What Does a CRNA Do? (20 Typical Duties & Responsibilities)
Written By: Jennifer Schlette MSN, RN
Are you already a nurse, but you are just yearning for more excitement and autonomy? Do you feel like you want to advance your education? Have you ever thought about becoming a nurse anesthetist, but you are not really sure what the duties and responsibilities of the nurse anesthetist are? I hope that by the time you are finished reading this article, you can surely answer the question of what a CRNA does? Maybe you wonder where you could work as a CRNA, and how long will my days be? Let’s take a look!
CRNA Scope of Practice Laws: What You Need to Know?
So, you have now decided that becoming a CRNA is something you want to do, but what does a CRNA do? Well, let's explore what the CRNA is permitted to do first. Like other advanced practice degrees, the scope of practice of the CRNA
will be determined by their education, the type of experience they have, state regulations, and the institution’s policies and procedures that they work for. These regulating bodies will also dictate which CRNA duties and responsibilities can be performed independently and which ones require supervision or consultation by an anesthesiologist. If you wish to pursue this degree, you should familiarize yourself with your state’s regulations. Here
you can find a list of all 50 states and an analysis of the scope of practice in these states for the CRNA.
RECOMMENDED ONLINE NURSE PRACTITIONER PROGRAMS
Following are the 20 Typical CRNA Duties & Responsibilities
As mentioned above CRNA duties may vary based on a variety of factors. Let us look at some of the most common duties & responsibilities.
1. Perform a comprehensive history and physical exam to develop a patient-specific treatment plan
By obtaining a comprehensive history and physical exam of your patient, you, as a CRNA, will conduct a pre-anesthesia assessment
. This pre-anesthesia assessment will help drive the patient-specific treatment plan that you will devise. The meticulous gathering of information from the patient’s history and physical are essential aspects of the CRNA duties. These two components will help ensure that you deliver the safest and most complete care possible for the patient.
2. Obtain informed consent
In order for you to deliver anesthesia or place a patient under a pain management plan, you would first need to obtain informed consent
from the patient or family. Who you receive informed consent from will depend on the patient’s age and their capacity to make decisions. This informed consent is a legal document that ensures that the patient or family understands the anesthesia or pain management plan's risks and benefits. It also ensures that you have answered any questions that may arise pertaining to the anesthesia course.
3. Select, order, and administer pre-anesthetic medications
One of the nurse anesthetist responsibilities would include selecting, ordering, and administering the pre-anesthetic medications. The degree to how independent you are in these duties would depend on your license and the state and institution regulations. You may need to have your patient-specific treatment plan verified by an anesthesiologist before proceeding independently or you may need to conduct your patient-specific treatment plan with an anesthesiologist present.
4. Select, order, and administer medications, fluids, and blood products intraoperative and intraprocedural
The CRNA’s duties regarding intraoperative and intraprocedural fluid, blood, and drug administration may also be regulated in terms of how independent you can be of a physician. You as the CRNA would have the knowledge base to recognize and implement care as a patient’s status changes in these areas. Your main priority will be to ensure that the patient is safe and remains sedated and pain-free for their procedure.
5. Select and implement invasive and noninvasive monitoring modalities
You, as the CRNA, will have the knowledge and training to decide on what type of monitoring the patient will need for a specific procedure. These monitoring modalities may be noninvasive such as a cerebral oximetry or transcutaneous carbon dioxide monitoring. If the patient requires more invasive monitoring such as central venous lines and arterial lines, you will be inserting and monitoring these. Regardless of the monitoring modalities, you will have to respond to changes in the patient’s hemodynamic status, as you see on the monitor. This may lead you to change the course of your patient-specific treatment plan either independently or in conjunction with an anesthesiologist.
6. Manage the recovery from anesthesia
As a CRNA, you will be responsible for ensuring that the patient is monitored appropriately while recovering from anesthesia regardless if it was local or general anesthesia. In the procedural areas, you will be responsible for administering reversal agents to the patient, extubate the patient if they were intubated, and ensure that they are awake enough and stable enough to be moved to further recover in the PACU.
7. Oversee the patient in the post-anesthesia care area (PACU)
The patient who has received anesthesia will continue to recover in the PACU. You as the CRNA will provide orders to the licensed staff, such as a bedside nurse who will continue to monitor the post-anesthesia care patient until they are fully recovered and ready to be discharged or transferred to inpatient. When a patient is recovering in the post-anesthesia care area of a procedural site, you will be responsible for selecting and ordering medications and setting parameters to the licensed professional who will helpfully recover the patient. As the CRNA, you must remain available to this patient should an issue arise and give the final evaluation to be discharged or transferred.
8. Assess if the post-anesthesia patient is ready for discharge or transfer and educate the patient and family regarding the anesthesia recovery process
As the CRNA, you will have the knowledge base and training to determine when it is safe for a fully recovered patient to be discharged home or transferred to inpatient based upon your post-anesthesia assessment. You will be providing the patient and their family with education regarding ongoing pain management at home or inpatient if indicated. If the patient is remaining in the hospital, you will ensure that the staff you are endorsing the patient to is briefed on the aesthesia course and provide orders for ongoing assessment and pain management if indicated.
