February 4th to 10th is National Burn Awareness Week, and Daily Nurse is recognizing the specialized work of burn nurses. Burn nurses are known for their exceptional skills, commitment, and unwavering dedication to patient care. They work tirelessly to treat individuals who have been affected by burn injuries and to advocate for burn injury prevention within their communities.
Meet Emily Werthman, PhD (c), MSN, RN, CBRN, the Burn Program Manager at The Johns Hopkins Burn Center. She is also a member of the Board of Certification for Emergency Nursing (BCEN) board of directors for the 2024-2025 term and shares her insights on burn nursing as a specialized nursing practice.
-What are your title and credentials at The Johns Hopkins Burn Center?
Burn Program Manager
PhD (c), MSN, RN, CBRN
-How long have you worked there?
13 years
-What do you enjoy most about your role as burn program manager?
I love the detective aspect of my job: finding a problem, discovering its root cause, and then developing a plan to fix it. I also work with an amazing interdisciplinary team that makes it exciting to come to work every day.
-Talk about how you ascended to that role.
I started as a BICU nurse and loved our burn program’s research and quality aspects. I knew that burn nursing was where I wanted to practice, but I also wanted to further my career options by pursuing an advanced degree. After about 10 years at the bedside, the burn program manager position became available while I was obtaining my MSN in nursing education. I was so happy to be able to combine my love of research, quality, and bedside burn nursing knowledge into this role. I am also incredibly fortunate to work for a health system that encourages and supports its nurses’ continuing education so I can continue with my PhD.
-What inspired you to become a burn nurse?
My mother died in a house fire shortly after my college graduation. Knowing that her nurses were with her, providing the best possible care, inspired me to do the same for all the families and patients we care for here at the Johns Hopkins Burn Center.
–What associations are you a member of, and how have they helped your career?
I am an American Burn Association (ABA) member, serving as the lead nurse planner. I volunteer with the Board of Certification for Emergency Nursing (BCEN), serving as a CBRN Exam Construction Review Committee member, and have just been appointed to BCEN’s board of directors.
These roles have allowed me to work outside of my hospital system to impact the work of burn nurses nationally and internationally. My work with the ABA has allowed me to progress from member to committee member to lead nurse planner. Similarly, at BCEN, I started as an item writer and have continued to work within the organization to support its mission. Both organizations have provided opportunities for professional growth through networking and continuing education.
-What does a burn nurse do?
There is not a typical day in burn. We see patients at their worst on the first day they are injured, their best on the day they are discharged, and everything in between. Burn is unique because we know our patients and their families through one-on-one interactions during daily wound care sessions. A shift in the BICU or BWU will usually involve all your standard nursing interventions but with a healthy dose of specialized wound care, wound vac placement, dressing takedowns, and lots of psychosocial support for our patients and their families.
–Burn nurses are more than trauma care. Can you talk about the other types of care they provide patients?
Burn nurses genuinely care for the patient across the entire continuum from admission to discharge and then reconstruction procedures in the years following an injury. In addition to critical care, they provide outstanding psychosocial support to families and patients. Many burn nurses participate in prevention activities like outreach at local schools and partnerships with local firefighters.
-How do you become a burn nurse?
After graduating with a history degree, I returned to school to get my AS in nursing, eventually earning a BSN and MSN. I am currently preparing to defend my PhD dissertation, as well. I knew when I entered nursing school that burn nursing was my calling. I contacted the burn center for my senior honors project to arrange a guest lecture at my nursing school. I kept in touch with them after graduation so that they were aware of my interest in the burn center and to let them know when I applied for an open position there.
–Talk about the need for burn nursing and BCEN specialty certification.
I seek to effect change in the field of burn nursing as a subject matter expert, test question writer, and exam content review committee member for the CBRN exam. Specialty certification is an essential part of recognizing burn nurses’ unique work. As more hospitals move toward Magnet certification, standing with other certified nurses offers burn nurses the ability to demonstrate our commitment to quality care.
-What are the benefits of being a burn nurse?
Burn nursing is a challenging field. But it is just as rewarding as it is difficult. We see patients progress through their recovery, and through our work with the Burn Therapy Program, we continue to see them for years as they return to their lives.
–Talk about the reward of being a burn nurse.
The payoff is the outcome. When we see a patient with substantial burn injuries overcome their injuries and go on to live happy, successful lives, it makes all the long, hot days in a tub room worth it.
–Talk about being 1 of 12 expert nurses selected by BCEN to serve on the Burn Nursing Role Delineation Study Advisory Committee.
No other specialty provides you with a level of interaction with patients and their families, all while providing life-saving critical care. The burn nurse is truly the best representation of a holistic nurse that I know—integrating critical care with psychosocial care, wound care, focused systems assessments/interventions, and all that comes with the care of surgical patients. Being selected to help define what a burn nurse does was an honor. And to be able to work with some of my role models in burn care (Gretchen Carrougher and Katie Hollowed, in particular) was so exciting. To think that we could work together with burn experts from all over the country to help on our path to certification was life-changing.
