National CRNA Week kicked off its inaugural celebration when the American Association of Nurse Anesthesiology introduced it in 2000. Since then one week in January (this year it’s January 22-28) is designated as a time to celebrate the nearly 60,000 nurse anesthetists practicing in the United States.
Certified Registered Nurse Anesthetists (CRNAs) work collaboratively with healthcare teams or independently. They administer or assist with administering anesthesia for patients undergoing procedures in various healthcare settings. CRNAs can be present for planned surgical procedures, in emergency settings, in pain management clinics, in dental offices, and in birth centers to name a few.
Nurse anesthetists are responsible for caring for and monitoring a patient’s anesthesiology needs during a procedure, but their work pre- and post-procedure are critical. They will gather medical history, medication information, and assess the patient’s physical and emotional condition when possible. They are constantly looking for and identifying any potential issues that could interfere with plans for anesthesia.
As with other nursing specialties, CRNAs have taken on more responsibility and needed to master increasingly complex healthcare conditions and tech-based equipment. Because of this, changes to the practice entry requirements now require all nurses entering a CRNA program to exit with a doctor of nursing practice (DNP) or a Doctorate of Nursing Anesthesia Practice (DNAP) . Practicing CRNAs aren’t required to return to school for this additional advanced degree if they already have a master’s degree and have been in practice. Although it’s not required, some nurses may find that employment parameters are changing and that the DNP might be a requirement in a new place of employment.
CRNAs have careers that are dynamic and exciting. They can work directly with patients or they may choose to work in administration where they can have an impact on the conditions for patients and nurses. CRNAs also have options to work in government settings or to become active within committees to help shape the policies that surround CRNA work and career expectations. As CRNAs take on more leadership roles, they can use their direct real-world experience to inform the nuances of proposed changes.
As in all nursing specialties, time spent on the job is an excellent way to build skills and empathy for patients. CRNAs will want to continue learning about the rapid changes in the field with certification through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). Certification, which needs to be renewed to stay current, helps you remain informed on the latest developments that impact the duties you perform in your work. By staying up-to-date on the most current techniques and developments, you’ll be able to offer high-quality patient care that will result in better outcomes for your patients and the best performance by your team. Certification is a way to learn about everything from patient care to technological changes in equipment that can change your process.
Celebrate the CRNAs on your team this week and if you’re a CRNA take time this week to reflect on the work you do with your patients and your healthcare team. Be proud of the change you make in each patient’s life as you perform a critical task within the process.
Like many other nursing specialties, nurse anesthesia education programs face the challenge of recruiting, retaining and graduating a sufficient number of qualified students to meet the demands of the health care workforce. A significant aspect of this challenge is the struggle to achieve a racially and culturally diverse student mix that represents the patient population.
The assertion that racial and ethnic minorities are underrepresented in the field of nurse anesthesia does not require sophisticated statistical analysis. One need only visit the meeting rooms and exhibit halls of a professional nurse anesthesia conference to arrive at this conclusion. A recent survey by Dr. Prudentia Worth, director of the Nurse Anesthesia Program at Wayne State University, reveals that only 16% of students in such programs are non-Caucasian.
The Nurse Anesthesia Program at Georgetown University has begun to address this challenge by developing a project designed to prepare more minority nursing students for nurse anesthetist careers. Funded by a grant from the Health Resources & Services Administration’s Bureau of Health Professions, Division of Nursing, the project’s approach is multifaceted, encompassing student recruitment, admissions and, above all, successful completion of the program.
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The success of this diversity initiative serves to benefit not only students but also communities that are at the greatest risk of suffering from a shortage of nurse anesthetist professionals. In creating and implementing this project, our goal was to produce a diverse group of graduates with the competencies to deliver cost-effective, culturally appropriate, quality care to all patients.
The project was officially launched in July 2001. As the result of our initial efforts, the Nurse Anesthesia Program’s class of 2003 has more minority students enrolled than any previous class.
Beginning the Journey. . .