9. Provide patient assessments regarding a patient who requires a pain management plan
Some patients will seek the expertise of a CRNA for pain management
purposes. One of the nurse anesthetist duties will be to assess the patient to determine the appropriate pain management plan. Upon your assessment, you may come to the conclusions that you may need referrals from other medical and ancillary services to holistically treat the patient. When choosing a medication plan for the patient, you may need to work in conjunction with an anesthesiologist.
10. Provide acute pain management services
In cases when a patient is experiencing acute or sudden pain, the CRNA will be responsible for providing pain management to the patient using a multimodal approach. In using a multimodal approach, as the CRNA, you will be implementing various techniques
to decrease the use of opioids. In certain circumstances, the patient may only find relief from pain medication use. If this is the case, you will be ordering pain medication via different routes to treat the patient.
11. Pain management of the obstetric patient
As a CRNA, you may be responsible for providing anesthesia and analgesia for the obstetric patient
. You will also be responsible for monitoring this patient regarding his or her pain management and any side effects that may coincide with these medications' administration. Keep in mind that you are also providing them to the baby when you deliver these medications to the patient, so the utmost caution must be taken.
12. Provide interventional pain management
As with most of a CRNA's responsibilities, your independence will once again be dictated by your license and your state and institution regulations. As a CRNA working with patients who require interventional pain management, your duties may include such procedures and nerve blocks or other pain management injections
. After administering these medications, you will need to assess for side effects, relief, and warranted intervention.
13. Provide emergency, critical care, and resuscitation duties
As a CRNA, you may have to care for a critical patient during your career. The nurse anesthetist duties would include the management of the critical patient regardless of the setting. In certain instances, the resuscitation of the patient may be needed. This role of directing the resuscitation efforts if another more advanced provider is not present would be the CRNA's responsibility.
14. Perform the insertion and management of an advanced airway
To reach a certain level of sedation and pain management, a patient may need the insertion of an advanced airway. The patients who become incredibly sick and critical may also need an advanced airway. The placement and management of this advanced airway can fall into the duties and responsibilities of a CRNA. You, as the provider, have the task of distinguishing when an advanced procedure like an endotracheal tube is needed to provide the safest care to your patient.
15. Perform ABGs and intervene if necessary
One of the point-of-care tests that are a critical tool in the world of anesthesia is the ability to perform a rapid arterial blood gas—based upon the results of this ABG, you, as the CRNA, may choose to intervene with further respiratory support, fluids, blood or electrolytes. These interventions may need to stabilize a critical patient or ensure that a stable patient does not become unstable.
16. Order and interpret the diagnostic test
You may find that you as the CRNA are in need of a further diagnostic test to guide your patient's treatment in certain instances. You would then be responsible for ordering diagnostics such as a diagnostic test as a chest x-ray or an EKG. Based on the results, you may tweak your treatment plan for the client to provide the safest and most effective care.
17. Use and supervise the use of technology for diagnostic and delivery of care purposes
Depending on the setting you are working in, you may need to use technology such as an ultrasound to guide your patient's line placement. You may also require the technology of a fiber optic scope to fiber optically intubate a patient who has an established difficult airway in certain instances. These procedures can be done in a controlled and elective environment, or they may arise in response to an emergency.
18. Provide medications for palliative care patients
As a CRNA, one of your duties may be to administer sedation medications and provide pain management for the purpose of palliative care. This may be in the form of working with a palliative care
team or an independent consultant. When working in palliative care, you will first need to establish the patient’s and family’s goals before proceeding to an assessment. Based on the goals set for the patient and your assessment, you will be able to design a tailored plan for the patient.
19. Order consults and treatments related to patient care
Sometimes a patient may need other treatments to help manage pain that is not related to medication administration. In such a case, as the CRNA, you would consult services such as physical therapy or occupational therapy to assist in the treatment and recovery of a patient. Another therapy that could be used in the place of administering medication is the use of massage techniques. You ultimately would have to make the decision based upon your assessment and knowledge base.
20. Provide education
A CRNA can provide education to students and colleagues. You may be educating your colleagues on new research or techniques in the anesthesia field, or you may find yourself educating CRNA students. The CRNA may also serve as a preceptor to the next generation of nurse anesthetists by training them in their practicum portion of education. Education can be formal in a presentation or informal, arising from whatever circumstance is occurring.
Where Do Most of the Certified Registered Nurse Anesthetists (CRNAs) Work & What Do They Do?
Majority of the CRNAs work in Offices of Physicians (47%), General Medical & Surgical Hospitals (27%), Outpatient Care Centers (8%), Colleges & Universities (4%), and Offices of Other Health Practitioners (3%). Let us take a deeper look at what a CRNA does in each one of these work settings.
