A nurse anesthetist (CRNA) is an Advanced Practice Nurse who is specially trained to administer anesthetics to those patients who are undergoing dental, medical or obstetrical procedures (McIntosh, 1995). The specialty of nurse anesthetics was created to respond to surgeons’ requests for a solution to the alarmingly high rates of mortality and morbidity caused by anesthesia during that time. The surgeons visualized nurse anesthetists as professionals who would devote themselves to patient care in the course of surgical procedures. With time, nurse anesthetists became part of the whole range of specialized surgical procedures, refinement in anesthetic equipment and techniques.
In order to qualify for studies as a CRNA, the candidate must possess a Bachelor of Science in nursing degree. The candidate must also be a registered nurse with at least one year experience in acute care. Some programs may require the candidate to have experience of two years either in critical care or the operating room. The CRNA program itself runs for approximately 2-3 years and includes clinical training and a graduate degree. After the completion of training, the nurse anesthetist must undertake an exam to obtain national certification to qualify as a CRNA. It is a requirement that CRNAs must be recertified every 2 years and must demonstrate credits of continuing education which are specific to the area of specialty. The CRNA must also give proof of satisfying a designated amount of time that has been spent in the provision of anesthesia to patients (Nagelhout and Zaglanicziny, 2001).
Duties and Responsibilities of the Nurse Anesthetist
CRNAs usually work together with anesthesiologists (Medical Doctor) but can also work independently (Dulisse and Cromwell, 2010). Their duties are mainly related to operative procedures. In the operating room, the first step for a CRNA is to evaluate the patient before administering anesthesia. This generally includes a review of the patient’s medical history and discussions about the anesthetic procedures with the patient so as to obtain informed consent for the use of anesthesia. The next step for the CRNA is to formulate and implement the anesthetic care plan. This plan should outline the needs or requirements, treatment and expected results for regarding the patient. The CRNA also chooses the appropriate mode of delivery of anesthesia to the patient.
As the operative procedure continues, the CRNA keeps administering any anesthesia, adjunctive fluids or medications which may be required to maintain the anesthetic state and patients’ homeostasis. The CRNA is also charged with the duty of managing the oxygen saturation and pulmonary status of the patient. The CRNA also monitors the physiological status of the patient. These include hemodynamics, vital signs and equipment (heart monitors and ventilation systems). The CRNA must be able to quickly detect abnormal responses like anaphylaxis and malignant hyperthermia which may be fatal if not recognized early enough. After the procedure, the CRNA must assess the recovery of the patient from the anesthesia and determine at what point the patient is discharged (McIntosh, 1995).
CRNAs are very important professionals in the operative room. In addition to their traditional roles, CRNAs may practice in chronic and acute pain management through specialized techniques. They may also opt to specialize in patient populations like geriatrics, pediatrics, neurology or obstetrics. The American Association of Nurse Anesthetists (AANA) advise that the continuing necessity for safe, available and effective anesthetic care ensures that the nurse anesthetist will continue to be a much sought after professional (Dulisse and Cromwell, 2010).
Dulisse, B., and Cromwell, J. (2010). No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians. Health Affairs, 29(8), 1469-75.
McIntosh, L. (1995). Essentials of Nurse Anesthesia. New Jersey: McGraw Hill.
Nagelhout, J. and Zaglaniczny K. (2001). Nurse Anesthesia. 2nd ed. Pasadena: Kaiser Permanente.