Becoming a CRNA - From One Who Did It

TraumaNurse · Oct 31, 2004

i would like to dispel some of the myths that icu nursing is a requirement to become a crna. here is the excerpt directly from the aana website:
education and experience required to become a crna include:
a bachelor of science in nursing (bsn) or other appropriate baccalaureate degree.

a current license as a registered nurse.

at least one year of experience as a registered nurse in an acute care setting.

graduation with a master's degree from an accredited nurse anesthesia program. as of february 1, 2004, there are 92 nurse anesthesia programs with more than 1,000 affiliated clinical sites in the united states. they range from 24-36 months, depending upon university requirements.
all programs include clinical training in university-based or large community hospitals.
pass a national certification examination following graduation.
i am a cpt in the us army and a military trained crna who has performed roughly 150 battlefield anesthetics (some of the worst trauma you have ever seen)......i never worked in an icu. now that will depend on the school itself, but the aana does not stipulate that icu experience is necessary. i was a labor and delivery nurse for 4 years (all i ever did) before becoming an anesthetist. i had no difficulty with school ( the second ranked in the nation this year behind vcu) or my boards (my score 600/600). if anyone has any questions please email or post to this thread.
cpt michael bentley
us army

first of all, welcome to the board. second, you are correct about what the aanas requirement statement is but, as you pointed out, it is up to the individual program as to what experience that consider "acute care". when researching the many programs, i personally found very few that accept non-critical care experience. they do exist and i know there are several on this board with experience outside of icu, but the majority of programs that i have seen prefer icu.

my own program for example is one of the schools that does accept er and pacu to meet the acute care requirement. however, every single person in my class is an icu nurse. i know there were people with pacu and or experience who interviewed with me but they did not get in.

i will not say that you must have icu, but your chances of being accepted to any program are greatly increased with icu experience. er, pacu l&d may or may not meet the requirement (according to a particular program). icu always does.

Athlein1 · Oct 31, 2004

Agreed, TraumaNurse. If you want to be competitive at the vast majority of programs, get ICU experience. I think you will be a better anesthetist for the experience (and that comes from someone who has ICU, ER, and other nursing background).

mwbeah · Oct 31, 2004

I am sorry you feel that way, again I gave a brief description of my background only to lend credence to my statements (this is one of the only times that I have "boasted" about my accomplishments, if I made those statements without some background than my statements would not have any merit). I think that the state of our community is at a critical shortage and the addition of Anesthesia Assistant programs impinges on our career. We need to strengthen our numbers and by making a blanket statement that all CRNAs should have ICU experience is wrong and limits our applicant pool. I have worked with several ICU nurses and several nurses in other units. My opinion is that you are either an excellent nurse or you are not. Truly ask yourself, just how much did ICU experience facilitate your becoming a CRNA. I will compare my accomplishments to anyone: Graduate of the 2nd highest ranked CRNA program in the Nation according to the US News and World Report rankings, 2002 AANA College Bowl Champion, Outstanding Student Nurse Anesthetist during Phase II William Beaumont Army Medical Center, 600/600 on National Certification Exam (I could go on).....but I guess I am not a very good anesthetist (thats ridiculous)....... I don't mean to be harsh and again I am not known to "boast" but this criticism that only ICU nurses can be anesthetist is just ridiculous and should be re-evaluated. Your training you receive determines the quality of your work, not your background. Again, I have worked with excellent ICU nurses and questionable ICU nurses and the same goes for other unit nurses. The bottom line is that the quality of the candidate lies within the candidate. Actions, not experience, display the talents of the individual. It seems that this is a type of "eating your young" mentality or "Since I was an ICU nurse than only ICU nurses are going to get into my program". I am not trying to instigate anything, I just think that it is a shame that we are giving misinformation to potential program applicants. I am actively pursuing my PhD currently and hope to bring light to this topic in the near future. Please continue this dialogue, as I feel it is important to shed light on this topic.

