CRNAGuide2016

Welcome to taking care of humans! You are right. There are no CRNA programs in CO. So if you truly want to become a CRNA- you will HAVE to move out of state, not just be open to moving out of state. CO is traditionally a state that was controlled by Anesthesiologists meaning they owned the anesthesia practices and only hired other MDAs. They only recently converted their practices to include CRNAs (MDA only practice models are very difficult for hospitals/practices to afford). My point is that the practice of CRNAs in CO is still considered to be in its early stages- so even if a program was created today- I would think it would be difficult to get good clinical experiences...but you never know. Perhaps there are CO CRNAs that have better insight? By 2025 the entry level for CRNAs will be DNP. This means that most CRNA programs are working on converting or have already converted into DNP programs and soon there won't be any BSN to MSN CRNA Programs. You haven't earned your BSN quite yet so that means you still have at least 2-3 more years before you apply or are accepted- gotta get that ICU experience and get into a program as you know! There aren't any post-DNP CRNA Programs because right now the MSN part is the Nurse Anesthesia Speciality and the DNP part is often generic and related to research. Although there are rumors that DNP's are or will become available with specialities in anesthesia related issues- meaning in the future you could earn your DNP in say...pediatric anesthesia or regional anesthesia instead of research! So technically you could earn your DNP at your current program, but you would have to go back and get a second masters in Nurse Anesthesia. Seems pointless and a waste of time...especially because those MSN programs are becoming more scarce. Hopefully that makes sense and helps!

You seem to have an extremely limited view of what a CRNA can do, is capable of doing and what earning an MSN or DNP in Nursing Anesthesia actually entails. It sounds as if you might be an OR RN? It also sounds like you may work in a facility that utilizes a "team model" of anesthesia where an MDA medically directs several rooms run by CRNAs. A "team model" in its ideal state considers an MDA and a CRNA to be colleagues and it can be quite a cost effective and collegial model for delivering anesthesia care in large facilities that have many OR's and offsites. But on the flip side, many facilities and private practices utilize CRNAs as sole providers, i.e. there are no MDA's in the OR at all. And, in the military, CRNAs are often the sole providers on the front lines taking care of our soldiers and foreign citizens that have become injured in war zones. Unfortunately, in some "team models," (some not all!) doctors treat the CRNA's poorly, like assistants, which is mostly related to politics and a struggle to hold on to power (and money) in an ever changing healthcare market that wants to reduce compensation to physicians and Anesthesia departments in general. CRNA's are licensed to be independent autonomous practitioners- we can administer our own medications, place airways (via direct laryngoscopy, video laryngoscopy or with a fiberoptic scope), and place invasive lines (arterial, central, etc.). We can run codes, enter order sets, etc. I find it odd you say we don't do anything autonomously- aren't your CRNAs constantly administering medications and adjusting dials and settings while the MD is away in his office or do your CRNAs call them before they give any med? Also, 220K is on the high end of the salary range for a very experienced practitioner- a practitioner that is highly desirable to a hospital because they've likely been there done that for every patient and case. Most salaries for new grads start at about half that. And do you know how much the MDA gets paid? It's a substantial amount larger than that- and they also get some very cushy fringe benefits as well. Because of the politics involved in team models (especially in large hospitals or teaching facilities), it is often the case that the MDs attempt to limit the practice of the CRNA. For example, where I work, the CRNA's used to consent their own patients, run the heart rooms, do pre-op and post-op regional anesthesia (nerve blocks, epidurals, etc), place CVL's, etc. But as the practice of CRNA became more threatening to the MD's paycheck, anesthesia departments run by MD's started to say ok, let's not have CRNA's run the heart rooms, let's not have them do blocks, let's not have them place CVL's...and so on. But there are thousands of facilities where CRNAs do all of these things- YOU, Garden, RN, just happen to work in a facility that doesn't, am I right? If an MDA comes in when something goes wrong and appears to take charge, this does not mean the CRNA is unable to perform that leadership role. We train for long periods of time to be able to do this. There is so much that goes on in a CRNA's mind before, after, and during a case which you obviously are completely oblivious too and the fact that you are oblivious to it is a good thing- unless you think the CRNA is just sitting there messing every thing up and the MDA has to come fix it? Every comorbidity has an anesthesia consideration. Every patient receives a different combination of medications. This doesn't get verbalized out loud to the OR RN or to anyone else