Becoming a Certified Registered Nurse Anesthetist (CRNA) can be a daunting journey, and it’s often difficult to know where to even begin.
the moment you decide that CRNA is the career for you all the way to
the glorious finish line, there are 8 strategic steps you can take to
ensure that you are as highly qualified as possible before you apply
to CRNA school.
1) Graduate from an accredited BSN program
It doesn’t matter how you obtain your BSN, but be wary of pass/fail programs because they will hurt your GPA. If you already have your MSN you can still go back for CRNA. (Hopefully some of your graduate coursework will transfer!)
in mind that your ADN GPA will matter more than your BSN GPA because
your ADN demonstrates your competence in core sciences. For example,
if you get a 3.0 in your ADN but a 4.0 in your BSN and your average
is a 3.5, you might still fail to get an interview. This is because
they look at your science GPA from your ADN which would not meet the
minimum to apply (3.0), or it isn’t competitive enough. I have met
a wide variety of CRNA’s with various educational backgrounds,
dentistry, EMT, business, accounting, NP, military, just to name a
no matter how you obtain your BSN just focus on your GPA as much as
possible, especially your core sciences.
2) Maintain good grades
To be considered competitive for CRNA school you should aim to have a
3.5 or higher. Keep in mind that a lower GPA will still be considered
because they look at the candidate as a whole.
there are necessary steps you need to take to be competitive with a
lower GPA. They will evaluate your core science GPA, like chemistry,
A&P, micro-bio, etc.
GPA is calculated differently in each school. Some only consider your
BSN or the last 60 credits along with core sciences. Others combine
all grades (all degrees) to figure overall GPA. Some even look at
high school GPA and ACT/SAT scores.
Rejection is common regarding lower GPA, so be willing to apply to multiple schools and to go the extra mile to make up for a less competitive GPA by retaking courses and/or graduate-level courses.
aware that science grades have to have been completed within the last
5-10 years, depending on the school.
Another thing to keep in mind is some CRNA schools limit how many times you can interview/apply, (two times seems to be the max at schools that set a limit). This is why it is important to reach out and get guidance prior to applying.
3) Obtain critical care experience as an RN
Before you apply to CRNA school, ideally you should accumulate 3-5 years of experience to be competitive. You should always shoot for a level 1 adult ICU (not ER). However, in areas that this is not possible a level 2 can still be competitive. If you do not want to work in an adult ICU know that you may struggle to find a school that will accept your experience. (Some will accept NICU/PICU/ER.)
note that a lot of schools only require 1-2 years at minimum for ICU
experience, but to be competitive aim for more than the minimum.
often determine that ICU experience greater than 5 years could
potentially hinder your ability to be a “teachable” student
again. Do not let this intimidate you, but go into the application
and interview knowing that you need to make it clear that you are
ready and able to be a novice again.
It also helps to have taken a recent graduate-level course in which you get an A to provide proof that you are ready academically to be a student once again.
you do not have a level I or II hospital near you, consider commuting
to get this experience. Remember where your program of choice is
located, if the school is near a level one hospital you will be
competing with those applicants.
quality over quantity in most cases.
4) Be a leader in your community—get involved
Seek out learning opportunities. It will help give you a competitive
extra certifications, (CCRN at minimum even if it is not required).
involved in a unit leadership committee, precept students, volunteer
or offer to work on a research project with your unit’s CNS.
5) Job Shadow
Do this as much as possible. A highly competitive CRNA candidate on average spends 40 hours or more shadowing. Even if the school only recommends shadowing experience, still DO IT!
programs turn away highly qualified candidates simply because they
did not take the time to shadow a CRNA.
want to see you have put a lot of thought into pursuing anesthesia
and that you have taken the time to make sure this is a career in
which you will thrive.
can be difficult to get this experience. I encourage you to continue
to start with your current hospital of employment.
that does not work, then reach out to local hospitals or surgery
you still can not find experience, call your program and ask for
6) Take the GRE/CCRN
Most schools will require prospective CRNA candidates to take one or the other or even both. If the schools say they require the GRE but do not give you a benchmark score, know that to be competitive you need a score of 300 or greater with a 3.5-4 on writing.
schools will state the minimum GRE to be 290-300. Know that getting a
290 or 300 is equivalent to just having a 3.0 GPA in the realm of
being competitive, so always aim for more than their minimum.
schools do not look at CCRN scores, but some do. It never hurts to
find this information out ahead of time- you can even use it to your
advantage on your resume if you did score high.