Thanks,

Mike

TraumaNurse · Oct 31, 2004

I think we must make the distinction between getting in to a CRNA program and how well you will do once your accepted. I never said ICU nurses make better anesthetists, I don't know if that is true or not. I said, in terms of applicants chances of getting accepted, ICU lends the best odds (based on number of schools that accept other areas for experience)

Can L&D, OR, PACU and ER nurses make excellent anesthetists....absolutely! Do ICU nurses bring favorable things to the table...I think so. You are correct that there are good and bad nurses no matter what area they come from and in the end, good nurses make good CRNAs and vice versa. I think the benefits of ICU nursing are the assessment skills that are developed, the experience with ventilator management, titration of vasoactive drips and hemodynamic monitoring. I personally believe these are assets to anesthesia practice.

You mentioned discouraging applicants in a time of anesthesia provider shortage by suggesting that ICU is the only acceptable experience. The fact is, there are a lot of applicants to every program each year (Although I have heard the military school applications are down...maybe you have more insight in to that). The problem is not lack of applicants, but lack of space in schools and, more importantly, clinical sites.

The US news school rankings are meaningless in the anesthesia world. If you are in an MBA program that it impresses people to see you graduated from a "top ranked" program. As a CRNA no one really cares where you went to school as long as you have CRNA after your name. Also, the AANA requirements for CRNA education are fairly strict, so most programs are producing excellent CRNAs. Even with the differences in format, in the end, everyone comes out and takes the same exam (and most do very well). I am not trying to belittle your background (because your stats are impressive), so don't take it personally.

In a long winded way, I agree that ICU nursing does not make better CRNAs and, yes, there are those who can get accepted with experience other than ICU. I will stick to my point that ICU nursing does offer one better odds at getting into any program.

If I was to speak with someone in nursing school interested in anesthesia, I would not say "Go to any acute care unit and get your 1 year minimum experience" . I would encourage them to go into an area that gives them the best all around chances of getting in. ICU does offer some advantages. I understand that you feel differently because you are living proof that non-ICU nurses can succeed in anesthesia, but I think to discourage ICU is going too far the other way.

futurenp · Oct 31, 2004

I'm really struggling with which direction to go in prep for nurse anesthesia programs. I have a BA in economics. My plan was to go to the local CC and get my ADN. I was also going to take more general chemistry, o-chem and a quarter of physics. Upon researching programs, however, I noticed that most require a BSN or a major in a science. The only BSN program around is a 40 minute drive and a private school at 20k per year. The other option is to get my adn and then go another year after that for my BSN. That's the same as getting an entirely new bachelors degree. I even looked into getting another bachelors in biology. I could also go to the same private school and do an entry level masters degree in 3 years. The cost of that is around 50k. Will having another masters hurt me? I'm driving myself crazy with all the options. WHAT WOULD YOU DO?

mwbeah · Oct 31, 2004

Again, you fail to see my point....I know of several prospects that were discouraged from applying because a CRNA or ICU nurse told them that ICU was a requirement, IT IS NOT. My point is this, it should be a case by case basis with a thorough interview process.

I can tell you this, many ICU nurses do not assess patients (in spite of what you might think....I know....what a statement to make!), or implement plans...they simply do what is written on the orders (if you disagree than you have been out of the clinical arena for sometime or are blinded by your bias to this discussion). They do not run the vents - RT does. The drips they hang are the ones written and described in the orders. How many ICU nurses intubate? How many start central lines? Granted some can perform arterial sticks. Can many of them correctly describe exactly what the arterial line means (area under the curve, etc), the CVP waveform, the wedge wave form. Can they tell you the exact reasons for why they are using crystalloid or colloid, or have a substantial discussion on hemodynamics and fluid management? Do they know the pharmacokinetics and pharmacodynamics of the agents they use (ask them to tell you how the drug works or why they are giving it)? Some nurses (BOTH ICU and other unit nurses) can go into great detail, some the basics, and the majority have a blank stare when you ask them to explain it to you (I work in military AND civilian hospitals and see it everyday). But its not there fault, they are in a system where they are supposed to do as they are told or they don't want to ruffle any feathers. Not much independent thinking, I would have to say that from observation within many settings in many states and countries.

Additionally, I disagree that training programs and there reputation are not important. The demand for military trained CRNAs (because of our regional skills, trauma skills, and autonomy) is huge once we leave the military. If you do not believe me I have several recruiters you can talk to and get their opinion. I will say this about where you train without reservation...you are just wrong. The training that a military trained anesthetist is unmatched in the civilian community....bottom line. (come observe for yourself if you have any concerns, I would be happy to arrange a trip to one of our phase II student rotations and possibly a trip with the FST to Iraq).

