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OVERVIEW Nurse anesthetists, also known as certified registered nurse anesthetists (CRNAs), are one of four classifications of advanced practice nurses (APNs). They are registered nurses (RNs) with advanced training in anesthesiology. They are responsible for administering, supervising, and monitoring anesthesia- related care for patients undergoing surgical procedures. General anesthesia is not necessary for all surgical procedures; therefore, nurse anesthetists also work on cases in which they provide various types of local anesthesia—topical, infiltration, nerve-block, spinal, and epidural or caudal. There are approximately 30,000 CRNAs working in the United States. HISTORY Reliable methods of putting a patient to sleep were first developed in the 1840s, when the discovery of ether anesthesia revolutionized surgery Before that time, when surgery offered the only possible chance of saving a person’s life, all that the surgeon could do was give alcohol or opium to deaden the pain. Similarly, mandrake, hemp, and herbane may have been given orally, or by inhalation, during childbirth. The first nurse anesthetist was Sister Mary Bernard, who practiced in Pennsylvania in the 1 870s. The first school of nurse anesthetists was founded in 1909 at St. Vincent Hospital in Portland, Oregon. Since then, many schools have been established, and the nurse anesthesia specialty was formally created on June 17, 1931, when the American Association of Nurse Anesthetists held its first meeting. Contemporary anesthesiology is far more complicated and much more effective than in the early days when an ether- or chloroform- soaked cloth or sponge was held up to the patient’s face. Today, a combination of several modern-day anesthetic agents is usually used to anesthetize the patient. THE JOB According to the American Association of Nurse Anesthetists, approximately 26 million anesthetic procedures are carried out annually in U.S. medical facilities, and 65 percent of these are administered by nurse anesthetists. In approximately 66 percent of rural hospitals, nurse anesthetists are the only anesthesia providers. Nurse anesthetists are clearly important members of health care teams across the country. Prior to surgery, a nurse anesthetist takes the patient’s history, evaluates his or her anesthesia needs, and forms a plan for the best possible management of the case (often in consultation with an anesthesiologist). The nurse anesthetist also explains the planned procedures to the patient and answers questions the patient might have. Prior to the operation, the nurse anesthetist administers an intravenous (IV) sedative to relax the patient. Then the nurse anesthetist administers a combination of drugs to establish and maintain the patient in a controlled state of unconsciousness, insensibility to pain, and muscular relaxation. Some general anesthetics are administered by inhalation through a mask and tube, and others are administered intravenously. Because the muscular relaxants prevent patients from breathing on their own, the nurse anesthetist has to pro vide artificial respiration through a tube inserted into the windpipe. Throughout the surgery, the nurse anesthetist monitors the patient’s vital signs by watching the video and digital displays. The nurse anesthetist is also responsible for maintaining the patient’s blood, water, and salt levels as well as continually readjusting the flow of anesthetics and other medications to ensure optimal results. After surgery, nurse anesthetists monitor the patient’s return to consciousness and watch for complications. The nurse anesthetists must be skilled in the use of airways, ventilators, IVs, blood- and fluid-replacement techniques, and postoperative pain management. REQUIREMENTS High School If you want to become a nurse anesthetist, you will first need to become a registered nurse. To prepare for this career, you should take high school mathematics and science courses, including biology, chemistry, and physics. Health courses will also be helpful. English and speech courses should not be neglected because you must be able to communicate well with patients. Postsecondary Training All applicants to nurse anesthetist programs must be registered nurses with a bachelor’s degree and have at least one year’s acute care nursing experience. Eighty-eight programs have been recognized by the Council of Accreditation of Nurse Anesthesia Educational Programs. The American Association of Nurse Anesthetists pro vides a listing of these programs at its website, http://www.aana.com. Admission is competitive, and programs last 24 to 36 months. All accredited programs offer at least a master’s degree, and some offer a post-master’s certificate or a doctorate. Students take extensive classes in pharmacology and the sciences. They also acquire hundreds of hours of anesthesia-related clinical experience in surgery and obstetrics. Certification or Licensing All registered nurses must be licensed to practice in the United States. In addition, nurse anesthetists are required to pass a national certification exam given by the Council on Certification of Nurse Anesthetists. All states recognize certified registered nurse anesthetist (CRNA) status. Certified nurse anesthetists are not required to work under the supervision of an anesthesiologist, although some licensing laws do stipulate that they must work with a physician. CRNAs must be recertified every two years according to the criteria established by the Council on Recertification of Nurse Anesthetists. Part of this requirement