For Gloria Spires, CRNA, BS, one of the most rewarding aspects of her work as a nurse anesthetist is when a patient wakes up after surgery and says with surprise, “Is it done?”

To the patient, it seems like it was only a few seconds ago when Spires offered comfort and confident reassurance before putting him under. He is grateful and relieved: The surgery was a breeze. Little does he realize, though, that while he slept and the surgeon worked, Spires watched over him like a guardian angel, monitoring every heartbeat and every breath, making sure he would come through just fine.

Nurse anesthetists like Spires, who is African American and works at the Surgery Center at Southwoods in Youngstown, Ohio, have been providing anesthesia care for more than 100 years. Today they administer 65% of the 26 million anesthetics given each year to patients in the United States, according to the American Association of Nurse Anesthetists (AANA). They are the sole anesthesia providers in about half of all U.S. hospitals, almost 70% of the nation’s rural hospitals and in many inner city health care facilities.

This advanced practice nursing specialty involves significant challenges and responsibilities-and provides significant rewards to match. Rather than having to juggle many patients at once, nurse anesthetists care for one patient at a time. They also enjoy a greater sense of autonomy than many other nurses. Last but definitely not least, they earn great money, with starting salaries averaging about $118,000, according to a recent survey by Allied Consulting, a Dallas-based health care staffing firm.

In fact, Certified Registered Nurse Anesthetists can even earn more than what some physicians make. According to Allied, salary offers for CRNAs can go as high as $180,000-more than 20% above the average salary offered to pediatricians and family doctors. Because skilled, experienced nurse anesthetists are currently in extremely short supply, their field is one of the top 10 recruited health care specialties. And like most other specialty areas of nursing, racial and ethnic minority nurses are seriously underrepresented in the field.

To become a CRNA, a nurse must earn a master’s degree in nurse anesthesia and pass a certification exam after graduation. Nurse anesthesia academic programs are full-time, range from two to three years in length and include clinical training. The prerequisites needed for acceptance into a program are a BSN or other appropriate bachelor’s degree, a current license as a registered nurse and at least one year of practice in an acute care setting.

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Nurse anesthetists practice in any setting where anesthesia is administered: hospital operating rooms, obstetrical delivery rooms, critical access hospitals and outpatient surgery centers. They also work in the offices of dentists, podiatrists, ophthalmologists and plastic surgeons as well as in the military, the U.S. Public Health Service, and Veterans Administration health care facilities. They collaborate with other health care professionals, such as surgeons, dentists and anesthesiologists, but they don’t necessarily have to work under the supervision of an anesthesiologist.

This high degree of independence was one of the factors that attracted Juan Quintana, CRNA, MHS, to the field. “This career allows nurses to do what we got into the profession to do,” he says. “The patients’ lives are in our hands and we are there to care for them.”

Quintana had been a registered nurse for 10 years, working with pulmonary patients in operating rooms and intensive care units, when he decided he wanted to have a greater say in patient care. Working as a CRNA allows him to combine his critical thinking and decision-making skills with advanced knowledge and sensitivity toward patients.

Today Quintana runs an independent nurse anesthesia practice in rural Texas that includes himself, two other full-time and two part-time nurse anesthetists. The practice, called Sleepy Anesthesia Associates, works on contract with five hospitals.

Moving up to this more advanced, autonomous role after working as a staff nurse requires a shift in thinking, agrees Ronny Ancog, RN, a nurse anesthesia student at Samuel Merritt College in Oakland, California. “As a nurse, you’re often reliant on a physician to give orders,” explains Ancog, who is of Filipino descent. “As a nurse anesthetist, I can actually write orders for other people to implement. I can decide that an intervention is necessary and have that decision carried out.”

Risk Management

Nurse anesthesia is a demanding, intense career that is ideal for nurses who thrive on challenge. “The time in which we’re taking care of patients is a very dynamic time for them physiologically,” says Julie Pearson, CRNA, MSN, assistant director of the Nurse Anesthesia Program at Georgetown University in Washington, D.C. “When something goes wrong, it’s a matter of life or death.”

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Constant vigilance is critical even when things are going well. A nurse anesthetist must always maintain the perspective that a patient’s status can change dramatically at any time.

There is no one-type-fits-all, “cookbook recipe” for anesthesia, notes Prudentia Worth, CRNA, PhD, director of the anesthesia department and post-anesthesia care unit at Detroit Receiving Hospital and director of Wayne State University’s Department of Anesthesia. Therefore, nurse anesthetists must gather a complete patient history and use it to develop a custom anesthesia plan.

But in emergency situations, there may be no opportunity to get full information about the patient. In these cases, says Worth, “you’re working with individuals you know nothing about. You’re faced with physiological changes in the OR that you don’t have a history to relate to, but you still have to manage. The response has to be quick and correct.”

Another challenge CRNAs must master is informing patients of the risks of anesthesia without frightening them. Fortunately, today’s improved anesthetic drugs and procedures have substantially reduced patient mortality rates in anesthesia care. According to a 1999 Institute of Medicine report, the practice is almost 50 times safer today than it was 20 years ago. Yet there are still some lingering risks, which nurse anesthetists must be able to communicate to patients while still putting them at ease.

