So you want to be a nurse anesthetist?

Plenty of people who have no desire to be nurses find the average national salary for nurse anesthetists appealing. The 2018 median pay for the nurses who administer intravenous drugs and inhaled gasses for surgical procedures was $174,790 in salary or $84.03 per hour according to the Bureau of Labor Statistics. And the career overall is expected to increase by 17% and add 3,200 positions by 2028.

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But if you're seriously considering pursuing the career, you’ll have to look beyond that healthy paycheck and job growth outlook. Nurse anesthetists can come from many backgrounds, but the field favors people with certain strengths. And gaining the necessary education and developing the mindset to cope with this often-stressful and always demanding nurse discipline requires tradeoffs that other nurses may not have to make.

To give you a clear idea of what's involved in the work and education, here's a guide to what to expect as an aspiring nurse anesthetist:

Anesthesia experts on the front lines: "As advanced practice registered nurses, CRNAs are anesthesia experts who administer more than 49 million anesthetics to patients in the U.S. each year and are the primary providers of anesthesia care in rural America," according to the American Association of Nurse Anesthetists. "In some states, CRNAs are the sole anesthesia professionals in nearly 100 percent of rural hospitals."

The job is so important that the U.S. House of Representatives recognized CRNA contributions in a bipartisan resolution in 2020. "You will find CRNAs in every possible practice setting," AANA President Kate Jansky, CRNA remarked on that occasion. "We provide anesthesia for traditional hospital surgical suites and obstetrical delivery rooms, critical access hospital ambulatory surgical centers, the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists, and in our nation's military service branches. As highly educated, advanced practice registered nurses, CRNAs have the important role of keeping patients safe."

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An emphasis on academics: According to the AANA, the minimum education obtained by practicing certified registered nurse anesthetists includes a baccalaureate or grad degree in nursing or another suitable major, a state license as a registered nurse, and a minimum of a master's degree obtained from an accredited nurse anesthesia educational program. And only lifelong learners need apply: "CRNAs must complete 40 hours of continuing medical education credits every two years to maintain certification," noted All CRNA Schools.

No jump start: There may be lots of jobs waiting, but nurses can't skip or condense the work requirement between earning a BSN and entering a master's program to become an anesthetist. "You'll also need to complete at least one year of experience in an acute care setting such as an ICU or ER, though you might need more depending on the acceptance requirements of your school," explained All Nursing Schools. Some RNs complete this experience working in a U.S. military hospital outside the United States.

The entire educational process will take at least seven years total, including an average of four years to earn a BSN, the one-year minimum of acute care experience and at least two more years to earn a master's in nurse anesthesia. The master's takes some as many as four years, noted ANS, which means some have been in school or working as RNs almost nine years before landing their first CRNA job.

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High praise from practicing CRNAs: In January 2020, CRNAs ranked 21 on the list of U.S. News & World Report's Top 25 Best Jobs. Those who work as CRNAs also "report the highest satisfaction of any advanced-level nurse," noted All Nursing Schools.

Wide state differentials: Not every state has the same buff salary average for nurse anesthetists, and job availability varies widely by region. Texas, North Carolina and Ohio have the highest employment levels for nurse anesthetists, for example, but these states pay the highest mean wages: Montana, $246,370; California, $212,210; and Iowa, $209,130. Georgia pays more modest nurse anesthetist wages, with its annual mean wage being $151,070 in 2018 and the mean hourly average $72.63.

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Strides in non-surgical pain management: The National Board of Certification and Recertification for Nurse Anesthetists now offers a voluntary subspecialty certification for nurse anesthetists in Nonsurgical Pain Management (NSPM-C).

Self-starters valued: As Joseph A. Rodriguez, MSN, CRNA, president of Arizona Association of Nurse Anesthetists, told Nurse.org: "For those looking to join the ranks of CRNAs... get used to thinking independently. Protocols, order sets, guidelines – all are useful and important – but you have to have the critical thinking ability, the knowledge, and judgment to make the right choice for the patient – in the crucial moments. Second, get used to constant advocacy. CRNAs only exist because we've battled, for over 100 years, just for the right to do our job and take care of our patients... Few people (even surgeons, physicians, and nurses) understand the knowledge, background, and capabilities of CRNAs, and fewer will know that you have a deep understanding of perioperative anesthetic management."

Common traits that ease the way: "While many personality types enter the CRNA profession, certain common traits are shared by successful individuals," noted All CRNA Schools. "Like any nurse, you must have a desire to help people. You should be patient, compassionate, accurate, and responsible... willing to work diligently and meticulously until the patients are taken care of. A CRNA needs to be self-motivated and willing to continue their education after graduation to keep pace with changes in the field of anesthesia."

Introverts, sure: Strong communication skills are essential for CRNAs, who "interact with patients and medical personnel on a daily basis," All CRNA Schools explained. "You can be an introvert, but you must be able to develop a good rapport with people. Some patients will need you to alleviate their concerns about being under anesthesia. Good writing skills are also critical, particularly the ability to write content appropriate for your audience."

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Stress expected: "Stressful and emergency situations are inherent to working in the field," the website continued.

Brutal hours: CRNAs may be part of the upper echelon of nurses, but they can still work crummy schedules and spend lots of time on call. According to Nurse.org, "CRNAs work with surgical teams, with most surgical procedures occurring from early morning (6 a.m.) to late afternoons/evenings (6-7 p.m.), Monday through Friday. However, emergency surgery and unplanned cases can occur at any moment, thus it is not unusual to see CRNAs working evenings, nights, weekends, and holidays."

CRNAs will cope with aging Boomers down the road. According to the BLS, "overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 26 percent from 2018 to 2028, much faster than the average for all occupations. Growth will occur primarily because of an increased emphasis on preventive care and demand for healthcare services from an aging population."