The need for diversity in the nurse anesthesia profession is a growing concern driven by the U.S. population's rapidly changing demographics and the low representation of minorities in the nurse anesthesia workforce across the nation. As a result, efforts to increase racial, ethnic, cultural and gender diversity in nurse anesthesia education have taken the forefront at many universities. In recent years, academic institutions such as Florida International University, Georgetown University School of Nursing and Louisiana State University Health Sciences Center (LSUHSC) School of Nursing have implemented programs designed to attract qualified minority students into their anesthesia schools.
Initiatives such as these, coupled with the identification and elimination of barriers—both real and perceived—to recruitment and retention of minority students in anesthesia programs, are pivotal to increasing minority representation in the nurse anesthesia profession. The cultural knowledge and insights minority certified registered nurse anesthetists (CRNAs) bring to the table can impact patient outcomes by providing presence, communication and comfort to an increasingly multicultural patient population. In addition, minority CRNAs bring new perspectives and insights to the anesthesia community and can help other practitioners increase their awareness of cultural issues in anesthesia care.
If you are a minority RN who is contemplating a career in the highly rewarding field of nurse anesthesia, you're probably well aware that the process of becoming a CRNA is uniquely challenging. Chances are, you are thinking about your own real and perceived barriers to getting admitted into anesthesia school, succeeding in the demanding curriculum and finding a way to pay for it all. As a diverse group of minority nurses who recently graduated from the nurse anesthesia program at LSUHSC, we offer this advice— based on our personal experiences of what worked for us—on how to successfully navigate the journey from applicant to SRNA (student registered nurse anesthetist) to graduate nurse anesthetist (GRNA).
If you are considering nurse anesthesia school you must already have some idea how drastically your life is about to change. Anesthesia school is extremely demanding, timeconsuming and stressful—but also exciting and incredibly rewarding.
Most nurse anesthesia programs range in length from 24 to 33 months. Some programs begin with a didactic course load lasting approximately 12 months, with clinical requirements beginning after the didactic phase is complete. Other anesthesia schools begin with both didactic and clinical phases taken roughly at the same time.
Each phase has its own set of challenges. The didactic phase may be difficult for some students and easy for others. During this phase, the SRNA is taught pathophysiology from an anesthetic perspective. You will learn how anesthetic agents are distributed throughout the body and how body systems respond to anesthetics. Additionally, you will be introduced to the anesthesia machine, airway management techniques and how to properly induce, manage and emerge a patient presenting with an array of co-morbidities.
The first two to three semesters are very difficult because of the rapid pace at which information is provided. You can expect to be tested weekly or biweekly during this phase. In most anesthesia schools, the SRNA must maintain a B (3.0 out of 4.0) grade point average in order to progress and graduate from the program.
If you plan to attend a program in which the didactic and clinical phases overlap, you will have to juggle examinations, care plans, classroom participation, case documentation, clinical participation and your family life all at once. You will be expected to cover day, evening and night shifts during the clinical phase, and some traveling may be required.
Always come to the admissions interview well dressed and well prepared. Do not chew gum during the interview or bring coffee/beverages or food into the interview room.
You are likely to be asked clinical questions to assess your knowledge base. Questions regarding medication infusions, critical thinking and ventilator settings are common.
To prepare yourself for the interview, make sure you shadow a CRNA and learn as much as you can about the nurse anesthesia specialty. You should spend the entire day with the CRNA and observe everything that happens, from the preoperative period through the postoperative period. Visit the American Association of Nurse Anesthetists (AANA) Web site at www.aana.com to review information about the CRNA profession. Visit the Web site of the CRNA program(s) you are planning to apply to, and contact a faculty member with any questions you might have about the program.
Belong to a professional association and know why they are important. Find other minority RNs like yourself who are interested in attending CRNA school and make plans to apply together. (Editor's Note: An excellent way to meet and network with other future minority nurse anesthetists, as well as experienced CRNAs of color who can serve as mentors, is through the Diversity in Nurse Anesthesia Mentorship Program, www.diversitycrna.org.)
If your undergraduate GPA is not very good, do not let that deter you from applying to a CRNA program. Here are some things you can do to improve your chances of getting into a program if your GPA is low:
Prior to acceptance, you will be required to discuss your intentions to become a nurse anesthetist with either the program's staff or directors. These personnel are experts at sniffing out individuals who may not be ready for success. Before you contact them, be prepared to explain and justify your intentions, as well as any possible missteps you may have experienced along the way. Remember, you only have one opportunity to make a lasting first impression. Make sure you are representing yourself in a manner which reflects the core values of the institution you plan to attend.
