This page was last updated in 2022.
The future of nurse anesthesia looks bright! We have come a long way since the 1800s when ether and nitrous oxide (previously used as party drugs) were discovered to be great anesthetics. Since then, new discoveries in medicine and advances in technology have made a huge impact on how we manage pain. But what does the future hold for the field of anesthesia? And what does the future look like for an aspiring nurse anesthetist?
Future of nurse anesthesia: Safety
Anesthesia is the safest it has ever been. According to the American Society of Anesthesiologists, “a person is more likely to be struck by lightning than die from anesthesia-related complications.”
This is great news for patients and for practitioners! We are already seeing a huge improvement since the 1990s when anesthesia-related deaths were more than 10 times higher than today. As technology continues to advance and we see more scientific improvements, the world of anesthesia will continue to become even safer for patients.
Multiple studies have also been done to prove the safety of CRNAs. Nurse anesthetists have been found to provide very safe and high-quality anesthesia. Compared to physician anesthesiologists, CRNAs are just as safe and there is no measurable difference in the quality of care they provide. CRNA schools will be transitioning to all doctorate-level programs by 2022 (see below), and this will continue to ensure that CRNAs are as safe as possible.
Future of Nurse Anesthesia: Changes in Education
Currently, aspiring CRNAs can achieve their dream with a master’s degree. However, this will be changing very soon! By 2022, all CRNA programs must transition to be at a doctorate level (a DNP, DNAP, etc.).
This is a positive change for the profession in many ways. This will allow CRNAs to:
- Conduct research
- Teach future CRNAs
- Be even more respected in the medical community
- Continue to provide high-quality care
Unfortunately, this may also discourage prospective students from going to CRNA school. Those that are interested in being a CRNA should be ready to commit to a rigorous three-year program or longer. Most programs do not allow you to work during this time, and you will have to prioritize your education above everything else. If your dream is to be a CRNA and you are willing to work for it, don’t let fear keep you from achieving your goals!
Future of Nurse Anesthesia: Unique New Programs
There are also some unique CRNA school opportunities that have been introduced in 2021. Hofstra University introduced its dual-degree AGACNP-CRNA program. This allows students to become nurse anesthetists and get their acute care nurse practitioner degrees at the same time! There are many people predicting that more schools will follow in Hofstra’s footsteps, offering dual degrees and other unique options for CRNA students.
Another new program this year was made for students struggling to get into CRNA school. Case Western Reserve University partnered with four other CRNA programs to create the Leadership Excel and Achievement Program (LEAP). This certificate allows students that have been rejected from previous schools or do not qualify for CRNA school to get additional training. Once a student completes this one-year program, they will be automatically admitted into one of the five affiliated CRNA programs. This is very promising for students that are nervous about getting accepted!
The Future of Nurse Anesthesia: Job Outlook for CRNAs
The future of nurse anesthesia is bright, partly because of the job outlook. Jobs abound for Certified Registered Nurse Anesthetists or CRNAs. Currently, there is a shortage of anesthesia providers in the United States. CRNAs present a high-quality and cost-effective option for hospitals that want to hire more healthcare workers but also want to minimize costs.
Currently, CRNAs are listed as #39 in the 100 best jobs and #15 in the best healthcare jobs on US News. Reasons for this include a high salary, greater opportunities for advancements, and a high level of job satisfaction. They are also the tenth best-paying job on the list with a median salary of $174,790. The growth rate for advanced practice nurses (CRNAs, Nurse Midwives, and Nurse Practitioners) is 45%, which is much faster than average! CRNAs will continue to have many job opportunities for years to come.
How will CRNA Practice Change?
Nurses have been providing anesthesia since the Civil War, but they have only been recognized as a profession since 1956. Since then, nurse anesthetists have been fighting for their right to practice autonomously.
CRNAs have been proven to provide safe care to their patients, and they provide this care in all 50 states. In fact, CRNAs represent more than 80% of the anesthesia providers in rural areas! This is because these areas require anesthesia care but may not be able to afford the salary of an anesthesiologist. Other reasons could include the area being an undesirable location or just a lack of available anesthesiologists. For these reasons, it makes sense for CRNAs to work independently and autonomously.
Currently, there is a law that requires CRNAs to work under the supervision of a physician for reimbursement. In 2001, states were given the ability to “opt-out” of this requirement. The states that chose to do this and have allowed CRNAs to be autonomous include:
Alaska, Arizona, California, Colorado, Iowa, Idaho, Kansas, Kentucky, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Washington, and Wisconsin.
