









































Volume 6 - No. 9 2018

Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 6 - No. 9 2018 

Anesthesia eJournal - Online
ISSN 2333-2611

Page 41

Contributions of South Korean Registered Nurses in Anesthesia Practice
Michong Rayborn, DNP, CRNA1 
Gyeseon Jeong, PhD, CRNA2

Hwanseok Choi, PhD1

SatAnanda Hayden, PhD, MSN, RN3

1
Affiliation:
Dr Rayborn is corresponding author and Assistant Professor at University of Southern Mississippi, Hattiesburg

2Dr Jeong is co-corresponding author and Assistant Professor in the Chosun College  Nursing, Kwang Ju, South Korea
3Dr Hayden is Director of Clinical Information Systems, Forrest General Hospital, Hattiesburg, Mississippi 

Funding/Conflict of Interest Disclosure: 
This study received a grant from the International Federation of Nurse Anesthetists (IFNA) Foundation Research Grant 2017.

Discussion: RNAs are an integral part of anesthesia services in Korea, although they are not certified and lack clear scope of practice. The authors recommend a pathway for 
RNAs to obtain advanced degrees and certification as anesthesia providers.

KEYWORDS: Certified Registered Nurse Anesthetist (CRNA), Registered Nurse in Anesthesia (RNA), Scope of Practice, Elements 
of Anesthesia Care

INTRODUCTION

Globally, nurses today are involved in a variety of anesthesia practices.1 South Korea is not an exception; however, there are 
currently not enough certified registered nurse anesthetists (CRNAs) to meet the country’s need. To overcome the shortfall, 
registered nurses (RNs) are trained by anesthesiologists in their hospital workplace to provide anesthesia-related services. 
However, these trained RNs lack certification by national examination.2 This study assessed RN and CRNA involvement in 
providing anesthesia care in South Korea, the degree of autonomy of these nurse anesthesia providers, and the presence of a 
scope of practice or guidelines for providing anesthesia.
A previous study examined the contributions of both CRNAs and uncertified RNs in South Korea.  Several startling 
facts were revealed regarding South Korean nurse anesthesia practice.2  The authors noticed that the number of practicing 
CRNAs was declining in the country. Only one university in the country currently offered a graduate CRNA program. 
The authors also discovered that, to meet the provider shortfall, hospitals often trained RNs in-house to provide anesthesia 
services.2 

Abstract
Introduction: Certified Registered Nurse Anesthetists (CRNAs) were recognized by law as legitimate anesthesia 
providers in Korea 44 years ago. Since 2005, CRNAs have been educated at the graduate level and certified by national 
examination. In recent years, the number of graduate educational programs has decreased and the number of practicing 
CRNAs has declined correspondingly. To meet the shortfall, hospitals train registered nurses to perform anesthesia. This 
study examined registered nurses in anesthesia (RNAs) and CRNAs in anesthesia care in South Korea. 
Materials and Methods: A confidential survey was administered to a sample of 308 nurses in anesthesia practice. The 
chi-square independent test and independent two-sample t-test for continuous variables were used for comparison. 
Results: While all were involved in anesthesia, RNAs were more likely to work under supervision. Almost 34% of the 
participants planned to leave anesthesia practice within the next 5 years, and nearly 20% of participants indicated that 
they planned to retire within 5 years. 

AEJ



Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 6 - No.9 2018 Page 42

Nurse anesthesia practice in South Korea has its roots in the af-
termath of the Korean War. At that time there was a critical need 
for anesthesia services due to the many military and civilian war 
injuries, as well as from refugees flooding the country from the 
north.2-4 There were only a limited number of anesthesiologists 
in the country, and the Korean military trained the first nurse 
anesthetists in 1961 to help meet the shortfall.2-5

One of the most influential advocates for nurse anesthesia in 
the country at that time was an American woman named Sister 
Margaret Kollmer. She arrived in the country in 1964 as a young 
CRNA assigned to Maryknoll Hospital in Pusan, South Korea. 
Recognizing a lack of anesthesia providers in country, she decided 
to create a program to train RNs as anesthetists. In 1969 she 
implemented a training program in hospitals. The programs were 
based on the American educational model and consisted of 18 
months of training and supervised practice.2 The CRNAs were 
certified by the hospital where they trained.
For the next 29 years Sister Margaret was the most ardent pro-
moter of nurse anesthesia in Korea.2 But the journey has not al-
ways been smooth and there are still many bumps along the road. 
Her efforts were rewarded in 1973 when the Ministry of Health 
and Welfare formally recognized anesthesia practice by CRNAs. 
At that time, a total of 13 hospitals trained CRNAs. However, 
the number of hospital-based CRNA training programs gradually 
declined over the years.2,3,5

