Minority CRNAs and Student Registered Nurse Anesthetists: Soaring to New Heights with Doctoral Degrees

So many are called, but only a few are chosen! You have finally made the decision to apply to a nurse anesthesia program. Before you start navigating any of the 113 accredited nurse anesthesia programs’ websites and firing up the search engines, you must be proactive in being well acquainted with the most updated Practice Doctorate Standards for Accreditation of Nurse Anesthesia Programs. These proposed changes will determine what doctorate degree will be awarded upon successful completion of a nurse anesthesia program.

How do you become a Certified Registered Nurse Anesthetist (CRNA)? In order to be a CRNA, you must graduate from a nurse anesthesia program accredited by the Council of Accreditation of Nurse Anesthesia Educational Programs (COA) and successfully pass the national certification examination administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

Today, CRNAs are masters’ or doctorate-level advance practice registered nurses (APRNs). Although there are many accredited nurse anesthesia programs offering master’s degrees including Master of Science (MS), Master of Science in Nurse Anesthesia (MSNA), and Master of Science in Nursing (MSN), you may consider applying to a nurse anesthesia program that offers a Doctor of Nursing Practice (DNP) or Doctor of Nurse Anesthesia Practice (DNAP). Many nurse anesthesia programs are currently in transition into doctoral degree programs in nurse anesthesia. It has been determined by the COA, that by 2025, all accredited nurse anesthesia programs will be mandated to offer a doctoral degree including DNP or DNAP.

In addition, in June 2007, the American Association of Nurse Anesthetists (AANA) Board of Directors adopted a position statement on a proposed change for all nurse anesthesia programs to transition from master’s degree programs into doctorate degree programs by 2025. Nursing schools and allied health programs will award DNP and DNAP degrees upon completion of a capstone project and fulfilling the requirements of the nurse anesthesia curriculum. AANA Chief Executive Officer, Wanda Wilson, CRNA, PhD, stated, “to best position CRNAs to meet this challenge and remain leaders in anesthesia care, the AANA strongly supports doctoral education that encompasses technological and pharmaceutical advances, informatics, evidence-based practice, systems approaches to quality improvement, and other subjects that will shape the future for anesthesia providers and their patients.” Presently, many nurse anesthesia programs are hiring doctoral-prepared faculty and transitioning to the practice doctorate while others are still conferring master’s degrees.

Requirements for admission into a doctoral degree nurse anesthesia program include a bachelor’s degree in nursing or other appropriate baccalaureate degree; active RN licensure; a minimum of one to two years critical care experience; acceptable GRE and/or TOEFL; CCRN (preferred) scores (if applicable); a calculated GPA of 3.0 or higher; letters of references from nursing supervisors and/or colleagues; and a formal one-to-one panel intensive interview. Most, if not all, doctoral nurse anesthesia programs require candidates to complete and implement a capstone project. It is an evidence-based practice intensive written document that is subject to peer scrutiny and guidance approval by committee. In the DNP programs, your capstone project will be related to nurse anesthesia practice, leadership, or an education focus.

In the past five years, CRNAs with master’s degrees have been able to work and enroll in doctorate programs. Some of the CRNAs have completed a Doctor of Philosophy (PhD) and Doctor of Education (EdD) program that culminates in a dissertation and successful defense, while many have enrolled or been awarded a doctorate of nursing practice degree (DNP or DNAP). This article will illustrate six distinct interviews of minority CRNAs with DNP degrees and student registered nurse anesthetists who are in pursuit of their doctorate in nursing practice.

The following interview was conducted with Dr. Gould, CRNA, EdD, and Dan Lovinaria, CRNA, MBA, DNP, the associate director of the University of Minnesota’s BSN-DNP nurse anesthesia program.

Where did you obtain your master in nurse anesthesia?

Lovinaria: “I have been a registered nurse in Honolulu, Hawaii since 1991 where I obtained my bachelor of science in nursing (BSN) at the University of Hawaii at Manoa. While in Honolulu, Hawaii, I have worked in nurse specialties including rehabilitation, psychiatric, nursing home, risk management, telemetry, infection control, nursing staff education, and lastly, critical care nursing. After intensive exploration and understanding of the noble nurse anesthesia profession, I had decided to pursue my master in nurse anesthesia at St. Mary’s University of Minnesota and earned a certificate in nurse anesthesia at the Minneapolis School of Anesthesia in September 2000 and successfully obtained my master and certificate in December 2002.”