If you have a 3.4 GPA or less, having a good GRE score can help
admission committees look past this shortcoming. Some schools will
require GRE from students with a lower GPA. Even if they don’t, it
would be in your best interest to take the test as long as you are
prepared to do well on it (and only if you have exhausted other
measures, like graduate level courses).
In my opinion, if they do not require the GRE, you would be better off taking more than one graduate-level course that will transfer to prove your academic abilities.
taking the GRE is one more modality to overcome a less than desirable
7) Take Graduate level courses
If you want to be a competitive candidate for CRNA school this is a must.
Taking a graduate-level stats or chemistry that will transfer into the program will help boost your application and is a MUST for candidates with less than a 3.4 GPA.
in mind that if you have a science grade (undergrad) of a C or less
that you may have to take that class over again.
Start by assessing your core science GPA. If you have less than a 3.4 then consider retaking an undergrad science class (if you got a C or lower) on top of a graduate-level course.
consider where you are applying and what their average student GPA
is. If you do not know, then email the admissions counselor to find
8) The interview is KEY
You can have the most competitive application, but without a good interview you will not be accepted by a CNRA school. So preparation is of vital importance.
should start well before you get an invite to interview. All schools
have a different interview style.
hit mostly personal questions (emotional intelligence style), while
others hit pathophys/Pharm. Some do both along with a written CCRN
style test (math, and on the spot short essays).
is very beneficial to network and attend open houses. Speak with
current students to determine what to expect.
houses are also a great opportunity to talk to the program director
and allow you to get to know them. This helps take the edge off on
interview day when you see a familiar face.
following these 8 steps, you can ensure that you will stand out
amongst a sea of applicants and be well on your way to reaching your
goal of becoming a CRNA!
While you will face a number of challenges along your path, you are not alone in this journey. Check out the CRNA School Prep Academy. Membership provides access to a powerful community, individual instruction, and accredited guidance. Another helpful resource is the 4,500+ member Facebook Group, I.C.U. Dreaming About Anesthesia.
The position is just a few years old at this point, but nurse navigators are proving their worth as they shepherd patients and families in their journeys through the healthcare system.
What does a nurse navigator do? In an interview with the Mooresville Tribune, Arin McClune, MSN, RNC-OB, Women’s Services Navigator at Lake Norman Regional Medical Center, defines the nurse navigator as “a nurse who will help the patient facilitate and coordinate their care, depending on what their specific needs are. So whether it’s to coordinate care with the physician, with seminars, education, and then follow up on pre-hospitalization, during their hospitalization, as well as their discharge time to ensure that all their needs are being met and that their outcomes are what their goals were, their expectations.”
nurse navigators have quickly established their value: “Organizations
that choose to create roles for nurse navigators are putting the
patient at the center of the care, and increased patient satisfaction
scores reinforce this fact. Numerous articles are published each year
touting not only the intangibles such as the patient’s perceived
improvement of care, but also decreased hospital readmission rates
and ED visits in the departments where nurse navigators are
Nurse navigators primarily work with oncology patients, being instituted, as RegisteredNursing.org notes, to provide “one-on-one contact with patients to offer resources and education regarding the planned treatment,” and to act as “a liaison between the patient and all members of the care team.” With their successful implementation in oncology, nurse navigators now specialize in a wide range of areas. In the Mooresville Tribune article, for example, the navigators interviewed cover everything from bariatric surgery to breast health, and chest pain/stroke patients. For Tina Hunter, a breast health specialist who spoke with the Tribune, the position brings with it some of the classic rewards of nursing: “I enjoy teaching patients, having that one-on-one time with the patients that I take care of. We all enjoy talking to patients, spending time and we wanted to do more of that.”
