CRNA vs. Nurse Practitioner

tele jelly · Aug 27, 2009

keeping this bumped because i am torn between the two as well. would love to hear some opinions on the professions

AbeFrohman, BSN, RN · Aug 28, 2009

Why not do both? Get your CRNA/NP and practice critical care medicine with an anesthesia group. Lots of autonomy, money, variety, independence. Just get one and get a post master's in the other.

allnurses Guide · Aug 28, 2009

Why not do both? Get your CRNA/NP and practice critical care medicine with an anesthesia group. Lots of autonomy, money, variety, independence. Just get one and get a post master's in the other.

While it is not unusual to have CRNAs that went to NP school 1st. It would be highly unusual to be a CRNA working for anesthesia group providing critical care outside of the OR. Fist off CRNAs rarely provide anything other than anesthesia or pain management outside the OR (and even that isn't that common). Most NPs work under colloboration agreement with an MD.....CRNAs have a wide variety of ways to practice from totally independent to working in ACT envirnoment under the supervision of an MDA. As far as money goes if you are working as an NP then you are going to paid as an NP, more than likely, which is usually considerably less than what you can make as a CRNA.

Now saying all that my suggestion is to shadow both an NP and CRNA to see which one you like best.

reded · Aug 28, 2009

I feel absolutely no loss of opportunities for interactions with patients. When you talk to a patient in the holding area you 're often dealing with an anxious individual that is just waiting to be reassured. This is a time when your compassion and humor come into play. Most practitioners have their spiel that they give most patients, little things like when I ask a patient if they smoke and they say no I tell them "OK we want you to start smoking on Monday". Things like that. Looking them right in the eye and telling them you are going to take good care of them and will sedate them almost before their head hits the pillow. It never occurs to me that I am missing something regarding interactions with patients. When you bring them into the PACU and their comfortable with no recall of anything unpleasant, they thank you. You brought them through a trying time unscathed and they are grateful. It's a great line of work. Ed

AbeFrohman, BSN, RN · Aug 31, 2009

While it is not unusual to have CRNAs that went to NP school 1st. It would be highly unusual to be a CRNA working for anesthesia group providing critical care outside of the OR. Fist off CRNAs rarely provide anything other than anesthesia or pain management outside the OR (and even that isn't that common). Of course they don't, that's why you get your NP degree so you can. Most NPs work under colloboration agreement with an MD.....CRNAs have a wide variety of ways to practice from totally independent to working in ACT envirnoment under the supervision of an MDA. Really? I had no idea... As far as money goes if you are working as an NP then you are going to paid as an NP, more than likely, which is usually considerably less than what you can make as a CRNA. You'll get paid for both if you do both. No reason an anesthesia group wouldn't hire you to do CCM, Pain Clinic, and OR anesthesia, just like a anesthiologist, if you have both your NP and CRNA certs.
Now saying all that my suggestion is to shadow both an NP and CRNA to see which one you like best.

Anesthesia is great in my opinion and I wouldn't want to do anything else and I don't think that NPs get much more patient interaction in my opinion. There is a reason why they teach you to do a 15 minute focused assessment. However, some people feel everything is black and white and no middle ground. Create your own cocktail of degrees (nursing is easy that way) and get what fits for you. It takes slightly longer but you'll be happier in the end.

allnurses Guide · Aug 31, 2009

Anesthesia is great in my opinion and I wouldn't want to do anything else and I don't think that NPs get much more patient interaction in my opinion. There is a reason why they teach you to do a 15 minute focused assessment. However, some people feel everything is black and white and no middle ground. Create your own cocktail of degrees (nursing is easy that way) and get what fits for you. It takes slightly longer but you'll be happier in the end.

I was speaking from personal experience....Can you quote me an anesthesia group that has hired a CRNA/NP to do critical care? Probably not, it would not be in an anesthesia groups financial interest usually to hire a CRNA to do critical care. A hospital might have interest in hiring a CRNA/NP to do both, but that is not what I was talking about. It wouldn't be profitable to have a CRNA work in critical care when they could be doing cases in the OR, in general, the payment for anesthesia services is much higher than working in critical care as NP. Unless you are billing your own time then you aren't going to get paid for being both an NP & CRNA or unless you negotiate your contract to get paid for both.

Actually, CRNAs don't need to get their NP to take care of critical care patients/chronic pain patients etc. It is part of nurse anesthesia training to take care of these type of patients in the OR all the time. It isn't that much of a leap for CRNAs to take care of critical care patients outside of the OR or chronic pain patients outside of the OR, but it is not something most CRNAs seek out not to say some CRNAs don't do this kind of work it just isn't that common.

I still think the best advice for anyone thinking of doing any kind of advanced practice nursing is to shadow several types of APNs and see which role suits you best. You can always be an NP and a CRNA, but it isn't likely that you will find many single jobs where you can work as both a CRNA and an NP.

bucknangler · Sep 2, 2009

Sounds like you love helping patients when they are at the most vulnerable.

Don't listen to others when they say it can't be done. Nursing is VERY flexible and just because its not considered "norm" doesn't mean it shouldn't be attempted.

Our ICU is starting an intensivist program and we are in currently in talks with a ACNP who can do rounds when the intensivist is not around. The MD's want her too because she will be able to start a-lines, chest tubes, read xrays, lumbar puntures, and run codes and help meet current patient outcomes and update the family daily. If that person had a CRNA background, then she would be able to start c-lines and intubate which is a huge plus! We probably intubate at least 8 patients a week at the bedside and start c-lines daily. The physicians never want to start c-lines and they always consult anesthesia to intubate. Then if a patient needed emergent surgery, you can assist in that as well!