In 2003, South Korean national law recognized CRNAs as legit-
imate advanced practice nurses. The same year, 2 graduate-level 
university CRNA education programs were established. However, 
one university CRNA program closed soon afterward. In 2005, 
the Ministry of Health and Welfare required all new CRNAs to 
earn a master’s degree from an accredited university and to pass a 
national certification examination.2,4,5  
Now, 45 years after the Ministry of Health and Welfare recog-
nized the practice, the number of graduate-level CRNA educa-
tional programs has declined sharply and the number of prac-
ticing CRNAs has decreased correspondingly.2-6 Today, only one 
university offers a graduate degree in nurse anesthesia and that 
program produces about only 10 CRNAs each year.2-5 In a coun-
try of 51 million citizens, that is hardly enough to meet the need.
Since the demand for anesthesia services has not diminished, 
hospitals in Korea have looked for an alternate way to meet the 
shortage of CRNAs and medical residents. RNs are often trained 
on the job as anesthesia providers. Although these nurses are 
trained by the anesthesiologists at the hospital where they work, 
there are no standard training guidelines or established scope of 
practice. Most importantly, these RNs are not certified as anes-
thesia providers by a national examination.4,5

Here we will refer to these uncertified anesthesia providers as 
registered nurses in anesthesia  (RNAs) to differentiate them from 
CRNAs.  Depending on the level of training they receive and 
the location of their practice, these RNAs practice under many 
different job titles. Generally, these nurses are referred to as either 
specialty nurses ( Jeon Dam nurses) or as peri-anesthesia depart-
ment nurses.7

Specialty Nurse ( Jeon Dam Nurse) 
Nurses commonly known as specialty nurses ( Jeon Dam in 
Korea) practice a medical specialty or delegated medical tasks 
or services under a physician’s license.7,8 Most of these specialty 

nurses are not advanced practice nurses and they are not required 
to pass a certification examination by the Ministry of Health and 
Welfare. In 2014, there were an estimated 2220 specialty nurses 
working in different specialties at hospitals throughout the coun-
try. Since there are no standard guidelines for training and scope 
of practice, the roles of specialty nurses are often confused by the 
medical community. Only 14% of specialty nurses are advanced 
practice nurses.7,8 The result is a unique situation that fosters con-
fusion about the identity of these nurses as health care providers, 
as well as their level of training and scope of practice.7 We will 
refer here to specialty nurses who practice anesthesia as anesthesia 
specialty nurses (ASNs).
Peri-Anesthesia Department Nurses
In addition to ASNs, peri-anesthesia department nurses are also 
trained in the hospital where they practice. Like the ASNs, the 
peri-anesthesia department nurse is also deeply involved in anes-
thesia practice. Depending on the location of their practice, they 
may be referred to as anesthesia department nurses, operating 
room nurses, or recovery room nurses.7 Like the specialty nurses, 
these nurses do not receive formal university anesthesia training 
and are not required to pass a certification examination. They 
practice various levels of anesthesia under physician supervision.
The Korean Association of Nurse Anesthetists
There is a professional organization in place for nurse anesthetists 
in Korea. Shortly after successfully lobbying of the Ministry of 
Health and Welfare for recognition of CRNAs, Sister Margaret 
Kollmer realized the need for a professional organization.2-5 She 
was the catalyst in the formation of the Korean Association of 
Nurse Anesthetists (KANA). Modeled after the American As-
sociation of Nurse Anesthetists (AANA), KANA is an advocate 
for the advancement of nurse anesthetists and for patient safety. 
Today, KANA membership is open to both CRNAs and RNAs.2

It is easy to understand the confusion regarding RNAs in Korea, 
with so many different job titles and the absence of specific 
guidelines for training and practice. Although there are many 
Korean studies examining the role of specialty nurses, there are 
no current studies that have focused specifically on anesthesia 
practice by ASNs or peri-anesthesia department nurses.7-10

Depending on level of training and location of employment, 
RNAs are involved in various levels of anesthesia services, in-
cluding administering anesthesia.  However, unlike CRNAs, the 
exact number of RNAs is not known and their scope of practice 
is not clear. This leads to confusion between roles of RNAs and 
CRNAs.
Purpose of Research
The purpose of this study was to assess the involvement of RNs 
including RNAs and CRNAs in anesthesia care in South Korea. 
To achieve this purpose, we sought to determine which elements 
of anesthesia practice these RNAs and CRNAs are performing. 
Additionally, we examined whether these nurse anesthesia provid-
ers are engaging under direct supervision by anesthesiologists and 
surgeons or whether they practice with some degree of autonomy. 
The other desired outcome was to determine whether there is a 
defined scope of practice for these 2 levels of nurse anesthesia 
providers.
  Finally, this study highlights the contributions of nurses to 
anesthesia practice in Korea. The aim was to provide information 