Spires reports that patients often ask her, “I’m going to wake up, aren’t I?”

Bringing Diversity to Nurse Anesthesia

Because patient education and communication is such a critical component of the nurse anesthetist’s work, there is an urgent need within this specialty for racial and ethnic minority CRNAs who can provide culturally and linguistically competent care to an increasingly diverse range of patients.

As a Hispanic nurse anesthetist, for instance, Quintana’s first-hand understanding of Hispanic culture and his ability to communicate in both Spanish and English help him establish rapport with patients and their families. “We’ve found that it really does make a difference,” he says.

Yet nurses of color are vastly underrepresented in the field. According to the AANA, only 2.1% of CRNAs are black, 2.1% are Asian, 1.4% are Hispanic and less than 1% are Native American.

This situation is slowly beginning to change, however, thanks to the efforts of a growing number of university nurse anesthesia programs to attract more minority students. For example, last fall Florida International University (FIU) School of Nursing in Miami, in an effort to address South Florida’s severe CRNA shortage, received a grant from the Health Resources and Services Administration to expand its nurse anesthesia program from 15 to 40 students. Forty percent of the program’s students and a third of the faculty are nurses of color.

John McDonough, CRNA, EdD, ARNP, director of the FIU nurse anesthesia program, attributes much of this diversity recruiting success to the school’s reputation for cultural sensitivity. As part of its P.R.I.D.E. Project, for instance, FIU is partnering with two local high schools to recruit and mentor minority students who are interested in nursing careers. The program includes a summer camp where the teens can meet nurses from various specialties, get hands-on lab experience and shadow nurses at work.

The expansion of FIU’s nurse anesthesia program was also made possible by the school’s collaboration with Miami Beach Anesthesia Associates, which runs the anesthesia department at nearby Mount Sinai Hospital. The anesthesia group is paying half the salaries of the nurse anesthesia professors, and the hospital is serving as a clinical site for the program. Through this partnership, the anesthesia associates will gain opportunities to recruit the program’s students when they graduate.

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FIU has also started a distance learning program for nurse anesthesia students in central and north Florida. This flexible, convenient program enables students to do their clinical work close to home and take most of their classes locally or through two-way videoconferencing. The new distance learning option is expected to make nurse anesthesia education even more accessible to minority students, who are more likely to be working full-time than their Caucasian counterparts.

In 2001, Georgetown University School of Nursing launched a diversity initiative to recruit more minority students to its nurse anesthesia program. As a result, says Pearson, the 2003 nurse anesthesia class has more students of color than any other class in the program’s history. At open houses for the nurse anesthesia program last year, 38% of those who attended were nurses of color.

The program is reaching out to minority candidates through state and regional nursing associations, local critical care units and minority nursing professional organizations, such as the National Association of Hispanic Nurses. It is also priming the pipeline by establishing partnerships with local associate degree nursing programs-e.g., helping the students find financing for school and providing support and mentoring to help them complete their studies and make plans to continue their education to the next level.

Exploring the Opportunities

What qualities and skills does it take to be successful in a nurse anesthesia career? “We look for individuals who are self-motivated, self-directed and can think outside the box,” Worth says.

Prospective CRNAs should also be prepared for a vigorous program of study and a lifetime of learning. Worth, who is one of the nation’s most prominent and respected minority nurse anesthetists and CRNA educators, was raised in the West Indies, then worked as a nurse in England before moving to New Jersey with her family in the 1960s. She was working as a private duty nurse at Henry Ford Hospital in Detroit when a surgeon said he thought she would make a good nurse anesthetist and referred her to a university program.

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“I worked extremely hard, and the field was more than I bargained for,” Worth recalls. Support from instructors and a strong drive to succeed helped her finish the program, but she didn’t stop there. After becoming certified in nurse anesthesia, Worth went on to earn a master’s and then a PhD in education. “This was a profession that was constantly moving and growing,” she explains, “and I felt like I needed to grow with it.”

Ancog says one of the challenges for RNs enrolled in a nurse anesthesia master’s program is adjusting to being a student again, rather than an expert on the job. “Every day you get critiqued,” he points out. “You have to adapt to that and be open to suggestions.”

Spires believes nurse anesthetists need to be confident and assertive, able to make quick judgments and able to work well in conjunction with other health care professionals, such as anesthesiologists and surgeons.

How can you find out more about whether this demanding but highly rewarding advanced practice career is right for you? To get a feel for the specialty’s expectations, Sandra Morris-Harris, clinical director of the Georgetown Nurse Anesthesia Program, suggests reviewing the national practice standards for nurse anesthetists. Here are some additional ways to explore what the field of nurse anesthesia is all about:

Visit the American Association of Nurse Anesthetists Web site at www.aana.com. The site contains a wealth of information about the profession, a list of accredited nurse anesthesia education programs, national practice standards, news, links to other helpful sites and more.
Get in touch with a local AANA chapter and ask to shadow a nurse anesthetist at work.
Contact an accredited nurse anesthetist program and ask to visit different clinical settings. Worth says talking to nurse anesthesia students will provide insight into the academic requirements of the program, and visiting a variety of clinical sites will give a feel for what kind of work setting might be the best fit for you.
Strengthen your science background and get familiar with the anesthetics used in hospital ORs and intensive care units.

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