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How To Become a CRNA

April 9, 2021 | Staff Writers

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Certified registered nurse anesthetists, or CRNAs, are highly trained nurses who have specialized in the field and practice of anesthesia. To become a CRNA, a nurse must first qualify as a Registered Nurse and complete a bachelor’s degree in nursing.

After gaining some clinical experience, a Registered Nurse can complete a nurse anesthesia educational program and become a nurse anesthetist. People who have trained in anesthesia become a registered nurse anesthetist, which is a type of advanced practice nurse, and have the choice of working in hospitals and clinics or moving into other health-related professions, for example assisting dentists.

Those who have completed a CRNA program are highly respected nurses with a significant level of autonomy in their fields. They are considered experts in anesthesia and can make decisions within their scope of practice and think ‘on the fly. They have significant responsibilities and the training and certifications they go through are rigorous.

Responsibilities of a certified registered nurse anesthetist (CRNA)

Certified registered nurse anesthetists play a vital role in the health care system, administering anesthesia to patients in a variety of settings. They are trained to prepare patients for surgery or labor, assist with emergency care, and pain management.

A nurse who is trained to administer anesthesia is known as an anesthetist and a physician who has specialized in the same role is known as an anesthesiologist. Both specialties provide the same type of service to patients and are expected to have a robust knowledge of the anesthetics they work with, the doses to deliver and procedures and precautions to apply.

Each state has different rules for how anesthetists operate. In 25 states, plus the District of Columbia, CRNAs are permitted to operate independently, meaning there is no need for them to be overseen by a physician as long as they’re operating within their code of practice. This is a testament to the level of training and expertise of CRNAs.

What does a CRNA do?

CRNAs deliver hands-on patient care. In most cases, if you go to the hospital for an operation, it is a CRNA who will administer anesthetic. The profession came about during the Civil War when nurses shouldered the burden of frontline health care for wounded soldiers. Today, medical science has progressed a long way from the chloroform that was used back then, but the principle remains the same. Highly trained nurses manage pain relief, allowing surgeons and physicians to focus on other areas of patient care.

Anesthetists are required in large city hospitals and clinics, rural hospitals, dental surgeries, and within the military. The profession is in-demand, interesting, and widely considered to be close to the top of the ladder of the nursing profession.

How is a CRNA different from other nursing specialties?

Nurse anesthetists have more autonomy than other types of nurses. A certified nurse anesthetist will work alongside doctors and surgeons, preparing people for surgery and administering anesthetics. Common settings where CRNAs are found include:

  • Hospital operating rooms
  • Emergency rooms
  • Intensive care units
  • Cardiac care units
  • Outpatient clinics

There are some other settings where anesthetics may be required, such as in labor wards, where a nurse anesthetist may work alongside a nurse-midwife.

This means a CRNA can choose from the bustle of emergency wards or a more steady flow of patients in an operating room. Surgical procedures are usually scheduled for weekdays, giving relatively predictable working hours and workloads for those who choose to work in those settings.

Emergency surgeries can, of course, occur at any time, so there is a demand for CRNAs who are willing to work outside of normal hours too.

The advanced level of education and expertise required of CRNAs means they are highly respected in the medical field. Their job requires precision, knowledge and attention to detail.

CRNAs are some of the highest-paid nurses, due to the extensive training and education the position requires. According to the Bureau of Labor Statistics, a nurse anesthetist can expect to earn $115,800 per year, or $55.67 per hour, on average.

Studying for a CRNA position can take eight years, or longer, and the total cost of tuition for the BSN, postgraduate qualifications and the CRNA itself may be intimidating, but there are scholarships available from many organizations, including the AANA Foundation, that can reduce the total cost.

What does the job of a CRNA look like?

Each state has its own rules and requirements relating to how CRNAs work. As an advanced practice nurse, a CRNA has a broader scope of practice than a registered nurse or an LPN, but the makeup and hierarchy of surgical teams vary from state to state.

A CRNA’s duties will usually involve:

  • Educating patients before and after they receive anesthetic
  • Identifying risk factors such as allergies or potential for overdose
  • Administering the correct does of anesthetic
  • Assessing the patient’s response to anesthesia

The CRNA will be one of the medical team that a patient sees before their operation, and will also be someone they see post-operation to ensure they are recovering properly.