Anesthesia eJournal          www.anesthesiaejournal.com
Volume 6 - No. 9 2018 Page 43

that may help to establish guidelines to develop the scope of 
practice for the different levels of nurse anesthesia providers. We 
also advocate for reestablishing and strengthening graduate-level 
education for CRNAs so they may reach their full potential as 
advanced practice nurses. 
BACKGROUND 
Anesthesia Providers and Scope of Practice in the United 
States
In the United States, anesthesia services can be provided by either 
physician anesthesiologists, CRNAs, or anesthesiology assistants 
(AAs). These 3 groups are the only professionals qualified to 
administer anesthesia. Their scopes of practice are clearly defined 
and all are certified by their governing body after completing 
graduate-level education. This system is structured and governed 
to ensure public safety and to protect the profession.11 
Physician Anesthesiologist
Physician anesthesiologists are medical doctors who specialize in 
anesthesia practice. After undergraduate school, they complete 
4 years of medical school to earn either a Doctor of Medicine 
(MD) degree or a Doctor of Osteopathic Medicine (DO) degree. 
Upon completing a 4-year residency, physicians are eligible to sit
for the American Board of Anesthesiology (ABA) examination. 
According to the American Society of Anesthesiologists, about
75% of anesthesiologists are board-certified.12 In 2017 there were
46,971 anesthesiologists practicing in the United States.13

Anesthesiology Assistant
AAs work under direction from licensed anesthesiologists.12,14 
To earn certification, they must complete a 4-year undergraduate 
degree and satisfactorily complete an accredited AA graduate 
education program and pass the National Commission for Cer-
tification of Anesthesiologist Assistants (NCCAA) examination. 
The National Board of Medical Examiners (NBME) provides 
performance information for the test. According to the NCCAA, 
there are approximately 2300 AAs currently practicing in the 
United States (NCCAA, email communication, March 27, 2018)
Certified Registered Nurse Anesthetist
Nurse anesthetists have practiced in the United States for more 
than 150 years, dating back to the American Civil War. They 
were the first recognized advanced practice nursing specialty and 
were first credentialed in 1956. When anesthesia is administered 
by a nurse anesthetist, it is recognized as the practice of nursing, 
whereas anesthesia administered by a physician anesthesiologist 
is recognized as the practice of medicine.15,16 CRNAs admin-
ister approximately 43 million anesthetics to patients each year 
in the United States.  There are approximately 52,000 CRNAs 
practicing in the United States today.16 

CRNAs in the United States are educated at either the master’s 
or doctoral level under strict guidelines established by the Coun-
cil on Accreditation of Nurse Anesthesia Educational Programs 
(COA). After completing a graduate of nurse anesthesia educa-
tional program, they must pass the National Certification Exam-
ination (NCE).  CRNAs are required to recertify every 8 years 
through the Continued Professional Certification (CPC) Pro-
gram, which is administered by the National Board of Certifica-
tion and Recertification for Nurse Anesthetists (NBCRNA).11,16 

Most importantly, all US anesthesia providers must complete an 
accredited educational program at either the master’s, doctoral, 
or physician level. All CRNAs, AAs, and most physician anes-
thesiologists are certified by national examination and all practice 
under clearly established scopes of practice. The level of autono-
mous practice may vary from state to state.16 However, such is not 
necessarily the case in South Korea. There, anesthesia providers 
may be either board-certified physicians or CRNAs, but may 
also be RNAs who have not completed graduate-level anesthesia 
training or passed a board-administered certifying examination. 
The disparity between training and practice guidelines for nurse 
anesthetists in the United States and Korea was the catalyst for 
this study.
Scope of Practice and Application to this Study
There are 4 essential elements of anesthesia care: pre-anesthetic 
evaluation and preparation of equipment and anesthetic drugs; 
anesthesia induction, maintenance, and emergence; post-anesthe-
sia care; and peri-anesthetic support functions.11 Each element 
of anesthesia is vital for successful anesthesia performance and 
positive patient outcomes. A misstep or miscalculation in any area 
may have detrimental consequences for the patient.11

We identified 9 specific anesthesia-related tasks to examine as the 
basis of the study. The 9 tasks were as follows: pre-anesthetic as-
sessment, prescribing an anesthetic plan, checking the anesthesia 
machine and required materials, administering or injecting induc-
tion agents, inserting an endotracheal tube, managing emergence 
from anesthesia and deciding when to remove the endotracheal 
tube, post-anesthetic and pain management, performing regional 
blocks, and documenting anesthesia notes. All 4 essential ele-
ments and all 9 anesthesia tasks were evaluated during this study.
 MATERIALS AND METHODS
Data Collection and Procedures 
This study was conducted with approval from the University 
of Southern Mississippi Institutional Review Board and with 
support from the KANA.  It was a follow-up to a similar study 
conducted by surveying KANA members in 2015.2 The survey 
questions were adapted from a 2014 membership profile survey 
developed and administered by the AANA. With a few modi-
fications, a total of 17 revised survey questions were designed to 
obtain sociodemographic information and detailed status of the 
level of anesthesia practice by RNs in South Korea. The survey 
questions were translated into the Korean language. The trans-
lation and cultural accommodations were validated by South 
Korean CRNAs currently practicing in the United States, as well 
as by CRNAs and RNAs in South Korea (Table 1).2

