Nurses considering a career in nurse anesthesiology know the role is complex and demands a high level of critical thinking and commitment. The career path, in which many certified registered nurse anesthetists (CRNAs) obtain a doctor of nursing practice degree, also offers a high salary and an upward projection of job openings. With a dynamic mix of clinical practice and the capability to work in many settings, nurse anesthetists find a rewarding career.
How did your career path lead to nursing and becoming a CRNA? During my final year in college, I battled severe bronchitis and sought help at the health clinic. The provider who attended to me was not a doctor but a nurse practitioner, displaying both kindness and extensive knowledge. This encounter sparked a conversation about her nursing career, introducing me to the world of advanced practice nursing. This pivotal moment inspired me to explore nursing as a career path.
Upon college graduation, despite my Indian parents’ desire for me to pursue medical school, I knew I wanted a profession that combined science, pharmacology, and interpersonal interactions. Armed with a bachelor’s degree in cellular biology, I promptly earned another Bachelor of Nursing within a year. Upon graduation, I entered the field of critical care nursing, working in the most acute critical care unit settings such as burn, cardiac, and transplant ICUs. It was during my time at Northwestern Memorial Hospital’s Neurospine ICU that I witnessed the role of CRNAs. This experience solidified my decision to pursue a career as a CRNA.
I earned my Master of Science in Anesthesia Nursing from Rush University in Chicago in 2005. In 2021, I received my Doctorate of Nursing from University of North Florida, and in 2022 I received my Global Health Leadership Certification from Northwestern University. I have participated in numerous global mission trips and currently co-chair the AANA’s Diversity Equity and Inclusion (DEI) Committee. I am also the chair of the Illinois Association of Nurse Anesthesiology’s DEI committee. I am passionate about healthcare equity and access and have my own nonprofit called Citizens For Humanity which addresses social determinants of health.
Do you specialize in a certain area or population? Numerous healthcare environments rely on anesthesia services, encompassing fields such as dentistry, podiatry, surgery, obstetrics, and pain management. In my professional journey as a CRNA, I have experienced diverse settings, including community hospitals, ambulatory surgical centers, and plastic surgery centers, and participation in large teaching hospitals as part of an Anesthesia Care Team. The degree of autonomy varies across these settings, ranging from those with no supervision to those adopting a more interdependent model. I have experience working with diverse patient populations, including pediatric, low-income, and critically ill individuals.
What part of your job is particularly meaningful to you? The profession of nurse anesthesiology offers a richly diverse and demanding path. In the clinical realm, you have the profound privilege of impacting individuals during their most vulnerable moments. A significant aspect of the gratification derived from administering anesthesia lies in the opportunity to support individuals through what may be the most daunting day of their lives. They grapple with fear of diagnosis, anticipation of pain, and uncertainties ahead. Your presence as a reassuring figure by their side during this critical juncture becomes paramount. While your expertise and competence in ensuring their safety throughout the procedure are undeniably vital, it is the compassion and humanity you extend that hold greater significance than any medication you administer.
Is there something or someone that helped you in your career that others thinking of this career path will find helpful? My foremost recommendation is to shadow multiple CRNAs across various cases. This immersive experience will provide a comprehensive understanding of what lies ahead. Engage in conversations with current students to gain insights into the rigorous nature of anesthesia school. Recognize that anesthesia training demands significant dedication; therefore, it’s prudent to prepare financially by saving diligently.
Building a robust financial cushion alleviates stress and minimizes post-graduation debt, especially considering the constraints on working while in school. Enhance your academic foundation by enrolling in graduate-level courses in anatomy and physiology, pathophysiology, and pharmacology. This not only demonstrates your commitment but also strengthens your candidacy, particularly if your undergraduate GPA is subpar. While these courses may not be transferrable to most anesthesia programs, they serve to fortify your knowledge base and reacquaint you with the rigors of student life.