The academic journey toward a career as a practicing nurse anesthetist is not an easy one. After earning a bachelor’s degree and licensure as an RN, the nurse must acquire experience in an acute care setting. From there, the formal application and enrollment process into a nurse anesthesia program can begin.
The length of these programs ranges from two to three years, with 27-28 months being the average. The student faces a rigorous course of study, including classes in the basic sciences (e.g., anatomy, physiology, pathophysiology, pharmacology), professional aspects of nurse anesthesia and advanced principles of nurse anesthesia practice. Upon completion of the program and conferral of a master’s degree, the graduate may sit for the certification exam. It is only after all of these steps are successfully completed that a nurse becomes a Certified Registered Nurse Anesthetist (CRNA).
The Georgetown project’s first step in bringing a more diverse group of nurses into this journey was to initiate strategies for recruiting qualified minority RNs into the Nurse Anesthesia Program. This ongoing effort currently includes outreach to members of student associations, state and regional nursing associations, nurses practicing in local critical care units, and minority nurses’ professional organizations, such as the National Association of Hispanic Nurses.
Another key focus of this outreach effort is personal visits by faculty, alumni and admissions recruiters to hospitals that have a high percentage of nurses of color. Students in our program spend 15-16 months in clinical rotations in the operating room, providing anesthesia under the supervision of a licensed anesthetist. Because of a growing need for more nurse anesthetists in the D.C. area, enrollment in Georgetown’s program has risen 400% in the past five years.
This has required an increase in the number of hospital sites students can use to obtain their clinical experience. To dovetail this need with the goals of our diversity initiative, we have sought out new clinical sites that not only provide contact with minority nurses who could be potential applicants to the program but also give students exposure to a more diverse patient population.
Applicant selection is important to the success of a nurse anesthetist education program, in order to minimize the student attrition rate without compromising the professional expertise of the graduates. For this project, we developed a selection tool based on such criteria as previous nursing education, GPA (undergraduate and graduate), GRE scores, number of years of nursing and critical care experience, three references and a personal statement. The process also includes a personal interview with faculty.
The admissions committee then ranks candidates based on their overall presentation, including academic, clinical and personal accomplishments. In addition, the faculty identifies candidates who have potential but may not meet all requirements or have deficiencies in certain areas. For these applicants, the faculty recommends specific actions, such as additional course work or clinical experience, to increase the candidate’s chance of being accepted into the program and completing it successfully.
In 2001, Georgetown faculty and students conducted a pilot study that describes the benefits of providing associate degree nursing students with information about nurse anesthesia as a career path. As a result of this study, our diversity project also focuses on establishing partnerships with local associate degree programs. This provides minority graduates of these programs with information about the field of nurse anesthesia and the opportunity to pursue an advanced degree. Georgetown offers a number of bridge programs for associate degree students, including RN-to-MSN and a second-degree program.
. . .and Finishing It
The philosophy of Georgetown’s Nurse Anesthesia Program is that every effort must be made to ensure that the students who receive their degrees on graduation day are the same students who sat in orientation on the first day of the program. This level of commitment to student retention requires a labor-intensive strategy of evaluation and advisement throughout the course of study.
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Program faculty conduct individual evaluations with students at least once each semester. Students who need to improve their performance receive assistance in the form of advising, tutoring and mentoring. In the program’s clinical phase, mentoring is provided by practicing CRNAs. A more formal peer mentoring program for incoming students is also under development. When indicated, faculty provide individualized remediation programs to help students address specific areas of weakness.
A concern of all students is the ability to fund their education, and this is even more critical if the students are economically disadvantaged. The project at Georgetown is addressing this issue by seeking means to increase financial assistance sources for minority students. These sources include future employers who are willing to provide tuition assistance, corporate funding, support within the nursing school and the university, government-sponsored minority scholarships, program traineeships and alumni-sponsored scholarships.
A major initiative to recruit more minority students also requires appropriate resources in terms of faculty and staffing. We have addressed this by increasing the number of full-time faculty, hiring a full-time administrative assistant and using adjunct faculty and teaching assistants to provide supplemental teaching and administrative support.