The point of my outrage is that if you are not an ICU nurse then you are treated like a stepchild in the application process and I think that is discrimination and a disservice to the CRNA community. That is just like saying because your of a different type then you have to ride on the "back of the bus".

People (BOTH ICU nurses and other unit nurses) who have the desire and aptitude for becoming a CRNA should not be pushed aside and frowned upon simply because they didn't care for patients in the ICU.

Trauma Tom · Oct 31, 2004

I agree with you that there are many non ICU nurses who could make fine CRNA's. But there is another reason that this requirement exists. CRNA school is about attitude and determination. You can have the aptitude, good GRE scores and good grades, and great experience, yet it is the desire and discipline that will ultimately get you through. I am only in my first year of CRNA school, however I can see why the ICU experience is required. By placing many requirements for CRNA school admission many students may be discouraged from applying. That is the point. Only those who are highly motivated need apply. If I was told that I needed to do a year of psych nursing, something I would hate to do, I would do it if it was a requirement. To me this discussion is much like the discussion of why is the GRE a requiremnt to get into anesthesia school. I worked with many ICU nurses who wanted to apply to school but who were not motivated enough to prepare for and take the GRE. Again, if they are not determined enought to prepare for and take the GRE, they don't belong in CRNA school. Preparing for the GRE is a cake walk compared to CRNA school.Trauma nurse is right, the shortage of CRNA's is not because of a lack of applicant's, but because of limited instructor's and clinical sites. In the final analysis, by making the requirements high to attend anesthesia school, and making the training difficult to finish, I think you guarantee a high quality of product when you are finished. As to your statements about the limited critical thinking skills you have seen in nurses in the ICU, I agree with you that there are many who do lack these skills. They exist in other types of nurses as well.

Again, you fail to see my point....I know of several prospects that were discouraged from applying because a CRNA or ICU nurse told them that ICU was a requirement, IT IS NOT. My point is this, it should be a case by case basis with a thorough interview process.
I can tell you this, many ICU nurses do not assess patients (in spite of what you might think....I know....what a statement to make!), or implement plans...they simply do what is written on the orders (if you disagree than you have been out of the clinical arena for sometime or are blinded by your bias to this discussion). They do not run the vents - RT does. The drips they hang are the ones written and described in the orders. How many ICU nurses intubate? How many start central lines? Granted some can perform arterial sticks. Can many of them correctly describe exactly what the arterial line means (area under the curve, etc), the CVP waveform, the wedge wave form. Can they tell you the exact reasons for why they are using crystalloid or colloid, or have a substantial discussion on hemodynamics and fluid management? Do they know the pharmacokinetics and pharmacodynamics of the agents they use (ask them to tell you how the drug works or why they are giving it)? Some nurses (BOTH ICU and other unit nurses) can go into great detail, some the basics, and the majority have a blank stare when you ask them to explain it to you (I work in military AND civilian hospitals and see it everyday). But its not there fault, they are in a system where they are supposed to do as they are told or they don't want to ruffle any feathers. Not much independent thinking, I would have to say that from observation within many settings in many states and countries.
Additionally, I disagree that training programs and there reputation are not important. The demand for military trained CRNAs (because of our regional skills, trauma skills, and autonomy) is huge once we leave the military. If you do not believe me I have several recruiters you can talk to and get their opinion. I will say this about where you train without reservation...you are just wrong. The training that a military trained anesthetist is unmatched in the civilian community....bottom line. (come observe for yourself if you have any concerns, I would be happy to arrange a trip to one of our phase II student rotations and possibly a trip with the FST to Iraq).
The point of my outrage is that if you are not an ICU nurse then you are treated like a stepchild in the application process and I think that is discrimination and a disservice to the CRNA community. That is just like saying because your of a different type then you have to ride on the "back of the bus".
People (BOTH ICU nurses and other unit nurses) who have the desire and aptitude for becoming a CRNA should not be pushed aside and frowned upon simply because they didn't care for patients in the ICU.

