How to Become a Certified Registered Nurse Anesthetist (CRNA)

    Nurse anesthetist holding a drip line

    If you’re a Registered Nurse (RN) looking for more autonomy working with patients in an operating room, intensive care unit, or surgical facility, then becoming a Certified Registered Nurse Anesthetist (CRNA) might be the perfect job for you.

    Nursing students and RNs often set a long-term goal of becoming a CRNA, and for good reason. CRNAs are highly respected for their work and earn some of the best salaries in the nursing field. They’re also an important part of our healthcare system.

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    Part One What Is a Certified Registered Nurse Anesthetist (CRNA)? 

    CRNAs are advanced practice registered nurses (APRNs) who administer anesthesia and other medications. They also monitor patients who are receiving and later recovering from anesthesia. CRNAs have acquired a minimum of a Master’s degree focusing on anesthesia, have completed extensive clinical training, and have passed a certification exam approved by the National Boards of Certification and Recertification of Nurse Anesthetists (NBCRNA).

    CRNAs care for patients from all walks of life. Some patients are scheduled for surgery, while others come in for emergency surgeries related to trauma or other potentially life-threatening events.

    Part Two What Do CRNAs Do?  

    Many CRNAs work with anesthesiologists, surgeons, dentists, and other physicians in serving patients who are to receive anesthesia. CRNAs usually work in hospital operating rooms (ORs), emergency rooms (ERs), intensive care units (ICUs), cardiac care units (CCUs), or outpatient surgical clinics.

    CRNAs work with surgical teams, with most surgical procedures occurring from early morning (6 am) to late afternoons/evenings (6-7 pm), Monday through Friday. However, emergency surgery and unplanned cases can occur at any moment, thus it is not unusual to see CRNAs working evenings, nights, weekends, and holidays. 

    CRNAs have specific duties, which include but are not limited to:

    • Assessing patient response to anesthesia
    • Identifying possible risk to the anesthetized patient, including allergies and overdose
    • Administering precise dosages 
    • Educating patients before and after receiving anesthesia 

    Nurse Anesthetists are a vital part of today’s medical facilities, and the need for CRNAs is expected to grow.

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    Part Three CRNA Salary: How Much do Nurse Anesthetists Make? 

    CRNAs are some of the highest paid RNs in the field. Depending on the work setting and state where they are employed, the U.S. Bureau of Labor Statistics (BLS) noted that in 2019, the median annual salary for a nurse anesthetist was $181,040. In comparison, the average annual salary for an RN in 2019 was $73,300, less than half the earning potential of a CRNA. Note that conditions in your area may vary.

    CRNA Salary by City and State

    The top 5 states with the highest annual wages for CRNAs in 2019 were: 













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    Metropolitan areas tend to pay higher salaries to CRNAs. Some of the highest paying cities include:

    • Toledo, OH - $266,260
    • San Francisco, CA - $254,860
    • Columbus, GA-AL - $2247,540
    • Vallejo-Fairfield, CA - $240,820
    • Sacramento, CA - $236,400

    Though metropolitan areas often offer the highest compensation, non-metropolitan and/or rural areas also need CRNAs, and working in these locales often offers CRNAs the ability to work independently. CRNAs frequently are the only anesthesia providers.

    Non-metropolitan areas with the highest employment of CRNAs include: 

    • West Central-Sothwest New Hampshire
    • Southwest Minnesota
    • Upper Savannah South Carolina
    • West Kentucky
    • Southeast Minnesota

    High salaries may often be accompanied by high costs of living. Below is a comprehensive listing of CRNA salaries by state along with the cost of living percentage for each one:

