The poor morale that plagues many overworked and underappreciated RNs isn't an issue for the 30,000 nurses who practice one of the profession's most desirable specialties: Nurse anesthesia. Certified registered nurse anesthetists (CRNAs) -- nurses with master's degrees who administer approximately 65 percent of all anesthetics given to patients each year nationwide, according to American Association of Nurse Anesthetists (AANA) data -- are highly skilled, highly autonomous, well-paid and in demand.

"It takes a lot of time, energy and effort to become trained in this profession, but it is well worth the commitment," says Indianapolis-based CRNA Jackie Rowles. "The opportunities are endless, and the satisfaction is very high. People in this profession really love their jobs."

Nurse anesthetists practice in every setting in which anesthesia is administered, including operating rooms, obstetrical delivery rooms, outpatient surgery centers, and in the offices of dentists, podiatrists, ophthalmologists, plastic surgeons and other physicians. While nurse anesthetists can administer anesthesia without physician supervision in many states, there is still some public misunderstanding about CRNAs' scope of practice, Rowles says. "Some people think we just assist the physician," she explains. "They don't realize we do the exact same thing as an anesthesiologist."

Job Flexibility Is Just One Reward

Rowles finds the job's biggest rewards are the bonds she forms with patients and the ability to quickly relieve their pain. "This is one profession where you can actually work with one patient at a time and give them undivided attention," she says. "It's a time when patients are scared or nervous or hurting after an accident, and you can help them and make them feel better almost immediately."

Another advantage of the job is flexibility. Rowles's day job is providing pain-management services at an office shared by a group of 18 neurosurgeons, but she also takes OB anesthesia calls at a local hospital. "The beauty of our profession is that there are so many options and schedules available," she says. "Most nurse anesthetists I know are working more than one place. It's not for greed, but because there is a need out there."

Rural Areas See Big Demand

CRNAs are the sole anesthesia providers in approximately two-thirds of all rural hospitals in the country. Wendell Spencer, CRNA, MHS, is a partner in a group of nurse anesthetists that contracts with 12 small hospitals in Nebraska and South Dakota. Spencer spends $600 a month on gasoline traveling between the hospitals, which are located up to 70 miles in all directions from his home. Some days he works 6 a.m. to 11 p.m. On days when he's on call and doesn't get any cases, Spencer doesn't get paid.

"It takes a uniquely dedicated professional to be out here providing services for these patients," says Spencer, who is the Region 4 director for the AANA. "I love the fact that the patients get to know me on a first-name basis. They count on me and trust me with something pretty sacred, which is the loss of control for them. They trust me to put them to sleep and wake them up."

Rigorous Education Leads to Healthy Salary

Nurses seeking to apply to one of the more than 100 US nurse-anesthesia programs must have a bachelor's degree, a nursing license and at least a year's experience in an acute-care setting. The education is rigorous and competitive, with four to six applicants for every student accepted into a program, Spencer says. The programs last 24 to 36 months and include clinical training in university-based or large community hospitals. Following graduation with a master's degree, the aspiring nurse anesthetist must pass a national certification exam.

Six-figure salaries await newly minted CRNAs. The mean salary for 2003 graduates was $120,000, according to the AANA's 2004 Practice Profile Survey. However, most new CRNAs are saddled with student loans of $50,000 to $80,000, Spencer says.

Nurse-anesthesia programs must produce 1,500 to 1,800 new graduates a year to meet the demand for CRNAs expected by 2010, the AANA says. The new blood will be critical, given that the average age of CRNAs is projected to peak at just older than 48 in 2018. "We need some young folks to pick up the slack and carry on," Spencer says.