Where did you obtain your DNP and what was your capstone project on as your research focus?

Lovinaria: “While practicing as a full-time CRNA at Fairview Southdale Hospital, I had decided to pursue my doctorate in nurse practice (DNP) at the University of Minnesota in Minneapolis and successfully obtained the DNAP in December 2008. My clinical capstone project was on the “Implementation of Perioperative Blood Glucose Protocol in Diabetic Patients Undergoing Cardiac Surgery.”

What is the DNP degree? What are the criteria for the nurse anesthesia program for the DNP at the University of Minnesota?

Lovinaria: “A DNP is one of the highest terminal professional degrees in nursing that primarily emphasizes on translating evidence rather than generating new evidence or research. The DNP curriculum generally includes advance practice, leadership, informatics, teaching, health policy, program evaluation, ethics, and more importantly, application of clinical research. The DNP degree is to prepare registered nurses to become advance practice registered nurses, including: certified registered nurse anesthetist (CRNA), nurse practitioner (NP), certified nurse midwife (CNM), and clinical nurse specialist (CNS).”

What is the length of the program for a DNP at the University of Minnesota nurse anesthesia program? Would you suggest nurses search online well in advance before applying to a nurse anesthesia program and for mentoring opportunities?

Lovinaria: “The BSN-DNP program is a 36-month program (9 semesters) full-time study. The Post-MS DNP can be earned in one academic year (3 semesters) as a full-time student, or in two academic years (6 semesters) as a part-time student.

It is important that registered nurses of color be proactive in exploring and searching the specific nurse anesthesia programs of interest, understanding its requirements, and being strategic by taking the opportunities to visit nurse anesthesia programs to meet program directors. As an Associate Program Director of the BSN-DNP nurse anesthesia program at University of Minnesota, I highly recommend prospective students participate in shadowing different clinical CRNAs to understand the profession and attending nurse anesthesia information sessions, including the well-organized and established Diversity in Nurse Anesthesia Mentorship Program held all over the country.”

How does a student find a research focus on their capstone project? How is it different from a PhD dissertation?

Lovinaria: “DNP students learn about the components of the DNP scholarly leadership project by completing a series of three seminar didactic courses. Students complete the project-related clinical work and write their final DNP project paper under the direction of a faculty project director/advisor during a series of three project direction practicum.

Students are expected to submit capstone project proposals as part of their application packets. However, students also find generated evidence to translate into practice during their clinical rotation at various perioperative care settings.

A PhD dissertation is embodying results of original research and especially substantiating a specific view, whereas a DNP capstone project is translating evidence into clinical practice in ways that improve the quality and safety of patient care and outcomes, improve organizational systems, and processes.”

What type of support is provided for a nurse anesthesia student enrolled in the DNP program at the University of Minnesota?

Lovinaria: “Upon start of the DNP program at the University of Minnesota, students are immediately assigned to a faculty advisor to help facilitate, guide, coach, and direct them to successful completion of the program. Students are required to meet with faculty advisor on an ongoing basis for guidance and support.”

What opportunities exist for CRNAs with a DNP?

Lovinaria:CRNAs with DNP degrees will have opportunities to advance in various positions. DNP leads to degree parity with other health care professions and assist graduates to assume leadership roles in clinical practice including Chief CRNAs, Directors of Nurse Anesthesia, Anesthesia Program Directors, Clinical Professors, and Health Care Policymakers.”

The following interview was conducted with Dr. Gould, CRNA, EdD, and Wonedwesson Goshu, CRNA, DNP, of Texas.

Where did you obtain your MSNA?

Goshu: “I earned the Master of Science in Nursing Anesthesia at Saint Mary’s University of Minnesota, Minneapolis, in 2004. It was there that I was able to start building a network of fellow students, mentors, and professionals from the nursing industry to build upon both my education and experience as well as branch out into other areas of opportunity such as speaking engagements on a variety of topics related to obtaining a nursing degree, the anesthesia field, and DNP.”

Where did you obtain your DNP and what was your capstone project on as your research focus?

Goshu: “I graduated from the DNP program at Rocky Mountain University of Health Professions in 2011. My capstone project described the level of Advanced Practice Nurse (APN) knowledge, awareness, and attitudes toward non-operating room (non-OR) timeout procedures before and after participation in an online educational intervention. In this process, the researcher seeks to answer the following questions:

(a) According to the literature, what is the current level of health care knowledge regarding non-OR timeout procedures?

