In recognition of this week’s Certified Registered Nurse Anesthetists Week (CRNA Week), Minority Nurse spoke with Flanagan about his career path and what it takes to succeed in this field.
Flanagan says his original plan included nursing school as a stepping stone to medical school. He wanted a secure career that gave him options as he moved toward that goal. But during his first year in nursing school, he heard about anesthesia as a nursing path and was intrigued. Once he saw it in action, he decided it was the choice for him.
His opportunity came unexpectedly. In Flanagan’s labor and delivery rotation, some families made it clear they didn’t want a young male nursing student attending. “I spent a lot of time at the front desk because I couldn’t see patients,” he recalls. But a CRNA noticed and one day invited him to shadow her for the day. “We did C-sections and epidurals all day,” he says. “I saw the autonomy, the interaction with patients, the assessment she did, and the camaraderie with the surgeons and other staff.”
Flanagan saw how CRNA’s are the authority on their practice in the room, so if people have questions, they look to the CRNA for validation, approval, and answers. “As a CRNA, you’re a patient advocate and you’re forced to make a decision or intervene,” he says.
Mentorship to Career
Flanagan gained a valuable mentor in that CRNA, and he continued to shadow her several times. While he was learning, he was also gaining the shadowing hours he would need to apply to his own anesthesia path. Eventually, she helped him secure a job through her own professional network. “She said, ‘You’re a young Black male with the skill set and the desire for this,’ and she saw the potential in me.” Flanagan worked as a nurse extern to obtain the required experience before graduating with his BSN from Emory University. He passed the boards and in two weeks was working in the ICU in cardiac. He went back to school for his MSN at Samford University, worked for five years, and then began his DNP degree at Columbia University with a focus on anesthesiology.
The strenuous academic requirements for becoming a CRNA are significant but critical to a CRNA practice, says Flanagan. There’s the rigorous course work and then also a regimen of clinical and procedures for the hands-on skills. “There’s strict criteria for what we need to do for procedures before we can sit for the boards,” he says, noting the need to understand the physiology and pharmacology for patients as well. “It’s an all-or-nothing career process,” he says. “You’re giving up three to four years of your life. You have to be committed to that up front.”
Prepared for the Profession
Unlike other nursing specialties, CRNAs don’t specialize in a particular patient type or condition. They have to be ready for anything from a routine surgery to significant trauma and for patients of all ages and conditions. “Hospitals have a list of what’s needed, and we fill those rooms with CRNAs.” he says.”Seventy-five percent of CRNAs don’t get to pick the surgeries they do every day.”
As the anesthesia expert, Flanagan says you’re expected to excel at what you are doing every time. “You carry that with you in everything you do,” he says. Any nurse who begins the career knows that, he says. “When you decide to go to nursing school, you are accepting ownership of the patient,” he says. “They depend on that ownership. You have to take that on when you walk into this profession.”
With the responsibility, Flanagan says the preparation and the dedication to the work become even more essential. “You do so much that you do feel comfortable and confident walking into those spaces,” he says. “That’s one of the dynamics about the role. There’s a stoicism about it. We see things that make others nervous, and we know how to resolve the issue. That makes it a lot easier to be comfortable.” The expertise becomes something CRNAs can’t switch off, he says. “Once you’re in it, it becomes part of who you are.”
As a CRNA, Flanagan is able to meet with patients and families before a procedure to get to know them and gain their trust. He explains procedure details in easy-to-understand language if they want, but respects if they’re not interested.
As with all nursing paths, nurses bring their own skills to each interaction to learn what works best for them and their patients. Flanagan’s PhD research focused on music therapy in the OR, something that remains an important part of his practice to this day. He always asks patients about the music or artists they like and would want playing in the OR. “People know that about me–there’s going to be music playing,” he says with a laugh.
Passing Along Knowledge
Thanks to that chance early connection with a CRNA who gave him an opportunity, Flanagan says the career is something he’d choose all over again. He continues to work for diversity in nursing, beginning the Bigger Dreams, Better Tomorrows foundation is a piece of that advocacy.
Flanagan recognizes the responsibility for helping the next CRNAs and showing them how the hard work pays off with everything CRNAs do with patients. “After they wake up and they thank you and tell you they appreciate that you were the one taking care of them–that never gets old.”
CRNAs recently received a public recognition of their career path when U.S. News and World Report published a Best 25 Jobs of 2020 and nurse anesthetist came in at the number 21 slot.
This nursing career has a lot going for it. It pays well, is constantly changing, and has lots of patient interaction. Nurse anesthetists often assist during surgery or may be in charge of the patient’s entire anesthesia plan and process. In fact, in some places, including rural areas or on the frontlines of the military, nurse anesthetists are often the main providers of anesthesia care to a patient.
