Becoming a Certified Registered Nurse Anesthetist offers plenty of unique opportunities, and it all starts with finding and applying to the right program for you. With a nursing degree under your belt, you are already familiar with the application process, but there are a few key things to consider when pursuing an advanced degree—from shadowing and mentoring programs to important family discussions.
CRNA programs want candidates with ICU nurse externship experience and a high GPA, but if your grades reflect a less-than-stellar performance, there are ways to mitigate this deficiency. Your goal is to be the most competitive person in the applicant pool. "Often, we would have candidates that were less than optimally academically focused in their undergraduate programs, particularly around core courses that ended up with a marginal science GPA," says Art Zwerling, D.N.P., D.A.A.P.M., American Association of Nurse Anesthetists Senior Peer Assistance Advisor and former Director of the University of Pennsylvania's Nurse Anesthesia Program. "Sometimes these folks are able to demonstrate their current level of maturity and focus either retaking a core course, science course, or taking one or two graduate level science courses such as pathophysiology and/or pharmacology." You can elect to retake courses in chemistry or biochemistry, or complete graduate nursing research as well. This will not only demonstrate to the admission committee your ability to handle graduate course work, but will also provide a welcomed boost to your GPA.
Most programs require standardized tests like the GRE as a prerequisite for admission. For many, this can feel like taking the SATs all over again. "I prepared by studying aggressively for the GRE exam," says Macario Acosta, B.S.N., C.C.R.N., a nurse currently in the midst of applying to a nurse anesthesia program. "I purchased a GRE review book with a CD and Web access so that I had as many practice questions as possible." According to Dr. Zwerling, applicants often make significant improvements in their relative academic competitiveness by taking practice exams, enrolling in a formal preparation course, or utilizing one of the GRE review texts.
Your essay should exhibit CRNA shadowing experience, ICU experience, financial and academic preparedness, and the emotional fortitude to progress through a demanding nurse anesthesia program. While you are writing the essay, preparing for tests, and taking additional classes, you can do an exhaustive search for anesthesia programs that best fi t your needs through a professional association, such as the AANA (www.aana.com).
Enrolling in a CRNA program means committing 27–32 months to rigorous course work and a demanding class schedule. It will certainly impact your lifestyle and family dynamic, so it's important to engage in a heartfelt discussion with your loved ones. "I sat down with my husband regarding the possibility of returning to school," says Yolanda Salas-Lee, C.R.N.A., M.S.N. "Upon getting accepted, I shared an article with my husband regarding the hardships of the program, how things will change in our lives, and how relationships are put through a test. My family and friends are my world and it was difficult for me not to be able to participate in family functions."
The financial considerations require taking an inventory of your current situation and planning accordingly, as you will likely no longer be employed full time. "I began saving a year in advance," Salas-Lee says. "I would look at the monthly bills and see which ones I can eliminate, as well as credit card debt. I did a lot more cooking for meals instead of going out to restaurants while in the nurse anesthesia program."
You should also familiarize yourself with the reasons why applicants are not admitted. "Sometimes they just did not interview well because they were too anxious or too fatigued. Sometimes it's because another applicant was deemed a better match for the particular cohort that is being selected. Sometimes it's simply a matter of being patient and committed to the process," Dr. Zwerling says. "I would recommend that any candidate that isn't selected feel free to have an open and honest discussion with the program faculty with a focus on what they could do to improve their profile should they apply again."
Consider seeking out a practicing CRNA (perhaps a colleague from work) to shadow for a day or two. You'll instantly gain a better understanding of the work a CRNA does. Start your day early, so you can watch the CRNA perform a full anesthesia machine check. Study how they prepare pertinent medications prior to a patient's arrival in the operating room. Accompany the CRNA to the holding area and observe the assessment of the patient's airway and the interview of their medical and surgical history.
"Shadowing is a must for potential candidates," says Joseph Rodriguez, S.R.N.A., a student in the Thomas Jefferson University Nurse Anesthesia Program. "Having 30–60 hours of shadowing [experience] shows program directors you are dedicated to your decision on pursuing nurse anesthesia." Macario Acosta was also able to shadow a CRNA. "My CRNA gave me access to a variety of cases, so I gained good insight of what CRNAs do in different situations," he says. "I made myself available to whatever schedule the CRNA had so that it was easy and convenient." Dr. Zwerling strongly recommends shadowing a CRNA prior to interviewing. "I think it's an invaluable way to really get a feel for our profession as it's practiced in the real world. I also think it provides a great opportunity to witness the wonder of anesthesia," he says. "I always wanted applicants that had a good grasp of what they were hoping to be part of."
