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The role of Certified Registered Nurse Anesthetists in the United States


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.

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  1. Certified Registered Nurse Anesthetists (CRNAs) at a Glance. Available at:

  2. Historical Resources. Available at:

  3. Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services. Available at:

  4. Accredited Nurse Anesthesia Programs. Available at:

  5. The National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). Available at:

  6. American Association of Nurse Anesthetists. Education of Nurse Anesthetists in the United States; At a Glance 2008. Available at:

  7. Scope and Standards for Nurse Anesthesia Practice. Available at:

  8. Questions and Answers: A Career in Nurse Anesthesia. Available at:

  9. Occupational Employment and Wages, May 2009: 29-1111 Registered Nurses. Available at:

  10. Occupational Employment and Wages, May 2009: 29-1061 Anesthesiologists. Available at:

  11. Abouleish, AE, Stead SW, Cohen NA. Myth or Fact? Nurse Anesthetists Cost Less Than Anesthesiologists. ASA Newsletter 2010;74 (Dec): 31-34. Available at:

  12. The American Academy of Anesthesiologist Assistants. Available at:

  13. The Japanese Society of Anesthesia. Available at:

  14. Australian Society of Anesthesia. Available at:

  15. Grogono AW: Anesthesiology Recruitment. Available at:

  16. Australian and New Zealand College of Anaesthetists. Available at:


  1. Takeda J. Measures to address the manpower shortage in anesthesiology in Japan. Jpn Med Assoc J. 2007;50:325–9.

    Google Scholar 

  2. Garde JF. The nurse anesthesia profession. A past, present, and future perspective. Nurs Clin North Am. 1996;31:567–80.

    PubMed  CAS  Google Scholar 

  3. Merwin E, Stern S, Jordan LM. Supply, demand, and equilibrium in the market for CRNAs. AANA J. 2006;74:287–93.

    PubMed  Google Scholar 

  4. Gunn IP. Rural health care and the nurse anesthetist. CRNA. 2000;11:77–86.

    PubMed  CAS  Google Scholar 

  5. Poirier NB. Opting out: liability and policy implications of eliminating the Medicare CRNA supervision requirement. J Leg Med. 2004;25:229–48.

    PubMed  Article  Google Scholar 

  6. Michels KA. HCFA issues 1995 CRNA and anesthesiologist Medicare conversion factors. AANA J. 1995;63:9–11.

    PubMed  CAS  Google Scholar 

  7. 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.

    PubMed  Article  Google Scholar 

  8. Hogan PF, Seifert RF, Moore CS, Simonson BE. Cost effectiveness analysis of anesthesia providers. Nurs Econ. 2010;28:159–69.

    PubMed  Google Scholar 

  9. Abenstein JP, Long KH, McGlinch BP, Dietz NM. Is physician anesthesia cost-effective? Anesth Analg. 2004;98:750–7.

    PubMed  Article  CAS  Google Scholar 

  10. 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.

    PubMed  Article  Google Scholar 

  11. 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.

    PubMed  CAS  Google Scholar 

  12. 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.

    PubMed  CAS  Google Scholar 

  13. 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.

    PubMed  Article  CAS  Google Scholar 

  14. Needleman J, Minnick AF. Anesthesia provider model, hospital resources, and maternal outcomes. Health Serv Res. 2009;44(2 Pt):464–82.

    PubMed  Article  Google Scholar 

  15. Pine M, Holt KD, Lou YB. Surgical mortality and type of anesthesia provider. AANA J. 2003;71:109–16.

    PubMed  Google Scholar 

  16. Dulisse B, Cromwell J. No harm found when nurse anesthetists work without supervision by physicians. Health Aff. 2010;29:1469–75.

    Article  Google Scholar 

  17. Ouellette SM, Horton BJ. Toward globalization of a profession. AANA J. 2011;79:12–4.

    PubMed  Google Scholar 

  18. Egger Halbeis CB, Macario A. Factors affecting supply and demand of anesthesiologists in Western Europe. Curr Opin Anaesthesiol. 2006;19:207–12.

    PubMed  Article  Google Scholar 

  19. 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.

    PubMed  Article  Google Scholar 

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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.

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Correspondence to Tetsuro Sakai.

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Matsusaki, T., Sakai, T. The role of Certified Registered Nurse Anesthetists in the United States. J Anesth 25, 734–740 (2011).

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  • Nurse anesthetists
  • United States
  • Anesthesia practice