rn29306 · Oct 31, 2004

Again, you fail to see my point....I know of several prospects that were discouraged from applying because a CRNA or ICU nurse told them that ICU was a requirement, IT IS NOT. My point is this, it should be a case by case basis with a thorough interview process.
"They do not run the vents - RT does. The drips they hang are the ones written and described in the orders. How many ICU nurses intubate? How many start central lines? Granted some can perform arterial sticks. Can many of them correctly describe exactly what the arterial line means (area under the curve, etc), the CVP waveform, the wedge wave form. Can they tell you the exact reasons for why they are using crystalloid or colloid, or have a substantial discussion on hemodynamics and fluid management? Do they know the pharmacokinetics and pharmacodynamics of the agents they use (ask them to tell you how the drug works or why they are giving it)? Some nurses (BOTH ICU and other unit nurses) can go into great detail, some the basics, and the majority have a blank stare when you ask them to explain it to you (I work in military AND civilian hospitals and see it everyday)."
No one ever stated that ICU nurses run the vent; however, some do and some don't. No one said ICU nurses intubate or start central lines either. THAT said, neither do L&D nurses. While doing critical care transports, I frequently intubated, but I am not here to brag. In fact, none of these procedures are done on a regular basis by bedside RNs, be it ICU/ED and certainly not L&D.
The whole problem it seems you have is with the civilian system of accepting accplicants. Here in our world, however skewed it seems, that schools the gatekeepers and that is that. If they want previous ICU experience (which almost all do), then that is basically end of discussion. I would have to side on the school's stance that ICU offers the most invasive monitoring environment (outside of fetal monitoring) in the nursing realm and SINCE a large part of anesthesia IS monitoring (often invasive) then I can see their argument. That is simply my opinion, something I am entitled to and you most certainly are entitled to yours.
Congratulations on your achievements, knowledge, and military experience.

Pete495 · Oct 31, 2004

Generally speaking, you will not find many programs that will "actively recruit" L&D or similar nurses. If I was running an SRNA program, I would not actively recruit them either. I'm not saying they're idiots, but they don't have the experience with critical care patients. Also, more and more, Programs are not looking only to ICU anyway. They are looking to CVSU's, ER's, and Trauma ICU's because they have ventilators and hemodynamic monitorring. Applying hemodynamics to patients is a crucial part of assessment and evaluation of patients. The experience gained here is extremely valuable because it forces RN's to think about there patient. I disagree that nurses just go with the doctor's orders a majority of the time. Why would you want to be in a CCU to just follow orders all the time. I could do that on a med-surg floor. Most, I repeat most CCU nurses go into it because they have the sickest patients. You have to read and interpret the numbers for doctors, family, other staff,and especially residents who usually don't have a clue anyway. If I were running a CRNA program, I would much rather have a strong CCU student rather than a med-surg student who is faint at the first site of a ventilator in walking into the OR.

The point is to get the best experience you can with the sickest critical patients, and ICU's and CVSU's are the places to do this. CRNA schools aren't expecting you to know all the answers, or have every answer to everything. They just want you to get the most out of your clinical experiences, esp. with sick patients. I'm not saying RN's who treat sick patients are all good RN's. I'm saying at least they have a clue what to expect when one get's to be an SRNA. I understand your point that CRNA programs should be more diverse, however, I disagree that they should be so diverse that they are recruiting students without any idea of the extensive nature of the job. Nurse Anesthesia is critical care nursing to the infinite degree, no matter how you slice it.

At some point you have to draw a line, and say this is the experience you have to have, and these are the requirements for getting there. It's the same everywhere. This way, people know what they need to get themselves where they should be. Requirements exist to make the best possible workers in the work environment.

Just my opinion. Not looking to offend anyone.

David

Athlein1 · Oct 31, 2004

Mwbeah,

I know you are new to our board (welcome!), but FYI - we are trying to avoid bursts of personal outrage or incendiary back-and-forth posts between members. Neither is conducive to productive dialogue. They tick people off and members quit the board.

It's clear that you feel strongly that ICU experience should not be a requirement for entry into CRNA programs. It's also clear that you have accomplished much to be proud of in your anesthesia career.

