Abstract
Certified Registered Nurse Anesthetists (CRNAs) have been providing anesthesia care in the United States (US) for nearly 150 years. Historically, anesthesia care for surgical patients was mainly provided by trained nurses under the supervision of surgeons until the establishment of anesthesiology as a medical specialty in the US. Currently, all 50 US states utilize CRNAs to perform various kinds of anesthesia care, either under the medical supervision of anesthesiologists in most states, or independently without medical supervision in 16 states; the latter has become an on-going source of conflict between anesthesiologists and CRNAs. Understanding the history and current conditions of anesthesia practice in the US is crucial for countries in which the shortage of anesthesia care providers has become a national issue.
Similar content being viewed by others
Notes
Certified Registered Nurse Anesthetists (CRNAs) at a Glance. Available at: http://www.aana.com/ataglance.aspx
Historical Resources. Available at: http://www.aana.com/Resources.aspx?id=2049
Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services. Available at:http://www.gpo.gov/fdsys/pkg/FR-2001-11-13/html/01-28439.htm
Accredited Nurse Anesthesia Programs. Available at: http://webapps.aana.com/AccreditedPrograms/accreditedprograms.asp?State=all
The National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). Available at: http://www.nbcrna.com/
American Association of Nurse Anesthetists. Education of Nurse Anesthetists in the United States; At a Glance 2008. Available at: http://www.aana.com/BecomingCRNA.aspx?ucNavMenue-TSMenueTargetID=18&ucNavMenuTargetType=4&ucNavMenu-TSMenuID=6&id=1018
Scope and Standards for Nurse Anesthesia Practice. Available at: http://www.aana.com/uploadedfiles/resources/practice_documents/scope_stds_nap07_2007.pdf
Questions and Answers: A Career in Nurse Anesthesia. Available at: http://www.aana.com/BecomingCRNA.aspx?id=110&linkidentifier=id&itemid=110
Occupational Employment and Wages, May 2009: 29-1111 Registered Nurses. Available at: http://www.bls.gov/oes/2009/may/oes291111.htm
Occupational Employment and Wages, May 2009: 29-1061 Anesthesiologists. Available at: http://www.bls.gov/oes/current/oes291061.htm#(5).
Abouleish, AE, Stead SW, Cohen NA. Myth or Fact? Nurse Anesthetists Cost Less Than Anesthesiologists. ASA Newsletter 2010;74 (Dec): 31-34. Available at: http://viewer.zmags.com/publication/8de38f6e#/8de38f6e/32
The American Academy of Anesthesiologist Assistants. Available at: http://www.anesthetist.org/
The Japanese Society of Anesthesia. Available at: http://www.anesth.or.jp/english/tips.html
Australian Society of Anesthesia. Available at: http://www.anzca.edu.au/news/bulletin/bulletin-oct
Grogono AW: Anesthesiology Recruitment. Available at: http://www.grogono.com/nrmp/
Australian and New Zealand College of Anaesthetists. Available at: http://www.anzca.edu.au/news/bulletin/bulletin-oct
References
Takeda J. Measures to address the manpower shortage in anesthesiology in Japan. Jpn Med Assoc J. 2007;50:325–9.
Garde JF. The nurse anesthesia profession. A past, present, and future perspective. Nurs Clin North Am. 1996;31:567–80.
Merwin E, Stern S, Jordan LM. Supply, demand, and equilibrium in the market for CRNAs. AANA J. 2006;74:287–93.
Gunn IP. Rural health care and the nurse anesthetist. CRNA. 2000;11:77–86.
Poirier NB. Opting out: liability and policy implications of eliminating the Medicare CRNA supervision requirement. J Leg Med. 2004;25:229–48.
Michels KA. HCFA issues 1995 CRNA and anesthesiologist Medicare conversion factors. AANA J. 1995;63:9–11.
Kemppainen JK, Taylor J, Jackson LA, Kim-Godwin YS, Kirby E. Incidence, sources, and self-management of depression in persons attending a rural health clinic in southeastern North Carolina. J Community Health Nurs. 2009;26:1–13.
Hogan PF, Seifert RF, Moore CS, Simonson BE. Cost effectiveness analysis of anesthesia providers. Nurs Econ. 2010;28:159–69.
Abenstein JP, Long KH, McGlinch BP, Dietz NM. Is physician anesthesia cost-effective? Anesth Analg. 2004;98:750–7.
Li G, Warner M, Lang BH, Huang L, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999–2005. Anesthesiology. 2009;110:759–65.
Torgersen KA, Chamings PA. Examining collaborative relationships between anesthesiologists and certified registered nurse anesthetists in nurse anesthesia educational programs. AANA J. 1994;62:139–48.
Jordan LM, Kremer M, Crawforth K, Shott S. Data-driven practice improvement: the AANA Foundation closed malpractice claims study. AANA J. 2001;69:301–11.
Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Koziol LF, Showan AM, Longnecker DE. Anesthesiologist direction and patient outcomes. Anesthesiology. 2000;93:152–63.
Needleman J, Minnick AF. Anesthesia provider model, hospital resources, and maternal outcomes. Health Serv Res. 2009;44(2 Pt):464–82.
Pine M, Holt KD, Lou YB. Surgical mortality and type of anesthesia provider. AANA J. 2003;71:109–16.
Dulisse B, Cromwell J. No harm found when nurse anesthetists work without supervision by physicians. Health Aff. 2010;29:1469–75.
Ouellette SM, Horton BJ. Toward globalization of a profession. AANA J. 2011;79:12–4.
Egger Halbeis CB, Macario A. Factors affecting supply and demand of anesthesiologists in Western Europe. Curr Opin Anaesthesiol. 2006;19:207–12.
Egger Halbeis CB, Schubert A. Staffing the operating room suite: perspectives from Europe and North America on the role of different anesthesia personnel. Anesthesiol Clin. 2008;26:637–63.
Acknowledgments
The authors thank Christine M. Heiner, BA (Scientific Writer, Department of Anesthesiology/Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA) for her editorial assistance with the manuscript. The authors also thank Richard Henker, Ph.D., CRNA, FAAN (Professor and Interim Chairman, Acute/Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA) for his review of the manuscript.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Matsusaki, T., Sakai, T. The role of Certified Registered Nurse Anesthetists in the United States. J Anesth 25, 734–740 (2011). https://doi.org/10.1007/s00540-011-1193-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-011-1193-5