CRNA Education and History

The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. Nurses first provided anesthesia on the battlefields of the American Civil War. During WWI, nurse anesthetists became the predominant providers of anesthesia care to wounded soldiers on the front lines; today, CRNAs continue to be the primary providers of anesthesia care to U.S. military personnel on front lines, navy ships, and aircraft evacuation teams around the globe.

Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.

In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt-out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria:

  1. consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state,

  2. determine that opting out is consistent with state law, and

  3. determine that opting out is in the best interests of the state's citizens.

To date,17 states have opted out of the federal supervision requirement, including Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, and Kentucky. Additional states that do not have supervision requirements in state law are eligible to opt-out, should the governors elect to do so.

Education and experience required to become a CRNA include:

  • A baccalaureate or graduate degree in nursing or other appropriate major.

  • An unencumbered license as a registered professional nurse and/or APRN in the United States or its territories.

  • A minimum of one-year full-time work experience, or its part-time-equivalent, as a registered nurse in a critical care setting. The average experience of RNs entering nurse anesthesia educational programs is 2.9 years.

  • Graduation with a minimum of a master’s degree from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. As of August 2019, there were 121 accredited nurse anesthesia programs in the United States and Puerto Rico, utilizing more than 1,870 active clinical sites; 91 nurse anesthesia programs are approved to award doctoral degrees for entry into practice.

  • Nurse anesthesia programs range from 24-51 months, depending on university requirements. Programs include clinical settings and experiences. Graduates of nurse anesthesia educational programs have an average of 9,369 hours of clinical experience.

  • Some CRNAs pursue a one-year fellowship in a specialized area of anesthesiology such as chronic pain management following attainment of their degree in nurse anesthesia.

Before they can become CRNAs, graduates of nurse anesthesia educational programs must pass the National Certification Examination.  A recertification program called the Continued Professional Certification (CPC) Program, which is administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA), is based on eight-year periods comprised of two four-year cycles and officially began on Aug. 1, 2016. In addition to practice and license requirements, the CPC Program includes four main components: 60 Class A CE credits or traditional continuing education credits; 40 Class B credits or professional development activities; completion of Core Modules in four content areas, including airway management technique, applied clinical pharmacology, human physiology and pathophysiology, and anesthesia equipment and technology (recommended but not required); and pass a comprehensive examination every eight years.