Nurse anesthetists bring home a large paycheck. Although the U.S Bureau of Labor Statistics reports the amount will vary based on location, an average annual salary comes in at $167,950. Nurses interested in this path will complete a rigorous educational training. After your early nursing career, a typical path starts out in a critical care role, such as the intensive care unit, where they gain valuable training on evaluating and caring for patients with life-threatening injuring or illnesses. These nurses often have a masters’ degree, but more and more nurse anesthetists earn doctoral degrees. Beginning in 2022, all nurses entering accredited anesthesia programs will be required to earn a doctorate in the specialty.
This role requires initial certification and continued professional certification as the field changes rapidly. Lifelong learning in this specialty is essential for providing the best nursing care and ensuring the best patient safety.
Because of their role in providing essential care, nurse anesthetists routinely work in many areas, so finding a role that suits your career plans and your lifestyle is possible. Flexibility within this role isn’t as common as within other nursing roles, but because there is such a high demand for this role, the job variety is excellent.
According to the AANA, nurse anesthetists provide care to patients in varied locations and settings. From a chaotic battlefield to an organized dental office, nurse anesthetists are required to provide focused, deliberate, and incredibly precise anesthesia care. This role is also essential in pain management clinics and in surgical settings.
CRNAs also play an active and important role in the policies and regulations surrounding the patient care and the professional standards of this specialty. The CRNA Political Action Committee represents the interests of CRNAs and their patients in Washington and in the political establishment of each state.
Nursing leaders and those who take an active role in political decisions can offer a perspective that speaks to ensuring patients have equal access to the best care possible, no matter where they live or their income. These nurses are also proficient in speaking about veterans’ affairs, the opioid crisis, and patient safety.
CRNAs are a vital part of patient care. This week is acknowledgement of all they do.
Sponsored by the American Association of Nurse Anesthetists (AANA) , this week of celebration was once known as National Nurse Anesthetists Week. The Additional of “certified registered” helps people understand the rigorous training and continuing education for this specialty.
Nurse anesthetists work closely with a medical team and in some states, they are often the sole anesthetist on a team. According to the AANA, nearly 53,000 certified nurse anesthetists and student nurse anesthetists provide care throughout the country. Career growth in the field continues to attract top talent as the opportunities for lifelong learning and fast-paced advancements offer a dynamic environment. In addition, nurse anesthetists are among the highest paid nurses with a median annual salary of $165,000.
CRNAs have a vital role in patient care at all stages of surgery or a procedure. They assess patients prior to anesthesia, monitor them during the procedure, and continue to watch for any difficulties or problems after they come out of anesthesia. In this role, nurses offer compassion, comfort, and an intense focus on the details of medical care. They must assess visually and with equipment readings to understand how a patient is tolerating anesthesia.
In this career, CRNAs can work with a wide range of medical teams. They can practice in hospitals, stand-alone facilities, dentist offices, trauma teams, surgical facilities, military units, or pain management clinics to name only a few areas. The variety of settings means a CRNA can choose to work in specialties that hold particular interest or match an educational background or a life experience best.
Anyone interested in this field should have the correct path of educational attainment. According to the AANA, “graduates of nurse anesthesia educational programs have an average of 9,369 hours of clinical experience.” Programs for nurse anesthetists can range from 24 to 51 months. Program requirements can vary with the university, but will include essential clinical placements. Certification and recertification are also required to become a CRNA and maintain that professional standing. By 2022, students will be required to enter doctoral programs for this field.
Many CRNAs say the direct patient care, the satisfaction of being an essential part of the medical team, and the technical challenges of the work make this an exciting career path. In some states, CRNAs provide the majority, if not all of, the anesthesia care. Anesthesiologists work with patients of all ages and in settings so varied, their days are never the same. But the responsibility of keeping patients safe and being their advocate in a vulnerable time is rewarding.
With more than 52,000 nurse anesthetists and student nurse anesthetists, the career is thriving and attractive for several reasons. Many nurse anesthetists say the patient interaction they have is unsurpassed. They are with patients before, during, and after surgery, so there’s a necessary trust that is quickly established with the skill and care of the nurse.
Why is the AANA particularly aware of the health and wellness among student nurses looking to enter or actively studying in this field?
Student nurses are the future of the profession, and it is important to cultivate and prepare for a long and healthy career. Students who aspire to enter into nurse anesthesia programs must be healthy mentally and physically. They must have healthy outlets for stress relief, and healthy lifestyle habits that will support them throughout our educational programs.
Nurse anesthesia education programs are required by their accreditation standards to provide education content on wellness and substance use disorder. The AANA actively encourages members, students, as well as educational programs to engage whenever possible in healthy behaviors, whether that includes physical activity or simply reducing stress by encouraging individuals to take time for their loved ones or to engage in an activity they love.
The AANA is committed to providing resources and information about ways to become involved in establishing a healthy lifestyle and even offers fun runs, wellness tutorials and a massage therapy area at many of their conferences.
How does establishing good health and wellness practices now help a student nurse become better? And how will taking care of oneself now carry over once they graduate and are several years into a CRNA career?
