CRNAs and Our Role in the Health Care System
Below you will find resources to useful information about CRNAs and our role in the health care system.
1. Responsibility to Patients
CRNAs preserve human dignity, respect the moral and legal rights of health consumers, and support the safety and well being of the patients under their care.
1.1 The CRNA renders quality anesthesia care regardless of the patient's race, religion, age, sex, nationality, disability, social, or economic status.
1.2 The CRNA protects the patient from harm and is an advocate for the patient’s welfare.
1.3 The CRNA verifies that a valid anesthesia informed consent has been obtained from the patient or legal guardian as required by federal or state laws or institutional policy prior to rendering a service.
1.4 The CRNA avoids conflicts between his or her personal integrity and the patient’s rights. In situations where the CRNA’s personal convictions prohibit participation in a particular procedure, the CRNA refuses to participate or withdraws from the case provided that such refusal or withdrawal does not harm the patient or constitute a breach of duty.
1.5 The CRNA takes appropriate action to protect patients from healthcare providers who are incompetent, impaired, or engage in unsafe, illegal, or unethical practice.
1.6 The CRNA maintains confidentiality of patient information except in those rare events where accepted nursing practice demands otherwise.
1.7 The CRNA does not knowingly engage in deception in any form.
1.8 The CRNA does not exploit nor abuse his or her relationship of trust and confidence with the patient or the patient’s dependence on the CRNA.
The scope of practice engaged in by the CRNA is within the individual competence of the CRNA. Each CRNA has the responsibility to maintain competency in practice.
2.1 The CRNA engages in lifelong, professional educational activities.
2.2 The CRNA participates in continuous quality improvement activities.
2.3 The practicing CRNA maintains his or her state license as a registered nurse, meets state advanced practice statutory or regulatory requirements, if any, and maintains recertification as a CRNA.
3. Responsibilities as a Professional
CRNAs are responsible and accountable for the services they render and the actions they take.
3.1 The CRNA, as an independently licensed professional, is responsible and accountable for judgments made and actions taken in his or her professional practice. Neither physician orders nor institutional policies relieve the CRNA of responsibility for his or her judgments made or actions taken.
3.2 The CRNA practices in accordance with the professional practice standards established by the profession.
3.3 The CRNA participates in activities that contribute to the ongoing development of the profession and its body of knowledge.
3.4 The CRNA is responsible and accountable for his or her conduct in maintaining the dignity and integrity of the profession.
3.5 The CRNA collaborates and cooperates with other healthcare providers involved in a patient’s care.
3.6 The CRNA respects the expertise and responsibility of all healthcare providers involved in providing services to patients.
3.7 The CRNA is responsible and accountable for his or her actions, including self-awareness and assessment of fitness for duty.
4. Responsibility to Society
CRNAs collaborate with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.
4.1 The CRNA works in collaboration with the healthcare community of interest to promote highly competent, safe, quality patient care.
5. Endorsement of Products and Services
CRNAs endorse products and services only when personally satisfied with the product’s or service’s safety, effectiveness, and quality. CRNAs do not state that the AANA has endorsed any product or service unless the Board of Directors of the AANA has done so.
5.1 Any endorsement is truthful and based on factual evidence of efficacy.
5.2 The CRNA does not exploit his or her professional title and credentials for products or services which are unrelated to his or her professional practice or expertise.
CRNAs protect the integrity of the research process and the reporting and publication of findings.
6.1 The CRNA evaluates research findings and incorporates them into practice as appropriate.
6.2 The CRNA conducts research projects according to accepted ethical research and reporting standards established by law, institutional procedures, and the health professions.
6.3 The CRNA protects the rights and well being of people and animals that serve as subjects in research.
6.4 The CRNA participates in research activities to improve practice, education, and public policy relative to the health needs of diverse populations, the health workforce, the organization and administration of health systems, and healthcare delivery.
7. Business Practices
CRNAs, regardless of practice arrangements or practice settings, maintain ethical business practices in dealing with patients, colleagues, institutions, and corporations.
7.1 The contractual obligations of the CRNA are consistent with the professional standards of practice and the laws and regulations pertaining to nurse anesthesia practice.
7.2 The CRNA will not participate in deceptive or fraudulent business practices.
The above information was provided by the American Association of Nurse Anesthetists.