unless they ask, it is just inherently known by anesthesia providers (thanks to the intensive study/testing and years of clinical training). In a CRNA program, the SRNA has to meet competencies in every type of procedure with every age group- from NICU babies to geriatrics, from a colonoscopy to thoracic and cardiac procedures. Just because you don't see the CRNA doing it, it doesn't mean that they CAN'T do it. Also consider the experience level of the CRNA, if they're brand new, they may require some extra guidance- especially if they did not train where they currently practice- different facilities have different methods of providing care- there is no "right" way to perform anesthesia- it is the discretion of the provider and is often referred to as an art. This is the same for new MDA's. We have two freshly graduated MDA's and they are still learning the ropes as well and have made mistakes which had to be fixed by a CRNA- oooh scandalous! We have MDAs that have had bad and VERY bad outcomes with patients because he/she went against the advice of the CRNA and other MD's. My point is, anyone can make a mistake. Being a doctor doesn't mean you know everything. Anesthesia complications are extremely rare- it's very safe to receive anesthesia for the vast majority of the population. We train for those highly unlikely events so we can save a life if we need to. Currently, the VA is attempting to determine whether CRNA's in the VA system should be independent practitioners. You can access research that shows how safe anesthesia care is when provided in a CRNA only model, but as you can imagine, the MD's do not want to give up this control and they do not want to create competition in their marketplace. If CRNA's become independent practitioners in the VA system as they already are elsewhere, this gives MDA's a run for their money (and they make a lot of it). They are doing everything in their power to fight against this- including spending hundreds of thousands of dollars to lobby against CRNA's. AND, they use perception to undermine our skills- which apparently is working because you are falling for it. We actually had one of our worst and most lazy MDA's who never comes into the patient's room and doesn't want to do any intervention that takes extra time despite it being the right thing to do- well he actually made a comment on the VA website that he had to "save a CRNA at least twice a week." You have to take this with a grain of salt and look at what is motivating the doctors. The same doctors that say they have to save CRNA's are pushing to hire Anesthesia Assistants (who basically go to school for a few years and have no background in medicine) - but they are unable to practice on their own- therefore are not a threat to the MD practice. I can and do see my own patients, I can and do push my own drugs (although some docs still want to do it on their own- and they sometimes overdose the patient and leave the room- *you should take a look at the blood pressure post induction after an MDA pushes all those drugs the CRNA "hands him", I can troubleshoot my own airway if allowed to do so without the MDA feeling like they want to do it themselves, determine my own plan of care, determine what types of medications I want to give each patient, send labs/blood gases/interpret results, and emerge a patient on my own as well as treat a spasm or other issue if one arises. Do not get me wrong, I very much enjoy working with most of our MDA's and many are highly intelligent with training that extends way beyond what is useful in the daily ebs and flows of the OR, but CRNA's can reach an expert level of anesthesia care too when not limited- as proven in facilities that rely solely on CRNA care. Note that I did not say we can become an Anesthesiologist nor do we want to, which is why went into nursing instead. There are a lot of MDAs who don't even want to sit in the OR and take care of their patient (I've asked many of them)- they want the freedom of being able to pop in and out. And even though I know I can do things on my own, I work in a team model so I keep my staff informed as a professional courtesy and as an extra set of ears- there are often different interventions for different problems and you discuss to determine which you'd like to prioritize. Every Anesthesia provider will admit that when something is going downhill, an extra set of hands is essential- whether it's another CRNA or an MDA. Sometimes even a well trained OR RN can get you out of a pickle. You said that during an emergency the MDA takes over. Does the CRNA then leave the room? I doubt it, I bet they work as two sets of hands to resolve the situation. If a patient spasms after extubation, I might give my staff the airway to jaw thrust, while I close down my APL and give pressured breaths to break the spasm or draw up drugs to break the spasm and get ready to reintubate if I need to. Does this mean I don't know what I'm doing and I gave up? I don't think so- but to an uninformed bystander it could seem this way if the MDA comes in to stand at the head of the bed and then the problem magically resolves... I really don't want to be harsh to you, but your post is just so wrong that it's embarrassing and frustrating. We don't go to school for 3 years to learn to intubate- that IS actually a skill that anyone can learn- EMT's (high school