Your CRNA practice can be as routine and mundane or as challenging and stimulating as you desire. Your choice of employment setting AND your personal initiative within that setting determine it. I have worked in a world renowned academic trauma specialty anesthesia department with arguably one of the most CRNA friendly and respecting collegiate Anesthesia Care Team practices possible, where the CRNA yielded great autonomy and decision making in every aspect of the anesthesia care of the most critically ill patient's imaginable. I have also worked in another well know academic department of anesthesia which had an oppressive Anesthesia Care Team practice where the anesthesiologist expected to be consulted before a CRNA administered pharmacology to lower a patient's blood pressure, or administered a unit of blood.
In the second setting, which came along after years of practice in the first followed by more years of independent practice as a sole provider, there were 40 Anesthesia Assistants and 5 CRNAs. The ACT was clearly designed to fulfill the required-by-law direct supervision of AAs by anesthesiologists. Whether I continued employment in the department was not a worry of mine. I could take it or leave it and I was not going to allow myself to be "belittled" or micro managed if they wanted me to stay, which they did. On my second day I was 'floating' with the AA who was assigned to post-ops and carried the code/trauma/intubation pager. So I got my tour of the large inner city Level 1 Trauma Center as we did post ops (where I found a patient who had two broken tibias with external fixation, no BM for 7 days and abdominal pain, with a bed pan lying on her lap in great expectation...first 'let me help you treat this pt correctly' moment, not 8 am yet). Before the day was half over, how my CRNA practice would be defined for the remainder of my next two years there was made clear, by me, with two more events.
The pager went off and we were called to the trauma OR for a patient coming from the ER as an emergency. I do not recall the mechanism of injury, only that it was either a chest or abdomen and the patient was clearly in hypovolemic shock. There was myself and two AAs in the room and the patient was intubated. While they were connecting the monitors and taking care of the usual transition to the OR/anesthesia machine stuff I took note of the need for better IV access the situation demanded and grabbed a Cordis Introducer, quickly prepped the groin knowing in minutes the drapes would prevent access to a large volume line site below the injury location, and inserted it into the femoral vein, tossed in a stitch, done in 2-3 min. I hear "What are you doing!!?" and look up to see sheer terror in the eyes of one of the AAs. "I put in a femoral Cordis." He desperately exclaims "We don't do that here!" "You don't use femoral Cordises here? Why not?", was my reply. "No, no. WE don't put them in! Only the attending can do that!" he gasped, looking around as if he feared that at any moment every anesthesiologist in the building would burst through the doors to drag us all out and arrest us. "Well THIS is gonna be interesting" I said to myself, my mask hiding the smile on my face. Attending comes in, drapes go up, myself and my AA tour guide go off to our nest assignment leaving the nerve wracked AA and attending with the case.
A few hours later we answer a page for a head injury pt in the neuro ICU who has extubated himself. Due to swelling he has limited jaw opening and neck extension and it is clear he is not going to make it sans endotracheal tube, so we will reintubate. Must call the attending first. "OK, you call the attending and I will get everything ready so that we can get on with it when she walks in", says I. She arrives, tosses me an understandable "who the hell are you" glance as she scours my badge with a scowl. Not much is said as it is made clear that I am welcome to hush up while she and the AA handle things. The AA attempts the intubation a number of times unsucessfully. The attending calls down to the OR for the fiberoptic scope. As we wait I introduce myself to the attending and ask he if she would like me to take a look while we wait. The patient is stable and being bagged. "Nope". Another minute or two go by. "One of us might as well look. Who knows? A different blade or perspective and this could be over...couldn't hurt", I offer in a friendly, light tone. "No. We will wait for the fiberoptic." comes the 'I do the thinking' toned response.
I roll my eyes and go sit in a chair in the corner of the room. "I may not stay until dinnertime" I point out to myself in inner dialogue. At the same time I am also in my "Well THIS is gonna be interesting" mode. Fiberoptic is brought up by an anesthesia tech. Wrong one, too short...not the tech, the fiberoptic. A Trauma surgery attending is now in the room and the anesthesia attending says to her let's prep for a trach. Now everyone is running about doing just that. "And THIS is exactly how and when bad shite is unnecessarily created" my inner alarm bell screams. So I get up and nonchalantly walk back to the head of the bed as gowns are hurriedly being put on and the betadine is hitting skin. "Seriously, let's have a second person take one more look before we cut this guys throat" I suggest, not with any suggestion of a mere friendly opinion. "No." comes the reply, without even a glance my way. Well, I think to myself, 'I didn't really care if I ever ate the cafeteria food here anyway', and I place my bare hand on the betadine prepped neck..a few gasps, and before the trauma surgeon can say a word I say to the attending "We cannot do a bedside trach on a patient who has only had the least experienced anesthesia person in the room attempt an intubation with the wrong laryngoscope blade. While they reprep let me look. If I cannot intubate this patient then I will immediately quit." Sounds bold, but the blade used was a MacIntosh, notoriously difficult for a limited jaw/neck mobility situation, and the patient simply was not one I would peg as a difficult intubation based on lots of experience intubation trauma patients....and at that point I had had it and really would have quit. "Fine, it's on you"..whatever that was supposed to mean, was the reply. Patient quickly intubated on first try, Miller blade.
Surgeon thanks the attending. "Well IS gonna be interesting" I think, mask again hiding my smile. Attending turns to me and says "well I gotta go back downstairs, don't forget to write this up in the chart." "Not me", I reply, "I couldn't begin to explain in writing what just went on in here, and I guarantee you would prefer it if I did not." And out the door I went. The events of the day of course spread quickly within the department. Not one to wait for others to form the outcome of important things and then tell me about it, I took the dept MDA Chief aside in the hall a bit later and, ignoring the entire ICU incident since I figured "I DARE someone to criticize me on that", I asked, "Hey, what's this I hear about CRNAs no being allowed to insert central lines here?" Well, it's not that they are not allowed. No one has ever asked to before. Technically the AAs and CRNAs have privileges to do so, but only the AAs who do the hearts ever do them.", he replied. "I put a femoral Cordis in a trauma this morning, so you can add me to the list." "I bet THAT raised a few eyebrows." he chuckled, and that was that. From then on I treated the patients, without delay, as needed, and informed the attendings as soon as reasonably possible. Patient needs blood but not urgently? Sure, I'll give you a call if that is the sort of thing you want me to bother you with. But no, I will not delay urgent care trying to find you. Within a month or two it became clear each attending had their own version of the ACT, which became even another version specific to me...a 'what are you calling me for, get on with it version'.
My point: If as a CRNA you are feeling marginalized, lacking respect, unappreciated, unchallenged, bored, etc., you generally have willingly placed yourself in that position and in the end have no one to blame but yourself. Even in the WORST of practice settings you play a part....though the fact that you are IN one of those settings is usually the first thing you can and should change.
From everything you have said, I think that you would find being a CRNA a very rewarding career which, for you, would likely be a specialized one of your own making based on the challenges of the position you seek, rather than the paycheck from, say, an outpatient eye clinic. The only other career move that comes to mind which it sounds like you might enjoy is a critical care Nurse Practitioner in a setting where the NPs are used similar to residents in the ICU. These do exist.