(b) What is the level of Advanced Practice Nurse (APN) knowledge, awareness, and attitudes toward non-operating room (non-OR) timeout procedures before and after participation in an online educational intervention and at a six-week follow-up?

Post-DNP, I have used my research in teaching and sharing my experiences with students and peers and it often proves very effective and invaluable to those seeking more information on what it is really like to pursue a DNP. By telling my personal story, I hope that men and women alike will realize that they too can reach these same goals.”

What is the DNP degree? Did you work while you were enrolled in the program?

Goshu: “A lot of organizations define what DNP is and I think my school website describes it well. In a nutshell, the Doctor of Nursing Practice (DNP) degree utilizes system redesign and evidence-based decision-making to implement their program, which effectively prepares advanced practice leaders to affect change in the health care industry, whether it be influencing health policies, social change and procedures, and more.

The setting provides its education through coursework, directed independent study, and capstone project implementation.

The DNP graduate is trained to adapt to a variety of venues amongst diverse demographics. Point of care is a major focus as is research, the pace of the industry and its demands, and the DNP program pinpoints the need for highly degreed individuals with a skillset and approach of leadership.

Social responsibility, consumer savvy, financial/clinical/political factor expertise, care model transformation; these are all study areas that the graduate becomes immersed in. There are so many more facets to it; I encourage anyone considering their DNP to research it further by looking online. I would also be happy to assist in any way I can to provide good information in a positive way because I believe in it wholeheartedly!

Yes, I worked full-time while attending school, which was hard at times, but well worth the effort. In hindsight, time management is the key to juggle family, work, and school under the pressure and I greatly benefitted from the experience and its challenges in many ways. It made me the person I am today and I am happy to share my story with those that are facing obstacles, searching for tools, and wanting to also share information.”

Did you have any speaking engagements on your capstone topic at state and national nurse anesthesia association meetings?

Goshu: “In August 2012, I was fortunate to be one of the AANA Annual Meeting speakers in San Francisco to share my findings from my research and how to improve and implement timeout to improve patient safety. My title was ‘Time Out for Patient Time.’

I found the experience very positive in so many ways. It was invigorating to be able to share my story, experience, and my knowledge with so many industry professionals. I was blown away to find that my passion for the subject matter and the industry as a whole could be even more inspirational—to me and hopefully others—when I was able to interact with a large audience. Having enjoyed comedy my whole life, I felt as though I had discovered a way to educate and entertain while speaking on a topic I love and that total experience has led me to follow this journey through speaking engagements, and it has been awesome!”

What opportunities exist for CRNAs with a DNP?

Goshu: “While attending the AANA meeting I was approached to apply for teaching positions. This is another example of the scope of opportunity available to CRNAs with a DNP. Remember, a DNP will implement evidence-based practice and policy strategies that optimize access to care and clinical outcomes. It prepares you for leadership roles in the nursing discipline itself, which reflects such rapid growth that this type of higher education is a benefit to nurses, doctors, and patients alike.

It has been my experience that the profession offers such diversity (Nurse Practitioner/NP, Certified Registered Nurse Anesthetist/CRNA, Certified Nurse Midwife/CNM) and is employment-rich—job opportunities are abundant and equally diverse—that I am continually striving to learn more, set goals, teach, mentor, and better my knowledge base every chance I get. That included obtaining my DNP and I have never regretted it.

Again, my passion for the industry has led me to speak out on the topic, especially to high school and college students, and I make myself available to do so at events, tradeshows, job fairs—even just corresponding to emails through my website. CRNA is a career worth pursuing and a DNP can only enhance the experience.”

The following interview was conducted with Dr. Gould, CRNA, EdD, and Dr. Angella Jones, CRNA, DNP, of Michigan.

Where did you obtain your Master in Nurse in Nurse Anesthesia?

Jones: “I received the DNP from Oakland University in 2011. My capstone project was ‘Angiotensin Converting Enzyme Inhibitor Induced Angioedema in a Midwestern Hospital.’ I observed what appeared to be an unusual number of African American patients admitted with this life-threatening condition, although when researching, I found that much of the literature used the term ‘rare condition’ when describing it. This piqued my interest and was the motivation for my capstone project.”

What is the DNP degree? Did you work while you were enrolled in the program?