The survey was administered confidentially via both email and 
post mail to RNAs and CRNAs in 3 cities (Seoul, Incheon, 
and Kawang-Ju) and 3 different provinces (Kyong-gi province, 
Kyoung-sang province, and Jeol-ra province) from March 18 to 
September 30, 2017. Participation was voluntary and informed 
consent was verified when respondents completed and submitted 
the survey. Respondents submitting the survey with 50% or more 
of the questions unanswered were considered to have withdrawn 
their consent to participate, and their responses were removed 
from the study. A total of 325 surveys were returned, and among 
those, 308 surveys were included in the study. All data collected 
and used for this study remained anonymous. 

https://en.wikipedia.org/wiki/Medical_school
https://en.wikipedia.org/wiki/Doctor_of_Medicine
https://en.wikipedia.org/wiki/Doctor_of_Osteopathic_Medicine
https://en.wikipedia.org/wiki/Residency_(medicine)


Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 6 - No. 9 2018 Page 44

Data Analysis
Descriptive statistics were used to identify the characteristics of 
the participants. The chi-square independent test for categorical 
variables and the independent two-sample t-test for continuous 
variables were performed using SAS 9.3 (SAS Institute Inc) to 
compare components of practice between CRNAs and RNAs. 
RESULTS
A total of 308 respondents were included in the study. The 
respondents’ mean age was 33.53 years (SD = 7.95 years), and 
the average years of experience was 8.34 years (SD = 7.2 years). 
More than 85% of the respondents had bachelor’s degrees or less 
(n=267; 86.69%), while only 21 (6.81%) had master’s degrees or 
higher. Almost all of them worked full-time (n=302; 98.05%). 
Around 67% of the participants (n=193) were working in a uni-
versity hospital with more than 300 beds, whereas only about 10% 
(n=29) worked in hospitals with fewer than 100 beds.
From the total sample, only 42 respondents identified themselves 
as CRNAs (13.64%), whereas 266 identified themselves as RNAs 
(86.36%). The RNAs worked under a number of different job 
titles, such as anesthesia department nurse (n=152), anesthesia 
specialty nurse (n=14), recovery room nurse (n=89), and operating 
room nurse (n=11). Among RNAs, more than half indicated they 
would like to pursue graduate-level education to become CRNAs 
(n=171; 55.52%). Interestingly, almost 34% of the participants 
planned to leave anesthesia practice within the next 5 years, be-
fore they are eligible for retirement (n=104; 33.76%).  In addition, 
almost 20 % of participants indicated they plan to retire within 5 
years (n=60; 19.49%) (Table 2).
Table 3 shows the chi-square test results between CRNAs and 
RNAs for 4 separate variables: hospital size, education level, age, 
and years of experience. According to the chi-square test results, 
the 2 groups had different percentages in each category (x2 = 
37.86; p < 0.001). RNAs were working mostly in the larger hospi-
tal (92.8%), while more than half of the CRNAs were working in 
mid-size hospitals or hospitals with fewer than 100 beds (73.8%). 
Almost half of the CRNAs had at least a master’s degree, whereas 
the majority of the RNAs had bachelor’s degrees or less (92.2%).
For the continuous variables such as age and years of experience, 
t-tests were performed.  As expected, the CRNAs were older and 
more experienced (42.3 years old and 15.8 years of experience) 
than were the RNAs (32.1 years old and 7.2 years of experi-
ence). Satterthwaite t-tests were done in case the equal variance 
assumption was violated (Table 3).
Table 4 compares jobs and tasks between the 2 groups. There were 
no significant differences between the 2 groups in the percent-
age of time spent on clinical activities, education, management/
administration, research, and consultation. The variable labeled 
“anesthesia practice” looked at 9 anesthesia tasks selected by the 
authors. CRNAs were significantly more involved in 5 of the 
9 tasks (prescribe anesthetic plan, insert endotracheal tube and 
laryngeal mask airway, manage emergence from anesthesia and 
decision to remove endotracheal tube, post-anesthetic manage-
ment, and perform regional blocks). The other tasks that were 
not statistically significant also had more percentages of CRNAs 
involved.
There was a statistically significant difference in the level of phy-
sician supervision between the 2 groups (x2 = 9.548; p = 0.002). 
RNAs were more likely to work under supervision (n=224; 

