Nurse anesthetist
A nurse anesthetist (AE) is a registered nurse educated and trained to administer anesthesia. The title, Certified Registered Nurse Anesthetist (CRNA), reflects the nurse's qualifications and abilities.
Education
Nurse anesthetist education and training varies in different nations. In the United States, for example, education is overseen by the American Association of Nurse Anesthetists' Council on Accreditation of Nurse Anesthesia Educational Programs.
Historically, CRNAs received an anesthesia bachelors degree, diploma or certificate. However, all programs transitioned to a master's degree about 1988-1990 and this is now the current point of entry into the CRNA profession. In the U.S., nurse anesthetists must first complete a four-year baccalaureate degree in nursing or a science related subject. They must be a licensed registered nurse. Then, most nurse anesthesia programs in the United States require a minimum two years of nursing experience in a critical or acute care environment. Because most programs have far more qualified applicants than available spaces, successful candidates usually have several years of experience in nursing in addition to specialized education in nursing or other health disciplines. Following that, applicants compete to enroll in an accredited program of anesthesia education for an additional two-and-a-half to three years. These college or university based programs combine intensive theory, didactic education, and clinical practice. Upon completion of their education and passage of a national certification examination, they are then certified by the Council on Certification of Nurse Anesthetists (CCNA). Most CRNAs have master's degrees in either anesthesia or nursing. CRNAs also have continuing education requirements and recertification every two years thereafter, plus any additional requirements of the state in which they practice.
Some nurse anesthetists continue their education to the terminal degree level, either earning a Ph.D., DNSc (Doctor of Nursing Science) or DNP (Doctor of Nursing Practice). At the terminal degree level, nurse anesthetists have a wider variety of professional choices available to them, and may teach, participate in administration or pursue research. There are 34,000 members in the American Association of Nurse Anesthetists. This includes certified, recertified, and student members. Approximately 42% of the CRNAs are men, versus approximately 5% in the nursing profession as a whole.
Scope of practice
CRNAs practice in all 50 of the United States. Each state's Board of Nursing has its own regulations for professional nursing practice and establishes practice guidelines for nurse anesthetists. All states have nurse anesthetist associations, which govern nurse anesthesia practice.
Most lay people and health professionals don't comprehend the world wide extent of nurse anesthesia practice. Physician anesthesiologists practice most often in developed and modern countries, leaving many undeveloped nations to rely mainly on nurse anesthetists or even anesthesia technicians. In 1989, an international organization of nurse anesthetists was established. The "International Federation of Nurse Anesthetists" (IFNA) has flourished in membership and has become an authoritative voice for nurse anesthetists worldwide. They have developed standards of education and practice, and a code of ethics. Delegates from other member counties participate in the yearly World Congress. Recent studies by the IFNA find anesthesia care worldwide is operationally a nursing function. Researchers identified 107 countries where nurse anesthetists practice and 9 countries where nurses assist in the administration of anesthesia. Nurse anesthetists participate in 80 percent of anesthesia worldwide, and are the sole providers in 60 percent of anesthesia worldwide.
CRNAs practice in a wide variety of settings including for the military, in public and private sectors, traditional hospital settings, pain clinics, physician's offices, or solo. They may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs can administer anesthesia in all types of surgical cases, applying all the accepted anesthetic techniques - general, regional, local, or sedation.
According to the American Association of Nurse Anesthetists, CRNAs provide the majority of anesthetics in rural settings in the United States, and in over two-thirds (66%) of all rural hospitals are the sole anesthesia providers. CRNAs may practice as employees, members of the military, VA or public health service, as independent contractors, in an as-needed basis, or in short-term contractual agreements often called locum tenems. Many also practice in private anesthesia groups.
State laws vary, but CRNAs may work independently, under the direction of supervision of, in collaboration with, or with the consent of a physician in all 50 states. In none is there a requirement for anesthesiologist supervision.
Compensation
According to numerous salary reports throughout the years, CRNAs remain the highest compensated of all nursing specialties. Their average reported annual salary range in 2005, reported by the AMGA Medical Group Compensation and Financial Survey, was $130,000. [1]
History
Nurse anesthetists have been providing anesthesia care in the United States for over 125 years. Nurse anesthetists were the first "nursing specialty group" in the United States.
