A CRNA, or Certified Registered Nurse Anesthetist, is an advanced practice registered nurse who specializes in administering anesthesia. CRNAs are among the highest-paid nursing professionals in the United States, with a median annual salary of $223,210 as of May 2024. They provide anesthesia for surgeries, diagnostic procedures, and other medical interventions, working in hospitals, surgical centers, dental offices, and pain management clinics.
Nurse anesthesia is actually the oldest clinical nursing specialty in the country. The first nurse to administer anesthesia on record was Catherine S. Lawrence, who gave chloroform to wounded soldiers during the Civil War. A shortage of physicians willing to provide anesthetics in the second half of the 19th century pushed nurses into the role, and both World Wars further expanded their training and recruitment. Today, CRNAs deliver roughly half of all anesthetics given in the United States.
What CRNAs Actually Do
A CRNA’s work spans three phases: before, during, and after a procedure. Before surgery, they evaluate a patient’s medical history, identify risks like drug allergies or conditions such as asthma and diabetes that could complicate anesthesia, and explain what to expect. During the procedure, they select and administer the appropriate type of anesthesia, whether that means numbing a specific part of the body or inducing full sleep. They calculate precise dosages based on a patient’s weight, age, and health status. After the procedure, they monitor recovery, manage pain, and watch for complications like nausea or breathing difficulties.
The types of anesthesia CRNAs provide range from local numbing agents and regional nerve blocks to general anesthesia that renders a patient fully unconscious. They also manage sedation for less invasive procedures, where patients remain in a twilight state rather than fully asleep.
How to Become a CRNA
Becoming a CRNA requires more education and clinical training than almost any other nursing role. The path starts with earning a Bachelor of Science in Nursing and becoming a registered nurse. After that, you need at least one year of hands-on experience in an intensive care unit. This ICU requirement is strict: it must be a true ICU setting (medical, surgical, burn, trauma, cardiac, or neonatal), and step-down units, intermediate care, or cardiac catheterization labs do not count. Your ICU experience also needs to be recent, typically within two years of applying to a program.
Once you meet the prerequisites, you enter a doctoral program. The Council on Accreditation of Nurse Anesthesia Educational Programs now mandates a doctoral degree for entry into practice, replacing the previous master’s degree requirement. These programs run a minimum of 36 months and include over 2,500 supervised clinical hours on top of simulation training. Emory University’s program, for example, spans nine semesters and 89 credit hours. After graduating, you take a national certification exam to earn the CRNA credential.
From start to finish, the journey from entering nursing school to practicing as a CRNA takes roughly nine to eleven years, factoring in the bachelor’s degree, ICU experience, and doctoral program.
Staying Certified
Earning the CRNA credential is not permanent. CRNAs renew their certification every four years through the Continued Professional Certification Program, which requires completing 100 credits split between educational and professional development activities. At the two-year midpoint of each cycle, there’s a check-in where CRNAs verify their state licensure and confirm they’re still in active practice.
Can CRNAs Work Without a Doctor?
This is one of the most debated questions in anesthesia care, and the answer depends on where you live. A 2001 federal rule requires physician supervision of nurse anesthetists under Medicare and Medicaid but allows state governors to opt out of that requirement. As of 2024, 25 states have opted out, meaning CRNAs in those states can practice independently for Medicare and Medicaid patients. These include California, Colorado, Massachusetts, Washington, Oregon, and others spanning from Alaska to Delaware.
In states that haven’t opted out, CRNAs typically work under the supervision or medical direction of a physician anesthesiologist. In practice, the level of oversight varies widely. Some CRNAs work side by side with anesthesiologists in a team model, while others practice with minimal day-to-day oversight even in states that technically require supervision. In rural areas especially, CRNAs are often the sole anesthesia providers available.
CRNAs vs. Anesthesiologists
Anesthesiologists are medical doctors who complete four years of medical school and a four-year residency in anesthesiology. CRNAs take a nursing-based route that, while extensive, is structured differently. The practical question most patients care about is whether the distinction affects safety.
The research on this is genuinely mixed. A 2010 study published in Health Affairs found no evidence of increased patient risk when CRNAs provided anesthesia without supervision. A 2003 study reached a similar conclusion, finding that hospitals without anesthesiologists had outcomes comparable to those with anesthesiologist-directed care. Research on obstetric outcomes specifically found no systematically worse maternal outcomes at hospitals using only CRNAs compared to anesthesiologist-only models.
Other studies point in a different direction. A 2000 study found 2.5 excess deaths per thousand cases within 30 days when an anesthesiologist was not involved, after adjusting for how sick patients were. A 2012 study found that the odds of unexpected complications after outpatient surgery were 80% higher when a nurse anesthetist provided the anesthesia rather than a physician anesthesiologist. A 2014 Cochrane Collaboration review, considered the gold standard for evaluating medical evidence, concluded that no definitive statement could be made about one model being superior to the other because the available research was insufficient to answer the question conclusively.
One economic analysis found that CRNAs practicing independently was the most cost-effective delivery model, though it operated on the assumption that care quality was equivalent between the two provider types.
Salary and Job Outlook
CRNAs are the highest-paid nursing professionals in the country. The Bureau of Labor Statistics reports a median annual salary of $223,210 as of May 2024, which places them well above nurse practitioners and nurse midwives. Employment is projected to grow 9% from 2024 to 2034, faster than average for all occupations. Demand is driven by an aging population needing more surgical procedures and by ongoing shortages of anesthesia providers, particularly in rural and underserved communities.