84.2%) than were CRNAs (n=27; 64.3%). For most of the anes-
thesia activities, RNAs were supervised by the anesthesiologist 
more often, except for performing post-anesthetic assessment and 
periodically monitoring anesthetic course. Surgeon involvement 
in anesthesia practice was not statistically significant, regardless of 
whether they were certified (x2 = 0.877; p =0.349) (Table 4).
Table 5 highlights the lack of standardized scope of practice for 
RNAs. In this table, the RNAs are separated depending on the 
job title they worked under. These job titles are anesthesia depart-
ment nurse (n=152), anesthesia specialty nurse (n=14), recovery 
room nurse (n=89), and operating room nurse (n=11).  This table 
makes it clear that the RNAs, by any title, were involved in the 
same 9 anesthesia tasks as the CRNAs. For example, 13 of the 14 
(92.6%) respondents who identified as ASNs routinely inject-
ed induction drugs. Interestingly, of the 89 respondents who 
identified as recovery room nurses, 78 (87.6%) injected induction 
drugs, 19 (21.3%) performed intubation, and 4 (4.5%) personally 
performed regional blocks. Clearly, these 4 categories of RNAs 
were involved in a wide range of anesthesia tasks, but without a 
standardized scope of practice (Table 5).
DISCUSSION
The data analysis points to 4 important trends regarding the 
future of RNAs in Korea’s health care system. First, there is a 
great need for their services. With only one university graduate 
program producing 10 or fewer CRNAs per year,4 the country 
must fill the provider gap, and RNAs help to meet the need. 
Second, RNAs currently are involved in all 4 anesthesia essential 
elements to varying degrees. In fact, there was no significant dif-
ference in the time spent on clinical practice, education, research, 
or administrative tasks between the 2 groups, but CRNAs did 
tend to spend more time on patient consultation. Furthermore, 
RNAs were also involved in performing all 9 anesthesia tasks, 
although CRNAs were likely to be more involved in each task. 
Third, although most RNAs held only a bachelor’s degree or less, 
almost 56% indicated that they would like to pursue an advanced 
degree as a CRNA. However, graduate opportunities to progress 
from RNA to CRNA are very limited. The fourth trend is that 
RNAs worked under different job titles, which may imply they 
are not recognized properly as anesthesia providers. 
Despite the lack of recognition by job title, RNAs are involved 
in all elements of anesthesia practice. The combination of these 
trends leads us to conclude that an educational pathway from 
RNA to CRNA would be beneficial to both individual practi-
tioners and the health care system in Korea.
There are also several interesting trends regarding CRNAs. First, 
CRNAs describe greater independence in anesthesia practice 
than do RNAs. As a percentage of the sample, they are also 
significantly more involved in the 9 anesthesia tasks and the 4 
elements of anesthesia practice. This is reasonable because they 
are certified, tend to be older, have more years of experience, and 
are more likely to hold advanced degrees. However, the number 
of practicing CRNAs is declining and the one remaining gradu-
ate-level educational program is not likely to replace the numbers 
lost through attrition.
The RNAs are working mostly in large university hospitals 
(92.8%) and perform most anesthesia activities under anesthesiol-
ogist supervision. More than half of the CRNAs work in mid-
sized hospitals or hospitals with fewer than 100 beds (73.8%). 



This result mirrors the findings of Bae et al, who compared the 
job task and task elements of Korean nurse anesthetists by the 
size of the medical institution.6 CRNAs are more likely to work 
without an anesthesiologist’s supervision.
Alarmingly, almost 34% of participants plan to leave anesthesia 
practice before retirement within 5 years (n=104; 33.76%). Also, 
almost 20% of nurses practicing anesthesia are expected to retire 
within 5 years (n=60; 19.49%), which exacerbates the critical 
nurse anesthesia shortage. On the basis of this survey, we could 
expect tremendous shortages of anesthesia nurses whether they 
are certified or not within 5 years. We are not sure why one-third 
of practitioners want to leave anesthesia before their permanent 
retirement from nursing. One possible reason is the lack of a 
pathway to advanced education for RNAs. 

The results of our study suggest that RNAs are an integral part of 
anesthesia services in Korea. Our major concerns are that RNAs 
do not have required certifications for nurse anesthesia and there 
are no clear standards for their education and scope of practice. 
As a possible solution, we recommend a university-led effort to 
provide an educational pathway for RNAs to obtain advanced 
nursing degrees and certification as anesthesia providers. Any 
such educational program should provide clear guidelines for 
training and for the scope of practice. This would require the sup-
port of not only the universities, but also the hospitals, anesthesi-
ologists, and possibly the national legislature. As an advocate for 
patient safety, KANA is the most logical organization to lead the 
campaign to implement such a program. This would be the first 
step to ensuring a ready supply of highly qualified nurse anesthe-
tists to meet the country’s future need. 

Anesthesia eJournal          www.anesthesiaejournal.com
Volume 6 - No. 9 2018 Page 45



References

1. McAuliffe MS, Henry B. Countries where anesthesia is administered by nurses.  AANA J. 1996;64(5):469-479.
2. Rayborn M, Jeong G, Hayden S, Park S. The future of certified registered nurse anesthetists in South Korea: fading into the 

sunset or breaking of a new dawn. AANA J. 2017;85(5):361-367.
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Pusan; 2014:1-114.
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www.korea-ana.co.kr/v3/sub2_01.php. Published 2015. Accessed Feb 1, 2018.
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9. Lee HJ. Role adoption process for physician assistant. Asia-Pacific Journal of Multimedia Services Convergent with Art, 
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11. Foster S, Faut-Callahan M. A Professional Study and Resource Guide for the CRNA.  Park Ridge, IL: AANA Publishing; 2014.
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Profession.aspx. Accessed November 22, 2017.
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number-of-active-physicians-by-specialty-area/. Accessed November 22, 2017.
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Anesthesiologist Assistants (AAs). https://iowacrnas.com/wp-content/uploads/2017/03/crna-aa-comparison-table-
update-102014-1.pdf. Accessed November 26, 2017.