–How does the committee’s work serve as a roadmap for nurses who sit for the CBRN exam?
In our work, we helped define what the burn nurse does, which helped define the parameters of the CBRN exam.
-Do you have anything else to add for Burn Awareness Week?
This year’s theme is preventing flammable liquid injuries, so I encourage people to check out the resources available at ameriburn.org to ensure they are following all appropriate safety measures!
Embarking on the journey to certified registered nurse anesthetist (CRNA) school can be both exhilarating and daunting. To help you navigate this path, I’ve compiled a comprehensive guide outlining key steps to enhance your candidacy for CRNA school. This guide is not just a list of steps; it’s a culmination of foundational strategies that have been proven effective.
As the founder of CRNA School Prep Academy, we’ve mentored thousands of CRNA hopefuls. Our guidance has led over 3,000 students to gain admission to CRNA schools nationwide. Each aspiring CRNA I’ve mentored has walked a unique path, facing distinct challenges. However, these diverse experiences all fall within the scope of the steps outlined below. Following this guide can save time, money, energy, and the emotional toll many prospective students experience.
Consider this article your roadmap, rich with insights, practical advice, and important warnings. It’s designed to provide a clear understanding of what lies ahead, equipping you with the knowledge to make your journey as efficient and fruitful as possible.
While this guide outlines the general terrain, the specifics of your journey — how smooth or challenging it may be — will depend largely on your circumstances and where you currently stand.
For now, focus on these steps. Assess which areas require immediate attention and then prioritize the rest according to their significance in your preparation.
The key is to start on the right foot, whether at the beginning of your journey or you’ve already made some progress. Proper preparation from the outset, or starting now if you’re further along, can make a world of difference in your journey to becoming a CRNA.
Before diving into the specific steps for CRNA school preparation, I want to highlight three recommendations. These will provide clarity and focus across all aspects of your journey. By addressing these upfront, you can streamline your efforts and avoid unnecessary expenditure of time, energy, and finances..
To optimize your preparation and make informed decisions, consider the following foundational strategies:
Research Program Specifics: Contact them directly once you’ve shortlisted your programs. While their websites are a great resource, they might only cover some of the nuances of the application process and program requirements. This step is crucial for gathering in-depth information, some of which I’ll also touch upon in this guide.
Evaluate and Plan: Assess what’s required to meet the minimum criteria of these programs and distinguish yourself from other applicants. Develop a plan to fulfill these requirements, and identify areas where you can excel beyond the basic expectations.
Armed with this foundational knowledge, you’re better equipped to navigate the subsequent steps more precisely and purposefully.
Let’s embark on this journey together.
STEP 1: Educational Pathways to CRNA School
Complete Your Undergraduate Degree: Begin by graduating from an accredited Bachelor of Science in Nursing (BSN) program or combine a Bachelor of Science (BS) in a science field with an Associate Degree in Nursing (ADN). While a BSN is universally recognized, not all programs accept a combination of a BS and ADN. This is why verifying the specific requirements of your chosen CRNA programs is crucial.
Consider the Route to Your Degree: The pathway you take to obtain your BSN or equivalent undergraduate degree (such as LPN to ADN to BSN) is less important than the program’s quality. However, exercise caution with pass-fail programs, as they can negatively impact your GPA, which is a critical factor in your application.
Understand Accreditation Requirements: Pay attention to the accrediting bodies for your ADN and BSN programs. CRNA schools generally prefer candidates from programs accredited by national bodies like the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing (NLN). Programs with both national and regional accreditation are generally well-regarded. However, if your program is solely regionally accredited, this might limit your options for CRNA schools, so research this aspect early in your journey.
MSN Graduates: If you already hold a Master of Science in Nursing (MSN), you can still pursue a CRNA degree. Check with your target CRNA programs whether your graduate coursework will be recognized and transferrable.
Diverse Educational Backgrounds: CRNAs come from various educational backgrounds, including dentistry, EMT, business, accounting, nursing, and the military. The key factor across these diverse paths is maintaining a strong GPA, particularly in core science courses such as Biology, Anatomy, Physiology, Chemistry, and math courses like Statistics.
In the following section, we’ll delve deeper into the importance of your GPA and specific course performance…
STEP 2: Maintaining Strong Academic Performance
Securing a spot in CRNA school is highly competitive, and a solid academic record is crucial. Here’s how to navigate this aspect of your application:
Target a High GPA: Aim for a GPA of 3.5 or above to be a competitive candidate. While GPAs below 3.5 are still considered, they may necessitate additional steps to strengthen your application. The most important initial action is to contact the programs you’re interested in and request a review of your transcripts.
Understand the Focus on Core Sciences: As mentioned earlier, CRNA programs often prioritize your GPA in core science subjects like Chemistry, Anatomy & Physiology (A&P), and Microbiology. However, each school has its unique method of calculating your GPA. Some may focus on your last 60 credits plus core sciences, while others consider all your grades across all degrees. A few programs might even review high school GPAs and standardized test scores like the ACT/SAT. Early consultation with your chosen programs can clarify these requirements and save you confusion.
