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    CRNAs Offer Country’s Oldest Clinical Specialty

    By Susan Kreimer, MS, contributor 

    Before there were nurses in any niche, nurse anesthetists were blazing trails. The nation’s oldest clinical nursing specialty originated around the Civil War.

    Nurse anesthesia evolved in the late 1800s from surgeons’ escalating demands for anesthetists. And in 1956, the credential CRNA (Certified Registered Nurse Anesthetist) came to fruition.

    More than 31,000 CRNAs now administer about 27 million anesthetics to U.S. patients annually, according to the American Association of Nurse Anesthetists. They are the main anesthesia providers in rural America, allowing medically underserved areas to deliver obstetrical, surgical and trauma stabilization services.

    “CRNAs administer anesthesia for all types of surgical procedures ranging from simple to highly complex, including patients of all ages in various states of health and illness,” said Jim Walker, CRNA, MS, a regional director for the American Association of Nurse Anesthetists and chief nurse anesthetist at Ben Taub General Hospital in Houston.
    CRNAs practice in every setting in which anesthesia is delivered – from traditional hospitals and obstetrical delivery rooms to critical care facilities, ambulatory surgical centers, the military, veterans affairs and public health agencies. They also work in the offices of dentists, podiatrists, ophthalmologists, plastic surgeons and pain management specialists.

    “Nurse anesthetists must be very dedicated to the provision of high-quality, cost-effective anesthesia services in a professional culture of lifelong learning,” said Walker, 47, who is also director of the master’s degree program in nurse anesthesia at Baylor College of Medicine in Houston.

    CRNAs are well-compensated. The 2006 association membership survey – the latest available – indicates that the average annual salary is $140,000. Even at this going rate, health care facilities could use more CRNAs.

    “There is great demand for CRNAs, and there is a national shortage. We are increasing the number produced yearly, but we are a long way off from where we need to be,” said Col. Joseph Helminiak, MSN, CRNA, of the U.S. Army Nurse Corps at William Beaumont Army Medical Center in El Paso, Texas. At age 55, Helminiak plans to retire soon and hopes there will be enough newly minted CRNAs to replace the veterans.

    In Texas, there are nearly 2,200 active CRNAs – higher than in most states, according to the national association’s membership data. Other states with large concentrations of CRNAs include Florida, Pennsylvania, North Carolina and Michigan. Among the states with lower numbers of CRNAs would be Wyoming, Montana, Nevada, New Mexico, Alaska and Hawaii.

    “Whether or not there is a CRNA program in the state may have some influence on the number of CRNAs practicing there, but I believe the number of CRNAs in a state also correlates with the population in general,” said Sharon Hensley, CRNA, MS, of New Mexico, which has 128 active members in the national association. Hensley, 48, is a self-employed provider at Los Alamos Medical Center in Los Alamos, New Mexico, and Physicians Medical Center of Santa Fe.

    The number of accredited programs is increasing to meet the ongoing and growing need for CRNAs. As of January 2008, there were 108 accredited master’s degree programs in nurse anesthesia, with more than 1,500 affiliated clinical sites in the nation. The programs can take from 24 to 36 months to complete, says the American Association of Nurse Anesthetists.

    One of the newest programs is at Barnes-Jewish College in St. Louis, Missouri – a state with more than 800 active CRNAs. The first class from its Goldfarb College of Nursing graduated in December 2006. However, nurse anesthesia students have trained at Barnes-Jewish Hospital in Washington University’s anesthesiology department for more than 80 years, said Bernadette Henrichs, PhD, CRNA, CCRN, associate professor and director.

    “Our program is 28 months in length, but we plan to extend it to 36 months in the future,” she said, while adding, “You cannot work while you are in the nurse anesthesia program due to the intense difficulty, the enormous amount of time in the classroom and studying, and the amount of time in the operating room.”

    The number of applicants has been stable, ranging from about 35 to 40 annually. “We interview about 18 to 20 of them. We enroll six students each year and they start in August,” said Henrichs, who worked in intensive care for 10 years before attending anesthesia school. She has specialized in anesthesia for 15 years.

    So far, the anesthesiology department at Washington University School of Medicine, where students receive their training, has been successful in recruiting upon graduation. The department hired two of five graduates from the December 2006 class and four of six graduates from the December 2007 class. Others accepted jobs in the surrounding hospitals in Illinois and Missouri.


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