Another of the project’s goals is to provide role models for the students by increasing the number of minority faculty in the program. Our diversity recruitment efforts at the faculty level include both short- and long-term solutions: recruiting from areas where minority faculty work and encouraging new minority graduates and junior CRNAs to pursue teaching careers.
Although this project is still in its infancy, the initial results are encouraging. At open houses for the Nurse Anesthesia Program this year, 38% of the attendees were nurses of color. And while it is difficult to accurately measure changes in the racial and ethnic makeup of new applicants and enrollees, because 25% of these nurses chose to not specify their race or ethnicity, we have seen increased minority representation in both of these areas between 2001 and 2002.
Other quantitative and qualitative results we will evaluate on an ongoing basis to monitor the project’s success include student feedback, review of the selection tool and of admissions committee comments, enrollment of minority students whose initial nursing degrees were at the associate level and employer participation in tuition assistance programs.
The finance industry and the nursing profession may seem worlds apart. But Juan Pineda, RN, a former investment officer for the Massachusetts State Treasury Department who is now a cardiac surgery ICU nurse at NewYork-Presbyterian Hospital/Columbia in New York City, was able to make a smooth transition from the world of number crunching to the challenging and rewarding field of nursing, thanks to a passion for patient care and a love for helping people.
Making a total career change is often a risky endeavor, but for Pineda the bigger risk was remaining in a field that he was not passionate about. “I was more afraid of staying in my investment job than I was of making such a big change,” he says. “As hard is it might be to [have to start all over] in terms of education, it was harder for me to imagine myself in that same position .” Still, he admits, making such a dramatic career shift “definitely takes guts and determination.”
Pineda is the son of Colombian parents who immigrated to the United States in the early 1970s. They settled in the Boston area, where Pineda, along with his older brother, was born and raised.
Pineda’s interest in the health care field emerged in high school when he had to complete a community service project as a Spanish-language interpreter at Massachusetts General Hospital to earn credits toward graduation.
“It exposed me to the hospital environment and I thought it was great,” he recalls. “I really enjoyed helping people. Whenever I walked in to translate for a patient or a family, their faces would light up. They were probably so afraid about what was happening, and finally [here was someone who spoke their language] and could help them understand what was going on, rather than just having people poking and prodding them.”
After graduating from high school, Pineda thought about going to college as a pre-med major. But at 18 years old, he felt he was not ready for the rigor of pursuing a medical degree. “After I did the interpreting for about two months, I went away to college thinking that I was going to major in pre-med after having that experience in the hospital,” he says. “I was really interested in science and the human body. But I don’t think I was really ready to go to college at 18. I wanted to take some time off and really think about what I wanted to do. However, my parents didn’t think that was a good idea, and they strongly encouraged me to continue [with my education].”
He ultimately decided to remain at the University of Massachusetts Amherst to complete his degree, but not as a pre-med student. “[Back then], I just didn’t have the dedication for it,” he says. The thought of having to take difficult science classes, like organic chemistry, scared him. He decided to switch gears and pursue a degree in political science, one of his other big areas of interest.
As a political science major, Pineda focused his studies on international relations, comparative politics and issues affecting Central and South America. “At that time I thought I would go to work for the UN or something,” he says. “I minored in French and lived in France for a while and thought I would go down the path of working in international relations.”
After graduating with his bachelor’s degree in political science, Pineda took advantage of an opportunity to work at the Massachusetts State Senate. The job, however, focused more on the financial side of state politics than on the policy-making side.
“I worked as a budget analyst for the Ways and Means Committee,” he explains. “Then I moved to the State Treasury and became an investment officer. I did general fund investments in bonds and long-term debt, investing up to $1 billion. This wasn’t really complicated work—I didn’t have a background in investing. But I wanted to learn more [about the field], so I accepted a position at [the financial services firm] Morgan Stanley.”
At the time, the job at Morgan Stanley seemed like an attractive offer that would give him opportunities to use his Spanish-speaking skills and his background in international relations. With the possibility of assignments that would involve traveling to South America to gain clients seeking to invest money in the U.S., Pineda thought he had finally found a way to combine some of his interests.
