A CRNA, or certified registered nurse anesthetist, is a master’s or doctorate prepared advanced practice nurse who is trained to care for patients during the entire perioperative period. CRNAs complete pre-operative assessments, develop an anesthetic plan specific to the patient and procedure, perform airway management, maintain anesthesia intraoperatively, safely emerge patients from anesthesia, and manage care in the immediate post-operative period.
Specialized skills include spinal and epidural anesthesia (neuraxial), regional anesthesia (nerve blocks), general anesthesia, monitored anesthesia care, arterial and peripheral line insertion, central line insertion, and advanced airway management techniques. CRNAs deliver anesthesia for all kinds of surgeries and deliver anesthesia both in and out of the operating room.
The average salary of a CRNA depends on the state you work in. States like Montana, California, New Hampshire, and Wyoming have some of the highest average salaries for CRNAs ($200,000-$240,000). While states like Arizona, Illinois, and Louisiana have some of the lowest with an average salary of about $127,000.
According to the Bureau of Labor Statistics, the mean annual salary of a CRNA is $174,790, while the median salary is $167,950 (as of May 2018).
A ideal place to gain the experience necessary for CRNA school is in the intensive care unit (ICU) or another critical care environment. The patients you care for should be high acuity. The goal of your work experience is to provide you with the clinical experiences necessary to develop strong clinical and critical thinking skills. Nurse anesthetists rely heavily on their ability to think critically in high stress environments. Your work experience should give you the ability to manage vasoactive drips, interpret laboratory findings, and maintain hemodynamic stability simultaneously in critically ill patients. Programs typically require all work experience to be within the past 5 years.
The most common settings include: Trauma ICU, burn ICU, cardiovascular ICU, medical ICU, surgical ICU, neurosurgical ICU.
There are very few programs that will accept PACU or ER experience, and pediatric or neonatal ICU experience is reviewed on a case-by-case basis. Programs are expecting you to enter the program with a strong understanding disease processes, hemodynamic management, invasive lines and vasoactive titration in the adult population.
The minimum requirement is 1 year of ICU experience, however, the average experience of accepted applicants is currently 2-2.5 years. The amount of time you spend in the ICU is not as important as the quality of experience you gain by working there. Are you caring for high acuity patients? Do you frequently run and manage vasoactive medications on hemodynamically unstable patients? Are you developing strong critical thinking skills by caring for complex patients? Have you become a resource to other nurses on your unit?
If you can confidently answer yes to the questions above you’ve more than likely gained the adequate amount of work experience needed to apply. Keep in mind, it is important not to rush your work experience since you will rely heavily on the skills you learn as a critical care RN.
Applying to Schools
- A BSN or bachelor’s in a related science field is required. The average GPA for admitted students is 3.5-3.7, while the minimum GPA required to have your application accepted is typically 3.0.
- RN license obtained by passing the NCLEX-RN examination.
- One year of critical care experience. This does not include your orientation or probation period. The average experience is currently 2-2.5 yrs. Some programs will only accept intensive care unit experience, while others will accept PACU, ER, and other critical care areas as well.
- GRE examination. Currently average GRE scores of admitted students is around 300-315. The GRE must be taken within 5 years of application. Some schools allow you to waive the GRE requirement if you have already earned a BSN with a certain GPA (school specific). Other schools may require your GRE scores to be in the 50th percentile in both writing and math.
- Resume or CV.
- Personal Statement
- Professional references, usually about 3.
- Completed online application and an application fee of $50-100. (typically non-refundable). Responses to essay questions are typically submitted with your online application.
- Transcripts from all previous undergraduate and graduate schools attended.
- CCRN certification is not typically required but HIGHLY often recommended.
- Some programs require you to hold BLS/ACLS/PALS certifications before you start.
First, it’s important to note that all nurse anesthesia programs are required to transition to DNP by the graduating class of 2025 (admitted in 2022). This may or may not influence your decision when deciding between an MSN and a DNP program.
Think of what you hope to gain from your program. Is it important to you to have a rural anesthesia experience with independent providers? Do you hope to gain strong regional anesthesia skills during the program?
Here are the main points to consider when comparing schools:
- Program length: 24-36 months, most DNPs are 36 months
- MSN vs DNP/DNAP
- Front loaded didactic education (clinical started later) vs integrated programs (clinical started earlier).
- Does the program incorporate breaks in the program or is it straight through?
- Location of the school. Do you need to be close to family for child care and support during the program? Is the hospital you hope to work at one of your clinical rotations?
- Requirements: GRE vs none, minimum GPA, outside credits accepted, work experience
- Cost: in-state vs out of state/private
Use the above points to weight the pros and cons of each program to choose the ones that are right for you.
Your chances of getting accepted depend on how strongly your application convinces the program director that you are likely to succeed in the program. This is determined by your GPA, your performance in your undergraduate science courses (B and above), your work experince, and your ability to handle Master’s level coursework.
If you earned a C or below in any of your undergraduate coursework, especially science courses, it may be best to retake the course.
Taking Master’s level courses ahead of time and earning an A or B shows initiative and demonstrates your ability to handle graduate level courses.
As a side note, make sure to find out which courses you can take ahead of time. Speak with your prospective program to ensure they will accept credits from the courses you plan to take. Some programs only accept a certain number of credits, from certain institutions (or only theirs) and require a minimum grade to transfer.
Another thing you can do is earn your CCRN. Again, this shows initiative and your mastery of critical care concepts. Shadow a CRNA (or several), so you come in with a strong understanding of the profession and your future scope of practice.