For more information visit www.aana.com.
Research shows that Certified Registered Nurse Anesthetists (CRNAs) are the most cost-effective anesthesia providers with an exceptional safety record. In today's changing healthcare environment, patients want healthcare delivered with personal care, at a lower cost, with a high degree of confidence. CRNAs deliver all of these. So that you will have the information to better understand the role that anesthesia care and pain management play in the delivery of healthcare, this site will lead you to resources about the different types of anesthesia, what to expect during surgery, scientific research, and frequently asked questions about your care.
Click on the following link to view AANA's infographic "ANESTHESIA AND THE CHANGING HEALTHCARE LANDSCAPE"
The above information was provided by the American Association of Nurse Anesthetists.
For more information visit www.aana.com.
Honest and open communication between you and your nurse anesthetist prior to surgery is essential in order to enhance your safety and build a spirit of teamwork. Before surgery, a preoperative interview with your nurse anesthetist provides valuable information that helps determine your care. It is equally important to communicate with your anesthesia provider after your surgery. The medications you have been given can remain in your body for 24 hours or more after they have been administered, and you won’t be “back to your old self” until the anesthetic has been totally eliminated.
Please feel free to ask your nurse anesthetist any questions you might have — before and after your anesthesia is administered.
During the procedure, anesthesia allows you to be free of pain. All anesthesia care is provided with the highest degree of professionalism, including constant monitoring of every important body function. As changes occur in your reactions to anesthesia, the nurse anesthetist responds with modifications of the anesthetic to ensure your safety and comfort.
In addition to their role in the procedure itself, nurse anesthetists make many preparations for you before surgery. You can — and should — take an active role in these preparations by communicating and cooperating with your nurse anesthetist and your surgeon.
The one chosen for you is based on factors such as your physical condition, the nature of the surgery and your reactions to medications. Frank and open discussion with your nurse anesthetist is key in the selection of the best anesthetic for you.
In particular, you must speak freely and follow instructions closely regarding your intake of medications, food or beverages before anesthesia. Such substances can react negatively with anesthetic drugs and chemicals.
This confidential discussion with the nurse anesthetist prior to surgery provides information vital to your care. You may be given a questionnaire to fill out and bring along to the preoperative interview. Information supplied by the questionnaire assists your nurse anesthetist in doing the interview thoroughly and efficiently.
Different types of patients or procedures may require different types of anesthesia.
Speak frankly. Ask questions. Follow instructions. Provide your nurse anesthetist with a medical history. And, notify your nurse anesthetist or doctor immediately of any change in your physical condition prior to surgery. Communication and cooperation are essential to the anesthesia process.
All anesthesia care is provided with the highest degree of professionalism. Sensitive equipment monitors every important function of your body. In response to your body’s reactions, the nurse anesthetist modifies your anesthetic as needed.
But anesthesia care is not confined just to surgery. The process also refers to activities that take place — before and after — an anesthetic is given. Before anesthesia, a preoperative interview with your nurse anesthetist supplies valuable information that helps determine your care. Open communication and cooperation are essential during the interview.
The medications that you have been given can remain in your body for up to 24 hours after their administration. You are not completely “back to your old self” until the anesthetic has been totally eliminated.
Also during this time, it is still possible for substances entering your body to interact with the anesthetic. Certain substances may cause negative reactions. Therefore, check with your care provider about what medications you can take. Continue to cooperate with your nurse anesthetist and physician after surgery. Don’t hesitate to ask questions.
After receiving anesthesia during a surgical procedure, you can play an active role in your recovery by heeding the straightforward list of do’s and don’ts that follows:
Communication and cooperation are essential to the anesthesia process. Active participation in your care helps ensure your safety and comfort.
Conscious sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives. Patients who receive conscious sedation usually are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider.
Conscious sedation provides a safe, effective option for patients undergoing minor surgeries or diagnostic procedures. The number and type of procedures that can be performed using conscious sedation have increased significantly as a result of new technology and state-of-the-art drugs.
Conscious sedation allows patients to recover quickly and resume normal daily activities in a short period of time. A brief period of amnesia may erase any memory of the procedure.