But by the time he had completed his training and licensing in early 2001, the economy was in a downturn. It was not a good time to be working in the financial sector, and Pineda never got his chance to travel for Morgan Stanley. He was also beginning to feel that his career path was leading him further and further away from his original interest in public service.
“I didn’t feel like I was helping people by working in investing,” he says. “I realized I wouldn’t be successful in that career, because I didn’t have enough passion for what I was doing.”
Ready for Change
After quitting his job at Morgan Stanley and taking some time to think about what he really wanted to do, Pineda finally decided to return to square one and refocus on his first love: health care.
“That’s when I decided to go to nursing school,” he recalls. “I had a friend who was in nursing school and I would flip through his textbooks. He reminded me that it wasn’t too late to change careers. I agreed, and in 2001 I enrolled at Bunker Hill Community College and began taking anatomy and physiology courses.”
Pineda’s decision to make a career change into nursing was met with some resistance from his family—and even from other nurses. “When I first decided to go back to study nursing, a [nurse] friend of mine let me tour the ER of the hospital where he worked so that I could see up close what it was like. I wanted to be exposed to the ER to see if I would get nervous about seeing blood and things like that,” he explains. “One of the nurses there told me that I couldn’t go from [a field like finance] to nursing. I ignored the comment, because I knew that I can do anything if I really want to do it.”
He says his parents “rolled their eyes” when he announced that he was returning to college full-time to pursue a nursing degree. “Because I had had so many different jobs and was in my mid-to-late 20s and still struggling to find what I really wanted [to do with my life], they didn’t believe that I would [really] do it.”
But Pineda soon proved to his family—and his peers—that he was very serious about nursing. He attended classes during the day and supported himself by working as a waiter and bartender at night. “I needed something stable that wouldn’t interfere with school,” he says.
In 2004 he completed his associate’s degree in nursing, graduating at the top of his class. Shortly after that, he accepted his current position at NewYork-Presbyterian Hospital/Columbia.
Today, Pineda has no shortage of opportunities to feel passionate about his work. “I love my job. I’m one of the luckiest people in the world,” he says enthusiastically. “I can’t believe that I get paid to do this. This is the most interesting job [I’ve ever had]. It’s always challenging—physically, mentally and emotionally. I’m very proud of what I do. I’m helping people. I get to learn so much about the human body, how to work with families and how to educate patients about their recovery. I’m providing emotional support to patients and families. It’s great.”
Communicating and Connecting
Pineda feels there is a strong need for more bilingual Spanish-speaking nurses all over the United States. The community his hospital serves, for example, has a large population of immigrants from the Dominican Republic. “Every day another nurse asks me to interpret,” he says. “I can’t imagine working [here] and not speaking Spanish.”
Although many of the doctors on his unit do speak Spanish, Pineda’s ability to communicate in Spanish is still in demand. “[Here in the cardiothoracic ICU], patients are coming out of surgery, so it’s very helpful for them to connect [with the nurses] and much more effective for everyone that I speak Spanish. There’s a comfort for the patients [knowing] that I share the same culture, language and interpersonal dynamics with them.”
One of the reasons why Spanish-speaking nurses are so underrepresented in the RN workforce, Pineda believes, is the strong emphasis on family obligations in Hispanic communities. “[We] Hispanics seem to have children earlier in life,” he explains. “But [even if you do have kids] it’s worth it in the long run to continue with your education, because it will open so many doors in the future.”
As for being a man in nursing, Pineda doesn’t feel like he’s a minority in that regard. “I’ve been in units where on some days half of the nursing staff is male,” he says. “A lot of men in nursing are drawn to the ER or the ICU. It’s a very fast-paced environment. I’ve even been told by some families that [they think] male nurses are more compassionate than female nurses. The important thing, no matter what gender or race you are, is that this is a great career with lots of opportunities for growth. You can go as far as you want to go.”
Asked what qualities are necessary for a successful career in nursing, Pineda answers that a good nurse is empathetic, hard-working and determined. “You have to love this profession,” he emphasizes. “It can be difficult if you didn’t love it. The decision to become a nurse is so personal, but if [you] have a desire to learn a lot and really help people at the most critical points in their lives, it’s the best job in the world.