Completing a nurse anesthesia program is an incredibly daunting task, but you can do it. Success during all phases of anesthesia school hinges on the SRNA's ability to use the following survival strategies.
Identify, minimize or eliminate any stressors BEFORE you apply to anesthesia school. A nurse anesthesia program requires your full attention and focus. Taking an inventory of all aspects of your life to identify possible distractions and sources of stress will allow you to plan accordingly. Examples of possible problem areas include childcare, extended family care, transportation, finances, relationships, etc. Make sure you explore available resources for managing these issues and have plans in place to reduce stress "flare-ups" during your education process.
Manage your time wisely. Time management is vital to success in a nurse anesthesia program. Organization is also important, especially during the early phases of the program. During the first two to three semesters of your curriculum, you will be overwhelmed at some point. Get organized as quickly as possible and create a schedule. Many first-year SRNAs carry daily planners with schedules accounting for months of coursework and clinical time. Once study sessions are scheduled, stick to them. You may not get another opportunity to study again before examination time and your stress level will skyrocket.
Network! Network! Network! Seek out other SRNAs, especially minority students whose experience may be similar to yours. Ask them for advice about how to succeed during the various phases of anesthesia school. Talk to them about interview techniques, test-taking skills, study aids, reference materials and clinical reference sheets. You may find a treasure trove of information and success tips if you just ask. Also, seek out practicing minority CRNAs and ask about professional organizations that you could join. While there may not be a local organization in your area, you may find an online resource where you can communicate with peers from all over the country.
Stockpile as much money as you possibly can. The financial burden of attending anesthesia school can be overwhelming. The average debt accrued by an SRNA is approximately $100,000. And because nurse anesthesia programs are so time-intensive, most students are unable to work while attending CRNA school. Before starting your program, try to reduce or eliminate your current financial debt and save up as much money as you can.
Don't let debt stand in the way of your dreams. If you have decided that nurse anesthesia is your future, it is possible to enter the program with current debt and still finish. Some SRNAs begin their program carrying student loan debt accumulated during their undergraduate studies but are still able to graduate from anesthesia school without delay. Additionally, you can take advantage of CRNA loan repayment programs currently offered by the armed forces, anesthesia groups and hospitals across the nation. Moreover, some of these employers may even pay your full tuition cost as well as a monthly stipend while you are in school in exchange for a commitment that you will work for them after you graduate. The key is to not allow debt to become a distraction.
Don't be afraid to ask for help. If an unavoidable "flare-up" rears its ugly head, don't try to fix things on your own. Utilize your student support group and discuss your situation with your advisors and program directors. Anesthesia programs are often willing to grant time off for students who are having temporary personal difficulties, and in severe cases it is sometimes possible to postpone taking an exam.
Develop coping mechanisms. Take advantage of every opportunity you get to unwind and relieve stress. Anesthesia school will push you to the limit, especially during the first year of your program. Even if you only have one hour for stress relief, take the time to relax and rejuvenate your soul.
You may be asking yourself: "Is nurse anesthesia really for me? Do I have what it takes to succeed in anesthesia school and in this complex advanced practice career?" Our experience has shown that several key qualities are conducive to success as both an SRNA and CRNA.
Critical thinking is a skill that any SRNA candidate must possess. You will be placed in a position that requires you to formulate an anesthetic care plan on the spot and have a good rationale for choosing that particular plan. In some cases, this care plan will have to be formulated and implemented in a matter of minutes, if not seconds. Poor anesthetic care plans can sometimes result in negative patient outcomes, and even death. Your training, supervision and nursing experience will assist you tremendously in accomplishing this task, and you will not be expected to be proficient at it on day one of your training. However, your success as an SRNA and beyond hinges on your ability to think critically and quickly.
Initiative is another important quality to possess, due to the onthe- spot changes that are frequently needed during an anesthetic procedure. After a good anesthetic plan is formulated and implemented, vital sign adjustments are sure to follow. You must adjust your plan as needed and take the initiative in implementing changes. Airway management during a monitored anesthetic provides the perfect example. During this anesthetic technique, patients often lose the ability to maintain their airway, and oxygen saturation will fall quickly. The anesthesia provider must initiate an intervention immediately or risk adverse patient outcomes. Sometimes a simple jaw thrust is all you need, but it must be provided without delay.
