FNP vs CRNA crossroad

This seems to be the classic dilemma for the nurse who loves medicine as much as nursing. CRNA is so attractive to them. I’m only a nursing student but last year one of our guest speakers was an NP who worked solely in a pain management dept at the local university hospital (OHSU). Her entire job is pain management in a huge variety of cutting edge methods for numerous diseases. Her expertise in the field is amazing.

Papadoc,

While on a theoretical level one could argue that all anesthesia practice is "pain management", the reality is that there are a limited number of CRNAs whose primary practice is in this sub-specialty. I don't think there are any that participate on this board (please chime in if I am wrong). We have talked about pain management specialization in the past, you might be interested in those old threads.

You ask about the scope of pain management practice for CRNAs. In my estimation, this is an all or none situation. The average CRNA does zero (of what I would call specialized pain management). For CRNAs who specialize in pain management, it is 100% of their practice.

Pain management as an anesthesia sub-specialty is an evolution of expertise in regional anesthesia skills. I would generalize to say it usually goes like this-after school you work for a few years in the OR doing "regular" anesthesia. During that time you develop a particular interest in regional techniques. You gain above average skills in common blocks (spinal, epidurals, and some peripheral nerve blocks). You branch out and start doing some of the lesser known type of peripheral nerve blocks. You become the "go to guy" in your department for regional blocks in surgery cases. You learn how to apply these technical skills to patients with pain treatment needs that are not associated with surgery.

At this point, it would be possible to do some of both. And there are CRNAs who continue to do OR anesthesia, and also see office patients for pain treatment. Especially in a rural setting where there are limited providers, so the ones that are there have to cover more ground. But I think it is more likely that you would set up your own private practice (or enter into a partnership) to develop an office practice to treat pain patients using the regional expertise you have acquired.

There a couple issues I think you should consider about your crossroads:

NP is mostly an office based type of practice. You would follow patients over time, in an outpatient setting. While CRNA pain specialists end up in the same type of practice setting, they have to pay alot of "CRNA dues" before they get there. Meaning they work for some time like an average-Joe CRNA, working with surgical patients, in the OR, that you see once, turn over the care to someone else, and likely never see again. Some of my NP friends say it would drive them crazy to work like that.

Another issue is technology vs. alternative techniques. IMO, CRNA pain management's primary emphasis is on the technology. Ways to identify the nerve-fluro, peripheral nerve stimulator, ultrasound. Many different drug choices to inject. There may be some who incorporate alternative techniques, but I would guess that the technological ones are still their main business. If your main interest is alternative, the CRNA route may not be the most direct way to get where you want to be.

The beautiful thing about nursing is the diversity of practice. It is possible to develop any type of practice you desire, if you have the entrepreneurship and drive to make it happen. No matter your choice between NP and CRNA, also consider the business aspects of your career goal, and develop your expertise in this area as well through classes, mentoring by someone already practicing, etc.

Best of luck,
loisane crna