What requirements are needed to work in this field? Nurse.org suggests “solid clinical experience in a specific area of nursing care (usually several years)” and certification in a specialty area of practice, or in oncology nurse navigation. They also remark that the ranks of nurse navigators often include nurse practitioners and clinical nurse specialists. In assessing the abilities needed to be successful in the field, the journal Nursing Management notes that the well-trained nurse navigator “reaches out proactively, facilitates communication between providers, prevents delays in treatment, offers psychological support, monitors and manages symptoms, and identifies and recommends resources.”
As Jaycee Dedmon, BSN, RN, ONC, orthopedic nurse navigator says, the
role involves more than just guiding patients through paperwork
(though that is part of the job, too): “It’s very overwhelming
for patients. I think a lot of what I do is trying to alleviate some
of those fears and anxieties that they have about their surgery or
their diagnosis, because it’s a lot. It’s scary to have to need
surgery or be in the hospital and so (we do) as much (as) we can to
try to provide them information that’s in a way that they
understand. We could give them all the papers in the world but if
they don’t understand what it means, then we aren’t doing our job
New York state climbs the steep face of its COVID-19 curve, Gov.
Andrew Cuomo (D) issued
an executive order vastly
widening the scope of practice for some healthcare providers and
absolving physicians of certain risks and responsibilities.
the order’s provisions:
Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
Granting providers immunity from civil liability for injury or death
Suspending usual record-keeping requirements
Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries
order, which remains in place through at least April 22, was met
mostly with applause, though with some hesitation around work-hour
Michael Gibson, MD, of Harvard, called it “stunning in both the
breadth and depth of recommendations” on
Shamim, MD, described it as a “great move,” with the
exception that trainee work hour limits shouldn’t be scrapped: “They
are already working equivalent to 2 [full-time employees] without
Chinese-style PPE. More hours = more risk of exposure,” he
Gianelli, president of Mount Sinai Morningside hospital in New York
City, told MedPage
his team is “grateful to the governor for throwing the
regulations out the window right now. He’s encouraging us and
enabling us to do what we have to do to get through this. It’s the
right thing to do.”
Puskas, MD, chair of cardiovascular surgery at Mount Sinai
Morningside, agreed that the steps are the right ones given that New
York City “hasn’t flattened the curve adequately to avoid a big
wave crashing. We’re really going to feel it in the next 2 or 3
simultaneously with that, we lost a meaningful number of healthcare
providers to home quarantine, then we’d have a shortage not just of
ventilators, but of people to run them and care for patients,”
by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today
After years of opposition from the Florida Medical Association and seven years of passing in the state House but not in the Senate, the bill to allow Floridian Nurse Practitioners full practice authority has finally been passed. Starting in July 2020, advanced NPs who have accumulated at least 3,000 hours of experience under physician supervision will have the right to independently operate primary care practices in Florida without an attending doctor. To qualify, they will also have to complete minimum graduate level course work in differential diagnosis and pharmacology.
Under the new law, signed on March 11 by Florida Governor Ron
DeSantis, qualified NPs will be able to independently practice family medicine,
general pediatrics and general internal medicine. House Speaker Jose Oliva, who
made the bill a priority, praised the bill’s passage, saying, “Freeing
(advanced practice registered nurses) of the red tape that has historically
stopped them from working to the full extent of their education and training
will immediately improve access to quality care for all.”
