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.
Most nurses are familiar with evidence-based practice (EBP), using research-proven healthcare techniques to enhance patient care and the nursing environment and practices. And the benefits of EBP-led care are well documented. However, with all the positive results, EBP must consistently be taught or implemented in daily nursing practice.
Despite various studies that show the benefits of evidence-based practice for nurses, patients, and healthcare organizations, adopting the practice could be more widespread. Whether or not they work in an environment that supports EBP, nurses can learn more to apply EBP.
Why Use Evidence-based Practice?
What exactly is evidence-based practice? Kim M. Bissett PhD, MBA, RN, and director of the Center for Evidence-based Practice at the Johns Hopkins Institute, specializes in evidence-based practice and says, “At the most basic level, evidence-based practice (EBP) is a problem-solving approach to the decision-making process that uses the best available scientific and experiential evidence, coupled with critical thinking, to improve care.”
The method works, says Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for Health Promotion and the Helene Fuld Health Trust Professor of Evidence-based Practice at The Ohio State University. “We have such a strong body of evidence that when EBP is implemented, that patient outcomes and safety is better,” she says. “We know that.” With a patient-focused nursing priority, practicing nurses find inspiration in using innovative and successful methods. “Evidence-based practice is the most essential part of the nursing profession,” says Michael Williams, DNP, APRN, FNP-BC, a lead nurse practitioner at the Center for Health Empowerment-CHE in Austin, TX. “As a collective, organized workforce, it ensures we are keeping up with the demands of healthcare.” As healthcare delivery becomes more complex, Williams says evidence-based practice helps nurses answer their questions. “It allows us to be in a position to keep up with the demands and always be innovating.”
Patient care is only enhanced when identified and proven practices are followed. “EBP ensures patients are receiving the most current care using the best available evidence,” says Bissett. “By implementing evidence-based interventions, nurses can enhance the quality of care patients receive. For example, implementing evidence-based guidelines and protocols minimizes errors and complications such as medication errors, risk of infections, and unnecessary procedures that could lead to complications.”
Evidence-based Practice Is Good for Nurses
As Williams notes, nurses can pause and reexamine their actions when new evidence-based practices are introduced. “It’s exciting when we have the opportunity to learn something new,” he says. “It’s easy to get caught up in the day-to-day, giving us a chance to reset. When new guidelines pop up, it appeals to that side of nurses that are innovators or creators.”
The kind of pause that Williams mentions also refreshes nurses. “Nurses can use EBP for a variety of reasons. Some include improving or validating current practice, identifying better ways to achieve patient outcomes, and answering clinical questions,” says Bissett.
Stumbling Blocks to Widespread Adaptation
Despite all the good that comes from EBP, complex factors often result in an inconsistent application. A 2021 study found that moving research findings into regular practice takes at least 15 years. Despite medical and technological advances, that number has barely shortened in the past 20 years.
Other studies show that most nurses need to be more competent in EBP. Roadblocks to more widespread adaptation of EBP include a need for a targeted curriculum, too few mentors to show EBP in everyday work, a minimal amount of EBP investment by healthcare organizations, and a fallback to traditional nursing practices.
“In some nursing units, it is not uncommon to have practices persist even after scientific evidence has proven those practices to be ineffective,” says Bissett. “The nurses continue to practice the way they have always practiced. This persists until nurses start to question their practices and start looking for better alternatives.”
Gaining EBP Understanding
Nurses can still gain the needed knowledge even in organizations with little defined EBP work. At work, they can also bring research demonstrating the efficacy of EBP to management. “People are able to negotiate better with evidence,” says Melnyk, noting it can help nurses advocate for change or increase investment.
In general, active and involved nurses will become aware of new guidelines or evidence-based practices as these new developments emerge, and they can position themselves to gain more knowledge. If EBP isn’t part of a nurse’s training, Melnyk suggests nurses take a short, free course to familiarize themselves with the 7 steps of EBP or a more intensive course for mastery of skills.
Williams says that nurses may glean excellent information from listening to two or three podcasts in their specialty. They could also subscribe to a few nursing magazines or journals to keep abreast of the latest news. Getting involved in the nursing community by joining a professional organization is excellent. Williams is an active member of DNPs of Color. Bissett says setting up a Google alert for specific topics is an easy way to discover new information. She says conferences are also an excellent source of the most current information.
There’s also a link between nurses who practice with the most proven methods and their well-being, says Melnyk. She says that even the most highly skilled nurses can’t make much progress if they are burned out and acutely stressed. “You have to tackle this in the culture,” she says.