kids!) do it every day. They say once you've done 30 airways (or PIV's or arterial lines or spinals or epidurals) you are considered competent. The MD's don't "let us" intubate anymore than the surgeon "lets you" drive the patient into the OR and put in a foley catheter and "lets you" get him the right size gloves and gowns and suture- that's a very condescending way to phrase that statement. We go to school for years to learn the anesthesia considerations for every comorbidity, the pharmacokinetics for every single drug we give, how to best ventilate individual patients, how to interpret lab results, ECHO's, TEE's, PFT's, the list goes on and on! I do not mean to be rude, but the knowledge I gained as an SRNA and as an active CRNA goes so far beyond what I learned in nursing school that I feel like a different person altogether. If it looks like I'm just sitting down doing nothing- I'm not. I am listening to the HR on the monitor and the tone that tells me the O2 sat without having to read the number. I am listening to how much blood the surgeon is suctioning. I am listening to the terminology he is using and what tools he is requesting from his scrub tech. When I hear and see blood going into the suction canister, I have already calculated how much blood this patient could likely tolerate losing and when to istat a Hgb or get a type and screen converted to a type and cross with units en route to the OR. I know what is happening physiolgically to my patient in different positions and how to adapt ventilation (supine/prone/lateral/reverse T/trendelenburg, I know the danger that insufflation can cause and am hyper-vigilant during risky times that the OR RN isn't even aware of. I know which drugs are most likely to cause anaphylactic reactions and how to treat it if it occurs. I now how to treat Malignant Hyperthermia and I know all of the ACLS megacode algorithms. I am on constant guard for the rare complications that can happen during surgery even though I'm just "taking vitals and doing paperwork". We "stock our rooms" and "prepare the meds" because we are the ones in the trenches and if the S hits the F, my MD isn't going to get there in time and they definitely aren't bringing any drugs with them. Did you know we prepare different drugs based on the patient's history, size, procedure, and post op plan? Just because I haven't "seen" my patient (because the CRNA is the last one with the patient from the case before giving report in PACU) and then has to set up for the next case while the MDA is free to walk around day surgery and have lengthy conversations with patients and their families doesn't mean I haven't looked them up the night before, made notes, researched a rare disorder or refreshed myself on a medication the patient takes, checked lab values in the chart, texted my staff about concerns to get on the same page etc. We don't just "take vitals," we interpret what they mean. Does an elevation in HR mean the patient is being stimulated, are they in pain, are they dry, is it an arrhythmia? and what can I do about it that won't affect how long it takes the patient to wake up, e.g. if the surgeon is manipulating the uterus- it's highly stimulating to the patient- but if you give a boatload of narcotics- you're going to burn yourself because as soon as the surgeon lets go of the uterus, the stimulation has gone away. We don't tell you that as an OR RN, but these thoughts are constantly circulating in our brains- and they get into our brains because we have had years of training and textbook knowledge. The medications the patient takes at home can also affect what and how much we need to give in the OR and we prepare accordingly. Any nurse can do what a CRNA does? True, if they can get accepted into a highly competitive program, make it through the demanding 3 year program with grades always higher than an 83% (anything less is failing- it's not like it is in RN school), and then pass boards and continue their education annually and recredential every 4 years. Super simple, yep. No Anesthesia provider is perfect. You can have a bad CRNA, a bad Anesthesiologist, a bad resident, a bad Anesthesia Assistant (AA). Anyone can also have an off day- but be a great practitioner. Doctors consult other doctors all the time about train wreck patients...no one knows everything. But CRNA is also a profession that is constantly training, learning, gaining experience and ready to get more respect. And when not limited, the practice is quite impressive and has proven to be just as safe as MD care. I apologize for the tone of this post- as I am sure it reads as defensive and frustrated as I feel. As I began to respond to your post I became more annoyed at your perception of what I do for a living and have difficulty masking that. I hope that you will start to open your eyes to what we do, discuss things with your CRNAs (try to learn from them about your patients and the medications they're giving, what they're listening for and thinking about, etc.) so you do not continue to belittle our role inside and outside of the facility you work for. If you or anyone else has questions, I would love to answer them honestly. I love what I do and I know that I am great (with room to grow!) at what I do. Our MDA staff, for the most part, are supportive of our practice and rely on us heavily when difficult cases arise.