The first nurse to provide anesthesia was Catherine S. Lawrence, and probably along with other nurses, administered anesthesia for Civil War surgeons circa 1861 to 1865. However, little anesthesia was administered because it was considered too dangerous. The first "official" nurse anesthetist is recognized as Sister Mary Bernard, a Catholic nun who practiced in 1878 at St. Vincent's Hospital in Erie, Pennsylvania. The first school of nurse anesthesia formed in 1909 at St. Vincent Hospital, Portland, Oregon. Established by Agnes McGee, the course was 6 months long, and included courses on anatomy and physiology, pharmacology, and administration of common anesthetic agents. Following this many schools formed. Between 1912 and 1920, approximately 19 schools opened. All consisted of post-graduate anesthesia training for nurses, and were about 6 months in length. These included programs at Mayo Clinic, Johns Hopkins Hospital, Barnes Hospital, New York Post-Graduate Hospital, Presbyterian Hospital in Chicago, to name a few.
Since physician residences in anesthesia did not exist very early on, doctors attended these programs to learn anesthesia. For example, in 1915, chief nurse anesthetist Agatha Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio. This program was open to graduate nurses, physicians, and dentists. The training was 6 months, and the tuition was $50.00. A diploma was awarded on completion. In it's first year, it graduated 6 physicians, 2 dentists, and 11 nurses. Later, in 1918, it established a system of clinical affiliations with other Cleveland hospitals. Ms. Hodgins was orginally appointed as anesthetist in 1908 by Dr. George W. Crile. Under Dr. Crile's direction, she became an expert in the administration of anesthesia, and had administered 575 anesthetics by 1909.
Even some nurse anesthetists were appointed to medical school faculties to train the medical students in anesthesia. For example, Agnes McGee also taught 3rd year medical school students at the University of Oregon. Nurse anesthetist Alice Hunt was appointed instructor in anesthesia with university rank at the Yale University School of Medicine in 1922. She held this position for over 25 years. In addition, she authored the 1949 book Anesthesia, Principles and Practice.
Early nurse anesthetists where also involved in publications. For Example, in 1906, nurse anesthetist Alice Magaw (1860-1928) published a report on the use of ether anesthesia by drop method 14,000 times without a death. She had many other publications, beginning in 1899, with some published and some not recognized, because of her status as a nurse. Ms. Magaw was the anesthetist at St. Mary’s Hospital in Rochesterfor for the famous Drs. William J. and Charles H. Mayo. This, of course, is now the Mayo Clinic in Rochester, Minnesota. She is often refered to as "the Mother of Anesthesia." She set up a showcase for surgery and anesthesia and attracted students from across the United States and the world. Recently, the city of Corunna, Michigan, discovered that Alice Magaw and family are interned in Corunna's Pine Tree Cemetery.
During World War I, America's nurse anesthetists were the major providers of care to the troops in France. They even helped train the French and British nurses and physicians in anesthesia care. This was also the first time the U.S. Military started training nurse anesthetists for service. Nurse anesthetist Agatha Hodgins served in France from 1914 to 1915, two years prior to America entering the war.
After much growth, the nurse anesthesia specialty was formally organized on June 17, 1931, when the American Association of Nurse Anesthetist (AANA) held their first meeting. It was Agatha Hodgins who organized the event, inviting members from the Alumnae Association of the Lakeside School of Anesthesia and also nurse anesthetist from across the United States. As a new organization, it had two main objectives: establish a national qualifying exam, and establish an accreditation program for nurse anesthesia schools. The first national certification exam was held on June 4, 1945, with 92 candidates sitting for the exam. After many years of preparation, on January 19, 1952, a program for the accreditation of nurse anesthesia schools when into effect.
In the US military, CRNAs provide a critical peacetime and wartime skill. During peacetime, they provide the majority of anesthesia services for the retired service member, active duty military, and their dependents. CRNAs function as the only licensed independent anesthesia practitioners at many military treatment facilities, including Navy ships at sea. They are also a leading provider of anesthesia for the VA and Public Health medical facilities. During wartime, they are usually the primary anesthesia providers at forward positioned medical treatment facilities, and play a key role in the education and training of nurses and technicians in the care of trauma patients. In addition, CRNAs have provided the majority of anesthesia services in every U.S. war during the 20th century. They are represented by such heros Second Lieutenant Mildred Irene Clark, CRNA, BA, who provided anesthesia for casualties from the Japanese bombing of Pearl Harbor. American military CRNAs have been casualties, POWs, and have served directly in the heat of battle.
External links
- American Association of Nurse Anesthetists
- Council on Certification of Nurse Anesthetists
- The International Federation of Nurse Anesthetists (IFNA), representing 45,000 nurse anesthetists worldwide
- Anesthesia History
- Nurse Anesthesia Associations
- Nurse Anesthetists at a Glance
- No Significant Differences in Anesthesia Outcome by Provider
- Resource Website for Student Nurse Anesthetists and CRNAs