CRNA in Europe

jg0510 · Sep 13, 2017

Hi! I don't know if you will see this, but I just had a couple of questions about being a CRNA in Europe. I know about IFNA...but finding the specifics is kind of hard. So, in Sweden for example, what are your hours like? Here in the states if varies. For example my cousin is a CRNA and she works 2 long shifts a week, whereas my coworker works 3 days a week 12 hour shifts. And pay is also pretty hard to find online...

I want to live/work in Europe and I just want to know the specifics!

Also language will be a barrier, but I speak Spanish, so I could work in Spain. In Sweden/Denmark do you know any RN anesthetists that speak English?

Sorry for the lengthy message :)

crna_dropout · Sep 20, 2017

Do your nurse anesthetists and anesthesiologists work collaboratively with each other or bitterly fight each other like cats and dogs over who gets to be in charge?

Guest805836 · Dec 23, 2017

I am in my last year of studies to become an anesthesia nurse in France, if you want info.

jg0510 · Dec 27, 2017

Hi! Yes I would love more info please! :) Are you from France by the way?

hanakealoha · Aug 22, 2018

Hi Zhale Sami, I am a nurse anesthetist from the U.S. I am considering moving to Sweden, or another Scandinavian country, partly for this reason. I have nearly 30 years of experience, mostly in independent obstetric anesthesia practice. Are nurse anesthetists permitted to administer neuraxial anesthetics in Scandinavian countries? I would like to find out if I can practice as a nurse anesthetist in Scandinavia with my U.S. credentials in my field of expertise. I am very familiar with IFNA, but would prefer to hear directly from my Scandinavian colleagues. Any information you or the group may have would be gratefully appreciated. Thank you in advance.

airwaygeek · Sep 11, 2018

hanakealoha:

First post here.

I just started CRNA school in Norway (master's degree). The program is full time one and a half years, of which about half is time spent in clinical practice, then you're given the title of nurse anesthetist and booted to work. The master's can be done in either one or two semesters, depending on your school. The master's is a pretty new thing over here - no one really knows how it's going to play out. Are we supposed to become nurse practitioners, like midwives and district/school nurses, with autonomous prescription rights with certain meds - really only applicable to recovery orders, or is it just supposed to be a diploma to hang on our walls - become full time academics or just let it rot?

Some political/historical background:

Neuraxial blocks are not covered in basic training for nurse anesthetists over here, but depending on your hospital, and especially your anesthesiologist (who will be your supervisor, medically), you might get to do them anyway. A semi big centre in south-eastern Norway has a big project going on where the ER nurses are thought to do ultrasound guided femoral blocks, and like A-lines and PICC-lines, no central regulation states that you have to be an anesthesiologist(or doc in general) to perform them, but it all has traditionally been the role of an anesthesiologist, either resident or attending.

Intubations are pretty much solely the anesthetist's job, be it nurse or doc (some exceptions do exist; pediatricians intubate kids some places, but the preferred practice is to keep that skill on as few hands as possible to secure proficiency). In Sweden and Denmark, they are developing a program for em/crit docs, but that work stagnated in Norway a few years ago, due to factors including anesthetists not wanting to give up the few tubes a week they get, and primary care phycisians essentially being our first line/prehospital care docsdirecting and working with the paramedics.

In a rural hospital with no anesthesia resident docs, you'll probably get to do whatever you're comfortable with. As an RN with decent ICU/crit/ER experience, I've done a few femoral blocks, A-lines and PICC-lines, but that's probably more related to my good working relationship with our anesthesiologists and general set of interests than anything else.

As a nurse anesthetist, like someone else mentioned further back, my scope of practice will mainly consist of ASA1-2 patients and their anesthesia (at least if it's a general anesthesia or any depth of sedation), airways, meds, docs, etc. Formally supervised by a doc, but usually not in the OR, except for assistance with an unexpected difficult airway or the likes. Spinals and epidurals aren't covered, but I don't really see why one can't learn it if they really want to. According to the Norwegian Standard of Anesthesia, an ASA3 and up will require a close collaboration of the anesthesiologist and nurse anesthetist. ASA1 and 2 requires a pair of NAs or NA and a doc at induction if the plan is general anesthesia, but one can go solo if you just want them spontaneously ventilating during sedation. That's the case for ASA3s, too. The point of pairs of anesthetists is mainly to have a set of extra hands, or an extra set of brains, and in ASA3s and up, that the docs are ultimately responsible for the anesthesia.

There's been no real discourse over here speaking of autonomy of nurse anesthetists, other than if a foreign travel doc used to getting to do it all him-/herself does just that, but those are isolated incidents. The nurse practitioner role, as mentioned, is not fully developed yet, but it could probably be argued that you'd be solely responsible for your patient's anesthesia, limited to ASA1 and 2 patients, combined with a pay raise, but that's just speculation.

As for transferring your certification, you'd (in Norway, at least, which is not part of the EU, but follows most, if not all, of its regulations) most likely get it done after a language course, but I'd research the hell out of it beforehand before considering such a move. In my mind, we'd be lucky to have an American influence in our chosen field, but you might be discouraged by our relative lack of autonomy. Our model is, as far as I've researched your shores and possibilities of practice in the States, closer to an ACT model with a strong NA/anesthesiologist mix. The regulation pay of a nurse anesthetist is the same as that for a critical care and scrub nurse, given that the education is more or less the same in length. If you have a full tenure, which is ten years as a nurse, with the anesthesia education heaped on top, the state and nursing association are agreed on about NOK 530.000,- as of july 2019, but that's always negotiable. That's about USD 60-65k, but most hospitals have a call rotation, which should net you about 10-25% more a year, depending on staffing and workload. OT is time and a half for the first four hours of a given work week, after that double. That lands you about average on the pay scale in Norway, which isn't great, but not that bad either.

Groceries are just a touch more expensive compared to Publix, Target or Safeway (I think they still exist in CA?), and eating out more than at best a couple of times a month is a no go once you have kids. Air travel outside of the bigger centres is hellishly expensive, so the best option for travelling is either driving (which is expensive, but necessary many places) or train travel (unreliable, but pretty cheap). Housing isn't too bad if you've got cash for buying, mortgages are at about 2% these days, with a 15-25% cash down payment. Renting/leasing should be avoided like the plague once you find an area you like. Health care is free through your taxes, as are schools and such. Speaking of taxes; alcohol is heavily taxed, edible goods are at 12-13%, general goods are at 25% (electronics, etc). As a nurse anesthetist, you'll pay somewhere between 35-40% in income taxes, too (with the above mentioned pay). There are also property taxes, but they won't kill you. Haven't killed me, in any case. In general, we pay a lot of taxes. As a safety net, that works out well.

PM me if you have any questions (with your e-mail address, as I don't think I can send personal messages here yet). I have a somewhat limited insight regarding anesthesia, but that's knowledge in progress. I've spent all of my 32 years in Norway, and would be happy to help.