Nurse Anesthetist Overview

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), coordinate patient care and may provide primary and specialty healthcare. The scope of practice varies from state to state.

Advanced practice registered nurses typically do the following:

• Take and record patients' medical histories and symptoms
• Perform physical exams and observe patients
• Create plans for patients’ care or contribute to existing plans
• Perform and order diagnostic tests
• Operate and monitor medical equipment
• Diagnose various health problems
• Analyze test results or changes in a patient’s condition, and alter treatment plans, as needed
• Give patients medicines and treatments
• Evaluate a patient’s response to medicines and treatments
• Consult with doctors and other healthcare professionals, as needed
• Counsel and teach patients and their families how to stay healthy or manage their illnesses or injuries
• Conduct research

APRNs work independently or in collaboration with physicians. In most states, they can prescribe medications, order medical tests, and diagnose health problems. They may provide primary and preventive care and may specialize in care for certain groups of people, such as children, pregnant women, or patients with mental health disorders.

Some APRN duties are the same as those for registered nurses, including gathering information about a patient’s condition and taking action to treat or manage the patient’s health. However, APRNs are trained to perform many additional functions, including ordering and evaluating test results, referring patients to specialists, and diagnosing and treating ailments. APRNs focus on patient-centered care, which means understanding a patient’s concerns and lifestyle before choosing a course of action.

APRNs also may conduct research or teach staff about new policies or procedures. Others may provide consultation services based on a specific field of knowledge, such as oncology, which is the study of cancer.

The following are types of APRNs:

Nurse anesthetists (CRNAs) provide anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and some emergency services. Before a procedure begins, nurse anesthetists discuss with a patient any medications the patient is taking as well as any allergies or illnesses the patient may have, so that anesthesia can be safely administered. Nurse anesthetists then give a patient general anesthesia to put the patient to sleep so they feel no pain during surgery or administer a regional or local anesthesia to numb an area of the body. They remain with the patient throughout a procedure to monitor vital signs and adjust the anesthesia as necessary.

Nurse midwives (CNMs) provide care to women, including gynecological exams, family planning services, and prenatal care. They deliver babies; manage emergency situations during labor, such as hemorrhaging; repair lacerations; and may provide surgical assistance to physicians during cesarean births. They may act as primary care providers for women and newborns. Nurse midwives also provide wellness care, educating their patients on how to lead healthy lives by discussing topics such as nutrition and disease prevention. Nurse midwives also provide care to their patients’ partners for sexual or reproductive health issues.

Nurse practitioners (NPs) serve as primary and specialty care providers, delivering advanced nursing services to patients and their families. NPs assess patients, determine the best way to improve or manage a patient’s health, and discuss ways to integrate health promotion strategies into a patient’s life. They typically care for a certain population of people. For instance, NPs may work in adult and geriatric health, pediatric health, or psychiatric and mental health.

Although the scope of their duties varies some by state, many nurse practitioners work independently, prescribe medications, and order laboratory tests. All nurse practitioners consult with physicians and other health professionals when needed.

See the profile on registered nurses for more information on clinical nurse specialists (CNSs), also considered to be a type of APRN.

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), must earn at least a master’s degree in one of the specialty roles. APRNs must also be licensed registered nurses in their state and pass a national certification exam.

Nurse anesthetists, nurse midwives, and nurse practitioners must earn a master’s degree from an accredited program. These programs include both classroom education and clinical experience. Courses in anatomy, physiology, and pharmacology are common as well as coursework specific to the chosen APRN role.

An APRN must have a registered nursing (RN) license before pursuing education in one of the advanced practice roles, and a strong background in science is helpful.

Most APRN programs prefer candidates who have a bachelor’s degree in nursing. However, some schools offer bridge programs for registered nurses with an associate’s degree or diploma in nursing. Graduate-level programs are also available for individuals who did not obtain a bachelor’s degree in nursing but in a related health science field. These programs prepare the student for the RN licensure exam in addition to the APRN curriculum

Although a master’s degree is the most common form of entry-level education, many APRNs choose to earn a Doctor of Nursing Practice (DNP) or a Ph.D. The specific educational requirements and qualifications for each of the roles are available on professional organizations’ websites.

Nurse anesthetists must have 1 year of clinical experience as a prerequisite for admission to an accredited nurse anesthetist program. Candidates typically have experience working as a registered nurse in an acute care or critical care setting.

Most states recognize all of the APRN roles. In states that recognize some or all of the roles, APRNs must have a registered nursing license, complete an accredited graduate-level program, and pass a national certification exam. Each state’s board of nursing can provide details.

The Consensus Model for APRN Regulation, a document developed by a wide variety of professional nursing organizations, including the National Council of State Boards of Nursing, aims to standardize APRN requirements. The model recommends all APRNs to complete a graduate degree from an accredited program; be a licensed registered nurse; pass a national certification exam; and earn a second license specific to one of the APRN roles and to a certain group of patients.

Certification is required in the vast majority of states to use an APRN title. Certification is used to show proficiency in an APRN role and is often a requirement for state licensure.

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) offers the National Certification Examination (NCE). Certified registered nurse anesthetists (CRNAs) must recertify every 2 years, which includes 40 hours of continuing education.

The American Midwifery Certification Board offers the Certified Nurse-Midwife (CNM). Individuals with this designation must recertify every 5 years.

There are a number of certification exams for nurse practitioners because of the large number of populations NPs may work with and the number of specialty areas in which they may practice. Certifications are available from a number of professional organizations, including the American Nurses Credentialing Center and the Pediatric Nursing Certification Board.

Communication skills. Advanced practice registered nurses must be able to communicate with patients and other healthcare professionals to ensure that the appropriate course of action is understood.

Critical-thinking skills. APRNs must be able to assess changes in a patient’s health, quickly determine the most appropriate course of action, and decide if a consultation with another healthcare professional is needed.

Compassion. Nurses should be caring and sympathetic when treating patients who are in pain or who are experiencing emotional distress.

Detail oriented. APRNs must be responsible and detail- oriented because they provide various treatments and medications that affect the health of their patients. During an evaluation, they must pick up on even the smallest changes in a patient’s condition.

Interpersonal skills. Advanced practice registered nurses must work with patients and families as well as with other healthcare providers and staff within the organizations where they provide care. They should work as part of a team to determine and execute the best possible healthcare options for the patients they treat.

Leadership skills. Advanced practice registered nurses often work in positions of seniority. They must effectively lead and sometimes manage other nurses on staff when providing patient care.

Resourcefulness. APRNs must know where to find the answers that they need in a timely fashion.

Because the APRN designation is in itself an advancement of one’s career, many APRNs choose to remain in this role for the duration of their career. Some APRNs may take on managerial or administrative roles, while others go into academia. APRNs who earn a doctoral degree may conduct independent research or work in an interprofessional research team.