Schools and Degrees
A certified registered nurse anesthetist (CRNA) is a registered nurse with advanced training in administering anesthesia. These specialized nurses must have at least a master’s degree and prior experience in a surgical, operative or anesthesia unit. This guide discusses available degrees from CRNA schools and other professional qualifications, with advice from actual nurse anesthetists about training and career options.
In essence, CRNAs are trained nurses that administer anesthetics. The delivery of anesthesia is a critical and potentially dangerous procedure that requires specialized training and a graduate degree. Given the high level of responsibility and advanced educational requirements, CRNAs are some of the highest paid advanced practice registered nurses in the United States. Since CRNAs have a master’s or doctorate degree, training programs are usually found at nursing schools that have graduate level nursing programs, such as universities.
Currently, in order to become a CRNA, one must have at least a Master of Science in Nursing (MSN) degree. However, there is a trend toward requiring a doctorate in order to become a CRNA, such as a Doctor of Nursing Practice (DNP) or Doctor of Nurse Anesthesia Practice (DNAP). Because of this potential change in requirements, many schools are offering doctorate level CRNA programs. This article will discuss the evolution in educational requirements further on. Nurses at an earlier stage of their studies need to stay abreast of industry regulations so they can be prepared for them.
Most CRNA programs, if not all of them, are offered by a school’s nursing department. This also applies at institutions that have their own medical school. CRNA schools provide academic education and experiential training for either a master’s or doctoral degree in nurse anesthesia. Certain accredited schools specialize in anesthesiology, such as the Middle Tennessee School of Anesthesia, which offers a hybrid online/on-campus DNAP program for practicing CRNAs who hold a master’s degree.
The road to becoming a nurse anesthetist begins with a registered nursing license. Additional steps could vary, depending on each individual’s education and experience. Some nurses earn their RN credential after obtaining an associate degree or after working as a licensed practical nurse. However, most CRNAs today follow the steps below for becoming a full-fledged CRNA.
1. Obtain a bachelor’s degree in nursing.
The degree must come from an accredited program, which is usually recognized by either the National League for Nursing (NLNAC) or the Commission on Collegiate Nursing education (CCNE). Not all CRNAs have a bachelor’s degree in nursing, but if not, they probably have an associate degree in nursing and another degree, such as a bachelor’s or master’s.
2. Pass the National Council Licensure Examination (NCLEX).
Passing this exam is necessary to practice nursing in the United States. Would-be nurse anesthetists need to take the exam targeting RNs, known as the NCLEX-RN. The exam covers coordinated care, safety and infection control, health promotion and maintenance, psychosocial integrity, basic care and comfort, pharmacological therapies, reduction of risk potential and physiological adaptation.
3. Gain at least one year of “critical care” experience.
All accredited nurse anesthesia programs have this requirement for admission, and some schools prefer two or more years of experience. What constitutes qualifying critical care experience depends on the program, but it generally includes skills developed in evaluating unstable or critical condition patients. This experience is necessary for students to learn how to make independent decisions based on their prior training and information provided by medical instruments and monitoring technology.
4. Obtain a master’s or doctorate degree in nurse anesthesia from an accredited institution.
Presently, only an MSN in nursing anesthesia is required to become a CRNA. However, it is expected that a doctorate such as a DNP or DNAP will be required by 2025.
5. Pass the National Certification Examination (NCE).
The NCE is administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). The exam is used to ensure incoming nurse anesthetists have the requisite level of knowledge for competent entry-level performance. The NCE covers basic sciences and principles of anesthesia, as well as equipment, instrumentation and technology.
Additionally, CRNAs need to maintain their current certification and be recertified every two years. To do so, they must have at least 40 hours of continuing education, show evidence of substantial experience in the field and certify that they are physically capable of practicing anesthesia.
When deciding on a potential CRNA school to attend, prospective students should confirm it is accredited. Accreditation ensures the CRNA program meets certain standards for educational quality. The most common and prominent accrediting organization is the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).
Exam passage rates:
Would-be CRNAs must pass the NCE. If a school’s graduates are not able to pass the test, this is a warning sign. NCE passage rates generally differ for first-time test takers and test takers overall. The latter will ideally be very close to 100 percent. With first timers, it will be lower than the overall passage rate, but should be around or above the national average. If either rate is below the national average, contact the school to figure out why. Some schools have relatively small class sizes, so an outlier year where just two or three students fail can have a drastic effect on exam passage rates for that graduating class.
CRNA degree offered:
Does the school offer an MSN or doctoral degree in nurse anesthesia, such as a DNP or DNAP? The MSN degree minimum is expected to be phased out by 2025. Depending on when the prospective student intends to graduate, they may need the DNP or DNAP to become a CRNA. Also keep in mind that students who already have a prior graduate degree might be able to get a DNP or DNAP in as little as one year, depending on the school.