“It’s a competitive field,” Pineda continues. “[When you’re in nursing school], the classes are difficult. The first year is hard and from there it only gets harder. Then you have to take and pass the exams. And then when you start your first job, the work is hard and the hours are long. But it’s the most rewarding work. I advise others [interested in nursing careers] to be dedicated and do your best.”
Continuing the Dream
Now that Juan Pineda has fulfilled his dream of becoming a nurse, he is ready to take on new challenges. This summer he began taking courses in general chemistry, organic chemistry and statistics in order to fulfill requirements needed to apply to a master’s program in nurse anesthesia.
“I already had taken many of the [prerequisite courses] during my undergraduate work as a pre-med major, so I just needed three additional classes,” he says.
Today Pineda feels he is on track to achieve the kind of career he always wanted. “Being a nurse anesthetist is my ultimate goal,” he says. “That was my original plan—to have such a special role in someone’s treatment. I’m going to apply [to CRNA programs] in November. I have been focused on getting the best grades [in my prerequisite classes], because anesthesia school is very competitive.”
And what about his long-term goals? Where does he see himself in, say, 10 or 20 years? While Pineda has given it some thought, he admits that right now he’s focusing all his energies on getting through his CRNA program.
“I’ve planned on this for the past six or seven years and it’s such a big goal,” he says. “I’ve been focused on it for so long that [at this point] I’m not sure what my goals for the future are. I have thought about teaching, though. My ultimate goal for when I retire [from nursing] is to be a teacher of English as a second language.”
It’s often called the best-kept secret in nursing: Certified Registered Nurse Anesthetist (CRNA). These master’s-level advanced practice nurses prepare, administer and monitor the use of anesthetic medicine in patients. According to the American Association of Nurse Anesthetists (AANA), CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites, obstetrical delivery rooms, critical access hospitals, ambulatory surgery centers and the offices of dentists, podiatrists, ophthalmologists, plastic surgeons and pain management specialists.
Like many other specialty areas of nursing, CRNAs are in short supply and therefore in high demand. They also typically earn six-figure salaries. As the AANA puts it: “CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.”
Currently, nurses of color are significantly underrepresented in the field of nurse anesthesia. According to some estimates, African Americans and Hispanics each make up less than 2% of all CRNAs. As a result, nursing schools and the AANA are working to increase diversity in the specialty. And that means there’s never been a better time for minority nurses to take advantage of this career’s outstanding professional and financial rewards.
Completing the CRNA educational requirements, though, will require two or three of the toughest years of your life. CRNA programs are rigorous, intense and time-consuming. They are also very competitive to get into. Admissions committees will expect applicants to have high GPAs and high GRE (Graduate Record Examination) scores. Students are also expected to have a couple of years experience in critical-care or intensive-care nursing and outstanding references.
“This is probably one of the most rewarding fields in nursing, and almost [every CRNA] has a high level of job satisfaction. But that also makes it the most competitive,” says Henry Talley V, PhD, CRNA, MSN, MS, BA, director of the newly accredited CRNA program at Michigan State University College of Nursing. He is also the founder of Minority Anesthetists Gathered to Network, Educate and Train (M.A.G.N.E.T.).
How to Choose a Program
The journey toward becoming a nurse anesthetist begins with choosing the CRNA education program that best meets your needs. This means you’ll need to research potential programs thoroughly.
One of the most important things to look at is accreditation. There are currently more than 100 CRNA programs nationwide that are accredited by the AANA’s Council on Accreditation of Nurse Anesthesia Educational Programs. A complete list is available at the association’s Web site, www.aana.com.
In some states, students who earn degrees from unaccredited nursing schools can still take their NCLEX® exams and become RNs. But this is not the case with nurse anesthesia programs. “The program has to be accredited for students to sit for the national [certification] exam,” Talley explains. “Unfortunately, a few students have learned the hard way how important accreditation is.”