    CRNA Salaries by State And Cost Of Living

    State Avg Annual Avg Hourly Cost of Living
    Alabama $157,430 $75.69 -8.80%
    Alaska no data no data +31.60%
    Arizona $144,530 $69.48 -1.95%
    Arkansas $182,960 $87.96 -11.50%
    California $227,290 $109.28 +34.80%
    Colorado $175,100 $84.18 +2.10%
    Connecticut $198,750 $95.55 +30.70%
    Delaware no data no data +10.80%
    District of Columbia no data no data +49.20%
    Florida $160,030 $76.94 -1.00%
    Georgia $174,310 $83.80 -8.60%
    Hawaii $198,330 $95.35 +67.40%
    Idaho $150,670 $72.44 -10.40%
    Illinois $199,660 $95.99 -4.50%
    Indiana $165,770 $79.70 -12.10%
    Iowa $202,400 $97.31 -8.30%
    Kansas $162,010 $77.89 -9.60%
    Kentucky $167,400 $80.48 -9.60%
    Louisiana $158,500 $76.20 -5.60%
    Maine $188,840 $90.79 +12.00%
    Maryland $186,310 $89.57 +25.00%
    Massachusetts $201,890 $97.06 +34.7%
    Michigan $194,640 $93.58 -11.80%
    Minnesota $192,290 $92.45 +34.70%
    Mississippi $177,820 $85.49 -14.00%
    Missouri $161,420 $77.61 -9.20%
    Montana $239,380 $115.09 +0.80%
    Nebraska $179,450 $86.27 -8.70%
    Nevada no data no data +4.50%
    New Hampshire $196,000 $94.23 +0.80%
    New Jersey $193,900 $93.22 +21.00%
    New Mexico $162,320 $78.04 -4.30%
    New York $200,350 $96.32 +35.20%
    North Carolina $189,060 $90.89 -5.80%
    North Dakota $195,010 $93.76 -98.90%
    Ohio $184,380 $88.64 -7.00%
    Oklahoma $175,090 $84.18 -11.40%
    Oregon $234,750 $112.86 +15.40%
    Pennsylvania $174,240 $83.77 +2.80%
    Puerto Rico $54,690 $26.29 +22.10%
    South Carolina $165,940 $79.78 +0.50%
    South Dakota $190,880 $91.77 +2.80%
    Tennessee $157,070 $75.52 -10.20%
    Texas $167,020 $80.30 -9.30%
    Utah $146,470 $70.42 -7.20%
    Virginia $180,120 $86.60 +0.20%
    Vermont no data no data +12.00%
    Washington $192,440 $92.52 +7.10%
    West Virginia $188,580 $90.66 +4.30%
    Wisconsin $233,600 $112.31 -3.10%
    Wyoming $243,310 $116.98 -8.30%

    Cost of Living reflects percentage above or below the national average cost of living.

    Part Four Where Can CRNA's Work?

    CRNAs typically work in healthcare settings that have operating rooms, emergency rooms, and intensive care units.

    CRNA Work Environments

    • Medical and surgical hospitals
    • Critical access hospitals
    • Mobile surgery centers
    • Outpatient care centers
    • Nursing research facilities
    • Offices of plastic surgeons, dentists, ophthalmologists, pain management specialists, and other medical professionals
    • U.S. military medical facilities

    While most CRNAs choose to practice at the bedside, there are also numerous administrative jobs available for Nurse Anesthetists. Individuals can work in a managerial role that includes personnel and resource management, financial management, quality assurance, risk management, department meetings, continuing education, and staff development.

    Furthermore, CRNAs may hold positions within state and federal government agencies including the state boards of nursing, U.S. Food and Drug Administration, and for professional testing organizations such as the American Society for Testing and Materials.

    Part Five How to Become a CRNA  

    The rewards of being a nurse anesthetist are remarkable, and like anything worth having it requires a significant amount of dedication and commitment. Though there are several possible paths you can take, the most common will include these steps and corresponding investment of time:

    1. Earn your Bachelor of Science in Nursing – 4 years
    2. Get licensed as a Registered Nurse 
    3. Gain invaluable experience working as a Registered Nurse – 1-3 years
    4. Apply to and get accepted by an accredited nurse anesthesia program 
    5. Pay for your graduate program
    6. Attend an accredited nurse anesthesia program – 2-3 years
    7. Take and pass the National Certification Examination for Nurse Anesthetists 

    Once you’ve completed these steps, you’ll have done everything that’s required to qualify for an entry-level nurse anesthetist position. Let’s take a closer look at what each step entails.