First off, CONGRATULATIONS! Getting an invitation to interview is a big deal. May programs receive 100-200 applications, admitting 20-30 students.
Remember, if you were invited for an interview you’ve already done something to impress them. Go in with confidence! Prepare for the interview by reading everything you can about the program. Keep a running list of questions to ask during your interview based on what you’ve read.
Practice interview questions. Here.
Be prepared for different interview formats. Some directors prefer to interview one-on-one, while others prefer group interviews or multiple interview stations. Knowing these possibilities ahead of time will help to keep you focused (and calm) during your interview.
It goes without saying (but I’ll still say it) to dress professionally. This means slacks and a button up for men and slacks/skirt and a blouse for women. Be mindful of how you present yourself and the way you may be perceived.
Be prepared for clinical questions. A good way to practice is with a CCRN review book. You may be asked about vasoactive drugs you use and how they work at the receptor level. They will be assessing your understanding of basic physiology and pharmacology. (Taking this course ahead of time will help you to better understand the drugs you give and their mechanism of action.)
We are in the time of COVID, so your interview may be interviewd virtually. If this is the case, get clear instructions on the software you are expected to use. Do a test run to ensure your camera and microphone are working properly. Assess the light and do what you need to make sure you are not disturbed or distracted during the interview.
Practice your answers to common interview questions like your strengths and weaknesses and why you wish to pursue nurse anesthesia. You will make a positive impression with the interview committee if you appear genuine, prepared and confident in your answers.
Speak with current students if you’re able to. They have a wealth of knowledge about the interview process and can be a valuable resource.
If you didn’t receive any acceptance letters this time around, don’t fret! Take a couple of days to gather your thoughts and to regroup. Take an objective look at your application. Was your GPA lower than you’d like? Try taking a few Master’s level courses to improve your GPA. Did you fumble during your interview? Determine if it was nerves or a knowledge deficit. Did you earn your CCRN? The exam questions are similar to some of the common clinical questions asked in the interview.
Try not to think of this as a rejection or failure. You had an inside look at the interview process and now have a better idea of what to expect the next time around.
Use the time between applications to improve your application. Continue to seek out challenging patients on the unit and study or re-study the material for the CCRN. Try to apply the knowledge you gain to better understand the physiology behind your patient’s conditions.
When the time come to reapply, do so with confidence, knowing that the the work you’ve put in to improve your application will pay off in the end.
Preparing for School
The costs of nurse anesthesia programs can be extremely variable. An program for a resident who is ‘in-state’ may be $50,000, while a private or out-of-state school may cost upward of $200,000. DNP/DNAPs are typically more expensive than MSN programs, mainly due to the extra year of training.
Most students use federal loans to pay for tuition (unsubsidized direct, grad plus). If you’re able to, use the year before you start to save up cash. Saving enough to cover interest on your loans while you’re in school or your living expenses, will cut down on the amount you have to borrow. Remember, interest begins accruing from the date it’s dispersed to you.
CRNA school is an investment in yourself. The general rule of thumb is to borrow no more than what you plan to make in a year as a CRNA.
CRNA school is challenging. From the day you arrive on campus (or start virtually) you hit the ground running. Whether your program is front loaded or integrated, the first 3-4 months will be intense didactic instruction of basic anesthesia sciences. You are being taught the basics of anesthesia to bring you up to the level of ‘marginally safe’ by the time you start clinical. Students in front-loaded programs will go in to the OR with a better understanding of the machine, anesthesia considerations for comorbidities, and pharmacology. However, on the flip side, students in integrated programs spend more time in clinical than their front-loaded counterparts.
Be prepared for fast paced, continuous learning and constant examination. Class may be 7-10 hours long and you are expected to continue studying concepts when you go home. There’s not really a time that you’re ‘off’, unless you attend a program with vacation/breaks already incorporated into the schedule.
Once you start clinical, your days will start even earlier. Remember, everything in the OR will be new to you, so it will take time to learn the ins and outs of the OR. As time passes, you will get faster at drawing up meds and setting up your room for the day. Just be patient with yourself.
As you progress from year 1 to 2, you will see your confidence and independence grow. Continue to set goals for yourself and work on weaknesses in your practice. When you’re a student is the time to ask questions and try new techniques. You’re under the guidance of experienced providers who have so much to teach you. Stay humble and receptive.
Pretty soon, you’ll get into a rhythm. Waking up early and the constant examinations will become routine. Your comfort level in the OR will continue to grow, as will your autonomy.
CRNA school will take over your life but in the best way possible. You’re totally immersing yourself in a different world. Having conversations with your spouse, family and friends about what to expect during the program will help them to understand the demands the program will put on you.
Taking time for self care is so important. School can be stressful, so making time for something you enjoy, even if it’s just 30 min- 1 hr out of your day.
Hopefully, this gives you an idea of what school may be like. Develop a routine, stay disciplined and remember that school is only temporary.
The short answer is yes. Many SRNAs are able to keep part-time or per diem hours before clinical starts. Once clinical starts, you will likely have a commitment every day. Class and clinical will take up the majority of your week, leaving a couple of hours after school for home study. Weekends often remain open to pick up shifts, however, this time is usually spent catching up on studying or preparing for the next week.
Some programs don’t allow you to work, while others leave it to your discretion. The main point is that your nursing job should not interfere with your studies or clinical. Once you feel yourself slipping, it may be time to quit.