A prospective CRNA will need some clinical experience working as a nurse and will be expected to undertake a program of continuing education to maintain their skills and ensure their patients are always in good hands. Pain management is a complex and sensitive subject, and new drugs and best-practices for patient care are constantly being developed.

Educational requirements for CRNAs

It takes several years to become a CRNA. The typical route to becoming a certified registered nurse anesthetist looks something like this:

  • Take the Bachelor of Science in Nursing (4 years full-time study)
  • Pass the CLNEX-RN
  • Gain approximately two years of experience as an RN, ideally in the ICU
  • Study an accredited nurse anesthesia educational program, which takes 2-3 years of full-time study
  • Pass the nurse anesthetist certification exam

This is the current route to certification as a CRNA, but the Council on Accreditation has announced new plans to require nursing schools to only accept PhD-level applicants for CRNA certifications as of 2025.

What are the prerequisites for anesthesia school?

The entry requirements for the CRNA are high, even for those who are applying now, when there is no doctoral requirement in place. Individual schools are permitted to set their own entry requirements, but most schools have similar expectations. To enroll in a nurse anesthesia educational program, you should have:

  • A current, valid RN license
  • At least two years of experience as a registered nurse in a clinical setting
  • At least one year of experience working in an Intensive Care Unit or another similar setting
  • A BSN degree or a Bachelor’s degree from an appropriate science background
  • A GPA of 3.0 or above in science studies, as shown on a college transcript
  • References

The acceptance criteria for nurse anesthetist school are high, and entry to courses is quite competitive compared to an entry-level nursing degree. Experience in acute care and positive references from senior nurses is helpful for those who are hoping to get a place on a course.

How to get into a CRNA course with a low GPA

Some people decide that they’d like to become a CRNA a little later in life, and may have struggled academically when they were initially in nursing school. It’s much easier to get accepted on a CRNA course if you are a recent graduate with good grades, but it is possible to become a nurse anesthetist even if your GPA wasn’t perfect.

If you earned your BSN more than five years ago, or you didn’t get amazing grades in the science-related courses on your BSN, consider taking some graduate-level science classes so that you can prove you’re trying to improve your understanding in those areas.

CRNAs are expected to have an advanced practice degree, so taking classes that can be applied to an MSN or a DNP will stand you in good stead. Work hard on those courses and emphasize them on your transcript to show that you have the level of science understanding required to do well as an anesthetist.

Admissions committees look at transcripts, experience, and each applicant’s personality and background as well as their academic performance. If you have a good reason for having low grades at college, such as overcoming economic hardship or ill health, talk about the struggles you overcame to earn the BSN.

Emphasize the work you’re doing at the hospital now, and get references from respected people in your department. Show the extra studies you’ve been doing, and highlight any special skills or achievements you have.

It won’t be easy to get accepted, and the list of nursing colleges that will consider less typical applicants will be short, but it is possible to get accepted on a CRNA course even if you took a less typical route into nursing and the rewards are worth the struggle.

What influences how long it takes to become a CRNA?

There are many routes into nursing practice and for those looking to move in to the field of anesthesia too. Some people take the route of becoming a nursing assistant or an LPN and slowly upgrade their skills, studying part-time while working in a health care setting. It takes far longer to reach the required level of education in this way, but the trade-off is that you’ll earn clinical experience while studying part-time.

In general, it takes two years to complete an Associate’s degree and pass the NCLEX-RN. Many states require nurses to upgrade from an Associate’s degree to a BSN within ten years of licensure, which takes an additional two years. Nurses with a background in science or allied health may be able to upskill more quickly through an accelerated BSN.

Going from a BSN to a Master’s Degree takes a further two years, and the Doctor of Nursing Practice is an additional two years. This means by the time someone has reached the required educational background to become a CRNA they will have spent at least eight years studying nursing. Since many student nurses study part-time while working, they’ll also have a significant amount of clinical experience before they’re ready to take the national certification examination.