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    1. Earn your Bachelor of Science in Nursing (4 years) 

    Though there are several paths to becoming a Registered Nurse, the one that will provide you with the greatest opportunity and the educational background that is fast becoming the standard is the Bachelor of Science in Nursing (BSN). This four-year degree provides you with foundational knowledge in topics ranging from health assessments and pathophysiology to anatomy and pharmacology. BSN programs incorporate clinical rotations through the various care departments in hospitals and clinics, exposing you to a wide range of patients and colleagues to give you a well-rounded nursing education.  

    Keep in mind as you are pursuing your undergraduate studies that early academic achievement will be rewarded with greater opportunities and more options in the future. The better your grades and recommendations you receive from undergraduate faculty, the better your chances of being accepted into the accredited nurse anesthetist program of your choice. Most programs have a minimum GPA requirement of 3.0, and acceptance is becoming increasingly competitive. 

    2. Get Licensed as a Registered Nurse 

    Once you have earned your Bachelor of Science in Nursing you will be eligible to take the examination required to become a Registered Nurse This test, called the NCLEX-RN, or National Council Licensure Examination for Registered Nurses, is administered by the National Council of state Boards of Nursing (NCSBN). Every state has its own requirements for licensure and process for exam registration, so make sure that you are familiar with the requirements as they apply to you and your locale. 

    3. Gain Invaluable Experience Working as a Registered Nurse

    Though your undergraduate clinical rotations will have exposed you to a wide range of care settings, nurse anesthesia programs generally prefer candidates who have experience appropriate to the field. You will put yourself in the most optimal position for being accepted to a program if you have a minimum of one year (and preferably longer) of experience working in an acute care setting such as an emergency room, an intensive care unit or a cardiac care unit. Pursuing certifications that demonstrate this experience (such as a Critical Care Registered Nurse Certification) will further enhance your resume and make you more attractive to those who will review your nurse anesthesia program application. Another way to boost your chances is to shadow a working nurse anesthetist. This will not only demonstrate your commitment to the field but will also provide you with valuable insights into what your future as a nurse anesthetist holds.

    4. Apply to and Get Accepted by an Accredited Nurse Anesthesia Program 

    As the need for nurse anesthetists has grown, so too have the number of accredited nurse anesthesia programs. CRNAs historically have been able to earn either an MSN or DNP; however, by 2025 CRNAs will need a doctorate degree.

    As of February of 2020, the AANA website indicates 123 accredited nurse anesthesia programs available. Getting accepted into these programs requires that applicants demonstrate a commitment to the field of nursing and to the study of nursing practice. Though every program has its own unique focus and requirements, most have certain elements in common, including: 

    • Minimum of two years’ experience working as a Registered Nurse
    • Minimum of one year working in an acute care setting
    • Valid RN licensure
    • BSN degree or Bachelors’ degree in a related field of study, including completion of prerequisite courses in human anatomy, microbiology, chemistry, physiology and statistics
    • Minimum GPA demonstrated in college transcripts: may require 3.0 in related science studies
    • Excellent communication skills
    • References

    Nurse anesthesia programs value candidates who demonstrate attention to detail. Make certain that you read each school’s application requirements carefully to ensure that you are providing the exact information that they are looking for.

    5. Determine How to Pay for Your Nurse Anesthesia Program

    Deciding how to finance an advanced degree as an MSN can seem like a daunting task, and that’s ok. Luckily, there are many options to help offset or lessen the burden of the cost, including grants, scholarships, and student loans -- federal and private. If you're already paying off existing student loans, you can also consider refinancing them to a lower interest rate to save money. 

