A Certified Registered Nurse Anesthetist (CRNA) ensures that patients survive surgery without pain or recollection. The critical performance of these advanced practice nurses places their position high on the hottest jobs lists.

Nurse anesthetists, who work in a variety of settings such as hospitals, surgery centers, physicians’ offices, dental centers, pain clinics, and military health care facilities, ranked fourth on U.S. News & World Report’s top 100 jobs for 2016.

The good news for CRNAs gets even better with the U.S. Bureau of Labor Statistics predicting the profession—which earned a median salary of $157,140 in 2015—is poised to grow by 19% by 2024, which translates into 7,400 new job openings.

Nurse anesthetists collaborate with surgeons, anesthesiologists, dentists, and other health care professionals to provide anesthesia to patients. So what does it take for a registered nurse to pursue this demanding role and become a CRNA?

Qualifications

Applicants need a bachelor’s degree in nursing or the equivalent and have at least one year of critical-care nursing experience. Nurse anesthesia education programs consist of 25 to 36 months of graduate work including both classroom and clinical experiences. A CRNA may sub-specialize in pediatrics, plastic surgery, dental, obstetrics, cardiovascular, plastic surgery, or neurosurgical anesthesia.

Nurse anesthetists tend to be detailed-oriented leaders with a drive to excel as an independent decision-maker, experts say. For nurses considering this role, know this: CRNA programs are rigorous and competitive.

“You have to be the cream of the crop because the competition is so stiff,” says Marc Code, DNP, CRNA, director of the nurse anesthesia program at Samuel Merritt University in Oakland, California. “The GPA has to be competitive. For us the mean is a 3.4, or a 3.5. I would presume for other schools it’s also about the same. The student’s experience, the student’s emotional intelligence, and the student’s diversity all factor in. We’re looking for cohorts that reflect the diversity of our community. It is a competitive process, but not one with barriers so large that an individual who didn’t meet the bar in all the areas can’t do things to bring themselves up to become competitive to get in. But it will take more work.”

Diverse nurse anesthetists, as well as registered nurses, are needed to reflect the patient population, says Wallena Gould, EdD, CRNA, FAAN, founder and CEO of the Diversity in Nurse Anesthesia Mentorship Program. “Even in the black community, there are patients from Ghana, Cameroon, or Jamaica,” she says. Working with a CRNA who shares one’s culture or language can make a difference. “A lot of things can be missed, especially if you’re trying to take a patient history before the anesthesia or if they have questions,” says Gould, who is also chair of the American Association Nurse Anesthetists Diversity Task Force.

Expect Challenges and Sacrifices

Nurses entering the CRNA program lack any anesthesia experience so “what we have to do is take seasoned ICU nurses and turn them into nurse anesthetists in 27 to 36 months, and they have to have the same knowledge, skills, and critical thinking as a MD anesthesiologist because we are held to the same standards,” says Code. “We can do everything, everything that they can do. That’s a lot to learn in a very short time.”

When considering returning to school, review your monetary needs, as working full-time is likely not an option. Nurse anesthetist programs are quite different from the nurse practitioner programs, says Gould.

Before applying, take stock of the financial sacrifices you will need to make, advises Gould. If married, discuss how you will go from two incomes to one. Look at your credit worthiness, as many students will be loan dependent. Realize “you have to live off those loans… probably anywhere from 28 to 36 months. That’s almost three years without income coming in. It’s a huge sacrifice,” she says.

“A nurse practitioner program is doable in terms of working full-time and going to school. You cannot work full-time while in the nurse anesthetist program, so there are a lot of things to consider before enrolling,” says Gould.

When Gould started school, she was five months pregnant with an 8-year-old and the family lived on her husband’s income. “It was pretty difficult. You can no longer go on those lengthy vacations with family and friends. My husband and I didn’t exchange Christmas gifts. We cut back on social events. On a beautiful day during the summer when it’s 90 degrees, you are in the library. They take your life, basically. There are financial sacrifices, social sacrifices, and personal sacrifice you make before you enter a program.”