What would you like others to know about a being a CRNA? I believe that aspiring RNs should possess a robust grasp of physiology, pathophysiology, and pharmacology prior to embarking on anesthesia school. Embracing challenging assignments, volunteering for cases involving the most critically ill patients, and delving deeply into the rationale behind every action are crucial steps in nurturing a profound understanding of patient care. This comprehension extends to the selection of medications and interventions, ensuring that aspiring CRNAs are well-prepared for the demanding journey ahead. The ability to think critically is paramount in the delivery of safe anesthesia.
CRNAs must excel as problem solvers and keen observers, interpreting data independently and making informed decisions that can profoundly impact patient outcomes. The weight of responsibility underscores the imperative of being both accurate and decisive, recognizing that lives hinge on the choices made in the operating room.
What is your advice for RNs considering a career as a CRNA? Research various CRNA programs to find the one that best suits your needs. Consider factors such as clinical opportunities, cultural diversity, and program structure. Make an informed decision based on your personal preferences and goals.
Once enrolled in a program, maximize every educational opportunity, even if it seems insignificant. Graduate-level education requires proactive engagement, and your dedication will determine the quality of your learning experience. Learn from every case and practitioner, embracing the lessons they offer.
Collaborate with CRNAs who may be perceived as challenging, as they often uphold high standards and offer valuable insights. Maintain a positive attitude and remain open to feedback to maximize your learning potential. Avoid being labeled as unteachable, as it can hinder your educational progress.
In recognition of this week’s Certified Registered Nurse Anesthetists Week (CRNA Week), Minority Nurse spoke with Flanagan about his career path and what it takes to succeed in this field.
Flanagan says his original plan included nursing school as a stepping stone to medical school. He wanted a secure career that gave him options as he moved toward that goal. But during his first year in nursing school, he heard about anesthesia as a nursing path and was intrigued. Once he saw it in action, he decided it was the choice for him.
His opportunity came unexpectedly. In Flanagan’s labor and delivery rotation, some families made it clear they didn’t want a young male nursing student attending. “I spent a lot of time at the front desk because I couldn’t see patients,” he recalls. But a CRNA noticed and one day invited him to shadow her for the day. “We did C-sections and epidurals all day,” he says. “I saw the autonomy, the interaction with patients, the assessment she did, and the camaraderie with the surgeons and other staff.”
Flanagan saw how CRNA’s are the authority on their practice in the room, so if people have questions, they look to the CRNA for validation, approval, and answers. “As a CRNA, you’re a patient advocate and you’re forced to make a decision or intervene,” he says.
Mentorship to Career
Flanagan gained a valuable mentor in that CRNA, and he continued to shadow her several times. While he was learning, he was also gaining the shadowing hours he would need to apply to his own anesthesia path. Eventually, she helped him secure a job through her own professional network. “She said, ‘You’re a young Black male with the skill set and the desire for this,’ and she saw the potential in me.” Flanagan worked as a nurse extern to obtain the required experience before graduating with his BSN from Emory University. He passed the boards and in two weeks was working in the ICU in cardiac. He went back to school for his MSN at Samford University, worked for five years, and then began his DNP degree at Columbia University with a focus on anesthesiology.
The strenuous academic requirements for becoming a CRNA are significant but critical to a CRNA practice, says Flanagan. There’s the rigorous course work and then also a regimen of clinical and procedures for the hands-on skills. “There’s strict criteria for what we need to do for procedures before we can sit for the boards,” he says, noting the need to understand the physiology and pharmacology for patients as well. “It’s an all-or-nothing career process,” he says. “You’re giving up three to four years of your life. You have to be committed to that up front.”
Prepared for the Profession
Unlike other nursing specialties, CRNAs don’t specialize in a particular patient type or condition. They have to be ready for anything from a routine surgery to significant trauma and for patients of all ages and conditions. “Hospitals have a list of what’s needed, and we fill those rooms with CRNAs.” he says.”Seventy-five percent of CRNAs don’t get to pick the surgeries they do every day.”