Conscious sedation is administered in hospitals and outpatient facilities (for example, ambulatory surgery centers and doctors’ offices) to facilitate procedures such as the following:
Conscious sedation is extremely safe when administered by qualified providers: Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, other physicians, dentists and oral surgeons. Specifically trained registered nurses may assist in the administration of conscious sedation.
Because patients can slip into a deep sleep, proper monitoring of conscious sedation is necessary. Healthcare providers monitor the patient’s heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure. It is important that the provider who monitors the patient receiving conscious sedation has no other responsibilities during the procedure and remains with the patient at all times during the procedure.
A qualified provider monitors the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving conscious sedation. A follow-up phone call usually is made by the healthcare provider to check on the patient’s condition and answer any remaining questions.
A brief period of amnesia after the procedure may follow the administration of conscious sedation. Occasional side effects may include headache, hangover, nausea and vomiting or unpleasant memories of the surgical experience.
Following is a list of questions patients should ask prior to the surgical or diagnostic procedure:
Every woman experiences childbirth in her own unique way. In preparing for labor and delivery, some women are quite certain they will want pain relief. Some are unsure of their pain relief options and how they will affect their labor and delivery. Others would prefer to give birth without any pain relief.
No matter which category you fall into, it is important for you to know how anesthesia and pain relief are used in labor and delivery. Even if you fall into the latter category, you should know your options. Every woman should be prepared for the possibility of needing an anesthetic should an emergency arise.
This information will attempt to answer many of the questions you may have about the use of anesthesia in labor and delivery and give you a general overview of the various types of anesthetics available today. After reading this material, you may also want to meet with your obstetrical provider (obstetrician, family practitioner, nurse midwife) or an anesthetist to discuss the best pain relief and anesthesia options for you and your baby.
Obstetrical anesthesia is different from any other type of anesthesia in that there are two patients involved — you and your baby. It is important that you take both individuals into account when considering your anesthesia choices.
Another factor to be considered is that labor is unpredictable. It can range anywhere from relatively quick and easy to painful and exhausting. An important point to remember is that everyone experiences pain differently. Only you will know the level of pain you’re experiencing, so you should never feel guilty about asking for pain relief.
There are several different forms of anesthesia administered for childbirth. They may be used independently or in conjunction with one another. Some of the most commonly administered anesthetics include:
Local infiltration – This series of local injections can make you more comfortable for delivery and for the placement of sutures if you need them.
Narcotics or tranquilizers – Administered as an injection or intravenously, narcotics or tranquilizers can help reduce the pain of labor but will not eliminate the pain entirely. They are also used to ease the anxiety that sometimes accompanies the delivery process.
Pudendal block – Administered as injections of local anesthetics to numb your vaginal area in preparation for delivery.
An epidural is a local anesthetic delivered through a tiny tube called a catheter placed in the small of the back, just outside the spinal canal. An advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. In most cases, the anesthetist will start the epidural when cervical dilation is 4 to 5 centimeters. Under certain circumstances, it may be desirable to place the epidural earlier.
This anesthetic is similar to an epidural, but because it is administered with a needle into the spinal canal, its effects are felt much faster. You may feel numb and need assistance in moving during the delivery. Spinal anesthetics are sometimes used for delivery by cesarean section or when forceps use is indicated.
General anesthesia is administered by giving anesthetic drugs intravenously and having the patient breathe anesthetic gases. A general anesthetic may be necessary if complications arise during delivery. Because general anesthetics can be administered quickly, they’re considered the best choice when time is of the essence. Also, general anesthesia enables the uterus to relax if your obstetrical provider finds it necessary.
In order for your anesthetist to determine which type of anesthesia is best for you and your baby, it is important that you inform your anesthetist about:
If you are a woman with any of these conditions, it is especially important that you meet with an anesthetist prior to going into labor.
Here are some of the questions frequently asked by pregnant women about the use of anesthesia in labor and delivery:
Because no two women experience pain or react to drugs in quite the same way, and because different anesthetic techniques have different effects, the answers to these questions will vary. There is no ideal anesthesia for everyone. This makes it very important for you to be informed — and discuss your options with your obstetrical provider and anesthetist. The purpose of anesthesia during labor and childbirth is to help you have the most positive birth experience possible. Anesthesia should not hinder you from enjoying your baby as soon as possible after delivery. You should be able to bond with and breast feed your baby, if you so desire. The better prepared you are before labor and delivery, the more rewarding the entire birth experience will be for you.
