How to Thrive in CRNA School

Before School

You’ve received maybe the best news you have in a while, or maybe ever. You’ve been accepted into a nurse anesthesia program. Congratulations!! After the initial excitement of your acceptance fades, reality may begin to set in. You’ve heard that CRNA school takes over your life, that it’s a major time commitment. You begin thinking about all of the changes in your life that are about to occur. Possible relocation to a new state, less time with your family and friends, your last shifts as a full time ICU nurse. It can all become rather overwhelming.

Preparation before school is such an important part of success during your nurse anesthesia program. You’re essentially preparing yourself, your friends and your family for a major life change. Let’s start with friends and family.

Your time will be one of the most valuable things during school. Free time will likely be limited, if not non-existent. Prepare your loved ones for this change by communicating what you may need or expect from them during the program and what they can expect from you. This may include things like a change in responsibility for household chores, relocation, child care, or creating a dedicated area in the home for study. Having this conversation well before your program starts will help to set expectations ahead of time and keep your relationships happy and healthy. 

A few more things to consider before the program include a discussion with your nurse manager about your last day on the unit or your plan to continue working during your program on a part time or per diem basis. You may also have to consider new living arrangements, commuting and reliable transportation, childcare, saving money for the program and taking classes ahead of time. The goal here is to simplify your life as much as possible before starting the program, so that you can keep your focus on school.

Another key to success during the program is going in with a clear ‘WHY’. Why are you about to put yourself through something so demanding and time-intensive? Why are you potentially going to uproot your family and way of life to pursue this degree? Maybe it’s to give your family a better life, or to challenge yourself professionally, or to help you save up for a home you’ve been dreaming of? Whatever your motivation, going into the program with a clear intention will help you to stay focused when the going gets tough.

During School

Your first few months in school are generally spent adjusting to your new life as a SRNA. Whether your program is front-loaded or integrated, the first semester usually reviews general concepts in anesthesia to prepare you for the clinical setting. The goal is to teach you enough to be safe once you start clinical. It’s in this first semester that students are generally hit with a huge reality check. The amount of material taught in CRNA school is staggering! The constant assignments and examinations, long lectures and self-directed learning required during anesthesia school can definitely send a shock through the system. 

Here are a few things you can do during school to increase your chances of success during the program.

• Set up a study space. Create a designated space that is quiet, well lit and free from distraction. 
• Keep a calendar and to-do-list of all upcoming assignments and exams. This will help you to prioritize your study time after school.
• Take school one week at a time. Thinking about CRNA school in its entirety can be overwhelming. Instead, focus on what you have to do one week at a time. This change in perspective will help to make things more manageable for you.
• Develop a way to organize your class notes in a way that works for you. For example: Create a master folder on your desktop for CRNA school. Each semester, make a folder for each class you take and keep them on your desktop. Organize class notes into these folders by day and topic covered, so the file is easy to identify in the future. At the end of the semester, move the class folders into the master folder and repeat. *Remember, you will be referring back to these notes when you begin studying for SEE and boards, so having some sort of labeling system will be helpful to easily find what you’re looking for in the future. 
• Create a daily study schedule. Have a plan for what you want to achieve that day. Your calendar and to-do-list will help you to prioritize how you use your time after school.  For example:
  • Class MWF 8-4p. 430-530p: work out, dinner. 530-830p Study (1 h clinical prep, 2h reading/exam prep) 830-9p personal time (tv show, relax, family time).
  • Clinical TR  530a-4p. 430-530p Work out, dinner. 530-830p Study (1h clinical prep, 1h reading, 1h paper). 830-9p personal time (tv show, relax, family time).
• Prioritize your study time based on what’s coming up in the week; refer to your schedule. (A paper, an exam, a difficult case in clinical, etc…) Devote your study time (530-830p) to the assignments that are due first. 
• Take mental breaks during your study sessions. If you know you are easily distracted, a study schedule of 30 minutes on, 10 minutes off may work well for you. If you have the ability to stay focused for longer periods of time, a schedule of 60 minutes on, 15 minutes off may work for you. Experiment with different times to find the best balance for you. Keep a timer on your phone. Knowing there is a break coming up will help to you to remain focused on studying, rather than checking social media or succumbing to other distractions.