    >> Learn everything you need to know about private student loans

    6. Attend an Accredited Nurse Anesthesia Program 

    In recent years, a growing number of accredited nurse anesthesia programs have moved beyond the standard of educating towards a Master’s Degree upon graduation, and instead are providing a didactic level geared towards a doctoral degree. Depending upon which accredited nurse anesthesia program you are accepted by and choose to attend, earning your degree will take between two and three years and will provide both high-level classroom work and clinical practice.

    7. Take and Pass the National Certification Examination for Nurse Anesthetists

    The final step required before applying for an entry-level position as a nurse anesthetist is passing the National Certification Examination (NCE). This three-hour test is conducted on a computer and evaluates the knowledge, skills and abilities that every accredited nurse anesthesia program provides.  Once you pass the exam and have become a DRNA, you must maintain certification, which involves recertifying every four years and taking a new test every eight years. Recertification requires the completion of 100 units of continuing education in a variety of areas including pathophysiology and anesthesia technologies.

    Part Six How Long Does it Take to Become a CRNA?

    CRNAs must successfully complete an accredited nurse anesthesia educational program, which can take 24 to 51 months, depending on the intensity of the program. There are approximately 123 accredited nurse anesthesia programs in the U.S., with approximately 1,870 active clinical training sites.

    A list of all COA accredited CRNA programs is available here.

    Part Seven Which Schools Have the Best CRNA Programs?

    There are numerous CRNA programs throughout the country, we ranked them based on reputation, certification pass rate, cost, accreditation, and acceptance rates and these schools made the list. See our full list of the top ten CRNA programs of 2019.

    1. Rush University -  Chicago, Illinois
    2. Mayo Clinic College of Health and Sciences - Rochester, Minnesota
    3. Duke University - Durham, North Carolina 
    4. Villanova University - Villanova, Pennsylvania
    5. Georgetown University - Washington, D.C.

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    Part Eight Is There an Exam That CRNAs Must Pass?

    All nurse anesthetists must pass the CRNA exam prior to beginning to practice. The National Board of Certification and Recertification for Nursing Anesthetists (NBCRNA) outlines eligibility, registration processes, exam details, and renewal procedures in its Examination Candidate Handbook.

    Part Nine Advice For Future CRNAs

    We asked leaders in the nurse anesthesia field for their best advice for nurses who have the goal of becoming a nurse anesthetist.

    Joseph A. Rodriguez, MSN, CRNA, President of Arizona Association of Nurse Anesthetists

    Joseph A. Rodriguez, President of Arizona Association of Nurse AnesthetistsFor those looking to join the ranks of CRNAs, a few pieces of advice. First, get used to thinking independently. Protocols, order sets, guidelines – all are useful and important – but you have to have the critical thinking ability, the knowledge, and judgment to make the right choice for the patient – in the crucial moments.

    Second, get used to constant advocacy. CRNAs only exist because we’ve battled, for over 100 years, just for the right to do our job and take care of our patients.

    Third, you must properly – and frequently - articulate your practice to others who likely know nothing about your practice. Few people (even surgeons, physicians, and nurses) understand the knowledge, background, and capabilities of CRNAs, and fewer will know that you have a deep understanding of perioperative anesthetic management.

    Last, surgery and anesthesia are all about teamwork, not egos - the only measurement that ever matters - is the safety of our patients.

    Anesthesia is the only field in all of health care to be “jointly owned” by 3 professions – CRNAs, physicians, and dentists. If you want to join us, you’ll have to make great personal sacrifices, and continue to advocate for your profession your entire career. But it’s well worth it – you’ll almost never find a CRNA that doesn’t love their profession and their practice.

    Kris Rohde CRNA, MSN, BSN, President-Elect of the Nebraska Association of Nurse Anesthetists

    Kris Rhode, President of Nebraska Association of Nurse AnesthetistsFor nurses who would like to become Certified Registered Nurse Anesthetists, I recommend that one does a bit of research into the profession. I believe that it would benefit the nurse to shadow a couple different CRNAs in a couple different types of practice. See what it is like in a busy, metropolitan trauma center compared to a solo provider in a rural area serving many small communities. Understanding the different types of practice is key to understanding our profession completely.