Talley also cautions prospective CRNA students to do more than just look for the standard accreditation statement. “Find out from the Council on Accreditation if the programs you’re considering are in good standing or are on probation,” he says. A program on probation may be in danger of losing its accreditation, which could make students ineligible for the exam and certification.
While this type of information is easy to obtain, it’s not always so easy to research whether a CRNA program embraces diversity and will provide an environment where minority students will feel welcome rather than isolated. One approach is to visit the Web sites of programs you’re interested in and look for clues, such as the number of minority nurses on the faculty, the presence of a diversity director and whether the curriculum has a cultural competency component.
However, Talley cautions against placing too much emphasis on these factors.
“If you can find minority faculty in a program, that’s helpful. Sometimes, there are special problems that still occur in society where a minority student needs the input of another minority or a mentor. However, [the reality is that there are very few minority faculty in the nurse anesthesia field], so you can’t make that the top criteria of your program decision.”
Instead, he advises, look at passing and placement rates. Visiting the campus and talking to students and faculty members–preferably meeting them face-to-face–before submitting your application will give you an indication of whether you will fit in at that program.
While the number of racial and ethnic minority CRNAs is still small, the number of men in the specialty is unusually high. According to the AANA, nearly half–approximately 46%–of the nation’s nurse anesthetists are men, compared with only about 8% in the nursing profession as a whole. As a result, male CRNA students are likely to find that their program offers a male-friendly learning environment. They are also more likely to find male faculty members.
It’s also important to compare your learning style to the program’s teaching style.
“Some curricula spend the first three months in the classroom and then begin clinicals with students doing minor work in the operating room,” Talley says. “Other programs cover all of the academic coursework before beginning clinicals. Students work on [patient] simulators. If you’re someone who learns by doing, the first type of program might be best for you.”
You may also want to consider any special circumstances, such as accessibility or degree status. For Wallena M. Gould, CRNA, MSN, who graduated from La Salle University’s Nurse Anesthesia Program four years ago, finding a CRNA school that would accept her even though she did not have a BSN degree was what made the difference.
“My bachelor’s degree is in accounting,” she explains. “I went back to school and earned an associate’s degree in nursing. La Salle’s program did not require a BSN. I was accepted, but I was required to take two years of prerequisites before formally becoming part of the CRNA program.” Gould is now chief nurse anesthetist at South Jersey Regional Medical Center in Vineland, New Jersey.
How to Get In
Is it really that hard to get accepted into a CRNA program? Just how competitive is the field? The answer, unfortunately, is “very.” CRNA class sizes are small, only a limited number of slots are available and admission standards are very high.
“While our program’s GPA requirement is 3.0, my incoming class average is 3.73,” Talley says. “Meeting the minimum standards does not give you a good chance of getting into a program [that can only accept] 10 or 15 students. You really want to have at least a 3.5 GPA, with excellent grades in your science courses and in your last two years. If your GPA is lower, you need to do very well on your GRE. Get a study book with practice tests and practice, practice, practice.”
CRNA programs also require applicants to submit a 500-word essay. Consider this your opportunity to sell yourself. If your essay is not well written, chances are you won’t be invited in for an admissions interview.
With odds like these, it’s best to not get your heart set on one particular school. To increase your chances of getting into a CRNA program, plan on applying to at least three schools.
While getting in may be tough, take comfort in knowing that once you’re accepted, you’re very likely to succeed. In other words, if you’re good enough to get in, you probably have what it takes to complete the program.
“We’re very selective, but we lose very few students–usually only one or two each year,” says Sass Elisha, CRNA, EdD, academic and clinical educator at Kaiser Permanente School of Anesthesia in Pasadena, California. “At this school, we screen students carefully and accept them expecting success. We do what we can to help them realize that potential, but it is dependent on them. We’ll help them, but the heavy lifting is their responsibility.
“The people that apply are unbelievably high-quality students. Their knowledge base and scholarship are impressive and that makes it very difficult to analyze applicants.” He adds that applicants must show that they have a clear understanding of the program and the specialty.