In a compromise between the Florida House and Senate, while the bill grants full practice authority to advanced NPs, it does not cover physician assistants or certified registered nurse anesthetists. Calling the bill “a good first step,” the Florida Association of Nurse Anesthetists commented, “Although we are disappointed that the legislation did not include certified registered nurse anesthetists … we are pleased that some of Florida’s (advanced practice nurses) will be able to practice autonomously.” The group added, “Passage of this bill demonstrates Florida’s commitment to modernizing the way health care is being delivered in our state by ensuring that Floridians have full access to health care, particularly in rural areas that are often underserved.”
Florida Republican Representative Cary Pigman, a physician who has filed the bill multiple times in the state House, noted, “Beyond the classroom, the data from statewide experiments across the nation demonstrate without a doubt that nurse practitioners are highly skilled, highly trained, and highly eager to care for patients independently.” Pigman added, “Advance practice professionals achieve higher marks in patient outcomes, patient satisfaction, and they spend more time actually talking to patients.” For more details, visit here.
The Nurse Practitioner Association New York State (NPA), the only statewide professional association of nurse practitioners, has named Janice Ceccucci, DNP, FNP-BC, Nurse Practitioner of the Year, and Daniel Babcock, MS, FNP-C, NP Student of the Year. The awards were presented at The NPA 35th Annual Conference, held in Verona, NY, and were attended by nearly 500 NPs and NP students from across the state.
Stephen Ferrara, DNP, FNP, FAANP, Associate Dean of Clinical Affairs at Columbia University School of Nursing and Executive Director of the Nurse Practitioner Association New York State, said, “As health care professionals committed to excellence in patient care, nurse practitioners are redefining their role. We’re extremely pleased to recognize Janice Ceccucci and Dan Babcock for their dedication and service.”
Forensic NP and Professor at SUNY Polytechnic Institute Is NP of the Year
Janice Ceccucci is an outstanding Nurse Practitioner and SANE (Sexual Assault Nurse Examiner). Ceccucci began her career working with sexual assault victims in the Emergency Department. Recognizing that there were gaps in services, particularly for child sex abuse victims, she decided to pursue forensic nursing. She is committed to ensuring services for child sex abuse and physical abuse patients are widely available.
“Janice takes nursing to the next level,” says colleague (and nominator) Elizabeth Spooner Dunn. “Her passion for the profession, dedication to her patients and commitment to excellence make her not just a trusted colleague but an example and mentor to all.”
has also received the Joan Unger Memorial Award given by the New
York State Coalition Against Sexual Assault for demonstrating excellence and
innovation in services offered to the community in sexual assault. She has also
been published by the Journal of Forensic Nursing and
is co-founder of Forensic Nurse Practitioners of Schenectady.
On Call, Inside and Out of the Hospital
Outside the confines of Saratoga Hospital, Ceccucci is on call at home 36 hours a month to provide teleconsulting services to hospitals in remote areas that lack access to sexual assault nurse examiners (SANEs). In addition, she conducts sexual assault exams for pediatric patients at child advocacy centers—a service that Ceccucci and a colleague introduced in 2011 to better serve sexually abused children.
A leader in promoting the profession to the next generation, Ceccucci is an assistant professor at SUNY Polytechnic Institute. She is also the co-director and developer of Saratoga Hospital’s Advanced Practice Provider Fellowship Program, which mentors new nurse practitioners and physician assistants, also known as advanced practice providers. And, in case that was not enough to take on, Ceccucci is an assistant professor of nursing for SUNY Polytechnic in Utica and helped pilot a hybrid program that delivers live streaming and on-campus classes.
“I wouldn’t want to do anything else.”
Ceccucci received her master’s degree as a Family Nurse Practitioner from SUNY Poly in 2009, and was awarded her doctorate in Nursing Practice from State University of New York Upstate Medical University in Syracuse in 2016.
“I’m proud to be the recipient of the NP of the Year. There are so many wonderful opportunities in nursing. For newer NPs, I would advise they take advantage of every opportunity that presents itself. I love being an NP. I wouldn’t want to do anything else,” Ceccucci said.
For further information on Janice Ceccucci, visit here.