I get it. I apologize for assuming you were looking for assurance about what you are thinking of doing. Is the class you are trying to leave a large class? It would probably be easier to leave a large program than a small one. My class had about 25 students and was quite intimate- we all got to know one another very well. I had one classmate who wanted to switch programs because she was having a conflict with one of the clinical advisors (e.g. being accused several times of doing something she did not do). She was actively discouraged from leaving and basically told that no other program was going to take her (this was implied, not outwardly stated of course). She was a great student, and a great person. She ended up sticking it out and everything became much better. I also wanted to add (because I didn't really think about this in my first post), that they probably won't let you go quietly. They'll likely have you attend meetings with administration and the director. Like I said, it comes down to you took the spot of another student who would be paying tuition for 2-3 years and I really do think this would be frowned upon unless you had a very strong reason for leaving (family member sick, need to be local to help take care of them, etc.) Good luck and I hope everything works out!

Do you have time for your family? Yes, at our hospital we get to choose what shifts we want to work for the most part. Some CRNA's work 5 days a week 7-3:30, some work 4 10's (7-5:30), or 3 12's (this is getting more and more rare nowadays in Anesthesia as we are salaried and this is giving up 4 hours a week for free), and I choose to work 2 8's (2 early days) and 2 12's (2 late days) with one day off per week. I also like to sign up for call shifts (voluntary where I am employed), which means I do one 8 hour day shift and two overnight 16 hour shifts (3p-7a)- this sounds rough but most of the nights aren't busy after 11pm (we have anesthesia residents who do the night cases and the CRNA fills in a second OR if needed for a trauma/urgent or emergent case). I can sleep most of the night while on call and I get my post call days completely off. Also, my chief is extremely flexible with our scheduling (in advance I can request a Friday and a Monday off and get myself a 4 day weekend without having to use PTO). Also most hospitals offer at least 4 weeks of PTO if not more. We get 5 weeks PTO and another week to use for Continuing Education. Some hospitals request that the CRNA uses his/her PTO in week long increments but my employer allows us to simply request a few days off here and there if we want to. I travel a lot! Work hard, play harder! How many hours/week do you work? On average What dept. do you specialize in? This question is a little confusing. Most CRNA's specialize in Anesthesia (j/k) which means covering the main OR and off sites (endoscopy, OB, MRI/CT, Interventional Radiology, Cath Lab, Electrophysiology Lab, etc). If you're asking what kind of anesthesia I enjoy- I enjoy Ortho Trauma, Neuro and Plastics but I also very much enjoy having varied cases and varied patients so that I never become bored. Some CRNA's have a "home" and asked to be placed in certain specialties whenever possible. Some of the larger hospital systems (Duke, MGH, etc.) have teams (Ortho, Neuro, Vascular). Do you think it is feasible to start the CRNA program with a 2 year old? Absolutely- I know many people who have done this. It is never going to be easy. You are going to feel stressed, you are going to feel at times like a bad parent, and you are going to get frustrated- but so will the students that don't have children- it's the nature of the level of commitment required to complete the program. And when you're done, you will be able to give your children everything they need in life and you will love your job! Was CRNA school worth the debt school put you in? and approx. how much debt? Worth every penny of my 200K debt (I mentioned in another post that I went out of state for my Accelerated BSN $$ and to a private University for my MSN $$) Hope this helps!