Gould agrees. “The first question you’re going to be asked in your interview is ‘why do you want to become a CRNA?’” she says. “Applicants should be able to answer that question in a way that shows familiarity with the field and the responsibilities. It’s also very important that you read the requirements for completing the program instead of just getting into the program.” She also advises applicants to use their interview time to talk about how they will manage their family obligations and finances while in the program.
To seal the deal, do your homework. Know the traditions, history or alumni that make a particular program unique or special.
How to Survive
Getting accepted into a CRNA program is just the beginning. Perhaps more than any other nursing education program, earning a master’s degree in nurse anesthesia requires almost complete devotion to your studies. The pace is fast, the classes are rigorous and the clinical portion is so time-intensive that it feels like a full-time job. You pretty much have to live, eat and breathe CRNA for 24 to 36 months, depending on the length of your program.
With few exceptions, all accredited CRNA programs are full time. Students are usually prohibited, or at least discouraged, from working–even part time. If you are a parent, you will be expected to have fail-safe childcare arrangements.
“Many nurses don’t recognize the true rigors of the program and are unprepared when clinicals start,” says Gould. “You need to realize that you’ll be taking at least two exams a week. You’ll be challenged verbally all day during clinicals. Instructors will be asking you, ‘what are you going to do? Why are you doing it? How would you do it differently if the patient had asthma?’”
After seeing a fellow minority student in the La Salle University program struggle and eventually fail, Gould has made it her mission to prepare nurses of color to complete their programs and graduate as CRNAs. She is the founder and coordinator of a diversity mentoring program that currently provides assistance to students from 18 nurse anesthesia programs in eight states and Puerto Rico. (See page TK.)
One of the biggest obstacles minority CRNA students face is financing their education, Gould emphasizes. Very little financial aid or stipends are available from federal sources, and two or three years of graduate school are expensive. And even though there are a number of CRNA scholarships available (see “How to Pay for It” sidebar), there’s still the problem of being unable to work while you’re in the program.
All of the sources interviewed for this article agree that financing a return to school does put pressure on virtually every nurse anesthesia student. “It’s difficult for someone who has been working as a BSN to quit work and begin paying for tuition and books. The students are still paying living expenses with no money coming in,” says Elisha.
For students who are married, it means going from two salaries to one. For single parents, it’s difficult but it can be done, Elisha stresses. He also points out that some CRNA programs do have arrangements with hospitals in which students receive a stipend or scholarship in return for agreeing to work for the hospital for a certain amount of years after they graduate. Working RNs may also want to check with their current employers to see what benefits might be available.
Gould has seen adult students move back in with their parents to manage the financial crunch. “Almost everyone takes out some kind of loan, and some students pay for those three years entirely with loans,” she says. “I encourage nurses I talk to that are interested in the field to think about their finances now, even before they begin applying. Pay off your credit cards and pay down as much debt as you can. Try to save as much money as possible while you’re working.”
A few CRNA programs–including those at University of Detroit Mercy, Rush University College of Nursing and Rosalind Franklin University of Medicine and Science–do offer a part-time track, which allows students to continue working while enrolled. Keep in mind, though, that this option usually applies only to the classroom portion of the curriculum; the clinicals are invariably full time.
While no one ever said that completing a CRNA program is easy, minority nurses who have done it agree that the rewards of this career make it all worthwhile.
Gould says students of color often ask her about the low number of minorities in nurse anesthesia and how that environment will affect them when they start their program. This is a particularly strong concern for nurses who have already struggled with the experience of being the only minority in their undergraduate classrooms or their workplaces. She encourages them to view it as an opportunity to reach out instead of withdraw.
“[In a CRNA program,] your classes are going to be small and you’re going to grow close,” she explains. “I tell students to rely on other classmates. Find a study buddy who is as strong as you and will put in the hours needed, regardless of that person’s color. That’s what counts.”
Putting Minority Students on the Path to Success
When Wallena Gould was studying to become a CRNA at La Salle University in Norristown, Pa., several years ago, she was one of only two students of color in the program. Gould successfully completed her studies and now works as chief nurse anesthetist at South Jersey Regional Medical Center in Vineland, N.J. The other minority student wasn’t so lucky.