1. CRNA Duties in Offices of Physicians:
As a CRNA working in a physician’s office, your job duties will typically include providing consults for pain management. By working in a physician’s office, you will be giving the client an interdisciplinary approach to the reason they are seeking care. You will work alongside other physicians and staff to provide the patient with a complete and concise treatment plan. The types of physician offices you may find yourself working in could be a gastroenterologist providing anesthesia for colonoscopies. You could also be working in gynecological offices providing sedation for procedures or possibly working in dental offices, giving anesthesia to patients requiring dental procedures, to name a few. Although prescribing medication for pain would be your responsibility, you may also be administering local injections to the client. These types of local injections may include nerve blocks. You may feel that pain medication may not be indicated in some circumstances, and you may write for referrals to other specialists and disciplines to assist the patient.
2. CRNA Duties in General Medical & Surgical Hospitals:
Suppose you are a CRNA working in the general medical and surgical hospital. In that case, you may find yourself working on a pain team, providing pain management to post-operative patients and other patients who are experiencing pain. You may be working in procedural areas providing sedation and pain medication to patients who require an MRI or an interventional radiological procedure or an endoscopy, to name a few. As the CRNA, another primary area you may find yourself working in is the operating room. Regardless of the location you work in; you will be responsible for managing the patient's airway, hemodynamic status, anesthesia administration, and recovery.
3. CRNA Duties in Outpatient Care Centers:
In the outpatient setting, CRNAs will manage patients undergoing same-day procedures, meaning they will go home after their procedure. In this setting, the anesthesia will range anywhere from local to general. You will be responsible for the safe and effective administration and recovery of the patient. Should an emergency arise in the outpatient care center, you would have the responsibility of airway management and resuscitation if warranted.
4. CRNA Duties in Colleges & Universities:
In the academic setting, CRNAs hold the responsibility of educating the next generation of nurse anesthetists. You will be involved in the planning, implementing, and evaluating the curriculum and the learning experiences of students in the classroom, simulation, and clinical settings. You will ensure that these students meet minimal competencies to practice and complete the certification process. Depending on the institution you work for, you may be called upon to oversee student advisement and remediation.
5. CRNA Duties in Offices of Other Health Practitioners:
The CRNA’s skill set is sometimes utilized in other health practitioners' offices as an adjunct to the therapy that these practitioners deliver. You may find that you are working with a physical therapist, massage therapist, or a chiropractor to ensure that the patient receives complete care. Another type of office setting that may utilize the CRNA is those practitioners who deliver alternative medicine treatment modalities. These types of environments will combine both eastern and western medicine to provide a multidimensional approach.
What are the Typical Work Hours for Certified Registered Nurse Anesthetists?
The typical work hours for a CRNA will vary depending on what type of setting you choose to work in. Typically, regardless of the environment, you will find yourself working 40 hours a week. If you decide that you want to work in the outpatient setting, in an office, or academia, your work week will typically look like five days a week, eight hours a day. Your workday will be anywhere from 4 to 5 days a week in the hospital setting, with various hours during the day when surgeries and procedures are scheduled. You will also be required to take night and weekend calls. In the instance that you are on call, you will most likely have a four-day workweek that week.
Summing It Up
So, what does a CRNA do? A CRNA provides patients with safe and effective care in a multitude of environments. Although the nurse anesthetist duties and responsibilities can be intimidating, they can lead to a life of welcomed challenges and accomplishments. Through your education and experience, you will safely and accurately carry out these duties and responsibilities. The fact that the CRNA can be utilized in so many different settings makes the career outlook
a bright one.
Top Questions Answered
1. What is the Difference Between a CRNA and an Anesthesiologist?
Although both the CRNA and Anesthesiologist work in the world of anesthesia, their training and, therefore, ultimate responsibilities and types of patients they will manage are different. A potential CRNA
will be a registered nurse who will need a minimum of 1 year of intensive care experience to attend CRNA school. The CRNA program is approximately 2 and 1/2 years long, consisting of didactic and clinical training. An Anesthesiologist
will attend four years of medical school after completing four years of college. They will then have four years of training or a residency before completing a one-year anesthesia fellowship. The Anesthesiologist will oversee some of the activities of the CRNA and approve their treatment plans. In terms of patient load, the Anesthesiologist will be managing the more critical patients at baseline.
2. What is the salary potential for a CRNA?
The salary you can earn as a CRNA will depend upon where you work, and the years of experience you have. According to the Bureau of Labor Statistics
, you can expect to be earning anywhere from $127,000 a year to about $208,000 per year.
3. Can I work full time and complete a CRNA program at the same time?
If you wish to pursue the CRNA role, you must be prepared that this is a full-time program, and you will not be able to work full time during your training.
4. How much does a CRNA program cost?
Tuition for a CRNA program can run anywhere from free education if you have received a scholarship all the way to $180,000. If you are an in-state resident of the program you are attending, you may get a bit of a discount.
5. Will I need to take an exam to become certified?
Yes, you will need to successfully pass a certification exam through the National Board of Certification and Recertification
for Nurse Anesthetists.
Jennifer Schlette MSN, RN
Jennifer Schlette is a registered nurse in pediatric critical care in New York City. She is the former Director of Undergraduate Nursing at a college located in New York. After obtaining her BSN from the College of Mount Saint Vincent, she went on to complete her MSN.