percent function as sole anesthesia providers collaborating with surgeons and other licensed physicians. In anesthesia care teams, anesthesiologists provide medical direction for up to four CRNAs, and CRNAs typically administer the anesthetics and remain in the operating room with the patient the entire time.

The ratio of anesthesiologists to CRNAs is set by the hospital or surgery center, based on the sickness of the patients and the amount of manpower the institution can afford, Lester said.

The demand for CRNAs, particularly in rural communities, has produced an 11 percent vacancy rate for CRNA job positions, according to a recent study by the American Association of Nurse Anesthetists. Allied Consulting reported it conducted more searches for CRNAs in 2002 than for any other type of health care professional.

"This is a tough market for recruiting. CRNAs can literally go anywhere they want to go," said Larry Hornsby, CRNA, president of Anesthesia Solutions, which staffs both CRNAs and anesthesiologists for a hospital in Mobile, Ala. "If someone is burned out with late hours at a large hospital, they can go to an ambulatory center across town, and salaries are increasing."

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