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What is a Nurse Anesthetist?

A nurse anesthetist is a nurse who specializes in the administration of anesthesia.

Education

In the United States a Certified Registered Nurse Anesthetist (CRNA) is an advanced practice registered nurse (APRN) who has acquiredgraduat level education and board certification in anesthesia. The American Associateion of Nurse Anesthetists' (AANA) is the national association in the United States.

In the USA, Nurse anesthetists must first complete a bachelor's degree in a science related field or a Bachelor of Science in Nursing. They must be a licensed registered nurse.  In addition, candidates are required to have a minimum of one year of full-time nursing experience in an acute care setting, such as medical intensive care unit or surgical intensive care unit. Following the acute care experience, applicants apply to a Council on Accreditation (COA) accredited program of nurse-anesthesia. Education is offered on a masters degree or doctoral degree. Program length varies from 24 to 36 months. Many programs require entrance prerequisites similar to medical schools (pre-med courses) and up to two years of acute care experience. The didactic curricula of nurse-anesthesia programs are governed by the Council on Accreditation (COA) standards and provide students the scientific, clinical, and professional foundation upon which to build sound and safe clinical practice. Clinical residencies afford supervised experiences for students during which time they are able to learn anesthesia techniques, test theory, and apply knowledge to clinical problems. Students gain experience with patients of all ages who require medical, surgical, obstetrical, dental, and pediatric interventions. In addition, many require study in methods of scientific inquiry and statistics, as well as active participation in student-generated and faculty-sponsored research.

Board certification

The certification and recertification process is governed by the National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). The NBCRNA exist as an autonomous not-for-profit incorporated organization so as to prevent any conflict of interest with the AANA. This provides assurance to the public that CRNA candidates have met unbiased certification requirements that have exceeded benchmark qualifications and knowledge of anesthesia. CRNAs also have continuing education requirements and recertification every two years thereafter, plus any additional requirements of the state in which they practice.



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Today, nurse anesthetists practice in all 50 United States and administer approximately 32 million anesthetics each year (AANA). Approximately 65% of CRNAs practice in collaboration with anesthesiologists, in what is termed the "Anesthesia Care Team.” However, CRNAs are educated to work independently or with anesthesiologist supervision. CRNA practice varies from state to state, and is also dependent on the institution in which CRNAs practice.

CRNAs practice in a wide variety of public and private settings including large academic medical centers, small community hospitals, outpatient surgery centers, pain clinics, or physician's offices, either working together with anesthesiologists, CRNAs, or in independent practice. They have a substantial role in the military, the Veterans Administration (VA), and public health.

The degree of independence or supervision by a licensed provider (physician, dentist, or podiatrist) varies with state law. Some states use the term collaboration to define a relationship where the supervising physician is responsible for the patient and provides medical direction for the nurse anesthetist. Other states require the consent or order of a physician or other qualified licensed provider to administer the anesthetic. No state requires supervision specifically by an anesthesiologist.

The licensed CRNA is authorized to deliver comprehensive anesthesia care under the particular Nurse Practice Act of each state. Their anesthesia practice consists of all accepted anesthetic techniques including general, epidural, spinal, peripheral nerve block, sedation, or local.[26] Scope of CRNA practice is commonly further defined by the practice location's clinical privelge and credentialing process, anesthesia department policies, or practitioner agreements. Clinical privileges are based on the scope and complexity of the expected clinical practice, CRNA qualifications, and CRNA experience. This allows the CRNA to provide core services and activities under defined conditions with or without supervision.

Because many less developed countires have few anesthesiologists, they rely mainly on nurse anesthetists.  In 1989, the International Federation of Nurse Anesthetists was established. The International Federation of Nurse Anesthetists has since increased in membership and has become a voice for nurse anesthetists worldwide. They have developed standards of education, practice, and a code of ethics. Delegates from 35 member countries participate in the World Congress every few years. Currently there are 107 countries where nurse anesthetists train and practice and nine countries where nurses assist in the administration of anesthesia.



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