NP Student of the Year Dan Babcock
Dan Babcock is an Air Force veteran and a former professional fire officer and paramedic who is currently a full-time Graduate Family Nurse Practitioner Student in the Decker School of Nursing at Binghamton University. He holds a BS in Nursing from Empire State College and as a Registered Nurse has worked in the emergency department and diagnostic imaging. After retiring as a lieutenant from the City of Binghamton’s Fire Department with 20 years of service, he decided to become a nurse practitioner. As Babcock grew up in rural Delaware County, New York, he has a particular interest in improving the health of the poor, rural and vulnerable populations that influenced his early life.
an honor to be awarded NP Student of the Year. I chose to become a nurse
practitioner because I love being challenged and love the relationships I form
with my patients. Aside from the need for primary care providers, I chose
family practice to give me a solid foundation for medical mission work. My wife
and I do mission work in Guatemala several times a year, and I would like to do
medical missions as a nurse practitioner,” Babcock said.
Nurse Practitioner Association New York State
Nurse Practitioners (NPs) are registered nurses who have completed advanced education, at a Master‘s or Doctorate level, plus additional clinical preparation. These professionals are authorized to independently diagnose illness and physical conditions, perform therapeutic and corrective measures, order tests, prescribe medications, devices and immunizing agents, and refer patients to other health care providers.
The Nurse Practitioner Association New York State (The NPA), the only statewide professional association of nurse practitioners, promotes high standards of healthcare delivery through the empowerment of nurse practitioners and the profession throughout New York State. For more information, visit: www.TheNPA.org.
When people experience sexual assault,
they may sustain more than just physical injuries; trauma also affects short-
and long-term mental health. The medical treatment needed may require a
provider to examine parts of the body that were recently violated, which can
cause more distress. When reporting an assault, survivors often lack the
information they need about how to proceed.
Sexual assault nurse examiners
(SANEs) are trained to help survivors across this spectrum of patient care.
From providing evidence-based treatment to performing assessments to collect
forensic evidence that can be used in a criminal trial, these nurses play a
critical role in supporting survivors at the beginning of their recovery
What Is the Role of a Sexual Assault Nurse Examiner?
When a sexual assault survivor comes to a SANE-certified hospital or community health center, a sexual assault nurse examiner is the first point of care, according to Kim Day, forensic nursing director for the International Association of Forensic Nurses (IAFN). SANEs ask the patient if they would like a forensic exam, which can be completed even if the patient decides to not report their assault to law enforcement.
“Just going through the process with
someone and providing holistic patient-centered care for that patient during a
traumatic time in their life can really impact the way they leave the
hospital,” Day said.
Forensic exams are meant to document
trauma from the assault and collect evidence that could be used in a criminal
trial. This includes taking a medical history; documenting scratches, bruises,
abrasions, and other injuries on a body map diagram; taking photos of injuries;
collecting DNA swabs to be processed; and observing the patient’s behavior. In
cases where toxicology information is relevant, SANEs will also perform those
tests on a patient.
In addition to performing a forensic
exam, the main duty of a SANE is to provide holistic nursing care for the
patient. Survivors of assault may need access to testing for pregnancy, as well
as prophylactic antibiotics to prevent the contraction of diseases. Depending
on the patient’s needs, SANEs also provide referrals to see other specialists,
such as a licensed professional counselor, who can help them in their recovery
The SANE in Court: It’s Not Like “Law and Order”
Beyond working in the clinical
setting, SANEs are qualified to testify in court if a patient’s case goes to
trial. The specialized training SANEs receive prepares them to effectively
answer questions regarding evidence discovered during a forensic exam. However,
while SANEs can play a critical role in the trial process, the legal aspect of
the job is not the main focus, Day said.
“If the nurse goes into this work
thinking that they’re going to get the bad guy and put him behind bars, they
will fail at this… because that is not what we do,” she said. “The work we do
is nursing. We take care of the patients.”