It sounds like you are worried about 1) finances and 2) if CRNA is right for you? I'd like to give you my thoughts on both of these... I think it is normal to worry about finances, especially when you have little ones and you are helping to support family members (that is highly commendable by the way!). Every time I accepted the full amount of the student loan offered, I felt some moments of stress but I kept pushing it away to focus on surviving. I have been a CRNA for 2.5 years. I have a total of 200K in debt from my out of state undergrad and from my private university I attended for CRNA (I knew what I was getting into when I started this). My take home pay after taxes and after putting aside the max for retirement is about 8k-11k per month depending on how much overtime I felt like working that month. My student loan payment is $1500 (I call it my second mortgage). I still have quite a bit of money leftover to travel, eat at nice restaurants, and buy the things I want (we don't have children so this is what we choose to do). This didn't happen right away. My first few paychecks went right to paying bills and there was one time I even cried to my husband that I was never going to recover from my debt and he just looked at me like I was insane (he's a finance guy and a business owner). But over time, my margin of being comfortable just kept increasing. I am not trying to be bragadocious- just factual that the money you will make will make you forget about the student loans and other financial commitments. You will be able to provide for your family in an even greater way than you do now. There were several students in my program who had small children. You will feel torn and you will feel like you are missing moments. You will be stressed. Getting through the program is very tough emotionally sometimes, and I've actually never heard anyone say that they really enjoyed their program either. You bond with your classmates, you will have ups and downs, and you will bust your butt and do the best you can working with different personalities all the time in a learning environment. But, I have NEVER heard anyone say it wasn't worth it. When you shadow, ask the CRNAs these questions- ask if they knew anyone who did it with small children and ask how they handled the financial situation. 2) Is CRNA right for you? Again, I've never heard any CRNA say that if they could go back and do it over- they would do something different. CRNA has one of the highest rates of satisfaction as any advanced nursing degree and jobs in general at this pay scale. Is it 100% rainbows and puppies? No, of course not! Sometimes you get obese patients that don't ventilate well, sometimes you have a crashing trauma, sometimes the people you are working with are unreasonable or rude, sometimes you don't get relieved from your shift exactly on time...BUT, is any job easy and fun 100% of the time? I don't know of any that are, and even NP's are hit or miss on their happiness level- sometimes they get the shaft on patient load, rude doctors, difficult patients and patient's families... Someone above mentioned it being boring...as a CRNA I am rarely bored. It may SOUND boring, "just monitoring someone's vital signs" but you always have a little undercurrent of adrenaline going. It's a common joke in the profession that it's hours of boredom and moments of sheer terror. What keeps it interesting is the vast array of surgical procedures we can anesthetize for, the different types of anesthetics we can administer, thinking about the different modes of drug therapy that would be right for our particular patient at this moment, etc. You are not just sitting behind the drape- you are listening to the audible beep of the heart rate (which tells you how fast the heart is beating and the tone tells you the patient's oxygen saturation), you are constantly treating high and low blood pressures, adjusting depth of anesthesia, and paying attention to the surgical procedure (is something stimulating about to happen? are we losing a lot of blood?), etc. Again, ask the CRNAs these questions- don't just take my word for it! I think it would be tough to find many CRNAs that would say they regret doing it or that it was a poor financial decision. I think your findings will be proof that you are doing the right thing!

It sounds like you are in a tough situation. But if I were you, I would never leave a program that I had committed to. CRNA is an amazing profession and highly sought after. Getting accepted into any program, as you are well aware, requires a lot of preparation, time, and money. If you leave your program after the first semester, you are taking that opportunity away from another student who was denied admission. It is highly likely that your first program would find out why you left, and they may even contact your local program and try to dissuade them from allowing you to transfer. Most CRNA programs are very small and intimate- and when they accept you, they are accepting your tuition for the next 2-3 years; if you leave, they have no financial way to regain that money. Money is a big motivator for a lot of people... Have you tried contacting your local program administrator and being honest about your situation? You can let them know that their school is your first choice (come up with solid reasons to support this in case asked why), and that you have already been granted admission into another program. Perhaps they have an early admission option that they can award? If they can't admit you early, I would really like to encourage you to just commit and enjoy your other program! I traveled across the country for mine and in many ways, it was a blessing not to be distracted by all the comforts of home. Other students had to wrestle with family time, long term friends demanding attention, etc. All I had to focus on was myself, my new SRNA friends (trust me after the first semester you will already have strong bonds), and being the best I could be. I hope this helps a little even though it's likely not the answer you wanted to hear...