John P. McDonough: Three key facts in support of nurse anesthesiologists

Portrait of professional anesthesiologist doctor medical team and assistant standing with surgery equipment in modern hospital operation emergency room
I feel compelled to share three important facts that I believe will help correct the record.

In a recent opinion column published in Florida Politics (titled “I am a physician anesthesiologist”), Dr. Leopoldo Rodriguez makes a spirited argument for his medical specialty while diminishing the role of advanced practice nurses who are certified and trained to deliver anesthesia safely: nurse anesthesiologists.

On behalf of my fellow nurse anesthesiologists, I feel compelled to share three important facts that I believe will help correct the record.

Fact #1: Nurse anesthesiologists administering anesthesia without the supervision of a physician is commonplace across the United States and beyond.

In 43 states, these professionals practice autonomously under the law. In the U.S. military, nurse anesthesiologists have full practice authority in every branch of service and are the primary providers of anesthesia care to U.S. military personnel on the front lines in Army medical facilities, Navy ships and aircraft evacuation teams around the globe.

Another health care setting in which nurse anesthesiologists commonly function independently without physician supervision is the rural hospital. These professionals represent more than 80% of the anesthesia providers in rural counties across the U.S.

Many rural hospitals are designated as critical access hospitals, which often rely on independently practicing nurse anesthesiologists for anesthesia care. Half of America’s rural hospitals use a nurse anesthesiologist-only model for obstetric care.

Fact #2: Numerous evidence-based, peer-reviewed studies demonstrate the quality, safety and cost-effectiveness of anesthesia care delivered by nurse anesthesiologists.

According to a 2010 study published in the journal Health Affairs, there are similarly low rates of adverse events for solo nurse anesthesiologists and solo physician anesthesiologists. Researchers studying anesthesia safety found no differences in care between nurse anesthesiologists and physician anesthesiologists based on an exhaustive analysis of research literature published in the U.S. and around the world.

This scientific review was prepared by the Cochrane Collaboration, the internationally recognized authority on evidence-based practice in health care.

Fact #3: Nurse anesthesiologists are highly trained professionals. It takes a minimum of 8 to 10.5 years of education and experience to prepare a nurse anesthesiologist to be certified in this profession.

Nurse anesthesiologists must hold a baccalaureate or graduate degree in nursing or another appropriate major, and have an unencumbered license as a registered nurse and/or advanced practice registered nurse in the U.S. or its territories and protectorates. They must have at least one year of full-time work experience as a registered nurse in a critical care setting. (In fact, the average work experience of RNs entering nurse anesthesia educational programs is 4.45 years.)

The aspiring nurse anesthesiologist must then graduate with a minimum of a master’s degree from an accredited nurse anesthesia educational program, which ranges from 24 to 51 months. Graduates of these programs have an average of 12,593 hours of clinical experience. Following graduation, they must then pass the National Certification Examination, and participate in the Continued Professional Certification Program focused on lifelong learning.

In closing, and in a spirit of collegiality and professional courtesy, I would like to point out that nurse anesthesiologists are among the most collaborative practitioners you will find in health care. We provide anesthesia in collaboration with surgeons, dentists, podiatrists, physician anesthesiologists, and other qualified health care professionals.

When anesthesia is administered by a nurse anesthesiologist, it is recognized as the practice of nursing; when administered by a physician anesthesiologist, it is recognized as the practice of medicine; when administered by a dental anesthesiologist, it is recognized as the practice of dentistry.

Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

In the past, our profession has used the terminology “Certified Registered Nurse Anesthetist” or “CRNAs” for our practitioners, but that title has been undergoing an evolution nationally. Recently, our professional society in Florida has adopted the new name of Florida Association of Nurse Anesthesiology.

We believe this title most accurately reflects the distinct role our professionals play as part of a patient’s health care team. We aim to continue that collaborative approach with our physician colleagues and other providers moving forward.


Dr. John P. McDonough, EdD, CRNA, APRN, is a nurse anesthesiologist and serves as a professor of Nursing, Director of Graduate Programs for the School of Nursing, and Director of Anesthesiology Nursing at the University of North Florida. He is president of the Florida Association of Nurse Anesthesiology.

Guest Author


  • Michael Dinos

    September 22, 2021 at 1:54 pm

    Well said Sr. McDonough.

    • Michael Dinos

      September 22, 2021 at 1:55 pm


  • CRNA

    September 22, 2021 at 2:27 pm

    Excellent explanation! Thanks for not scaring the public or slandering another medical profession.

  • Edwin

    September 22, 2021 at 3:16 pm

    Thanks for setting the record straight. I feel many physicians bend or muddy the water when it comes to clarity on their training and experience. It feels like politics anymore. CRNAs are the future from my research. I’m just a lowly PhD in a lab… MDs/DOs don’t think I’m a real doctor either so I get it …

  • Mike MacKinnon DNP FNP-C CRNA

    September 23, 2021 at 11:06 am

    Thank you for being frank, factual and not putting down or attempting to define or subjugate another profession in order to make your point. This seems to be lost on the FASA.

  • Gabriela

    September 24, 2021 at 1:34 am

    Thank you for shedding some light and educating the public!! The road to becoming a CRNA is extremely difficult.

  • Monica Heseman

    September 24, 2021 at 6:45 pm

    Well said Dr. McDonough! Thank you for educating the public. For thirty-nine years I worked as a team player delivering safe anesthetics as an equal partner with medical anesthesiologists. Only twice did I experience MDAs declare they gave anesthesia care better because they were “doctors”. My three shining moments were when a surgeon plus two medical anesthesiologists requested me as their anesthesia provider for their surgeries.
    Monica Heseman, retired nurse anesthesiologist

  • Emilio

    September 25, 2021 at 9:15 am

    Dr, McDonough,
    Thank you for advocating and explaining Nurse Anesthesiologists are highly trained and well-prepared professionals in their practice.

  • Jean

    September 25, 2021 at 2:30 pm

    Your explanation of the nurse anesthesiology education and practice is spot on! Thank you for setting the record straight in a forthright & factual way.

  • Robert Jones

    September 29, 2021 at 11:05 am

    He did not set the record straight.
    He is a CRNA with a doctorate degree.
    He is not a physician.
    Therefore I expect him to advocate for himself.

Comments are closed.


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