A CRNA, or Certified Registered Nurse Anesthetist, is an advanced practice registered nurse who specializes in administering anesthesia. CRNAs provide anesthesia for surgeries, dental procedures, and other medical interventions, caring for patients of all ages before, during, and after they receive anesthetic drugs. They are one of the most highly trained and highest-paid nursing professionals in the United States, with a median salary around $195,610 per year.
What CRNAs Do
CRNAs handle the full scope of anesthesia care. Before a procedure, they evaluate patients for potential risks, checking for allergies to anesthetic drugs and conditions like asthma or diabetes that could complicate sedation. They calculate and deliver precise dosages of anesthesia, whether that means numbing a specific body part or inducing full unconsciousness. During surgery, they continuously monitor the patient’s physical responses and adjust accordingly. Afterward, they oversee recovery until the anesthesia wears off safely.
Beyond direct patient care, CRNAs can order diagnostic tests and prescribe medications. They work alongside surgeons, anesthesiologists, dentists, and podiatrists across a range of settings: hospital operating rooms, outpatient surgery centers, emergency rooms, post-anesthesia recovery units, and dental offices. Some CRNAs specialize further in areas like pediatric, obstetric, cardiovascular, neurosurgical, or dental anesthesia.
CRNAs vs. Anesthesiologists
Both CRNAs and anesthesiologists administer anesthesia, but their training paths are very different. Anesthesiologists are physicians who complete four years of medical school followed by four years of residency, and often an additional one to two years of fellowship training. That adds up to eight to ten years of post-graduate education and roughly 12,000 to 16,000 patient care hours.
CRNAs follow a nursing track. Their graduate programs run about 36 months, and they do not attend medical school or complete a medical residency. During training, they accumulate approximately 2,500 hours of hands-on clinical anesthesia care, about five to seven times fewer than an anesthesiologist. Despite this difference, CRNAs deliver the same core anesthesia services in many clinical settings and are often the only anesthesia provider available in rural hospitals and military facilities.
How to Become a CRNA
The path to becoming a CRNA is demanding and takes years of preparation. Candidates must first earn a bachelor’s degree in nursing and become a licensed registered nurse. After that, they need at least one full year of critical care experience (or the part-time equivalent) working in a setting like an intensive care unit, where they develop skills in advanced patient monitoring and independent clinical decision-making.
Only then can they apply to a nurse anesthesia graduate program. Since January 2022, all students entering accredited programs are required to pursue a doctoral degree, either a Doctor of Nursing Practice (DNP) or a Doctor of Nurse Anesthesia Practice (DNAP). This transition became fully mandatory by January 2025, meaning every new CRNA entering the workforce now holds a doctorate. Programs typically run about three years and combine intensive coursework in pharmacology, physiology, and anesthesia science with thousands of hours of supervised clinical training.
After graduating, candidates must pass the National Certification Examination administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). This exam tests whether graduates have the knowledge and skills to practice safely. Passing it earns the CRNA credential, and ongoing recertification requirements keep practitioners current throughout their careers.
Where CRNAs Practice Independently
Whether a CRNA can practice without physician supervision depends on state law. Under federal Medicare rules, CRNAs originally required physician oversight, but states can opt out of that requirement. As of 2024, governors in 25 states have done so, including California, Massachusetts, Michigan, Colorado, and Oregon. Two states, Utah and Wyoming, have partial opt-outs that apply only to critical access hospitals and small rural facilities.
In states that haven’t opted out, CRNAs typically work under the supervision of a physician, though what “supervision” means in practice varies. In some facilities, an anesthesiologist is physically present. In others, a surgeon serves as the supervising physician while the CRNA manages all anesthesia care directly.
Their Role in Rural Healthcare
CRNAs are frequently the sole anesthesia providers in rural parts of the United States. Many small and critical access hospitals cannot recruit or afford a physician anesthesiologist, so CRNAs fill the gap, making surgeries and emergency procedures possible in communities that would otherwise lack access. They also serve as the primary anesthesia providers for the U.S. armed forces.
The relationship between state opt-out policies and rural access is more complicated than it appears, though. Research examining hospital data from 2010 to 2021 found that adopting opt-out provisions did not consistently increase CRNA staffing in rural counties. Many hospitals use both CRNAs and physician anesthesiologists, and the patchwork of state-level practice rules creates confusion about roles. Policymakers have been urged to consider additional measures beyond opt-out policies to address rural anesthesia shortages.
Salary and Job Outlook
CRNAs are among the highest-earning nurses in the country. Bureau of Labor Statistics data puts the median annual salary at $195,610, with those at the 25th percentile earning about $164,860 and the mean annual wage reaching $202,470. Pay varies by region, setting, and experience. CRNAs working in metropolitan hospitals or specialty surgical centers often earn more than those in smaller or rural facilities, though rural positions sometimes offer other incentives to attract providers.
Demand for CRNAs remains strong. The combination of an aging population needing more surgical procedures, ongoing physician shortages in anesthesiology, and the expansion of outpatient surgery centers continues to drive hiring. The profession’s roots stretch back to the late 1800s, when a shortage of physicians willing to provide anesthesia pushed nurses into the role. Pioneers like Alice Magaw and Agatha Hodgins helped establish it as a formal specialty, and today it stands as one of the most respected and competitive advanced practice nursing careers in the country.