Working in the USA

Requirements to Practice as a Nurse Anesthetist in the United States (US)

Ronald F. Caulk, CRNA, FAAN

The following information is designed to assist the foreign nursing graduate and/or foreign nurse anesthesia graduate with the necessary steps to become a Certified Registered Nurse Anesthetist (CRNA) in the United States.

State laws, Medicare and Medicaid, hospital accreditation and hospital privileges require that a nurse anesthetist be recognized as a CRNA and that they meet the requirements for Re-Certification every two (2) years.

To practice as a Certified Registered Nurse Anesthetist requires the following steps.

  • 1.A license as a Registered Nurse in one of the fifty (50) states, the District Columbia or Puerto Rico. To obtain information regarding licensure as a Registered Nurse (RN) contact the following:

    Commission for Graduates of Foreign Nursing Schools (CGFNS)
    3600 Market Street, Suite 400
    Philadelphia, PA 91904-2651
    Telephone: +(215) 222-8454
    Applicant Inquiries: +(215) 349-8767
    Fax: +(215) 622-0425
    Telex: 402409
    Cable: CGFNS, Philadelphia, USA
    Web site:

Enclosed are the "Steps on Becoming a Nurse in the United States" a document prepared by the Commission. This document provides detailed information regarding licensure as a Registered Nurse in the US as well as information regarding the Visa requirements to practice in the US either on a temporary or permanent basis. Information regarding the English Language Proficiency Examination is included in this document.

Upon successful completion of the National Council Licensure Examination (N-Clex) the following is required:

  • 2.The individual must then apply to an accredited nurse anesthesia educational program in the US. The educational programs are accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA). The COA is recognized, by the US Department of Education, as the official accrediting agency for nurse anesthesia educational programs. COA is also recognized by the Council for Higher Education Accreditation, a non-governmental organization.

    All U.S. nurse anesthesia educational programs are at the Master's degree level and therefore require a Baccalaureate Degree for entry. The Baccalaureate degree can be in nursing or a related science. Nearly all of the programs require a minimum of two (2) years nursing experience in intensive care. The educational program may choose to waive the nursing experience requirement for those individuals that are currently recognized as a nurse anesthetist within their country.

    Graduates of foreign nurse anesthesia educational programs may be place in an accelerated program. Accelerated programs may be determined by transferable credits and experience and is at the total discretion of the program director. Most frequently, accelerated programs are not offered until the individual has demonstrated their knowledge in the art and science of anesthesia care. US programs vary in length from 24-36 months. A list of the accredited programs can be obtained from the COA or from the office of the International Federation of Nurse Anesthetists.

    Council on Accreditation
    222 South Prospect Aveunue
    Park Ridge, IL 60068
    Telephone: +(847) 692-7050 extension 1162
    Fax: +(847) 692-7137

  • 3.Upon successful completion of a nurse anesthesia educational program, the individual must take the Certification Examination. This examination is administered by the Council on Certification of Nurse Anesthetists (CCNA) and is a Computer Adaptive Test (CAT). The examination may be taken at anytime throughout the US. It is recommended that the examination be taken soon after the completion of the program. Upon successful completion of the examination, the individual is entitled to use the credential CRNA. It is this council that requires that only graduates of an accredited program are eligible to take the examination.

  • 4.Once a CRNA, there is a recertification requirement to maintain the credential. The recertification process is managed and administered by the Council on Recertification of Nurse Anesthetists. Individual CRNA's are required to obtain 40 Continuing Education Credits (CEU's) every 2 years.

Why accreditation?
The accreditation peer review process is designed to provide a set of minimal educational standards and curricula necessary for a quality educational process. Each educational program, through established standards, periodic site visits, self-studies, review of certification exam results and curriculum review maintain their accreditation status. Currently, the US is the only national organization with an accreditation process. "Accreditation" is different from an "approval" process in that accreditation is a process of recognition by a non-governmental organization and controlled by the profession and whereby "approval" is a governmental process that may or may not involve the profession itself. . Accreditation also differs from the approval process in that recognition is granted through the successful completion of an educational program and a certification examination. In the approval process there is no national certification examination.

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