“The program at La Salle discouraged students from working, but a few worked a shift or two every month,” Gould recalls. “The other minority nurse in the program tried to work 12-hour shifts on the weekend and it was just too hard. She didn’t make it through the program. I didn’t want to see that happen again. I want minority nurses to enter CRNA programs ready to succeed.”
That’s what led Gould to create the Diversity in Nurse Anesthesia Mentorship Program. Originally designed for students at La Salle, the program has expanded and currently includes students of color from 18 CRNA programs in eight states and Puerto Rico. Gould and other minority CRNAs mentor the students throughout the entire one-year program. “It is a year filled with activities relevant to their education and overall improved graduation rate,” she says.
Each spring, the program begins with a luncheon for new and prospective CRNA students. The event includes presentations on topics like the requirements for entry into nurse anesthesia programs, preparing for the rigors of the program, balancing family obligations during the clinicals stage, financial planning, studying for the board exams and the certification process. There are also opportunities for attendees to dialogue with practicing minority CRNAs and ask them questions about how they survived their SRNA (Student Registered Nurse Anesthetist) experience.
This year’s luncheon will be held in March in Philadelphia and will feature special speaker Goldie D. Brangman, CRNA, MEd, the first African American president of the American Association of Nurse Anesthetists (AANA).
A month after the luncheon, the mentorship program brings new minority CRNA students into the OR for a hands-on introduction to the anesthesia machine and airway equipment. “This helps allay their fears of [not knowing what will be expected of them] in the OR environment,” Gould says.
“In the summer,” she continues, “I match minority nurse anesthesia students with CRNAs for sponsorship to the AANA’s Annual Meeting.” This past October, Gould held a graduation dinner at her home for a group of students from various programs. And this spring, she plans to visit nursing schools at historically black colleges and universities (HBCUs) to speak to students about nurse anesthesia programs.
For more information about the Diversity in Nurse Anesthesia Mentorship Program, contact Wallena Gould, CRNA, MSN, at [email protected].
How to Pay for It
Looking for ways to finance your CRNA education? One possible option is to sign up with Uncle Sam. By far, the largest health care employer that provides financial assistance to pay for CRNA training is the U.S. military.
“We do allow representatives from the military to come and speak to our students,” says Sass Elisha, CRNA, EdD, academic and clinical educator at Kaiser Permanente School of Anesthesia. “The military will pay for your education and offers a lot of money just to sign up. Some students do take advantage of it, in both active duty and reserve status.”
The U.S. Army, for instance, offers a Graduate Program in Anesthesia Nursing for nurses serving in the Army Nurse Corps. The Army pays tuition and educational expenses, and students also receive full Army pay. The catch, of course, is that the program requires an active duty service obligation.
Military CRNA programs do offer a great deal of racial and ethnic diversity, both in the training stage and, when you graduate, in the workplace. However, as the recruiting slogans advertise, the military is not just a job–it’s a way of life. Unlike civilian CRNAs, those in the military could find themselves in combat zones and must meet military standards in areas unrelated to nursing, such as physical conditioning, marksmanship and soldier skills.
If the military option doesn’t appeal to you, there are also a number of funding resources available in the private sector. For example, the American Association of Nurse Anesthetists, through its AANA Foundation, offers scholarships for student members of AANA who are enrolled in an accredited CRNA program. Some local AANA chapters also offer scholarships. For more information, visit www.aana.com.
In addition, some universities and medical centers offer scholarships for CRNA students. Doing a computer search on phrases like “CRNA scholarships” and “nurse anesthesia scholarships” is a good way to get an idea of what options are out there.
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).
What to Expect
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.
The Admissions Process
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:
Take a few prerequisite graduate courses and get a B or better in them. This shows that you have the ability to complete graduate- level work.
Take the critical care nursing certification exam (CCRN) and pass. Admissions committees know how difficult this is and it will underscore your dedication to pursuing nurse anesthesia.
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.
Success Strategies for SRNAs
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.
Do You Have What It Takes?
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.
Yes We Did: Overcoming Barriers
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 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.”