Nursing has unique stressors like dealing with patient care situations that require critical thinking, fast decision making, and autonomy is tough. If the student nurse does not have the ability to cope with these situations autonomously, it is very difficult to care for patients. Maintaining both mental and physical health and wellness are at the foundation of successful practice.
Developing healthy lifestyle habits early, helps students handle stress more effectively, set clear goals, and develop a clear plan to achieve them. They also assist students with discipline, good study habits, prepare for clinical experiences properly, and self-evaluate objectively. It also helps to establish diet and exercise plans that can be adjusted as one transitions to practice, to avoid elimination of healthy habits out of inconvenience.
Maintaining a school-life balance is also important to develop a support system and find time for small, pleasant breaks to gives a fresh perspective and recharge. Establishing healthy behaviors and habits early is vital to long-term health, wellness, and maintenance of a successful career.
Do you have any advice for student nurses about considering this field and being aware of any challenges unique to this branch of nursing?
For student nurses considering the field of nurse anesthesia, awareness about the depth and breadth of study is valuable, but is important to be well, so that an individual will have the endurance to graduate. A strong support system and personal discipline are necessary to allow for healthy stress relief and appropriate professional conduct. Anesthesia remains the field with the highest incidence of drug abuse and unhealthy coping behaviors, due to high stress and access.
Think about what you do when stressed. Review your lifestyle habits: exercise, eating, alcohol use, and other substance use. Some prospective students may want to employ a lifestyle coach who can look at a person individually and help one to develop positive lifestyle habits that will set one up for success in graduate school and a stressful career. Good study habits, a healthy respect for one’s self and career, use of study resources, and strong, supportive relationships will be required to succeed and thrive in this field.
During this year’s CRNA Week (#crnaweek), there are many nurse anesthetists who are remembering why they got into the profession, and even more are reflecting on how the face of the profession is changing.
John Bing, BSN, CRNA, American Association of Nurse Anesthetists (AANA) Region 6 director, and national AANA board of directors member, says one of his steadfast missions is to make sure the field continues to attract top nurses, but that it is especially welcoming to aspiring minority nurse anesthetists.
Bing knows first-hand how hard it is being a minority in the field. When he first started out, he was often the only African American in the OR, he says. At times, people assumed he was part of the housekeeping staff. Although he laughs about it now, Bing has made it a direct part of his mission to attract more minorities into this field.
He even takes on leadership positions with the primary goal of making sure he is representing the minorities in the field. “You need to see that in leadership,” he says. “If others don’t see that, they won’t see a place for them. I make sure they see it.”
“Many times you would go in and you were it,” he says of when he started out. “Maybe you were the only one in the hospital or the department. Now you go in and you see a fair amount [of minorities].”
One of Bing’s specific approaches is to make sure he talks to patients as the anesthesia takes effect. He finds out what they like so they can chat about it—sports, cooking, books, kids—anything that helps them relax. “That’s like a sedative,” he says. “It calms them down and they remember that.”
And while he’s monitoring a patient, Bing does exactly what he teaches his students—he assesses his patient over and over and over. “You must rely on your instinct,” he says. During travels with students to countries like Nicaragua, Bing teaches students that not every machine is calibrated the same or even correctly.
“The machine is a guideline,” he says. “You are ultimately responsible for anything that happens. You can’t blame the machine for anything. Look at the patient.”
Bing says that while he’s checking blood pressure every five minutes or so, he is constantly “circling the block,” as he calls it. All the machines are incredibly helpful, but they should only confirm what a nurse anesthetist is seeing, hearing, smelling, and touching.
And getting stale in this profession is not an option, he says. “I say to my students, ‘Tell me how this patient could die today,’” he says. That forces students to look at the big picture and not just look for complications, but to look for other factors that could impact that patient on that day.
Bing clearly enjoys working with his students, but he understands first-hand how sometimes they are not the ones who chose the profession. “The last thing I thought I would be was a nurse,” he says with a laugh. As an African-American, there were few role models that looked like him.
A chance look at a jobs list that revealed six pages of nursing jobs, convinced Bing, an athlete in high school and college, to take a look. Bing says he turned to his buddy he was working out with and said, “We get to be around girls and have a great job!” But he still didn’t expect to land in this field. Eventually, nurses in the recovery room where he worked nudged him to give it a try.
Now, Bing’s mission is to attract minorities into nurse anesthesiology. He speaks to kids in schools, paying special attention to making the field appealing to boys and young men. As it is, 49 percent of nurse anesthetists are male, he says, which is a high number considering less than 10 percent of all nurses are male.
But Bing lets kids know that there are chances to be out on a helicopter go team or even in the midst of trauma situations. “Men like that kind of stuff,” he says and it certainly gets the attention of younger kids who don’t know those possibilities exist.
Add in the good salary, the camaraderie, and the fair amount of autonomy, says Bing, and a career as a CRNA shows kids who might not initially consider a nursing career that the path is open to more possibilities than they ever imagined.