Diligence is also important to the SRNA, because your patient has placed his or her life in your hands. You will monitor every beat of his/her heart, oxygen saturation, blood loss, temperature, level of consciousness, pulses, pressure points, positioning, urine output and a host of other patient data. You cannot fail to continually assess both your patient and the effectiveness of your anesthetic plan. Even a temporary lapse in diligence may result in poor patient outcomes.
Patient advocacy is vital, because at times you must speak up for the best interest of your patient. In some cases, you may be the only individual in the room with up-tothe- minute patient data that may have gone unnoticed by others on the team. Or your patient may have been placed in an awkward position that could lead to injury or worse.
Organization is a must, not only in your studies but also in the operating room and beyond. While in the clinical setting, you will be performing many tasks, such as documenting data, administering medications and transferring patients from pre-op holding to the OR and then to recovery. Organize your OR workspace prior to patient arrival. Have everything you will possibly need ready to go before your patient rolls into the room. After the patient leaves the OR, set up whatever you can for the next case. Organize your paperwork and complete as much as you can before your patient is brought in. Stay ahead of the game!
Determination will be important— before, during and after your anesthesia education. If you are serious about your intentions to become a nurse anesthetist, pursue your goal with a high level of intensity. If you can find a reason why you shouldn't apply to anesthesia school, maybe this career choice is not for you. Once you decide and commit to an anesthesia program, this key quality may be a major reason why you are successful. Many SRNAs simply decide that this career path is not for them and quit the program. If you don't have the determination to stay focused and see it through, you may miss out on the opportunity of a lifetime.
In conclusion, nurse anesthesia is an extremely exciting and fulfilling career choice for any nurse who is willing and able to accept the challenge. We invite you to investigate all that this career has to offer, and make the decision to join a community of professionals dedicated to providing the best possible anesthetic care to each and every patient. Consider the suggestions and personal testimonials offered in this article, and network with practicing minority nurse anesthetists who can offer further guidance. A life-changing career filled with challenges and rewards is well within your reach. If we could do it, so can you.
As part of a capstone project completed during the authors' final year of anesthesia school at Louisiana State University Health Sciences Center (LSUHSC) School of Nursing in New Orleans, we examined the issue of potential barriers to minority participation in nurse anesthesia programs. Our goal was to identify the most common barriers to success, both real and perceived, and examine possible solutions for increasing enrollment, inclusion and acceptance of minority students in anesthesia programs.
We began by making lists of the barriers each of us had personally faced as minority nurses pursuing a career in nurse anesthesia. By sharing some of these personal testimonials, as well as the strategies that helped us overcome or work around some of the biggest barriers, we hope to inspire other future minority nurse anesthesia candidates to develop your own blueprints for success.
Kendell Andrus, GRNA, MN
Biggest Barriers: Finances, Age, Isolation
Kendell is a single, 27-year-old African American who was one of only five minority SRNAs in a class of 43 anesthesia students. After a brief stint in the Army as a combat medic, Kendell decided to pursue a career as a registered nurse. He was initially apprehensive about his career choice, because of his perception that nursing was not a typical career for African American men. But realizing that nursing is a profession that offers excellent opportunities and income potential, he decided to move forward with his decision and has never looked back.
One of Kendell's perceived barriers to success in anesthesia school was the fact that he had been accepted into the LSUHSC program at a relatively young age. Because all the other minority SRNAs in his class were older and married with children, he felt a certain amount of disconnect from them. "It would have been nice to have another younger minority student like me to relate to and connect with," he recalls. "I found myself [feeling] almost alone [even though I was] surrounded by a larger than average number of minorities at LSU."
Finances were at the top of Kendell's list of real barriers. His nurse anesthesia education was an expensive journey, especially since he had limited financial support. Fortunately, his time in the military provided an excellent opportunity to stockpile financial resources that may not have been available to him otherwise. Benefits such as the GI Bill, coupled with student loans, allowed Kendell to pursue his dream.
"I took advantage of student loan opportunities to buffer my financial situation," he says. "I wasn't going to let money stand in the way of my anesthesia career."
Linda Nguyen, GRNA, MN
Biggest Barriers: Finances, Self-Doubt, Limited Awareness of Nurse Anesthesia as a Career Option
Linda is a single, 31-year-old Vietnamese American. She is the first individual of Vietnamese descent to attend the LSUHSC nurse anesthesia program. She is also the first person in her family to attend college.