This is a key factor to consider when choosing to become a SANE. Nearly 80 percent of sexual assaults are not reported to law enforcement, according to a Justice Department analysis of violent crime in 2016 (PDF, 669 KB). While performing a forensic exam and being prepared to provide evidence in court is a requirement of the job, the emotional and medical needs of a patient come first.
SANEs are trained to work within a multidisciplinary team, also known as a Sexual Assault Response Team (SART), which includes survivor advocates, members of law enforcement, and mental health providers. Together, these professionals coordinate the response to survivors of sexual assault.
What Is a Sexual Assault Response Team?
SANEs and other trained health care
providers: When an individual decides they
would like to have a sexual assault forensic exam (SAFE), health care providers
like Nurse Practitioners (NPs) or SANEs address the initial physical and
psychological needs the patient might have as a result of their assault.
Survivor advocates: Individuals who need access to information and emotional
support can work with an advocate to navigate their path to recovery. A
survivor may reach out to an advocate via a crisis center, or one may be
brought in to support someone who has decided to seek treatment at a hospital
or report their assault to the police.
Law enforcement: In cases where an individual decides to report their
assault, police officers and detectives are responsible for taking statements,
coordinating with the hospital to receive the results of the forensic exam, and
investigating the alleged assault.
Prosecutors: In cases where the survivor has chosen to report their
assault and enough evidence is present, prosecutors are tasked with making the
decision on whether to bring the case to court.
Therapists and counselors: In the aftermath of an assault, whether a case goes to trial
or not, survivors need additional support to continue their recovery process.
Mental health professionals trained in working with sexual assault survivors
may provide care at any step in the recovery process, from coping with the
immediate aftermath of an attack to navigating long-lasting trauma.
SANE education programs are designed
to train nurses to address survivors’ specific needs. After completion of this
training, SANEs become uniquely qualified to treat this vulnerable patient
group. This means that they can provide trauma-informed care to minimize the
harm of invasive exams that may trigger a patient. In doing so, they can also
equip their patients with forensic evidence that can be used if they decide to
report their assault.
One of the key challenges of
completing a sexual assault forensic exam (SAFE) is examining a patient’s
physical injuries without retraumatizing them. To help survivors feel
comfortable, SANEs ask for consent during each step of the way while providing
information on why they are doing each test.
“Consent is not just a piece of
paper with a signature on it,” Day said. “It’s a process throughout the exam.”
In practice, the process of asking for consent may resemble the following:
will inform the patient what body part they will examine and ask permission to
do so. “I’m going to examine your neck now
to see if there are any injuries. Do I have your permission to do so?”
patient grants this permission and the SANE notices something that may require
a sample collection, the nurse will again ask for permission to collect a
specimen and explain why collecting that evidence is appropriate. “I notice a scratch that wasn’t
mentioned when I documented your health history. There may be DNA or other
materials near this wound, so I would like to swab it. Is that OK with you?”
In any instance where the patient
does not want a test performed, the SANE is directed to honor the patient’s
request. This integration of consent throughout the exam is meant to give the
patient a sense of control, a feeling that may have been lost during their
What Are the Requirements to Become a SANE?
Because SANEs work with a patient population that requires specialized care, nurses are required to meet certain expectations in order to take on this role. While some nurses go through training at the local level or through smaller programs, IAFN offers the most recognized certification for SANEs. Nurses can become certified as a SANE-A to care for adults and adolescents or a SANE-P to work in pediatrics. Some nurses elect to pursue both certifications so they can provide care to patients across all age groups.
Steps to SANE Certification
Education: To become a certified SANE, a nurse must have the minimum of a registered nursing (RN) license.
Experience: Prior to starting the certification process, a nurse must have at least two years of clinical experience working as an RN or at a higher level, such as an NP.
Training: As part of the certification process, nurses are expected to complete 300 hours of SANE clinical skills training.
Testing: The final requirement to become a certified SANE is to pass a certification examination. IAFN holds exams two times a year.