The interview is perhaps the most important criterion in determining a strong and committed applicant, capable of meeting the demands of the program. During the interview, be prepared to articulate your reasons for wanting to become a nurse anesthetist and to answer challenging questions related to the profession. To really shine, try practicing at home. "I did many mock interviews with my wife, which was extremely beneficial," Rodriguez says. "The nervousness of the interview can really inhibit many candidates' ability to answer smoothly, and by practicing beforehand I was able to deliver my answers calmly and without hesitation. I practiced a question sheet of 25 or so questions four to five times, until I had a high degree of comfort with the answers."
Dr. Zwerling says he looks for nurses who display "commitment, focus, integrity, critical-thinking ability, and a demonstration that they understand the full scope of available CRNA practice regionally as well as nationally." Regarding preparing for the interview, Jose Max Acosta, D.N.P., C.R.N.A., an associate faculty member in the Baylor College of Medicine Nurse Anesthesia Program, asserts, "You are going to invest much time and resources in the nurse anesthesia profession, so take time to read about it before the interview."
You've submitted an exemplary application and impressed the CRNA program directors during your interview. Before you know it, there's an acceptance letter waiting in your mailbox and you can breathe a sigh of relief! But don't get too relaxed; you need to academically and financially prepare yourself prior to matriculation. Continue taking graduate courses, if you're already enrolled, to complete prerequisites if you can and lessen the course work while in the nurse anesthesia program. Aim to pay off significant debt, save a considerable amount of money, and try to improve your credit score, as this will enable you to get competitive rates on student loans.
Your next challenge is learning how to balance clinical and didactic courses. Jessica Juarez-Pillai, S.R.N.A., a student at Virginia Commonwealth University, has carefully organized her tight schedule. "Monday through Thursday, I am in the operating room and usually home by 5:00 p.m. When I get home, I have dinner with my family, and then I spend two hours reading about the next clinical day, then spend a couple of hours doing readings on course work," she says. "On the weekends, I take my children to their extracurricular activities in the morning and [then] continue to study, reading, or doing homework." To prepare for clinicals, Juarez-Pillai incorporates studying upcoming procedures into her routine, reading about general anesthetic implications and potential complications. "As a senior nurse anesthesia student, I have to write an extensive care plan for ASA III and IV patients scheduled for surgery," she says. "I actually prepare these cases on four-by-four note cards and highlight surgical procedure, anesthetic considerations, complications, drug calculations, calculation of fl uid requirements, and allowable blood loss."
To stay on top of your didactics, you must make a habit of studying regularly, Rodriguez says. "The professors serve as guides to learning, but you're doing much of the learning during your own study. It takes 30–40 hours per week in addition to class to really master the material," he says. "Also, I must add that you have to know your physiology and pharmacology if you want to look like an all star in the clinical arena. You will be verbally challenged in the operating room." Rodriguez relies on impeccable lecture notes and review sessions, including class recordings, live notes, concept maps, flashcards, and pre-and post-test evaluations. "I'll review my tests to see if there were any errors in my thought process," he says.
"Didactic challenges you mentally, but clinicals challenges you physically and mentally," says Dr. Acosta. "In clinicals, there is the added pressure to you and your faculty of caring for human beings. You will be closely supervised during clinicals, so don't get your feelings hurt. Do not forget about the compassionate care that you have been providing as a RN." You are responsible for absorbing volumes of information in clinical and didactic course work, and "students have to be able to simultaneously process a large amount of time and remain in control during stressful situations." Many programs incorporate simulation teaching to enhance didactic and clinical learning.
Indeed, nurse anesthesia programs challenge students both in the classroom, in practice, and even at home, as they sacrifice leisure time, but there are ways to relieve the stress. "Mental preparation is key. I had to clear my life with distractions during school," Rodriguez says. "That said, I still exercise four to five days a week and eat well. I have to credit my wife for making most of the meals; she is very supportive. I also take the time to remind myself of why I committed to this process—to make a better life for my family and to challenge myself to great things. Last, I battle procrastination by taking small tasks one at a time, so I don't get overwhelmed."
By 2015, many CRNA programs plan to abandon their master's degree programs in favor of the Doctor of Nursing Practice (D.N.P.). "This will add additional months to a program," Dr. Acosta says. "During the didactic year, your intense course work may consist of basic to advanced anesthesia, basic sciences, pharmacology, and classes covering professional information necessary for your practice. The didactic year is very intense, and programs will push you to a limit that you never thought could be possible to reach."
As you investigate nurse anesthesia programs and continue your pursuit of the profession, it is worth mentioning that there is an established mentoring organization primarily for minorities seeking comprehensive information and guidance. The Diversity in Nurse Anesthesia Mentorship Program was created to inform, empower, and mentor underserved diverse populations with information to prepare for a successful career in nurse anesthesia.