15. Bankert M. Watchful Care: A History of America’s Nurse Anesthetists. New York: Continuum Publishing Company; 1989:164.
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Volume 6 - No.9 2018 Page 46

http://www.korea-ana.co.kr/v3/sub2_01.php
http://www.korea-ana.co.kr/v3/sub2_01.php
https://doi.org/10.11111/jkana.2013.19.2.239
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https://www.aana.com/membership/become-a-crna/crna-fact-sheet
https://www.aana.com/membership/become-a-crna/crna-fact-sheet


Table 1. Korean Nurse Anesthetist Survey Questionnaire

1. What is your job title in your organization?
a. Certified Registered Nurse Anesthetist
b. Anesthesia Department nurse
c. Anesthesia specialty nurse
d. Recovery room nurse
e. Operating room Nurse

2. Indicate your current employment status
a. Full-time (> 35 hours per week) b. part-time

3. indicate where is your anesthesia practicing setting
a. university hospital (More than 300 hospital beds)
b. Middle sized hospital (100-300 hospital beds)
c. Freestanding surgical center (Outpatient center)
d. Doctor’s office/Clinic

4. Indicate the percentage of time you spend in each of the 
following positions (The total must add to 100%)
a. Clinical practice      b. Education 
c. Department Management/Administration
d. Research e. Consultation

5. What year you were born? (age)
6. Please mark your highest levels of education completed

a. Associated/Diploma
b. Baccalaureate in Nursing
d. Master’s in Anesthesia
e. Doctorate

7. Do you have nurse anesthesia certification? If you do,
where was it obtained?

a. No, I do not have nurse anesthesia certification
b. Associated /Diploma
c. Baccalaureate in Nursing
d.  Master’s in Anesthesia

a. 1 year or less

8. Do you like pursue university graduate level education to 
be a Certified Registered Nurse Anesthetists?

a. Yes    b. No
9. How long have you been practicing as a nurse anesthe-
tist?

b. 2-5 years 
c. 6-10 years d. 11-20 years
e. 21-30 years f. 31 or more years

10. What year do you plan to leave anesthesia practice
before your complete retirement from Nursing Practice?

a. Spinal

11. What year do you expect to retire completely from Nursing 
practice?
12. Check ALL that you do following anesthesia hand on prac-
tice:

a. Pre-anesthetic assessment
b. Prescribe anesthetic plan
c. Prepare anesthetic material and check anesthesia machine
d. Injections anesthetic drugs during induction
e. Insertion endotracheal tube and laryngeal mask airway
f. Managing of emerging, and decision of removal of airway
g. Post anesthetic management include pain management
h. Personally perform regional blocks
i. Documentation of anesthesia note

13. Check ALL that you do following anesthesia hand on prac-
tice:

b. Epidural 
c. Bier d. Brachial plexus
e. Femoral f. Popliteal-Saphenous
g. Ankle block

14. Do you work in an anesthesia practice, where the anesthesi-
ologist supervises the nurse anesthetist?
15. Of the anesthetics you personally administer, how often is an 
anesthesiologist involved in the following anesthesia activities?

a. Pre-anesthetic assessment
b. Prescribe anesthetic plan
c. Present at induction
d. Present for emergencies or urgent situations
e. Present for emerging from anesthesia
f. Perform post-anesthetic assessment
g. Periodically monitor anesthetic course

16. Do you work in an anesthesia practice, where the surgeon 
supervises the nurse anesthetist?
17. Of the anesthetics you personally administer, how often is a 
surgeon involved in the following anesthesia activities?
18. Same as 15. 

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Volume 6 - No. 9 2018 Page 47



Table 2. Descriptive Statistics (N = 308)
Variable No. (%) Mean (SD)
CRNA

Yes
No

42 (13.64)
266 (86.36)

Full-time
Yes
No

302 (98.05)
6 (1.95)

Age 33.53 (7.95)
Years of experience 8.34 (7.16)
Education

Associate
BA in nursing

BA in other fields
MA in nursing

MA in anesthesia
MA in other fields

Doctorate

72 (23.38)
193 (62.66)

2 (0.65)
20 (6.49)
17 (5.52)
3 (0.97)
1 (0.32)

Job title
CRNA

Anesthesia department nurse
Anesthesia specialty nurse

Recovery room nurse
Operating room nurse

42 (13.64)
152 (49.35)

14 (4.55)
89 (28.90)

11 (3.57)
Working hospital size 

University hospital (>300 beds)
Middle-sized hospital (100–300 beds)

Freestanding surgical center (<100 beds)
Doctor’s office/clinic

193 (67.25)
65 (22.65)
23 (8.01)
6 (2.09)

Would you like to pursue university graduate-level education to be a certified regis-
tered nurse anesthetist?                                