As the anesthesia expert, Flanagan says you’re expected to excel at what you are doing every time. “You carry that with you in everything you do,” he says. Any nurse who begins the career knows that, he says. “When you decide to go to nursing school, you are accepting ownership of the patient,” he says. “They depend on that ownership. You have to take that on when you walk into this profession.”
With the responsibility, Flanagan says the preparation and the dedication to the work become even more essential. “You do so much that you do feel comfortable and confident walking into those spaces,” he says. “That’s one of the dynamics about the role. There’s a stoicism about it. We see things that make others nervous, and we know how to resolve the issue. That makes it a lot easier to be comfortable.” The expertise becomes something CRNAs can’t switch off, he says. “Once you’re in it, it becomes part of who you are.”
As a CRNA, Flanagan is able to meet with patients and families before a procedure to get to know them and gain their trust. He explains procedure details in easy-to-understand language if they want, but respects if they’re not interested.
As with all nursing paths, nurses bring their own skills to each interaction to learn what works best for them and their patients. Flanagan’s PhD research focused on music therapy in the OR, something that remains an important part of his practice to this day. He always asks patients about the music or artists they like and would want playing in the OR. “People know that about me–there’s going to be music playing,” he says with a laugh.
Passing Along Knowledge
Thanks to that chance early connection with a CRNA who gave him an opportunity, Flanagan says the career is something he’d choose all over again. He continues to work for diversity in nursing, beginning the Bigger Dreams, Better Tomorrows foundation is a piece of that advocacy.
Flanagan recognizes the responsibility for helping the next CRNAs and showing them how the hard work pays off with everything CRNAs do with patients. “After they wake up and they thank you and tell you they appreciate that you were the one taking care of them–that never gets old.”
January 21 through 27 is National CRNA Week, and we’re celebrating by getting up-close and personal with the CRNAs who make the medical world go ‘round! Certified Registered Nurse Anesthetists (CRNAs) safely administer about 43 million anesthetics each year, making surgeries and medical treatments safer. These professionals not only administer anesthesia, but also help ensure patient comfort and security.
CRNAs come from all walks of life and work in a wide range of communities. Interestingly, the American Association of Nurse Anesthetists (AANA) reports that CRNAs are the sole providers in nearly 100% of rural hospitals in some states as well as within the U.S. Armed Forces. Make sure to thank your favorite CRNA during CRNA week and surprise them with something special to say thanks! We love the idea of gifting them a personalized stethoscope with custom engraving as an awesome way to pay tribute.
What Does a CRNA Do Every Day?
What’s life like as a CRNA? Let’s take a closer look. Every day, nurse anesthetists monitor patients during surgery. This requires preparing and administering drugs before anesthesia, managing patients’ airways, and pulmonary status during surgery and closely observing their physical reaction to drugs. They may also perform pre-anesthesia screenings to determine a patient’s risk and administer epidurals in maternity wards.
But there are many other things that CRNAs are responsible for each day, according to Lincoln Memorial University Clinical Coordinator and CRNA Joy Lewis. “We do pre-op and post-op rounds, consults for pain management, place central lines, respond to codes, place and manage labor epidurals, upon consultation implement respiratory and ventilatory management including establish emergency airways,” says Lewis.
Dan Lovinaria, a CRNA with Veterans Affairs at Minneapolis Medical Center, says there’s an emotional aspect to the job, too.
“Being a VA CRNA comes with a tremendous responsibility and a great deal of accountability,” he says. “Patients are often anxious and nervous about their surgical procedures. It is my duty and responsibility to set the tone and make an immediate connection with my patients upon their arrival in the preoperative phase. Something as simple as providing warm blankets to my patients goes a long way. The little things make a significant impact.”
What’s the Schedule Like?
Surgeons have notoriously demanding schedules, whether they’re responding to emergencies or running on a tight, pre-determined schedule. Since CRNAs are required to be present for many of those surgeries, their schedules may be even busier than a surgeon’s.