    I also think that a nurse working in critical care will develop skills that are crucial to our profession. Understanding laboratory results, ventilator settings, & EKG interpretation are just the tip of the iceberg for us. A successful CRNA understands all of those things, plus the pathophysiology behind it. Working in an ICU or other critical care areas will also help an RN develop critical thinking skills that are absolutely essential to a CRNA. This is something that is learned over time, not just in a year. I truly believe that applying for school when one is ready, not just after the minimum requirement, is important.

    Shawn Seifert, MS, CRNA, President-Elect of the Maryland Association of Nurse Anesthetists

    Shawn Seifert, President of Maryland Association of Nurse AnesthetistsThe best advice I can give critical care nurses interested in a career in Nurse Anesthesia is to focus on leadership.

    That is, seek opportunities outside of the purely clinical and be involved politically, socially, or even artistically.

    These experiences will allow you to evolve into the advanced role of nursing leadership that Nurse Anesthesia demands as well as makes your application for school more impactful and likely to lead to an interview.

    Marcia Kluck, MNA, APRN, CRNA, President-Elect of the Minnesota Association of Nurse Anesthetists

    Marcia Kluck Presdient of Minnesota Association of Nurse AnesthetistsAfter you’ve made the decision and have gotten a minimum of two years of solid ICU, minimize your lifestyle and expenses for the short term while in school. This is to minimize debt. You will have time to decompress during school. But international vacations at this time are an unnecessary luxury (in my humble opinion and experience). You will have time and money after boards!

    Cheryl L. Nimmo, DNP, MSHSA, CRNA, President of the American Association of Nurse Anesthetists

    Cheryl L. Nimmo, President of American Association of Nurse AnesthetistsFor me, becoming a Certified Registered Nurse Anesthetist (CRNA) took my career to another level entirely. I’m still amazed that the vast array of surgical, obstetric, emergency and pain management procedures performed tens of thousands of times every day across the country is only possible thanks to the discovery and advancement of anesthetic drugs and procedures. There is nothing more personally rewarding than ensuring patients’ safety and comfort when they are at their most vulnerable. My advice for nurses who wish to become a CRNA is this: As you pursue your bachelor’s degree, attain the highest grades possible. It is difficult to get accepted into a nurse anesthesia program, so increase your odds with excellent academic work. After becoming an RN, you will need to obtain at least one year of experience working in an intensive care setting. My recommendation: Work for 2-3 years at a minimum before applying for nurse anesthesia school. Absorb advice and information like a sponge and become the best intensive care nurse you can be. Find a CRNA and ask if you can shadow him/her in the OR for a day. This will give you a total picture of what the career entails. Also, get your CCRN certification. Obtaining the certification shows that you are able to learn and retain new concepts and shows that you have the motivation to learn while working. Also, if you had a science course and your grades were not outstanding, take another science course before applying to show you are capable of the science courses in anesthesia school. This will position you well for the next stage of your career…as a CRNA! Good luck in your future career.

    Gus Powell, CRNA, President-Elect of the Idaho Association of Nurse Anesthetists

    Gus Powell, President of Idaho Association of Nurse AnesthetistsMy best advice for nurses who want to become a nurse anesthetist (CRNA) is to have a plan and be willing to challenge yourself. That plan begins with focusing on academic success and picking the anesthesia program that is right for you, such as a program with an independent practice or regional anesthesia emphasis. In addition, it is very important to gain as much clinical exposure as possible while working as an RN and applying to anesthesia programs. I also feel it is helpful to find a CRNA mentor and shadow that person for enough time to really establish if this profession is for you. Becoming a CRNA is very rewarding and challenging. I have never regretted my decision to become a CRNA. Good luck to you!