Yes
No

171 (55.52)
137 (44.48)

When do you plan to leave anesthesia practice before your retirement from nursing 
practice?

2017 to 2019
2020 to 2022

After 2022

31 (10.06)
73 (23.7)

204 (66.23)
When do you expect to retire completely from nursing practice?

2017 to 2019
2019 to 2022

After 2022

14 (4.55)
46 (14.94)

248 (80.52)
Abbreviation: CRNA, certified registered nurse anesthetist.

Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 6 - No.9 2018 Page 48



Table 3. Bivariate Analyses Between CRNAs and RNAs

Variable Certified 
Group

(CRNAs)

Non-certi-
fied Group 

(RNAs)

Test Test Statistic p

Working hospital size, No. (%)
University hospital (>300 beds)

Middle-sized hospital (100–300 beds)
Freestanding surgical center (<100 beds)

Doctor’s office/clinic

11 (26.2)
16 (38.1)
12 (28.6)

3 (7.1)

186 (69.9)
61 (22.9)
14 (5.3)
5 (1.9)

χ2 * 37.856 < 0.0001

Education, No. (%)
Associate

BA in nursing
BA in other fields

MA in nursing
MA in anesthesia

MA in other fields
Doctorate

8 (19.1)
14 (33.3)

0 (0.0)
5 (11.9)

14 (33.3)
0 (0.0)
1 (2.4)

64 (24.1)
179 (67.3)

2 (0.8)
15 (5.6)
3 (1.1)
3 (1.1)

0

χ2 * 43.299 < 0.0001

Age, y, mean (SD) 42.31 (8.28) 32.14 (6.97) t-test 8.56 < 0.0001
Years of experience, mean (SD) 15.76 (8.34) 7.16 (6.20) t-test** 6.41 < 0.0001
Abbreviations: CRNA, certified registered nurse anesthetist; RNA, registered nurse in anesthesia.
*Due to the lack of cell frequencies, Cochran-Mantel-Haenszel (CMH) chi-square test was done.
**Due to the equal variance assumption violation, Satterthwaite t-test statistic was applied.

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Volume 6 - No. 9 2018 Page 49



Table 4. Comparison of Jobs and Tasks Between CRNAs and RNAs

Variable CRNAs RNAs  Test Test Sta-
tistic

p

Percentage of time spent, %, mean (SD) 
Clinical practice

Education
Management/administration

Research
Consultation

Other

77.3 (23.5)
 7.3 (6.7)

11.6 (16.4)
1.31 (3.1)
1.31 (3.1)
1.19 (3.1)

81.2 (20.5)
7.4 (9.2)

8.5 (15.0)
0.73 (2.4)
0.72 (2.2)
1.34 (3.4)

t-test
t-test*
t-test
t-test*
t-test*
t-test

1.14
0.02
1.24
1.14
1.18
0.27

0.25
0.98
0.21
0.26
0.24
0.79

Anesthesia practice, No. (%)
Pre-anesthetic assessment
Prescribe anesthetic plan

Check anesthesia machine and material
Injections of induction drugs 

Insertion endotracheal tube 
Managing of emergence and  

decision of removal of endotracheal tube
Post-anesthetic and pain management

Perform regional blocks
Documentation of anesthesia note

31 (73.8)
22 (52.4)
40 (95.2)
40 (95.2)
23 (54.8)

22 (52.4%)
39 (92.9%)
17 (40.5%)
39 (92.9%)

165 (62.0)
54 (20.3)

254 (95.5)
243 (91.4)
59 (22.2)

41 (15.4%)
213 (80.1%)

12 (4.5%)
223 (83.8%)

χ2

χ2

χ2

χ2

χ2

χ2

χ2

χ2

χ2

2.18
20.08
0.005
0.734
19.71

30.47
3.98

55.01
2.32

0.14
< 0.001

0.94
0.39

< 0.001

< 0.001
0.046

< 0.001
0.13

Do you work in an anesthesia practice, where the anesthesiologist 
supervises the nurse anesthetist? No.(%)

Yes
No

27 (64.3)
15 (35.7)

224 (84.2)
42 (15.8)

χ2 9.548 0.002

Of the anesthetics you personally administer, how often is an anes-
thesiologist involved in the following anesthesia activities? Mean 
(SD)

Pre-anesthetic assessment
Prescribe anesthetic plan

Present at induction
Present for emergencies & urgent situations

Present for emergence from anesthesia
Perform post-anesthetic assessment

Periodically monitor anesthetic course

3.29 (1.81)
3.47 (1.77)
3.50 (1.76)
3.79 (1.65)
3.79 (1.68)
3.33 (1.66)
2.98 (1.69)

