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.
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