Some of the top areas of contention for Linda were finances and self-confidence. Most importantly, financial barriers were of the utmost concern. "In order to be considered for acceptance into most CRNA programs, a baccalaureate degree in nursing is required," she says. "[Paying for your undergraduate program is hard enough.] Once [you are accepted into anesthesia school], another 33 months of education inevitably leads to a mountain of debt."
Another barrier on Linda's list was lack of knowledge about the nurse anesthesia profession. She did not become aware of this career option until after she had finished her undergraduate coursework. "If I had gained exposure to nurse anesthesia prior to graduation," she says, "I could have adjusted my finances accordingly and possibly have been accepted into anesthesia school sooner." While she was easily accepted by her fellow SRNAs, Linda says she would have enjoyed the company of other Asian American students. "Having a support system is definitely a key to success in the program, and I was fortunate enough to have a great support system outside of anesthesia school," she notes. "[I had] moments of self-doubt both before and after I was accepted into the program. But I just knew that anesthesia was my future and I continued to work hard. After [spending a lot of time in] the operating room and applying the knowledge I learned in the classroom, my confidence level rose exponentially. I am excited about my future. "
Efrem Greely, GRNA, MN
Biggest Barriers: Finances, Entrance Exams, Racial and Cultural Barriers
Efrem is a 39-year-old African American who is married and has two children. After acquiring 14 years of nursing experience in the emergency room and advancing to the level of nurse manager in that department, he decided to further his education and pursue a career in nurse anesthesia. Like Kendell and Linda, Efrem listed finances as his leading barrier. He also cited other real and perceived barriers, such as limited anesthesia school slots available for minority students, the length of time required to complete the program while being unable to work, and cultural barriers to passing graduate school entrance exams, such as the GRE (Graduate Record Examination) and MAT (Miller Analogies Test).
"Traditionally, nursing specialty areas have been difficult to break into for minorities," Efrem explains. "Some specialties, such as critical care, require additional skills training, like ACLS and PALS, which require time and money to acquire. Add to that the fact that minorities traditionally score lower on many standardized entrance examinations and it's not hard to see the disparities minority students face in trying to successfully complete advanced education.
"I was fortunate in that I scored what was needed on the entrance exam after very little preparation," he continues. "With the many years of ER nursing experience I had acquired, I felt confident in my abilities and prospects as an SRNA. I also had a sound support system in my wife, who is an obstetrician, and extended family and friends."
Sedric Williams, GRNA, MN
Biggest Barriers: Finances, Limited Awareness of Nurse Anesthesia as a Career Option, Self-Doubt, Entrance Exams
Sedric is a married 43-year-old African American and a father of three. He was one of only two African Americans accepted into the 2009 CRNA class at LSUHSC who were actually born and raised in the city of New Orleans. In some ways, Sedric was the sole representative of the 61% majority African American community that literally surrounds the campus at LSU. While there were four other African American GRNAs in the 2009 graduating class, none of them were born and raised in New Orleans. Like Kendell, Sedric had served in the armed forces before becoming a nurse and was able to take advantage of opportunities for educational assistance through programs offered by the military. But one of his earliest barriers was a perceived gender bias that delayed his choice to even consider nursing as a career. He believed that nursing was a female-dominated field and he was apprehensive about what his family and friends would think of his career choice.
"My wife, who is also a nurse, attempted to persuade me to [go into nursing] long before my military career began," he says. "I never imagined that nursing could be a legitimate career choice for men until I met other men who were interested in the profession."
He also echoes Linda's comments about not being aware of the nurse anesthesia profession early enough to plan for it. "After earning a degree in English literature, I chose only to acquire an associate's degree in nursing, thinking that would be the extent of my nursing career," he recalls. "Had I known about nurse anesthesia, I would have pursued a BSN degree first, [with an eye toward continuing on into a CRNA program]—possibly saving money as well as time."
Not surprisingly, Sedric cited finances as the biggest perceived barrier to enrolling in anesthesia school. "I grew up in New Orleans, where the average annual income per family is about $32,000," he explains. "If I hadn't joined the military, obtaining a BSN may have been beyond my reach."
Some of his other perceived barriers included low representation of African American men amongst the CRNA ranks and anxiety about passing the GRE. "The GRE was difficult for me," Sedric says. "In fact, without the aid of a prep course, I may not have achieved the required score for acceptance. I really didn't allow the low [minority male] representation to prevent me from applying, but it did fuel some self-doubt. So I focused more on my studies and my duties as a future CRNA and worked as hard as possible to see my dreams come true."