includes earning 40 continuing education credits every two years. The American Society of PeriAnesthesia Nurses also offers a certification program. Other Requirements Nurse anesthetists must have the ability to concentrate for long periods of time and remain focused on monitoring their patient during surgery. They must be able to analyze problems accurately and swiftly, make decisions quickly, and react appropriately. They must have the ability to remain calm during emergencies and be able to handle stressful situations. Nurse anesthetists also need to have efficient time management skills in order to work efficiently with surgeons and their operating schedules. Did You Know? • Approximately 45 percent of CRNAs are men, compared to only 8 percent of the entire nursing profession. • Today, anesthesia care is almost 50 times safer than it was two decades ago. • Approximately 678 nursing programs offer bachelor’s degrees in nursing. Sources: American Association of Nurse Anesthetists, Institute of Medicine, U.S. Department of Labor EXPLORING Books, nursing association websites, and informational interviews with nurses will provide you with more information about nursing careers. You can also learn more about nurse anesthetists by visiting the student’s page of the AANA website (http://www.aana.com/students). EMPLOYERS The American Association of Nurse Anesthetists reports there are more than 30,000 CRNAs working in the United States. Many nurse anesthetists are employed by hospitals or outpatient surgery centers. Dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists also employ them. Others may be employed in a group or independent practice that provides services to hospitals and other health care centers on a contract basis. Some work for rural hospitals, the U.S. Public Health Services, the Department of Veterans Affairs, and the U.S. military. Because the high-quality, cost-effective anesthesia service provided by nurse anesthetists is widely acknowledged, health care institutions are eager to employ them. STARTING OUT Nurse anesthetists may apply for employment directly to hospitals, outpatient surgery centers, and government agencies that hire nurses. Jobs can also be obtained through school placement offices, by signing up with employment agencies specializing in placement of nursing personnel, or through the state employment office. Other sources of jobs include nurses’ associations, professional journals, and news paper want ads. ADVANCEMENT Nurse anesthetists who want new professional challenges beyond direct practice might consider teaching or administrative positions or involvement in research for improved or specialized anesthesia equipment and procedures. Some nurse anesthetists choose to acquire other advanced-practice nursing qualifications so they can be involved in a wider range of nursing activities. Doctoral programs for nurse anesthetists are expected to expand in the near future. EARNINGS Nurse anesthetists are among the highest paid nursing specialists. Earnings vary based on type and size of employer, years of experience, and location, among other factors. Salary.com reports that in 2005, the average salary for nurse anesthetists was $119,890, with salaries ranging from a low of $109,642 to more than $129,731. Nurse anesthetists’ salaries are also affected by the amount of managerial responsibilities they have. For example, a 2005 job posting for a chief nurse anesthetist in the Washington, D.C., area listed a salary of more than $150,000. The U.S. Department of Labor reports that median annual salary for registered nurses of all types was $52,300 in 2004, but again, most nurse anesthetists make considerably more than this. Fringe benefits are usually similar to other full-time health care workers and may include sick leave, vacation, health and life insurance, and tuition assistance. WORK ENVIRONMENT Nurse anesthetists usually work in sterile, well-lighted operating facilities. They spend considerable time on their feet and may be required to stand for many hours at a time. Emergencies can produce a stressful and fast-paced environment. Many nurse anesthetists must be on call, usually on a rotation basis, to respond to emergency surgical situations. OUTLOOK The American Association of Nurse Anesthetists predicts a bright future for CRNAs. In addition, the U.S. Department of Labor projects employment for all registered nurses to grow faster than the average through 2012. Strong demand for CRNAs will result from several factors. For example, there is currently a shortage of CRNAs in the marketplace. Also, with the continuing trend of cutting costs in all health care facilities, CRNAs will be in demand to provide an alternative to hiring higher-priced anesthesiologists. The increased use of managed health care services and the aging population will also result in a need for additional nurse anesthetists. FOR MORE INFORMATION For comprehensive information on the career of nurse anesthetist, contact American Association of Nurse Anesthetists 222 South Prospect Avenue Park Ridge, IL 60068-4001 Tel: 847-692-7050 For information on certification, contact American Society of PeriAnesthesia Nurses 10 Melrose Avenue, Suite 110 Cherry Hill, NJ 08003-3696 Tel: 877-737-9696 Email: aspan@aspan.org For general information, contact National League for Nursing 61 Broadway, 33rd Floor New York, NY 10006 Tel: 800-669-1656 Discover Nursing, sponsored by Johnson & Johnson Health Care Systems, provides information on nursing careers, nursing schools, and scholarships. 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