Clinical training sites:
CRNA schools require hands-on fieldwork for practical training. Students with an interest in a particular place of employment or region should look into where this training takes place. The American Association of Nurse Anesthetists notes that clinical training typically takes place in large community hospitals or those affiliated with universities. All else being equal, the more respected and advanced the clinical site, the better the clinical training will be.
Most of the time, the employment rate will be 100 percent or close to it. Given the demand for CRNAs and their marketability after graduation, an employment rate more than a few percentage points below 100 percent is a sign that further investigation is needed. There may be valid reasons for this, but prospective students must find out what those reasons are before enrolling.
Ideally, this would be zero, but it rarely is as the top schools have an attrition rate of over 5 percent and life is generally unpredictable. However, if this rate is over 10 percent, potential applicants should figure out why it’s that high. If the attrition rate is explained by students failing out, that is a sign that the school is not effectively teaching its students, or in a best case scenario, is admitting students who are not yet ready or prepared to become a CRNA.
The quality of the faculty is an important factor in determining the quality of education in a CRNA program. Look for faculty with doctoral level degrees in CRNA related fields and actual anesthesia experience in a clinical setting. Is the faculty member still actively practicing medicine? Continuing experience means that skills are being maintained and updated with recent developments. Other key considerations include the instructors’ level of teaching experience and current research projects.
In the past, only a bachelor’s degree and/or a certificate was needed to become a CRNA. Today, a graduate degree is a minimum requirement, and different types of these degrees are available.
The first option is an MSN in nurse anesthesia. This educational path often consists of about 72 credit hours beyond the baccalaureate and takes about two to three years, depending on the program and whether the student is enrolled part-time.
The second option is to earn a DNP or Doctor of Nursing Practice. This program usually takes three years to complete and consists of 74 to 92 credits, depending on the school. Most students entering a DNP program have a bachelor’s degree in nursing.
The third option is a DNAP or Doctor of Nurse Anesthesia Practice. Many students who enter a DNAP program already have a graduate level degree. As a result, DNAP schools have several options for completion, ranging from one year and approximately 30 credits (for students with a graduate degree) to three years and about 100 credits (for those without a graduate degree).
There are no longer any CRNA certificate programs. Historically, one could become a CRNA without a master’s or even a bachelor’s degree. But over time, the educational requirements have risen, such that becoming a CRNA with only a certificate is no longer possible.
As previously discussed, the MSN is the minimum degree needed to become a CRNA. As one would expect, the MSN in nurse anesthesia covers various aspects of anesthetics, from the scientific basis and background to medical techniques and administration. Also discussed are some policies related to the use of anesthetics. Lastly, there are fieldwork and clinical classes that provide hands-on experience.
While an MSN is the requisite to being a CRNA, it is expected that a DNP or DNAP will become the minimum degree by 2025. Both the Council on Accreditation of Nurse Anesthesia Educational Programs and the American Association of Nurse Anesthetists have endorsed this educational requirement change. Many schools have phased out their MSN nurse anesthesia programs or are in the process of doing so, replacing them with doctoral programs.
Below is a chart of several classes and course descriptions that students can expect to take in a typical MSN program:
Prepares students to effectively assess acute and chronic pain of patients. Also covered are both pharmacological and non-pharmacological pain treatments.
Covers various methods for the administration of anesthesia as well as the reasons for choosing one method over another. Complications for specific anesthetics and their mode of delivery are also covered.
Students obtain hands-on clinical experience in a medical setting, applying their knowledge to relatively healthy patients and integrating this knowledge with real world situations where ethical and diagnostic judgments need to be made.
A doctoral degree is not yet required in order to become a CRNA, but students would be remiss if they did not strongly consider attending a school that offered a doctoral CRNA related degree. This is especially true if the time requirement for the doctoral degree is the same or less than a master’s degree, which is possible at some schools, especially if the student already has a graduate degree.
Besides preparing for the change expected in degree requirements, students should explore a Doctor of Nursing Practice or Doctor of Nurse Anesthesia Practice degree due to increased professional potential. A doctorate provides training for potential leadership and teaching positions, thus broadening the employment horizons. There are few significant differences between a DNAP and a DNP.
Coursework covered in DNAP or DNP programs is similar to that of MSN nurse anesthesia programs, except for a capstone or doctoral project, leadership related coursework and other classes that are not included in MSN programs. The below chart lists several classes and course descriptions for a DNP or DNAP program that are typically not found in an MSN CRNA program:
Provides students with the opportunity to research an issue that is of relevance in anesthesia practice. Students identify current problem(s) and suggest a method of correcting or improving the situation.