Starting Clinical

In the ICU you may have been the go-to resource or charge nurse and excelled at your job. However, when it comes to CRNA school you will be starting from zero, which can be a hard pill to swallow. There is certain amount of humility required to be a successful CRNA student. This may involve a shift in your current mindset. You will not be ‘the best’ or even proficient for that matter. Remember that you are a beginner, just as you once were in the ICU. Malcom Gladwell outlines this concept perfectly in his book “Outliers”, which states that it requires approximately 10,000 hours to go from beginner to expert, so readjust your expectations for yourself. It will help you to keep a healthy mindset during school. It’s ok to be corrected and it’s ok to not know! Practice mental fortitude rather than self-deprecating behavior. You will have good days and bad days but keeping perspective of the process will help you to get through it. 

Another tip is to use simulations to help you to work out issues you have experienced in clinical. Ask to review skills you need to work on and pay close attention to changes in hemodynamics and patient condition during sim scenarios. Your experiences in simulation will help you to identify and work through similar issues in clinical. 

Come up with a game plan for clinical. At the beginning, you are being taught absolutely everything. How to put on a bare hugger, how to do a time out, how to hold a laryngoscope properly. Once you develop a foundation, you will naturally start to narrow down the things you excel at versus things you need more practice with. Seek out opportunities in clinical to help you work on your weaknesses. Come to clinical with a goal for the day and discuss this with your preceptor. For example, you may need more practice with central lines, epidurals, vascular cases, or intubations using alternative methods. Being clear about your objectives for the day will help you to keep your training focused and tailored to your particular needs. Also, communicate how you would like to work with your preceptor. Do you want your preceptor to be more hands off or do you prefer more interaction during the day? It’s ok to verbalize this to your preceptor based off of how much autonomy you wish to have. Your preceptor will intervene if they feel you aren’t ready for the autonomy you request!

What I miss most about school is being with different preceptors. Once you graduate and start practicing, you will work alone or with an MD. You wont have the luxury of being taught by different providers or asking any question that comes to mind. Take advantage of that now! Pick their brain. Ask the WHY behind everything they are doing. This will help you to develop the critical thinking skills necessary to help you work through issues that arise during more difficult cases. I see being with many different preceptors as a positive. It allows you to learn a myriad of styles and preferences that will ultimately become your ‘style’. Never turn down an opportunity to learn, even if someone has explained it to you before or you have some experience. Chances are, someone may explain something in a way that makes things click for you or you may pick up a new method of doing things. Stay curious and open to new ways. Adapt to each situation and continue to try new things.  If a preceptor corrects the way you have been taught or contradicts what another provider told you, be gracious. Take the feedback and move on. Ultimately, you will decide what you incorporate into your practice and what you don’t.

Preparing for SEE exam and boards

Use the Self-Evaluation Exam (SEE) to gauge where you are academically. Try to take the SEE at least a year into your program to ensure you have covered enough material to give yourself an accurate picture of your knowledge base. Your results will help you to tailor the way you study for the rest of your program. Concentrate on improving your weaknesses rather than continuing to study your strengths. Remember, you have a fixed amount of time in your program to study. Don’t continue to review subjects that you understand well. Select a preparation program to help you review for for both the SEE and NCE. These programs can be expensive, so selecting just one (or two at the most) will save you time and money in the long run. Here are a few commonly used programs of study: Apex, Prodigy, Core Concepts, Valley Anesthesia.

There is a great community of CRNAs both online and within your state nurse anesthesia association. No one will understand what you’re going through like another SRNA or CRNA will. The people you attend your program with will likely become future colleagues and lifetime friends. Support and uplift one another to get through one of the most demanding and most rewarding times in your life – CRNA school.

Good luck in your program!

Danielle