However, this law was suspended in March of 2020 due to the COVID-19 pandemic. According to the American Association of Nurse Anesthetists, or AANA, CRNAs were, “among the top 20 specialties that served the most beneficiaries in non-telehealth care between March 2020 and June 2020—the height of the COVID-19 public health emergency.” Nurse anesthetists have played a huge part during the pandemic, and this could provide more proof that CRNAs are capable of safe, independent practice.
The future of nurse anesthesia will be altered by a move toward independent practice for CRNAs this year. This March, Arkansas changed the wording in their legislation to say that CRNAs work “in consultation with” a medical professional instead of “under the supervision of.” This small change means that the presence of a medical professional is no longer required according to state law.
We are also seeing progress in Michigan, where the state house of representatives recently passed a bill allowing CRNAs to practice without the supervision of a physician. This bill will move to the state Senate next, where lawmakers will vote again to decide if it should become law. With two states making changes in the past few weeks, more states are likely to follow.
Future of Nurse Anesthesia: What Challenges are Ahead?
The future of nurse anesthesia will be largely influenced by challenges unique to this time. Anesthesia providers currently face many challenges during their workday. These include:
- An Aging Population
- High Rates of Obesity
- The Opioid Epidemic
- Covid-19 and its variants
Baby boomers, the largest generation, will need more care as they age. The youngest in this generation are in their mid-fifties and will retire in the next 2 decades. This presents two challenges that the entire healthcare system will face, including anesthesia providers.
The first challenge is that this population is currently retiring from the workforce at a rapid pace: many of these people work in healthcare and anesthesia. This may cause a shortage of healthcare workers as they retire. The second challenge is the draw on healthcare resources. Baby boomers will need more medical interventions as they age. Just think of all the hip and knee replacements!
To add to this, risk factors such as smoking, eating unhealthy foods, and obesity can cause additional issues. Diabetes, heart problems, and COPD are just a few of the many illnesses that can make providing anesthesia more challenging. CRNAs need to be prepared to care for these patients every day.
Another issue is that the opioid epidemic challenges CRNAs to use different methods to control pain. Patients may have a high tolerance to opioids or may need to avoid them entirely. Lidocaine drips and medications such as ketorolac are some different options that CRNAs have.
Lastly, since Covid-19 became a worldwide pandemic in 2020, there has been a wave of minor changes to nursing as a whole that will continue to have a ripple effect that touches all parts of the CRNA journey. For example, there are more ICU nurses who are deciding that now is the time to change careers and finally become a CRNA. This means competition to get accepted into a program will increase, while it is also harder to obtain shadow experience or go to a CRNA school interview or open-house, due to periodic closures and quarantines.
New Technology and Future Predictions
So where does the future of anesthesia go from here? Anesthesia has already improved to a point where it is extremely safe, and there are multiple ways to provide anesthesia. How can the art and science of anesthesia be improved further? There are multiple predictions that have been made about how anesthesia will be practiced in the future.
“Automation” seems to be the word of the day when it comes to the future of anesthesia. One example is a “closed-loop anesthesia delivery system”, or CLADS. This is a method of maintaining sedation without constant adjustments from a CRNA or anesthesiologist. This is achieved by using equipment that monitors the patient and automatically adjusts itself based on the anesthesia provider’s settings. While this equipment is not currently being used in the U.S. market right now, it is being tested internationally. Using this technology will be likely in the near future.
Pharmacogenetics is a new branch of medical science that we have also seen this past decade. Using genetic testing, we can predict how a patient will respond to types of medications, including what is used during anesthesia. This way, we can tailor how a patient can be sedated and improve their emergence from anesthesia, or how they wake up. These are just some of the ways we might see anesthesia change in the next few decades.
Conclusion
CRNAs and aspiring nurse anesthetists have a lot to look forward to in the years to come. While there are many challenges to face (achieving autonomy, treating sick and aging patients, etc.) we are also part of a thriving career that has a promising future. It will be interesting to see how this profession will continue to develop!
References:
https://www.abeo.com/anesthesia-advances-to-one-of-the-safest-modalities-in-medicine/
https://www.aana.com/membership/become-a-crna/crna-fact-sheet
https://www.coacrna.org/about-coa/position-statements/
https://www.hofstra.edu/graduate-nursing/adult-gerontology-agacnp-crna-dnp.html
https://case.edu/nursing/programs/dnp/nurse-anesthesia-dnp/leap-certificate-pathway
https://www.bls.gov/oes/current/oes291151.htm#(2)
https://money.usnews.com/careers/best-jobs/nurse-anesthetist
https://www.staffcare.com/physician-blogs/crnas-in-2020-practice-updates-and-trends/
https://www.arkansasonline.com/news/2021/mar/18/nurse-anesthetist-supervision-change-squeaks/
https://www.teamhealth.com/blog/anesthesiology-2028-bd/?r=1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236591/