Jones: “This degree is a practice doctorate. It is geared toward nursing clinicians performing as experts in their discipline. Many other professions have made the practice doctorate entry level. These professions include: dentistry, medicine, podiatry, pharmacy, and physical therapy. This degree is the next step in the evolution of advanced practice nursing. I worked full-time during my DNP education. The programs are usually flexible, and they are geared toward the working student.”

Do you teach as a faculty member in a nurse anesthesia program?

Jones: “I am a guest lecturer at University of Detroit Mercy in the anesthesia program and I am a full-time professor at South University. I teach advanced practice nursing students pharmacology, advanced pathophysiology, and advanced nursing practice.”

What opportunities exist for CRNAs with a DNP? And, why is it important to get a DNP?

Jones: “The opportunities available for those obtaining the DNP are both personal and professional. Personally, there is immense satisfaction in furthering your nursing education and being viewed as an expert in the profession. Professionally, the DNP will allow nursing to be viewed as an expert discipline by other professions that require a clinical doctorate as entry level. This degree will allow nursing to play a bigger role in this dynamic health care environment. It will also allow nursing the opportunity to be in a more decision-making position and have to more control over our profession.”

The following interview was conducted with Dr. Gould, CRNA, EdD, and Kim Kimble, a student registered nurse anesthetist at Case Western Reserve University in Ohio.

Where did you learn about nurse anesthesia?

Kimble: “I’ve wanted to go into health care since I can remember. I fell in love with nursing while in grade school after having surgery. Once I graduated from nursing school, I was drawn to the ICU because of the vigilance and critical thinking skills that were required to take care of the patients. Nurse anesthesia allowed for continuity of the passion I have for critical care. But as an APRN, I will now have more autonomy in the care that I provide to my patients.”

Were you mentored by any CRNAs prior to being accepted and enrolled in the nurse anesthesia program at Case Western Reserve University?

Kimble: “Yes, prior to my acceptance into anesthesia school, I had the distinct pleasure of being mentored by two wonderful nurse anesthetists who are highly active within their state, national nurse anesthesia associations, and the Diversity in Nurse Anesthesia Mentorship Program. Dr. Wallena Gould, CRNA, EdD, and John Bing, CRNA, were instrumental in my admission into my first choice, Case Western Reserve University’s nurse anesthesia program.”

What is your capstone interest in a DNP program?

Kimble: “My capstone interest is how to successfully implement education on hypertension self-management in Medicaid patients.”

Would you want to present your findings from your capstone project at a state and national nurse anesthesia association meeting?

Kimble: “Absolutely. Any research that may contribute to improvements in the patient care provided by nurse anesthetists should be shared. Also, I am the student representative for the Ohio State Association of Nurse Anesthetists and would like to prepare a formal presentation at the fall or spring meeting.”

Why do you want to pursue the DNP degree upon graduating from the nurse anesthesia program?

Kimble: “Because our patient population is aging and disease processes are becoming more complex, there is an increasing educational expectation of health care professionals. I believe that doctoral preparation will ensure that I am well prepared to tackle our complex health care system. With a doctorate in nursing practice, I feel that I will be educationally equipped to implement scientific developments that will improve the safety, efficiency, and quality of patient care. “

The following interview was conducted with Dr. Gould, CRNA, EdD, and Daniel Vera, a student registered nurse anesthetist at the Inter-American University Puerto Rico.

Where did you learn about nurse anesthesia?

Vera: “In 2001 I was given the opportunity to train as an Anesthesia Technician at a Hospital in Southern California. At the time, I was not sure of what I wanted to study. It was then that I was introduced to the wonderful specialty of anesthesia. The hospital employed Certified Registered Nurse Anesthetists (CRNAs) in the operating room. The continuous care, compassion, knowledge, and enthusiasm of the CRNAs were of great influence in my decision to obtain my Bachelor’s Degree in Nursing and pursue a Master’s in Anesthesia.”

Were you mentored by any CRNAs prior to being accepted and enrolled in the nurse anesthesia program at Inter-American University of Puerto Rico?

Vera: “During the process of fulfilling the prerequisites of getting accepted into a nurse anesthesia program, I was introduced to you as the founder of the Diversity of Nurse Anesthesia Mentorship Program; you then became my mentor. Thanks to your guidance, I completed a series of steps in order to make my resume more competitive upon applying to anesthesia programs. As my mentor, you were also a big part of my support system, intellectually and emotionally. I met minority CRNAs with DNPs and those who were enrolled, very motivating. You, Dr. Gould, helped me every step of the way to navigate through the process as a student nurse anesthetist at Inter-American University of Puerto Rico.”