Whether you rush through the qualifications or take a few years to get some experience on normal wards, in the emergency room, or in other settings is up to you. One of the best things about the nursing profession is that people have the freedom to experiment with different areas of practice until they find something they enjoy.

Many nurses pursue a certification as a Critical Care Registered Nurse while they are following the path to becoming a CRNA. This allows them to gain the required experience in an acute care setting and advance their career while they’re preparing for the CRNA qualification.

Certifications required for CRNAs

To become a certified registered nurse, a would-be nurse anesthetist must graduate from a course that is accredited by the Council on Accreditation then pass the CRNA certification which is administered by the National Board of Certification and Recertification for Nurse Anesthetists.

Individual states have their own requirements for CRNA courses, but the NBCRNA sets the bar for certification and requires nurses to have a good understanding of the subject, present good critical thinking skills and attention to detail. Nurses must also have experience in a clinical care setting before earning their license.

The CRNA exam itself costs around $725, and that’s on top of the cost of the university or college course. You’ll need to re-take the exam every eight years. 

The exam takes three hours and includes questions on several topics, including:

  • Sciences
  • Equipment, instruments and technology
  • The principles of anesthesia
  • Advanced anesthesia

The test is computerized and there are approved testing centers located all over the country.

How do you get your CRNA certification?

There are currently 121 CRNA education programs running in the United States. These programs are often over-subscribed, so entry into them is competitive. Students are often required to submit an academic transcript, demonstrate critical care experience, and provide references.

Once someone has been accepted into a nurse anesthetist program, they will need to complete the program of academic study and also complete at least 2,000 hours of clinical practice as a part of their training. Nurses are also expected to administer 600 cases before graduation. This means those who have the CRNA certification have proven they have the knowledge, training and experience required to work independently as registered nurse anesthetists.

The American Association of Nurse Anesthetists says the average experience of an RN entering into a nurse anesthetist education program is 2.9 years. Courses themselves take between two and four years, depending on whether they’re studied full-time or part-time, and upon graduation CRNAs typically have 9,369 hours of clinical experience.

What are continuing education options for CRNAs?

A qualified nurse anesthetist is expected to engage in continuing education. Every four years, a CRNA must submit evidence of having completed 60 hours of ‘Class A’ continuing education content, plus 40 hours of ‘Class B’ content. In addition to this, they must re-take the CPC examination every eight years.

Continuing education content can include short courses and qualifications, conferences, lectures, reading materials, or other similar materials. Someone who completes more than 60 hours of Class A material can have some of it counted towards their Class B required content.

Recertification is required for nurses who wish to continue practicing as an anesthetist. This ensures the nurse is up to date with current best practices and the latest research in the field. Of course, a Certified Registered Nurse Anesthetist is also required to have a current RN license and meet any state RN licensure requirements on an ongoing basis.

Best programs available for people wanting to become a CRNA

There are more than 100 CRNA programs available in the United States, and the CRNA licensing requirements are strict, so all programs can be considered to be good quality in terms of the material they cover. 

When choosing a CRNA school, the primary considerations are likely to be the cost of the course and the time it takes to complete, as well as how well the course will fit around the student nurse’s other commitments.

The NBCRNA says that the average pass rate for the CRNA exam is 81%. Given that, and the comparatively high cost of the examination compared to the NCLEX-RN, it makes sense to find a college or university that has a good reputation and a high pass-rate, saving you the stress and expense of a potential re-sit.

What makes a good CRNA program?

A good CRNA program will combine theoretical education with practical elements in order to give would-be nurse anesthetists a solid grounding in the subject and prepare them for practice. Since a part of the certification requirements is that the nurse has a significant number of hours worth of practice and 600 cases under their belt, it’s wise to choose a program that is geared towards providing this.

All CRNA programs that lead to the CRNA license are accredited by the AANA. If you’re unsure if the course is legitimate, it’s a good idea to check with the licensing body, being aware that in some cases the courses are delivered by a university, but the accreditation may be listed under the attached hospital or vice-versa.

A CRNA program will cover many subjects, both academically and practically, including:

  • Pharmacology
  • Chemistry
  • Neurobiology
  • Physiology
  • Health assessments
  • Leadership
  • Healthcare politics and economics

It’s assumed that someone who is admitted on a CRNA already has a good grounding in the basics of nursing due to their BSN, MSN (and, most likely, Doctoral studies) as well as their extensive clinical practice.

