James Walker, President

American Association of Nurse Anesthetists


Nurses need to develop an evidence-based perspective during their education to improve health care, control its costs, and extend patient access to care, said James Walker, president of the 40,000-member American Association of Nurse Anesthetists and director of Nursing Anesthesia for Baylor College of Medicine.

To become a certified registered nurse anesthetist (C.R.N.A.), a nurse must earn a bachelor’s degree, become a licensed registered nurse, and practice in acute care for at least 1 year. Today, C.R.N.A.s are prepared at the master’s level and take classes in pharmacology, anatomy, physiology, pathophysiology, and principles of anesthesia practice; they also gain extensive clinical experience. Nurse anesthetist graduates must pass a comprehensive certification exam to become a C.R.N.A., with recertification required every 2 years. By 2025, C.R.N.A.s will graduate from doctoral programs. Curricular content to be added in the future will focus on advancing clinical practice and research and improving the systems that shape anesthesia practice and care.

The outcome of the current educational system for nurse anesthetists is four-fold, Walker said:

  1. It produces skilled nurse anesthetists to provide the full range of anesthesia and interventional pain management services.

  2. It ensures patient access to care.

  3. It creates access to surgical, trauma, interventional, diagnostic, and labor and delivery services everywhere in the country, particularly in rural and underserved areas of America.

  4. It contributes to improving the quality of anesthesia care, which, according to the IOM, is approximately 50 times safer today than it was 20 years ago (IOM, 2000). This nurse-provided care is also a fraction of the cost associated with anesthesia provided by physician counterparts.

Given these outcomes, “there is now no place for restrictive federal barriers to nursing education practice,” Walker said. “What the patients in our country need is for nurses to continue leading the way by example.”



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