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To become a nurse anesthetist, students must have a Bachelor's in Nursing, current license as a registered nurse, at least one year's experience in an acute care nursing setting and graduate degree from an accredited school of nurse anesthesia. They must then become pass a test to become a certified registered nurse anesthetist (CNRA).

CNRAs normally rank higher in title and salary than many other nurses. Beginning salaries can be as low as $50,000 to $70,000, but the average was about was $118,000 in 2001. Salaries are expected to increase because the number of CRNAs is not keeping pace with need and this field is one of the top 10 recruited healthcare specialties. According to Allied Consulting, these professionals can even earn more than some physicians or about $180,000. Shortages are greatest in U.S. locations with large populations of seniors and aging patients and in those states having more stringent laws for CRNAs. In some places, for example, they cannot perform specific duties without an anesthesiologist being present. Some states such as Florida want to license anesthesiologist assistants (AAs) to do some of the CRNAs' tasks due to the employment shortage. Many of the CRNAs are naturally against such legislature and may consider leaving the state if the law passes.

CRNAs make high salaries because they have a number of major challenges. "A person needs a shift in mindset when moving from a staff nurse position upward to this advanced, autonomous role," says a CRNA from Mt. Sinai Hospital in Miami Beach. "Nurses frequently rely on a doctor to give orders and assume ultimate responsibility. As a nurse anesthetist, I write orders for other people to implement and determine that an intervention is necessary. When something goes wrong, it's a matter of life or death." Another CRNA challenge is explaining the risks of anesthesia. Although the practice is almost 50 times safer today than 20 years ago, there are still some risks that the nurse anesthetists must communicate to patients while still putting them at ease.