So do what you love, do some research, create an accurate job description of why an institution can use you. Then, do some research of what your salary should be.

Thats whats great with nursing, you can do so much with it. I know a guy FNP who approached a community hospital with a "minor care" initiative where he would have total manamgent over 7 rooms in the ER where he can perform minor suturing, diagnose common illnesses, and reduce the stress off the major parts of the ER. Once it was approved, the hospital met his asking price of $135,000 a year salary! And the best part was, this guy was a New Graduate FNP!! Its been 8 years or so since the minor care opened, however, it has been very successful.

AbeFrohman, BSN, RN · Sep 3, 2009

To wtbcrna:

You're right, I can't give you the name of a group because I can't remember it. But it does exist.

While the CRNA may generate more money in the OR, some anesthesiologists who practice in critical care would probably rather have some time off from the ICU rather than more money. They make enough as it is.

You're not billing for both, your billing as a CRNA while you are in the OR and as an NP in the ICU/Clinic.

It is a huge leap for a CRNA to practice in the ICU because they legally can't. You need your ACNP to do so. CRNA has no prescriptive priviledges to dish out antibiotics, lasix drips, etc, etc.

It's easier to chose one or the other. There are definitely not that many groups hiring for a CRNA and a ACNP. I was just offering a suggestion.

To Bucknangler:

Just one comment. You can't assist in surgery if you don't have your RNFA as well.

I'm also hoping that your friend, while ambitious, has some supervision in the minor care center. He is a new grad after all.

bucknangler · Sep 3, 2009

Abe,

As in "assist" i mean with anesthesia. And as for my friend James, He's been working for 8 years now and has seen approximately 50 patients per day 4 days a week for the last 8 years....I would say he's got plenty of experience :)

allnurses Guide · Sep 4, 2009

To wtbcrna:
You're right, I can't give you the name of a group because I can't remember it. But it does exist.
While the CRNA may generate more money in the OR, some anesthesiologists who practice in critical care would probably rather have some time off from the ICU rather than more money. They make enough as it is.
You're not billing for both, your billing as a CRNA while you are in the OR and as an NP in the ICU/Clinic.
It is a huge leap for a CRNA to practice in the ICU because they legally can't. You need your ACNP to do so. CRNA has no prescriptive priviledges to dish out antibiotics, lasix drips, etc, etc.
It's easier to chose one or the other. There are definitely not that many groups hiring for a CRNA and a ACNP. I was just offering a suggestion.
To Bucknangler:
Just one comment. You can't assist in surgery if you don't have your RNFA as well.
I'm also hoping that your friend, while ambitious, has some supervision in the minor care center. He is a new grad after all.

1. Would you care to share more about this group/hospital where they have hired a NP/CRNA to man the ICU? Again if the hospital wants to contract the anesthesia group to cover both the ICU and ORs that is one thing. Stranger things have happened, but I still wouldn't count on an anesthesia group hiring you to do both. I would look for a hospital (or an anesthesia group that specializes in contracting services for ICU) that would hire you directly if you are wanting to do both NP/CRNA roles, and you could probably work out somekind of deal with the hospital than an individual anesthesia group unless you can find anesthesia group that also has a contract to cover the ICU also. I personally haven't seen any anesthesia groups that have contracted to cover ICU outside of the normal anesthesia interactions, but I am sure there is some around since there are quite a few MDAs that do their fellowship in critical care.

2. CRNAs can get prescriptive authority depending on the state you live in. How do you think CRNAs do independent practice running pain clinics(not that I am advocating it one way or the other)? In the hospital setting CRNAs write orders all the time and believe it or not .

3. Would you care to show me the law(s) that state CRNAs can't practice in the ICU? In many states CRNAs are considered under the umbrella of APNs. A CRNAs/anesthesia provider whole practice revolves around providing critical care. The big difference is that it is usually only a short time that CRNAs give critical care. It isn't that much of a leap to convert those skills outside of the OR. Many nurse anesthesia schools require a rotation through the ICU in order to give SRNAs the opportunity to write orders and manage critical care patients in the ICU setting.

4. By the way what is your expertise in anesthesia? I am a military SRNA and will graduate in December of this year, so I feel my understanding is quite reasonable in most aspects of anesthesia. I am not expert by any means, but I do work in anesthesia everyday and have rotated through several civilian facilities providing anesthesia. I also have 20 semester hours towards my FNP.

You might want to try these links and do a search of http://www.aana.com.

https://allnurses.com/certified-registered-nurse/perscriptive-authortities-crna-246527.html

https://allnurses.com/certified-registered-nurse/crna-acnp-combination-66055.html

NurseKitten, MSN, RN · Nov 1, 2009

I have no lack of patient care interactions...I'm expected to see my patients post-op 24 hours after their surgery to check on anesthesia complications, and it's one of my favorite parts of the job. Matter of fact, I'm scheduled to be in on a breast reconstruction tomorrow of a young lady whose mastectomy I helped with a month ago...she had no sore throat, no nausea and felt the best she ever had with anesthesia after I had put her to sleep...so she asked for me again.

No shortage of critical care - and even as a student, which I still am, we do a lot of "critical care"...heck, that's all anesthesia IS. Where else are you expected to constantly balance everything we balance, every second of every case??