3.71 (1.55)
3.87 (1.52)
4.36 (1.22)
4.45 (1.15)
4.49 (1.17)
3.69 (1.39)
3.34 (1.32)

t-test
t-test

t-test**
t-test**
t-test**
t-test

t-test**

1.62
1.52
3.05
2.52
2.62
1.51
1.34

0.105
0.129
0.004
0.015
0.012
0.132
0.186

Do you work in an anesthesia practice where the surgeons supervise 
the nurse anesthetist? No. (%)

Yes
No

23 (54.8)
19 (45.2)

125 (47.0)
141 (53.0)

χ2 0.877 0.349

Of the anesthetics you personally administer, how often is a surgeon 
involved in the following anesthesia activities? Mean (SD)

Pre-anesthetic assessment
Prescribe anesthetic plan

Present at induction
Present for emergencies or urgent situations

Present for emergence from anesthesia
Perform post-anesthetic assessment

Periodically monitor anesthetic course

2.43 (1.65)
2.45 (1.86)
2.38 (1.83)
2.83 (1.65)
2.19 (1.64)
2.14 (1.72)
2.19 (1.60)

2.08 (1.64)
2.12 (1.70)
2.11 (1.58)
2.80 (1.55)
1.97 (1.40)
1.95 (1.45)
2.09 (1.35)

t-test
t-test
t-test
t-test
t-test
t-test
t-test

1.27
1.17
1.00
0.14
0.93
0.76
0.45

0.205
0.241
0.318
0.889
0.354
0.448
0.652

Abbreviations: CRNA, certified registered nurse anesthetist; RNA, registered nurse in anesthesia.

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Volume 6 - No.9 2018 Page 50



Table 5. Anesthesia Hands-on Practice of the Participants (N = 308)
CRNAs, No. (%)

(n=42)
Anesthesia Dept. 
Nurse, No. (%)

(n=152)

Anesthesia Specialty 
Nurse, No. (%)

(n=14)

Recovery Room 
Nurse, No. (%)

(n=89)

Operating Room 
Nurse, No. (%)

(n=11)

Yes No Yes No Yes No Yes No Yes No

Pre-anesthetic assessment 36
(85.7)

6
(14.3)

95
(62.5)

57
(37.5)

5
(35.7)

9
(64.3)

52
(58.4)

37
(41.6)

8
(72.7)

3
(27.3)

Prescribe anesthetic plan 25
(59.5)

17
(40.5)

29
(19.1)

123
(80.9)

1
(7.1)

13
(92.9)

20
(22.5)

69
(77.5)

1
(9.1)

10
(90.9)

Prepare anesthetic material and check anes-
thesia machine

42
(100.0)

0
(0.0)

146
(96.1)

6
(3.9)

14
(100.0)

0
(0.0)

81
(91.0)

8
(9.0)

11
(100.0)

0
(0.0)

Inject anesthetic drugs during induction 41
(97.6)

1
(2.4)

140
(92.1)

12
(7.9)

13
(92.6)

1
(7.1)

78
(87.6)

11
(12.4)

11
(100.0)

0
(0.0)

Insert endotracheal tube and laryngeal mask 
airway

27
(64.3)

15
(35.7)

34
(20.9)

118
(77.6)

2
(14.3)

12
(85.7)

19
(21.3)

70
(78.7)

0
(0.0)

11
(100.0)

Manage emergence and
decision of removal of endotracheal tube

26
(61.9)

16
(38.1)

22
(14.5)

130
(85.5)

7
(50.0)

7
(50.0)

7
(7.9)

82
(92.1)

1
(9.1)

10
(90.9)

Post-anesthetic management including pain 
management

41
(97.6)

1
(2.4)

122
(80.3)

30
(19.7)

10
(71.4)

4
(28.6)

72
(80.9)

17
(19.1)

7
(63.6)

4
(36.4)

Personally perform regional blocks: spinal, 
epidural, Bier etc

21
(50.0)

21
(50.0)

4
(2.6)

148
(97.4)

0
(0.0)

14
(100.0)

4
(4.5)

85
(95.5)

0
(0.0)

11
(100.0)

Documentation of anesthesia notes 40
(95.2)

2
(4.8)

139
(91.4)

13
(8.6)

12
(85.7)

2
(14.3)

62
(69.7)

27
(30.3)

9
(81.8)

2
(18.2)

Summary of Key Points
• In the South Korean health care system, RNs are an integral part of anesthesia services. These nurses work under different job 
titles, which may imply that they are not recognized properly as anesthesia providers.

• Depending on the hospital in which these nurses practice, they may be referred to by a number of different job titles, including 
anesthesia department nurse, anesthesia specialty nurse, operating room nurse, or even recovery room nurse. Regardless of job title, 
all are involved in providing anesthesia to some degree.

• This study revealed that a significant number of both RNAs and CRNAs plan to retire within 5 years. This will likely result in a 
future shortage of nurse anesthesia providers in the country.

• The authors are concerned that the RNAs are not required to pass a national certifying examination and that there are no clear 
standards for their education and scope of practice.

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