Analysis of the theories and practices used by effective CRNA leaders. Concepts such as project planning, improved medical quality and efficiency, and healthcare policy will be covered.
Teaches students ethical, legal and regulatory considerations in the clinical setting as they related to the CRNA and DNP practice.
In order to be admitted to CRNA schools, succeed academically and thrive in nurse anesthetist roles after graduation, it’s vital to develop and strengthen the traits and skills below listed:
Understanding of pharmacology:
One of the cornerstones of a CRNA’s skillset is the ability to determine the proper dosage, type and method of anesthesia. This requires a solid understanding of how the human body interacts with drugs, such as anesthetics.
Quick thinking and analytical skills:
CRNAs must be able to apply their prior experiences, training and educational background to new and unfamiliar real world situations in order to accomplish their job duties and effectively and safely treat patients.
- Interpersonal skills:
Attention to detail:
For accurate and consistent administration of anesthesia to patients, CRNAs need to confirm that the medical staff and equipment are doing exactly what they are supposed to be doing. Also, it might be possible to mix up medications or confuse decimal places and administer 1.5 cc instead of 0.15 cc — but CRNAs pay close attention to prevent this from happening.
Acute/critical care experience:
All accredited CRNA schools require at least one year of this experience, but some highly recommend additional years. This extra experience could help aspiring CRNAs get into the school of their choice and also increase chances of success for students once they’re admitted.
Critical care certification:
While not required, most schools prefer to see applicants with CCRN certification. Such certification indicates that a nurse is certified to work directly with critically sick patients. The CCRN certification from the AACN Certification Corporation is usually granted to nurses who work in intensive care, surgical and trauma units.
Nurse anesthesia is a specialization in and of itself. Most CRNA schools, whether at the master’s or doctoral level, do not offer further specializations within the nurse anesthesia practice area. Focused studies, for example, work with children or infants, would be possible through clinical training if students can choose their fieldwork sites. However, prospective students should look into each school to confirm that this flexibility is allowed.
Graduates from CRNA programs are trained and educated to be able to enter most areas within the field of anesthesia. Limitations in scope of practice are likely to be based on the fact that the CRNA is not an anesthesiologist, an MD who has graduated from medical school and completed a residency and fellowship.
Below is an interview with Alena Curry, a currently practicing CRNA.
What led to your decision to pursue your CRNA?
I have always known I wanted a master’s degree and after choosing nursing as a profession a nurse practitioner was the next step. I chose anesthesia because it is a master’s level job that is based off my intensive care unit experience as a critical care nurse.
What is your educational background, and how does it apply to your current job?
I have a master’s degree in nurse anesthesiology from Albany Medical College and a Bachelor of Science in Nursing (BSN) from University of Massachusetts-Amherst. I also have a certification in critical care nursing (CCRN). My job and professional license are based on my education and clinical experience 100 percent. I apply the skills I have learned in school to my job every day.
What does your day-to-day work entail?
A CRNA not only provides anesthesia for surgeries in many aspects of healthcare but also ensures patient are healthy enough for anesthesia before heading into surgery. In the morning, I make sure the operating room (OR) is ready for the incoming patient: setting up the ventilator, drawing up medications, and making sure emergency equipment is available. I then interview the patient, acquire a history and physical, and explain the anesthesia plan allowing the patient make an informed decision whether they would like anesthesia or not. After the consent is signed, I bring the patient back to the OR and provide anesthesia for the surgical case. I stay throughout the entire case monitoring the patient until the anesthesia has worn off.
Once students graduate from CRNA programs and pass the National Certification Examination, they become certified registered nurse anesthetists and are ready for employment. CRNAs practice in a wide variety of public and private settings, including hospitals, private practices, medical centers, outpatient surgery clinics and physicians’ offices. Basically CRNAs can work wherever anesthesia is administered. They play a more integral role in the United States military than in most civilian settings because they are usually the only licensed medical professional who can give anesthesia. In many civilian settings (and depending on the state), CRNAs work under the supervision of an anesthesiologist.
CRNA Salary Facts (from Payscale)
Median Salary $134,002
Salary Range: $86,493-$186,159
- 18% for more than 20 years experience
- 8% for pediatrics experience
- 5% for obstetrical anesthesia
Nick Angelis, MSN, CRNA and the author of How to Succeed
in Anesthesia School (And RN, PA, or Med School), has the following advice to future CRNA students: “Stretch yourself and welcome uncomfortable situations that stretch your knowledge and abilities (preferably with backup available). Without an objective understanding of your own skills and weaknesses, it’s difficult to become a nurse ready for the independent decision-making required of a nurse anesthetist. For example, in basketball games such as HORSE or Around the World, a player selects shots they know they can make but their opponents will miss. The winner isn’t usually the best player. Rather, it’s the player who understands their own abilities and limitations the most.”