What is your capstone interest in a DNP program?

Vera: “While many issues have heightened my interest in nurse anesthesia practice, I would like to research the clinical significance of cricoid pressure during rapid sequence induction in patients at risk for aspiration.”

Would you want to present your findings from your capstone project at a state and national nurse anesthesia association meeting?

Vera: “Yes, it would be my honor to present my findings to colleagues and peers.”

Why do you want to pursue the DNP degree upon graduating from the nurse anesthesia program?

Vera: “There are several reasons why anesthesia practitioners should obtain a Doctorate in Nursing Practice. In a few years from now, all the new graduates from nurse anesthesia programs will graduate with a Doctorate in Nursing Practice. I personally would like to become an instructor, educator, and mentor. I would like to transmit the passionate interest that I posses towards my profession to future students of different ethnicities. “

The following interview was conducted with Dr. Gould, CRNA, EdD, and Byron Anderson, a student registered nurse anesthetist at Arkansas State University.

Where did you learn about nurse anesthesia?

Anderson: “I learned about nurse anesthesia from my Godmother Fay-Theresa Smith, who works at Our Lady of the Lake Regional Medical Center (OLOLRMC) in Baton Rouge, Louisiana. When I attended Southern University A&M College in Baton Rouge, Louisiana, I wasn’t sure what I wanted to major in. At first I decided to major in biology pre-medicine because it was something that I was familiar with. It was Momma Fay that had a long conversation with me and encouraged me to choose nursing as a career option. I immediately questioned her by asking, “What does a nurse do that would make me interested in selecting that as a major?” She responded by saying, “NURSE ANESTHETIST, the most respected nurses in the hospital.” It was then that I began to research the career of advanced practice nurses that specialized in delivering safe anesthesia to millions of patients nationwide. I was so fascinated with CRNAs that I made a binder about all there was to know about this amazing profession. I unknowingly met my first CRNA when I was completing my OB rotation while pursing my BSN degree. He attended Texas Christian University and assured me that nurse anesthesia provided both professional reward and personal satisfaction. After his confirmation, I set a goal of doing whatever was required of me to become a CRNA.”

Were you mentored by any CRNAs prior to being accepted and enrolled in the nurse anesthesia program at Arkansas State University?

Anderson: “I was fortunate enough to be introduced to the Diversity in Nursing Anesthesia Mentorship Program (DNAMP) by my colleague and friend Kim Andrews, CRNA, APRN, where we worked together in a level-one trauma center in downtown Atlanta, Georgia. I attended my first DNAMP meeting and simulation workshop in Baltimore at the University of Maryland where I met the founder, Dr. Lena Gould, CRNA, EdD, and John Bing Jr., CRNA. It was there that I was able to gain more insight about the admission process and true rigors of CRNA programs. I was so inspired that the following year I attended the DNAMP airway workshop at Thomas Jefferson University and the University of Pittsburgh. Afterwards, I shadowed Mr. Alan Williams, CRNA, at the VA Medical Center in Atlanta.”

What is your capstone interest in a DNP program?

Anderson: “My capstone interest in a DNP program will focus on CRNAs and pain management with advanced interventional techniques. In November 2012, The Centers of Medicare & Medicaid Services (CMS) approved a ruling to allow millions of Americans to have access to CRNAs and allow CRNAs to bill Medicare directly for performing chronic pain management services. This was a huge victory for CRNAs and the American Association of Nurse Anesthetists (AANA). I am extremely interested in seeing an accredited and board-certified pain management fellowship program created specifically for CRNAs in the future. “

Who are the CRNA experts in that field and do you have access to them on your future capstone project for the DNP?

Anderson: “The experts in the field of pain management who I would want to learn more from are Arthur Zwerling, CRNA, DNP, DAAMP, and past-president of AANA Jackie Rowles, CRNA, MBA, FAAPM. I will seek their advice and hopefully they can serve on my doctoral committee.”

Why do you want to pursue the DNP degree upon graduating from the nurse anesthesia program?

Anderson: “I want to pursue my DNP to become an expert in the field of anesthesia as an African American male. My goal is to one day have an independent pain management practice in an urban area. Furthermore, I plan on teaching students nationwide about advanced pain management techniques. I believe that the future is bright for advanced practice nurses. I look forward to the day when all of my colleagues will graduate with a terminal degree.”