Attaining that additional knowledge is a powerful tool in nursing practice and a professional motivator that leads to more job satisfaction and even better work for individuals and teams. Melnyk says that if nurses negotiate for change and are met with endless pushback or flat-out denial, they may want to consider moving on to a different organization.
Bissett notes that their confidence grows when nurses are equipped to make informed decisions about patient care and have the resources to consider factors such as efficacy, safety, and patient preferences. The critical thinking that comes with EBP means nurses learn something new and have the tools to analyze why it works and then apply it to their practice, she says.
EBP as Workplace Culture
The nursing community offers exceptional learning opportunities if nurses are open to different perspectives. Williams says his position as an experienced nurse means that he learns from listening to the questions and ideas of new nurses. “That’s something that isn’t talked about enough,” he says. “Student nurses will say, ‘This is what I learned.’ And it’s different from what I learned in nursing school.” Some questions can prompt a reexamination of practices. A workplace culture that encourages information sharing and is open to all questions is one in which nurses can learn from each other in a way that is to everyone’s advantage.
A constant rotation of new nurses and information necessitates continual evaluation of practices. “It is important to understand that once an EBP project is complete and a practice change has been implemented, it does not mean that issue is closed,” says Bissett. “Nurses must continue to verify that their practices are in line with current best evidence.”
Nurses, says Bissett, need to be active consumers of evidence. “We should be constantly looking for ways to improve our practice and to use the best evidence,” she says. “We have to stay well-informed, and that requires some action on our part.”
The critical care transport nursing specialty offers variations of work settings so nurses can work in settings including air transport, ground transport, and military transport. Critical care ground transport nurse Casey Green, BSN, RN, CCRN-CMC, CTRN, CFRN, CEN, TCRN, CPEN, CNRN, NRP says the skills and approach to nursing care in this specialty appeals to her.
“I really enjoy the autonomy of nursing care in the emergency department and the intensive care units, and transport nursing is a combination of using both skill sets to assess, monitor, and treat patients safely,” she says.
Because critical care transport nurses work in ambulances, helicopters, or on ships, they are often the nurses who reach remote areas, trauma situations on roadways, and work in areas that are unfamiliar. They could transport one patient to a hospital or be part of team that needs to transport many people out of an area. The challenge appeals to Green. “I like the variety of patients and just how complex their care is,” she says.
As with any nursing situation, things can change quickly and nurses have to be ready. But transport nursing poses additional challenges including vehicles, weather, and terrain. Green says that transport nurses need to be aware of any potential situation. “To prepare myself for this line of work, I took a lot of courses in patient care for all patient populations, especially those who are critically ill,” she says. “Each shift I work I refresh myself on equipment, medication, or a patient population that we may have not transported recently just to keep the information fresh in case we have a request during my shift.”
Nurses who are interested in this specialty should enjoy the physical challenges, fine tune their critical thinking, and have an ability to read and react to a situation immediately. “Two of my biggest takeaways are to develop strong assessment skills because they help guide your intuition if something feels or seems off during transport,” says Green.
As with other nursing career paths, transport nurses don’t operate in a vacuum even though their work is done outside of a typical hospital or health care facility setting. “Teamwork needs to be at the forefront of your mind when you step on a transport vehicle,” Green says. “Often, your team is all you have between hospitals, and all levels of patient care have a say in patient care during transport.”
Critical care transport nursing is an exciting career path, and Green says if a nurse is interested in pursuing it, preparation is key. “Get experience in the ICU and the ED and apply,” she says. “Don’t worry that you may not have what an employer is looking for; get your experience and develop strong critical thinking and assessment skills.”
What inspired you to have a career in cardiac nursing? I was inspired to become a cardiovascular nurse in nursing school. I remember learning about heart failure in my pathophysiology course for the first time. I was fascinated by learning how the heart works, and the effect it has on our bodies when it isn’t working properly. I was surprised by how, when the heart fails, it creates a domino effect on our circulatory system, impacting other vital organs such as lungs and kidneys. It was then that I realized that I wanted to always care for patients who required care and treatment for heart problems. I wanted to become a part of the solution and prevention of cardiovascular disease.
