Nurse anesthetist

Nurse Anesthetist

Nurse Anesthetist providing independent anesthesia on a forward surgical team
Occupation
Activity sectors	Anesthesia, nursing
Description
Competencies	Administration of anesthetics and the elimination of pain
Education required	Varies by country
Fields of employment	Hospital Outpatient surgery centers Ambulatory surgery centers

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy.

A survey published in 1996 reported that there were 107 countries where nurses administer anesthesia in some form, and a further nine countries where nurses act as assistants in the administration of anesthesia.^[1] Depending on the local system of healthcare, they participate only during the operation itself, or may also be involved before and after (for preanesthetic assessment and immediate postoperative management).^[2] In some localities, nurse anesthetists provide anesthesia to patients independently; in others they do so under the supervision of anesthesiologists.^[2]

The International Federation of Nurse Anesthetists was established in 1989 as a forum for developing standards of education, practice, and a code of ethics.^[3] Delegates from 35 member countries participate in a World Congress every few years.

In the United States[]

In the United States, nurse anesthetists are called Certified Registered Nurse Anesthetists (CRNAs). CRNAs account for approximately half of the anesthesia providers in the United States and are the main providers of anesthesia in rural America.^[4]

Nurses have been providing anesthesia care to patients since the American Civil War.^[5] The National Association of Nurse Anesthetists professional association was established by Agatha Hodgkins in 1931.^[6] It was renamed the American Association of Nurse Anesthetists in 1939.^[6] The group established educational institutions for nurse anesthetists in 1952, and established the CRNA certification in 1957.^[6] AANA continuing education was established in 1977.^[6] As of 2011, some 92% of CRNAs in the U.S. were represented by the AANA.^[6]

Scope of practice rules vary between healthcare facility and state. Before 2001, Medicare required, that physicians supervise CRNAs in the administration of anesthesia.^[6] In 2001, Medicare's rules changed, allowing individual states to decide whether CRNAs may administer anesthesia without physician supervision.^[6] In the absence of a state requirement that anesthesiologists supervise CRNAs, individual healthcare facilities decide.^[6] CRNA organizations have lobbied in many states for the ability to practice without anesthesiologist supervision; these efforts are opposed by physician groups.^[6] In 2011, sixteen states granted CRNAs autonomy, allowing them to practice without anesthesiologist oversight.^[6] In 2017, there were 27 states in which CRNAs could independently practice (that is, "without a written collaborative agreement, supervision or conditions for practice").^[7] In 2020, there was no physician supervision requirement for nurse anesthetists in ambulatory surgical facilities in 31 states^[8] In states that have opted out of supervision, the Joint Commission and CMS recognize CRNAs as licensed independent practitioners.^[9] In states requiring supervision, CRNAs have liability separate from supervising practitioners and are able to administer anesthesia independently of anesthesiologists.^{[10][11][12][13]}

CRNA schools issue a master's or doctorate degree to nurses who have completed a program in anesthesia, which ranges from 2–3 years in length.^[14] By 2025 the Council on Accreditation, the organization which accredits Nurse Anesthetist programs requires all graduating CRNA to be doctorate prepared.^[15]

Dispute over use of term "nurse anesthesiologist"[]

The AANA recognizes Certified Registered Nurse Anesthetist, CRNA, nurse anesthetist, and nurse anesthesiologist as equivalent titles.^[16] The use of nurse anesthetist is substantially more common than the use of nurse anesthesiologist.^[17]

Use of the term nurse anesthesiologist has been criticized by those who argue that the term anesthesiologist should be limited to medical doctors.^[17] For example, groups representing anesthesiologists and other medical doctors, such as the American Medical Association (AMA) and American Society of Anesthesiologists (ASA), oppose the use of this phrase to describe CRNAs and call it misleading.^[18][19]

In 2021, after a year-long rebranding effort, the American Association of Nurse Anesthetists changed its name to the American Association of Nurse Anesthesiology. The name change was condemned by physician groups, including the AMA, ASA, American Board of Anesthesiology, American Board of Medical Specialties, and American Osteopathic Association. Physicians' organizations said that the name change was "title misappropriation" that was deceptive, misleading to patients, and cause confusion in care settings.^[20][21][22]

In 2021, the New Hampshire Supreme Court upheld a decision by the New Hampshire Board of Medicine that blocked nurse anesthetists from identifying themselves as anesthesiologists and limited use of the title to MDs and DOs specializing in anesthesiology.^[23]

See also[]

• Anesthesiologist
• Anesthesiologist assistant

References[]