“Oftentimes our schedules are busier than the surgeons if we work at a hospital with [obstetrics]. Once you place an epidural you may not be able to leave, and they will still want the operation to start on time,” Lewis says.
Lovinaria says he and his team work various shifts, including 8-hour, 10-hour, 12-hour, and overnight shifts.
Who’s Their Boss?
But there’s good news, too. CRNAs operate on a more autonomous schedule—they’re not required to be supervised by an anesthesiologist in any of the 50 states—so their shifts and schedules vary compared with traditional registered nurses. CRNAs may work as part of an anesthesia care team or as individual providers.
Robert J. Gauvin, a CRNA who’s also the president of Anesthesia Professionals, Inc. in Dartmouth, Massachusetts, says owning an anesthesia care business means more work but even more autonomy.
“Because of my unique position as a business owner and practicing CRNA, a typical day involves the 30-plus CRNAs in my group taking care of one to 45 patients in multiple facilities, followed by two to three hours of administrative duties,” Gauvin says. “On a weekly basis, I try to build in dedicated office days that allow me to focus on developing the business side of my practice.”
What About the Education Factor?
Because CRNAs have a much more specialized skill set than traditional RNs, they’re required to have extra education. Most CRNAs start out as RNs and are then required to complete a master’s degree in nursing (MSN), which typically takes about two years. CRNAs must then pass the National Certification Exam (NCE), which covers the knowledge, skills and abilities needed by entry-level CRNAs.
“Pursuing my studies as a CRNA demanded my efforts and abilities in many ways: mentally, physically, emotionally, financially, and so on,” says Mary Nguyen, a CRNA at Lourdes Hospital in Paducah, Kentucky. “My whole world was completely changed. With that being said, I’d do it all over again to have the privilege to work in my position as a CRNA.”
Nguyen also emphasized the importance of the CRNA certification exam. “The best advice that I can give to others is: ‘Respect the Test!’ The National Certification Exam (NCE) requires a level of thinking and comprehension of anesthesia that is only attained after rigorous clinical experiences paired with thorough reading and studies,” she says.
And then, of course, CRNAs must put a significant amount of time and money into continued education in order to keep their certification active. According to CRNA Bruce Schoneboom, the Senior Director of Education and Professional Development with the AANA, CRNAs must regularly become re-certified.
“The National Board of Certification and Recertification for Nurse Anesthetists’ new recertification program is called the Continued Professional Certification (CPC) Program and consists of eight-year periods. Each period is comprised of two four-year cycles. Every two years CRNAs will check in through a simple, online process known as the ‘two-year check-in,’” Schoneboom says. CRNAs must complete 100 additional education credits in an eight-year period.
Is It as Rewarding as They Say?
Talk to any nurse, and he or she will tell you that there’s a certain pride in putting on a pair of scrubs every morning. But is being a CRNA just as fulfilling as the traditional RN track? Yes, say CRNAs. And the proof is in the pudding: CRNA is a career with one of the highest job satisfaction ratings within nursing.
“There are so many rewarding moments being a CRNA. The one-to-one patient/CRNA interaction is a very valuable experience, and so is engaging the vets’ caregivers or significant others about the anesthesia plan of care,” says Lovinaria, adding that it’s the critical thinking component of the job and its dynamic changes that keep him on his toes.
Nguyen agrees: “I can honestly and wholeheartedly share that even on my worst day, doing what I love is better and more rewarding than a single day doing something else. I would choose this profession over any other option available,” she says.
Make sure to give your favorite CRNA plenty of props during CRNA Week this year!
We always thought the Diversity in Nurse Anesthesia Mentorship Program was a great initiative, and now it’s clear that industry heavyweight Johnson & Johnson thinks so too.
Johnson & Johnson featured the Diversity in Nurse Anesthesia Mentorship Program and its founder Wallena M. Gould, C.R.N.A., M.S.N., in its May 2011 Campaign for Nursing Nursing Notes e-newsletter, and we’re happy to share the link with you here!
For more info on the Mentorship Program, visit www.DiversityCRNA.org.
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