As a part of the course, the student nurse anesthetist will complete a residency where they will have the opportunity to administer anesthetic for patients undergoing a variety of procedures and in many different situations, such as:

  • Transplants
  • Trauma
  • Cardiovascular procedures
  • Neurological
  • Thoracic

Graduates can then work in ICU, emergency wards, private practices, hospitals, tertiary care centers and other areas where anesthesia is required. Later in their careers, they may decide to move into education or public policy, and their extensive training and experience help them do this.

What are some of the best programs to become a CRNA?

Many major medical-focused universities offer CRNA programs. Some of the highest-profile include:

  • Rush University
  • Baylor College of Medicine
  • Georgetown University
  • Northeastern University
  • Columbia University

These universities and colleges all claim very high first-time pass rates (in some cases 100%) for the licensing exam, giving prospective students confidence that they’ll receive high-quality tuition and be well-positioned to pass the exam when the time comes.

How can you gain the experience necessary to become a CRNA?

Depending on the stage of your nursing career you’re at, you may need to do some further study in order to certify as a CRNA. Given the plans to require nurses have trained to the DNP level before certifying, any newly qualified nurses should consider earning their DNP to future-proof their careers.

Several universities now offer an online DNP, allowing students to study from anywhere. Some of the most well-known include Walden University and Capella University.

While you’re studying for your DNP, you can spend some time earning the clinical experience you need to enroll on the CRNA. Take advantage of the opportunities you have to work in different departments in your assigned hospital or clinic. Early career experience on normal wards or at a doctor’s office is useful.

Once you have some experience, try to get assigned to the Intensive Care Unit where you can get some experience with acute care. Usually, you’ll be expected to have at least 1 year of clinical experience on the ICU before you can start a nurse anesthetist program. The time you spend there can be used to earn references as well as experience.

It takes four years to finish a DNP program, and over that time period you’ll have a chance to explore different areas of practice and get some idea of what different nursing specialisms are really like. 

It may be that after spending time in an emergency room or ICU you feel that it would be better to change your focus. The nice thing about nursing as a career is that there are so many different options for specializing, so you aren’t locked in if you change your mind.

CRNA school can take up to four years, and during that time you’ll get to experience working on a variety of clinical cases, such as preparing people for operations, administering pain relief for women in labor, and using anesthetic for acute cases in emergency rooms. Your course will prepare you for all kinds of scenarios.

Promotion opportunities for CRNAs

Once someone is qualified to be a CRNA, they have some options for further specialization and promotion. Depending on the state in which they are licensed, a CRNA may have some prescriptive authority as well as autonomy in terms of administering anesthesia.

An experienced CRNA may apply to become a Chief Nurse Anesthetist, taking on extra responsibilities such as managing and scheduling other anesthetists, training staff, and overseeing department operations. The extra pay for this is relatively small compared to the pay rise for going from Registered Nurse to Advanced Practitioner Registered Nurse and then CRNA, however.

Pay scales for CRNAs can vary massively depending on the state they are working in, however, the reasons for this are complex. Some of the difference in pay can be accounted for by the differences in cost of living, but some of the difference is due to the responsibilities and scope of practice of a CRNA in that state.

Before deciding whether to enroll in a CRNA course, consider how long it will take to complete the course, any out of pocket expenses you might have as a result, and how long it would take for the degree to pay for itself. The high cost of study means you’ll need to be planning on working as a nurse for a decade or more to pay off the loans.

For many student nurses, the time the training takes is worthwhile, because the pay increase means the study pays for itself quickly. Even after taking into account the cost of student loan repayments, most advanced practice nurses find themselves taking home a significant pay increase compared to their days as a Registered Nurse. The job is a rewarding and challenging one too. 

The case for training is made even easier if the hospital you work for is willing to reimburse the cost of study. CRNAs are always in demand, so many hospitals are happy to support reliable nurses who are willing to invest in their careers, as long as they stay at that hospital for a few years after completing their studies.

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