Acknowledgment: We gratefully acknowledge the assistance provided by Divina J. Santos, MD, and Carolyn J. Nicholson, CRNA, BSEd, Department of Obstetrical Anesthesiology, University of Cincinnati, Cincinnati, OH, and their videotape, “What Anesthesia Is Best for Me and My Baby?”
Surgery can be an emotional time. Surgery that is to be performed on your child can be especially stressful. There are things you can do to reduce the chance that your fears and anxieties, as a parent, will be transferred to your child. Children who are less anxious and less fearful have an easier time before and after surgery.
Remember your emotions and anxiety level influence your child. Keep calm and in control of your emotions to help your child do the same. Follow the recommendations listed to accomplish this goal. For more information, talk with your child’s physician, surgeon and nurse as well as staff at the hospital or surgicenter.
Ask your child’s doctor and nurse what you can do to care for your child after surgery and anesthesia.
The above information was provided by the American Association of Nurse Anesthetists.
For more information visit www.aana.com or www.AnesthesiaPatientSafety.com.
Nurse Anesthesia; no longer the best kept secret in health care.
Established in the late 1800′s as the first clinical nursing specialty, nurse anesthesia developed in response to the growing need surgeons had for anesthetists. Certified Registered Nurse Anesthetists (CRNAs), and the American Association of Nurse Anesthetists (AANA), have played significant roles in developing the practice of anesthesia. Today, more than 27,000 CRNAs provide cost-effective, quality patient care that is essential to America’s health care system.
CRNAs have a proud history of meeting the challenges of changing health care trends. The recent acceleration of managed health care services will provide additional opportunities and new challenges for these advanced practice nurses. CRNAs will continue to be recognized as anesthesia specialists providing safe patient care.
As anesthesia specialists, CRNAs administer approximately 65% of the 26 million anesthetics given to patients in the U.S. each year. As advanced practice nurses, CRNAs can serve in a variety of capacities in their daily practice, such as clinician, educator, administrator, manager and researcher.
The education and experience required to become a CRNA include:
Information for this page was obtained from American Association of Nurse Anesthetist (AANA).
Hopefully you are viewing this page because you are interested in knowing more about a career in nurse anesthesia. You have come to the right place! Below are some FAQ's about a career as a CRNA. Should you have further questions, please contact a NMANA Board of Directors.
A nurse anesthetist is a specially educated advanced-practice registered nurse. Officially, our title is CRNA, which stands for Certified Registered Nurse Anesthetist. CRNAs perform many different functions and roles within hospitals, surgery centers, physician's offices and other settings. Our primary role is to provide anesthesia care to a patient who is undergoing a surgical procedure or diagnostic test.
A career as a CRNA begins by becoming a registered nurse (RN). There are numerous types of RN educational programs, the most common being Associate Degree and Baccalaureate Degree programs. The Associate Degree in Nursing (ADN) typically takes two academic years to complete. The Baccalaureate Degree in Nursing (BSN) typically takes four academic years to complete. There are "bridge" programs available that allow nurses with Associate Degrees to obtain their Baccalaureate Degree. Most nurse anesthesia programs today require their applicants to have the BSN degree, but there are programs that will accept an ADN with a baccalaureate in another field. For specific academic requirements, check with the department of admissions at the school of interest. Other requirements for anesthesia school admission include a minimum of one year of clinical experience as an RN in a critical care nursing unit, and the completion of some type of standardized aptitude test (GRE, MAT, etc)
Admission to nurse anesthesia school is very competitive! There are always many more qualified applicants than there are student positions within any given school. Only the best and brightest applicants are choosen for admission. You will have a better chance of being accepted to anesthesia school if you maintain a high grade point average, get a good score on your standardized test, and have excellent letters of recommendation.
Program length varies from school to school, but generally ranges from 24 to 36 months.
No, one becomes a CRNA when one has successfully passed the National Qualifying Examination administered by the Council on Certification of Nurse Anesthetists. This examination is taken soon after graduation from anesthesia school.
The American Association of Nurse Anesthetists is an excellent source of information for students. Here is a link to their article: Qualification and Capabilities of Certified Registered Nurse Anesthetist. Should you need further information, do not hesitate to contact any member of the NMANA Board of Directors.