    Maricel Isidro-Reighard, CRNA, MSNA, DNAP, President of the California Association of Nurse Anesthetists

    Maricel Isidro-Reighard, California Association of Nurse AnesthetistsMy best advice would be that in order to be successful in the CRNA job market is that you have to check your pride at the door. There are many humbling moments that you will encounter, that you will need to rely on your current fellow nurses. You will learn how important it is to respect them in order for them to respect you. Our peers will have high expectations of us, and we have to know how to deliver. Don’t think that just because you have “CRNA” behind your name, that immediate ‘carte blanche’ is granted to you. It is, in fact just the opposite! We have to prove ourselves every single day! There is no doubt that in your CRNA career, you will need their helping hands and their moral support, and they will give it you almost 100% if they see that you did not shoot way too far into the stratosphere when you became a CRNA.

    Christopher Bartels, CRNA, President of the Connecticut Association of Nurse Anesthetists

    Christopher Bartels, Connecticut Association of Nurse AnesthetistsTake a job in a high acuity ICU and gain as much experience as possible by seeking out the challenging assignments. Get your CCRN and never stop learning. Take a leadership position in or out of the workplace (e.g. a professional association). Come in early and be willing to stay late. Prepare your family and support system for the commitment required in nurse anesthesia school. Utilize as a resource. Shadow a CRNA, save your money, avoid advertising your professional goals and stay humble.

    Part Ten A Day In The Life of a CRNA

    The best way to truly understand the experiences, challenges, and rewards of being a CRNA is to follow a practicing CRNA through their day. We strongly encourage anyone interested in becoming a CRNA to participate in shadowing a CRNA, but before you do that, sit back and watch this helpful video that highlights a CRNA and takes you through her typical day.

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    Part Eleven What is the Career Outlook for CRNAs?  

    The job prospects for CRNAs are excellent. Healthcare legislation, increased emphasis on preventative care, an increasing number of insured patients, and an aging patient population have led to more patients seeking medical care. 

    The BLS estimates that the projected job growth for CRNAs between 2018 and 2028 will be 26%, much faster than the 12% expected job growth for RNs. As noted above, many rural areas are already using high numbers of CRNAs when they are available, and this is expected to increase significantly. Many organizations are utilizing them in place of anesthesiologists due to availability and costs.

    Part Twelve Where Can I Find More Information On CRNA Careers? 

    The American Association of Nurse Anesthetists (AANA) is an excellent resource for those interested in more information about this career path. AANA offers information about continuing education, advocacy, and upcoming annual meetings.

    Additionally, is an invaluable resource for everything you need to know about a career as a CRNA and about CRNA programs. You’ll find the answers to all of your questions in these articles:

    Becoming a Nurse Anesthetist is a lot of work, but with that title comes a rewarding and lucrative career. If your goal is to take your RN career to the next level, look into becoming a CRNA.


    • What is a CRNA?

      • A certified registered nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery and/or other medical procedures.
    • What is the average salary for CRNAs?

      • The Bureau of Labor Statistics (BLS) reports the average income of a nurse anesthetist to be $169,450 per year, with some CRNAs earning over $252,000. Top earning states include Montana, Wyoming, and California.
    • What is the career outlook for CRNAs?

      • There are currently 42,620 registered CRNAs in the United States, with a projected rise of 31% from 2016-2026. 
    • What degrees can I earn after graduation from CRNA school?

      • Graduates can earn a Master of Science in Nursing, Doctor of Nursing Practice, or Doctor of Nurse Anesthesia Practice. By 2022, all CRNA programs will be switching to terminal degrees of either DNAP or DNP.
    • Is there a waitlist for CRNA school?

      • Most schools have a minimum one-year waitlist after acceptance. This is important to consider when determining your current job situation.  
    • What are the top CRNA programs?

    • Where can a CRNA work?

      • Research facilities
      • State and federal government agencies
      • State Boards of Nursing
      • U.S. Food and Drug Administration
      • Hospital administration
      • Medical and surgical hospitals
      • Critical access hospitals
      • Mobile surgery centers
      • Outpatient care centers
      • U.S. Military facilities
      • Offices of plastic surgeons, dentists, ophthalmologists, pain management specialists, and other medical professionals

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