The overall job outlook for CRNAs is positive, but take time to “understand the restrictions and opportunities related to your options: CRNAs lack utility outside of surgeries and procedures (and) salaries are stagnating,” says Nick Angelis, CRNA, MSN and author of How to Succeed in Anesthesia School (And RN, PA, or Nursing School).

“The profession is nearing a saturation point in some areas, so it’s more important to excel in nursing school, get a job that offers valuable experience, and look around to see what the most interesting and rewarding options are if you intend to go back to school. If there’s a nurse practitioner program in town with a low attrition rate that graduates competent, happy practitioners, that makes more sense than moving to another state for the ultimate anesthesia program,” says Angelis.

“Planning too far ahead causes some students to skip over valuable skills they need to master before entering graduate school. The exception is finances; as I mention repeatedly in my books, it’s never too early to start saving. Otherwise, much of the hard work you put into anesthesia school will go to paying off exorbitant loans,” Angelis says.

Another suggestion is to take advantage of current learning opportunities. What can you learn in school or at the hospital every day? Welcome uncomfortable situations that stretch your knowledge and abilities, preferably with backup available, he says.

“Without an objective understanding of your own skills and weaknesses, it’s difficult to become a nurse ready for the independent decision-making required of a nurse anesthetist.

“For example, in basketball games such as HORSE or Around the World, a player selects shots they know they can make but their opponents will miss,” Angelis says. “The winner isn’t usually the best player. Rather, it’s the player who understands their own abilities and limitations the most.”

CRNAs are the highest paid of the advanced practice nurses, but that compensation reflects their ability to handle critical tasks.

“We take full control of every body function that a patient has during a surgery and we solve problems during the surgery, and bring them out awake and recovered on the other end,” says Code. “And we have done it thousands and thousands of times every day. That responsibility has a compensation value and it’s very valuable.”

Gould agrees. “Our responsibility is much higher than all the other advanced practice nurses. When I tell high school students how much money we make, their eyes pop out of their heads. But the more money, the more responsibility. You literally have someone’s life in your hands every day and we make good decisions,” she says.

A CRNA can own their own anesthesia service to do their own billing and make even more money than a CRNA at a hospital or surgery center, experts say.

Match Jobs to Lifestyle

“The jobs are all over the United States,” says Code. “There are 17 states that have opted out of physician supervision, which allows nurse anesthetists to practice without supervision of a physician, which allows them to go into rural settings and provide the access to anesthesia care that wouldn’t be there otherwise.”

A 2015 study published in Nursing Economic$ found that CRNAs provide the majority of anesthesia care in U.S. counties with lower-income populations and people that are more likely to be uninsured or unemployed.

More advanced practice nurses are required to meet the population demand, which means greater job security, experts say. “With that being said, there is also security in the fact the nurse anesthetists are being utilized and are finding roles in more areas within the perioperative setting than just the operation room, and this allows them to practice to the full scope of their education and training,” says Code. “This also gives, I think, a great deal of security moving forward.”

For newly minted CRNAs, one of the biggest decisions is to choose a position that fits your goals, says Gould. “What type of lifestyle do you want? A Level I trauma center provides lots of opportunities to work and make considerable overtime if you want to. Some people want a local hospital…where it is less stressful. Some CRNAs just work at surgery centers that are only open from 7 to 4, no on-call and no weekends. So it depends on what lifestyle you want once you graduate,” she says.

The profession has the highest job satisfaction and highest compensation among advanced practice nurses, says Code.

“The opportunities are the greatest among advanced practice nurses. We can work in a team setting and we can work independently. Nurse practitioners cannot work independently. I currently practice still and I love the interaction, thought processes, and the problem solving. And the satisfaction that comes out of delivering a safe anesthetic and seeing the patients on the other side wake up. It’s just a wonderful feeling that you’ve done a fine job.”