What are the most important nursing skills for cardiac nurses to have? One of the most important skills for a cardiac nurse is physical assessment. For some patients, their cardiovascular issues aren’t immediately identifiable by vital signs or diagnostic tests. Nurses must have very sharp assessment skills to detect when their patients are experiencing an issue. Physical assessments such as listening to the heart with a stethoscope, and assessing for changes in color of skin (paleness or bluish undertone) can tell us a lot about our patients. Also, asking the right questions about pain and symptoms can tell us a lot about what’s happening with our patients. Active listening is a great nursing skill that has proven to save lives. When nurses listen to their patients, they are more likely to detect that something is going wrong.
As a cardiovascular nurse, I have always relied on my assessments, diagnostic labs, and exams, as well as my patient’s verbal accounts to develop a safe plan of care to support good health outcomes.
With so many advances in cardiovascular health, how do you stay current on new trends, nursing techniques, or evidence-based practices? As a cardiovascular nurse, it is imperative that I stay abreast to the latest evidence-based literature and guidelines to support safe and efficient care, and education for patients. As a nurse and researcher, I follow the most up-to-date treatment national guidelines published by the American Colleges of Cardiology (ACC) and American Heart Association (AHA) and PCNA. These organizations are committed to providing the best practices, based on research to ensure good health outcomes for all.
I also attend ACC/AHA and PCNA conferences and continuing education programs to ensure that I’m learning the latest research-based guidelines. As a researcher, I conduct research and publish articles to contribute to the cardiovascular science. Finally, I also serve on writing committees for the above noted organizations, where I have the opportunity to contribute to the development of guidelines for nurses and other cardiovascular healthcare providers. All of these activities are a part of my commitment to lifelong learning and the enhancement of cardiovascular care of patients with cardiovascular diseases.
What do you most enjoy about your career as a cardiac nurse? As a cardiac nurse, I have the privilege of meeting and working with wonderful patients and colleagues. While working in community outreach, I meet the most dynamic patients. I found that through the years, I enjoy speaking with individuals living with cardiovascular disease. There is so much to learn from them as they share their experiences and wisdom.
What would you want other nurses to know about this career path? Almost 50 percent of individuals in the United States are living with some form of cardiovascular disease. There is much opportunity for nurses to enter the cardiovascular field. Cardiac nurses are not limited to hospital inpatient units, they can work in outpatient clinics, operating rooms, cardiac cath labs or rehabilitation units, nuclear medicine procedure areas, and critical care units, among others.
I want nurses to know that among several nursing specialties, they can choose any area of their choice, whether that is oncology, obstetrics, surgery, pediatrics, or neurology. What I’d like nurses to remember is that every patient has a heart, and the heart serves as the center for all functions. With that being said, every nurse is a cardiac nurse. All nurses are trained to take care of the heart.
Patients are often aware of all the nurses who care for them during a medical procedure, and particularly the perianesthesia nurses who are fierce patient advocates during a time when patients are under and emerging from sedation.
As PeriAnesthesia Nurse Awareness Week (this year from February 5-11) celebrates all the work nurses do in this specialty and helps raise awareness of perianesthesia nursing as a career path.
A perianesthesia nurse has diverse responsibilities that can change instantly. They assess patients as they are preparing for a procedure, as they begin, undergo, and emerge from anesthesia–and the process is different for every patient (even if they have worked with the patient previously). The skill set in this specialty is vast and includes an ability to use critical thinking to identify, prevent, or manage a potential crisis.
Perianesthesia nurses care for patients in the time before a procedure during what might seem like a hectic time for patients. As patients are answering questions, getting ready for the procedure, and meeting the medical team, the perianesthesia nurse is developing a rapport and gathering valuable information that can help keep the patient as safe as possible while they are under sedation.
Perianesthesia nurses are also right at the patient’s side during recovery keeping a close watch to assess patients as they are emerging from of the effects of anesthesia. This is an important time because although the procedure may be over, patients are just beginning their recovery process. Their bodies might react in different ways as the anesthesia wears off, so nurses have to be ready for anything from a patient who is crying to one who might be shouting. And during that time, they are constantly assessing the patient for their levels of pain so they can most effectively establish a pain management plan and ensure patient safety.
An essential part of perianesthesia nursing is to develop a fine-tuned awareness of each patient, even during hectic times. Perianesthesia nurses scan patients to take a comprehensive inventory of their vital signs, skin color, breathing patterns, and subtle body movements to ensure that a patient feels safe and has the very best outcome.
Perianesthesia nurses are often passionate about the work they do and the way they are able to connect with patients and their families in a short time. They develop an intuitive approach to patients–from their anxiety level before a procedure to their process in recovery. They are advocates for their patients and are also aware of the important professional connections they make with their other health care team members and with each other.
