A lot of my family members and friends have no idea what a CRNA is. It’s sad really because the practice of anesthesia started with nurses.
When anesthesia was first discovered, doctors didn’t feel like it was worth their time or energy, so nurses were specially trained to perform and monitor anesthesia.
Then the practice of anesthesia became more profitable and desirable, and doctors decided they wanted a piece of the action. However, now anyone that you ask will say that anesthesia is practiced by doctors. Not many people realize that approximately 65% of all anesthesia cases are actually performed by nurses.
The other misconception is that CRNAs work as assistants to anesthesiologists. This is not true at all. CRNAs are trained to practice anesthesia independently. There are many areas where the anesthesia care is provided entirely by CRNAs.
The scope of practice of CRNAs is actually the same as that of an anesthesiologist. Some states have different guidelines or restrictions, so you’ll want to make sure that you are aware of your state specific scope of practice.
There are many different areas of anesthesia that CRNAs can choose from. You can work in different settings, including hospitals, outpatient surgery centers, and even doctor’s offices (plastics, dental).
If you work in the hospitals, you can choose a large teaching facility where you may have traumas, heart surgeries, transplant surgeries, and neurosurgeries, in addition to typical general cases. Or you can work at a smaller hospital where you may have orthopedic, GI cases, urology cases.
You can also work in a GI lab. At an outpatient facility, you may have eye surgeries, orthopedic cases, and/or hernia repairs.
There are also different options for your work environment. Many hospitals operate under an anesthesia care team model. This means that the hospital employs anesthesiologists, CRNAs, and also usually anesthesia techs. Depending on the hospital, there may also be medical students and anesthesia residents and fellows.
The anesthesiologist will be assigned certain rooms to supervise, while the CRNAs are assigned to rooms to run the anesthesia cases. The anesthesiologist and CRNA will work together to manage the patients and anesthesia in each room. However, the anesthesiologist is not in the room with the CRNA unless help is needed.
There are other hospitals that are completely CRNA run, meaning there are no anesthesiologists whatsoever. Then there is the option for the CRNA to work independent practice. This means that the CRNA owns their own business and contracts out to various hospitals, clinics, and/or surgeons to provide their anesthesia.
Then there are different specialties. You can choose to work with adult, pediatric, or neonatal patients. You can work in OB anesthesia, which includes giving epidurals for labor and spinal anesthesia for C-sections. You can work in regional anesthesia, which involves giving nerve blocks, epidurals, and spinal anesthesia for pain management or orthopedic surgeries.
You can work specifically in pain management, which includes regional anesthesia specifically for chronic pain and cancer pain patients. You can work in an ICU, where you are managing critically ill patients’ ventilators and medications. You can teach at a CRNA school.
As you can see, the options for CRNAs are endless!! My recommendation is to keep your options open, especially when you are a new CRNA. If you think you want to specialize, that is fantastic. But keep in mind that specializing also means you may lose skills in other areas.
If you are in OB anesthesia, you usually do not need to intubate patients. If you specialize in regional anesthesia, the likelihood of performing general anesthesia regularly is slim.
When you are new, you should try to get as much experience as you can in all areas. There is always time to specialize later on down the road.