I have been a CRNA for over 25 years in middle and east Tennessee. I was trained at Erlanger Medical Center in Chattanooga, Tennessee. There we were taught and permitted to be autonomous. There was no MDA residency program there. In our senior year we were doing all but hearts essentially on our own and the day after graduation you were on your own again save for hearts. Since then I have been in more rural practices where there are only CRNAs who administer all forms of anesthesia including doing arterial lines, central lines, pain management, epidurals, spinals, and all forms of regional anesthesia. It is a little to moderately more stressful but the rewards are greater.