But, the fact of the matter is that - for now - ICU is inarguably the strongly preferred experiential background for candidates to civilian anesthesia programs. Even more specifically, high-acuity adult ICU experience is considered most desirable.

I can relate to your mindset. Despite vert high GRE scores and a decade of nursing experience, I was dissuaded from applying to a number of my first choice schools because I did not have current adult ICU experience. Fair? I don't know. It's their program, and they can select whomever they choose. The bottom line is that I am close to graduating from a good program now, and I am getting the education I need to be a competent anesthetist.

And, like Traumanurse, the problem I see in anesthesia education is not that we are screening out qualified applicants due to their experiential background, but that there are simply not enough slots for the qualified applicants who seek admission. Anesthesia education is no cakewalk job, after all. You are paid far more in practice with (usually) far less headache.

Perhaps we should focus more energy on recruiting and retaining instructors and faculty that can provide a superior academic experience to anesthesia students than debating whether ICU experience produces a better anesthetist.

loisane · Oct 31, 2004

Let me also welcome Mike to the board. Input from experienced CRNAs is always welcome here.

Mike, I hear what you are saying. I have worked with many fine CRNAs who did not have an ICU background. But that was then. Now is now, and times have changed. Let me tell you some reasons for the change.

Since you are interested in this, maybe you have participated in admission decisions for a program. I have sat on some of these committee meetings, and the view you present is held by many clinical representatives. But we only see a part of the picture.

The council on certification keeps detailed statistics on graduates taking that exam. These are available to programs. This means it is possible to determine some of the factors that predict a success on the certification exam. Guess what previous nursing experience rises to the top every time? Yep, ICU. You can look back for years. ICU nurses consistently make higher scores and have a greater percentage of passing than any other type of experience.

Now does that mean that non-ICU nurse always fail? Absolutely not. Many do very well in school, and on boards. But programs have many more times applicants than available spots. It is only logical to fill those spots with the people that you think will have the most chance for success.

So why don't we make ICU an accreditation requirement, and limit programs to those applicants? Then we really would be closing the door to those non-ICU nurses that would make good CRNAs. That is why the national requirement does not specify. It gives programs the flexibility to make these decisions on an individual basis.

But the reality is, for applicants now, in order to maximize your chance of acceptance, ICU experience is an excellent idea. Without it, you are really limiting your chance of success.

Kudos to you for pursuing your PhD. We have a great need for that in nursing and in anesthesia. And I agree, this would be a great subject for study. Then we could have more knowledge on which to make these difficult decisions.

loisane crna

Trauma Tom · Oct 31, 2004

Loisane CRNA

We can always count on you to offer wisdom based upon your years of anesthesia practice. Thanks for shedding some additional light on this requirement.

Let me also welcome Mike to the board. Input from experienced CRNAs is always welcome here.
Mike, I hear what you are saying. I have worked with many fine CRNAs who did not have an ICU background. But that was then. Now is now, and times have changed. Let me tell you some reasons for the change.
Since you are interested in this, maybe you have participated in admission decisions for a program. I have sat on some of these committee meetings, and the view you present is held by many clinical representatives. But we only see a part of the picture.
The council on certification keeps detailed statistics on graduates taking that exam. These are available to programs. This means it is possible to determine some of the factors that predict a success on the certification exam. Guess what previous nursing experience rises to the top every time? Yep, ICU. You can look back for years. ICU nurses consistently make higher scores and have a greater percentage of passing than any other type of experience.
Now does that mean that non-ICU nurse always fail? Absolutely not. Many do very well in school, and on boards. But programs have many more times applicants than available spots. It is only logical to fill those spots with the people that you think will have the most chance for success.
So why don't we make ICU an accreditation requirement, and limit programs to those applicants? Then we really would be closing the door to those non-ICU nurses that would make good CRNAs. That is why the national requirement does not specify. It gives programs the flexibility to make these decisions on an individual basis.
But the reality is, for applicants now, in order to maximize your chance of acceptance, ICU experience is an excellent idea. Without it, you are really limiting your chance of success.
Kudos to you for pursuing your PhD. We have a great need for that in nursing and in anesthesia. And I agree, this would be a great subject for study. Then we could have more knowledge on which to make these difficult decisions.
loisane crna