Certified Registered Nurse Anesthetist (CRNA): Advanced Practice Nursing
Considered as the most respected professional nurses and with the highest degree of autonomy, CRNAs capture the limelight in Nursing. Bedazzling as it can be as being a nurse anesthetist is regarded as the 13th Best Job among 100 from various sectors in the US.
The practice of anesthesia by nurses can be traced back in 1877 where Sister Mary Bernard, a Catholic nun was the first recorded nurse administering anesthesia. In spite of this, Alice Magaw is considered the “Mother of Anesthesia” for her exceptional contributions to this field of practice. In addition, Magaw was also the first nurse anesthetist to publish articles and engage in research that focused on the practice of anesthesia. As such she was regarded the title.
To date, educational preparation is a must before one is conferred as CRNA. A nurse entering a nurse anesthetist program must be a Bachelor of Science in Nursing degree holder with a license as Registered Nurse. A professional experience of at least one year in acute care setting is also a requirement. Upon successful completion of the nurse anesthetist program, which typically runs for 24 to 36 months including classroom and clinicals, a master’s degree is awarded. Then shall the nurse be eligible to take the national certification examination (NCE) which is required by all states in order to practice.
The expanded role of nurses in this specialty include the administration of any anesthetic agents, either indicated for pain relief or in preparation for surgical procedures. CRNAs decide which drugs, techniques and route best fit the patient’s needs. Prior to procedures requiring anesthesia, the patient and family members are met by the CRNA to obtain pertinent information such as medical history and how it might affect the response to anesthesia, and pain management needs prior to surgery, explanation of the process, and respond to any questions. Close monitoring of the patient’s response to anethesia and managing allergic reaction or adverse events are also instituted during administration by the nurse anesthetist upto until patients have recovered from anesthesia and are stable. Despite their competence, nurse anesthetists must work collaboratively with anaesthesiologists and other members of the healthcare team. Moreover, the American Association of Nurse Anesthetists (AANA) has promulgated the following “Standards for Nurse Anesthesia Practice”:
- Standard I: Perform a thorough and complete preanesthesia assessment
- Standard II: Obtain informed consent for the planned anesthetic intervention from the patient or legal guardian
- Standard III: Formulate a patient-specific plan for anesthesia care
- Standard IV: Implement and adjust the anesthesia care plan based on the patient’s physiological response
- Standard V: Monitor the patient’s physiologic condition as appropriate for the type of anesthesia and specific patient needs
- Standard VI: There shall be complete, accurate, and timely documentation of pertinent information on the patient’s medical record
- Standard VIII: Transfer the responsibility for care of the patient to other qualified providers in a manner which assures continuity of care and patient safety
- Standard IX: Adhere to appropriate safety precautions, as established within the institution, to minimize the risks of fire, explosion, electrical shock and equipment malfunction. Document on the patient’s medical record that the anesthesia machine and equipment were checked.
- Standard X: Precautions shall be taken to minimize the risk of infection to the patient, the CRNA, and other healthcare providers
- Standard XI: Anesthesia shall be assessed to assure its quality and contribution to positive patient outcomes
- Standard XII: The CRNA shall respect and maintain the basic rights of patients
Because CRNAs undergo extensive training as required, and they are exposed to a demanding nature of the job, they are the highest paid in the nursing field. It is in fact ranked 6th Highest Paid Job by the CNN Money with reference to the statistics of PayScale.com in 2010 where the Median annual pay of CRNAs amount to $156,000 and the Top pay at $206,000.
The future of this specialty field is very promising as the demand is expected to surge with the impending shortage of anesthesiologists. Opportunities for CRNAs will extend beyond a traditional operating room setting. Nurse anesthetists are foreseen in areas such as hospital labor and delivery units, outpatient healthcare centers, military and other medical facilities performing as primary providers of anesthesia, and in rural healthcare clinics where there may be not a single anesthesiologist.
Byron Webb Romero, RN, MSN
Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.