Addressing Lower GPAs: If your GPA is lower, be prepared to take additional steps. This might include retaking courses, enrolling in graduate-level classes, or both. If it’s been over a decade since you completed your science coursework, refreshing these subjects could be necessary. Also, some programs require recent science grades (within the last 5-10 years).
Strategize for Multiple Applications: If your GPA isn’t strong, plan on applying to several schools or reapplying to the same school. However, be mindful that some schools limit the times you can interview or apply (often a maximum of two attempts). Thorough research and direct communication with each program are essential. Inquire about their average accepted GPA to better understand their weight on this criterion.
Remember, reaching out to programs for specific guidance is critical to ensuring that your academic qualifications align with their expectations. This proactive approach can significantly enhance your chances of success.
If you possess an Associate Degree in Nursing (ADN), it’s crucial to understand that your ADN GPA carries more weight than your BSN GPA in the eyes of CRNA programs.
Why is the ADN GPA More Critical?
The emphasis on core science courses is the key reason. Typically, ADN programs include more of these crucial science courses than BSN programs. Therefore, your performance in the ADN program offers a more direct reflection of your abilities in these essential subjects.
A Common Misconception
Let’s consider a scenario where you have a 3.0 GPA in your ADN and a perfect 4.0 in your BSN. You might assume that an average of 3.5 would be sufficient. However, this is often not the case. CRNA programs tend to scrutinize your science grades from the ADN more closely. If these grades are on the lower side, you might either fail to meet the minimum application requirement (for example, a 3.0 GPA) or fall short of being a competitive applicant.
In summary, for ADN holders, excelling in the science courses during your ADN program is particularly crucial. It’s not just about the cumulative GPA; it’s about where and how you achieved those grades, especially in the core science subjects that are fundamental to the CRNA curriculum.
It’s important to note that even students with a perfect 4.0 GPA can face rejection from CRNA programs. This serves as a reminder that grades, while significant, do not encompass the entirety of what makes a successful CRNA candidate.
STEP 3: Gaining the Right Critical Care Experience as an RN is Vital in Your Journey to CRNA School
Here’s how to optimize this phase:
Ideal Duration of Experience: Aim for 2.5 to 5 years of work in a Level 1 Adult Intensive Care Unit (ICU). Many CRNA programs consider This timeframe the ‘sweet spot’.
If You Have Less Than 2 Years of Experience: Be aware that you might need to meet the minimum requirement of 1-2 years set by many schools. It’s important to ensure you meet this baseline before applying.
If You Have Over 5 Years of Experience: Demonstrating your willingness to learn and adapt is crucial. Despite extensive experience, showing that you are still open to new learning is key. One way to do this is by excelling in a graduate-level course and earning top grades.
Recentness of Experience: Most CRNA programs prefer your critical care experience to be recent, typically within the last 1-2 years. Ensure that your experience is up-to-date to meet these criteria.
Experience Outside the 2.5-5-Year Range: Don’t be discouraged if your experience doesn’t fit within this range. Instead, focus on strengthening other aspects of your application. Many candidates with more or less experience have successfully gained admission by excelling in other areas.
Type of ICU Experience Matters: While a Level 1 Adult ICU is ideal, due to its status as an academic center often providing more opportunities for research involvement (which is highly valued by CRNA programs), a Level 2 ICU can also be competitive, especially in regions where Level 1 access is limited.
Remember, the quantity and quality of your ICU experience are both critical. Alongside the duration of your experience, the type of ICU where you work plays a significant role in your application’s strength.
While Level I or II trauma hospital experience is highly valued, there are other environments where you can also acquire competitive critical care experience. Here are some key considerations:
Assessing the Acuity Level of Your Unit: If you’re working in a unit that regularly receives critically ill patients from smaller hospitals and involves managing vasoactive drips, ventilators, Continuous Renal Replacement Therapy (CRRT), or other advanced life support systems, this indicates a high level of acuity. Such experience can be valuable, even if the unit isn’t designated as a trauma center.
Considering Other ICU Environments: If an adult ICU isn’t your preference, be aware that your options for CRNA schools might be limited, as not all units are equally valued. Let’s explore some alternatives:
Pediatric ICU (PICU) and Neonatal ICU (NICU): Most CRNA schools accept PICU experience. However, NICU experience is more variable. Of 123 CRNA programs surveyed, 102 accept PICU, but only 27 consider NICU on a case-by-case basis, and 21 explicitly do not accept NICU experience.
Emergency Room (ER) Nursing: ER experience is less commonly accepted as equivalent to ICU experience. Currently, only 4 out of 129 programs categorically accept ER experience, while 5 consider it on an individual basis.
Remember, these numbers reflect the current acceptance rates and can vary. It’s important to verify with the CRNA programs you’re interested in directly. Each program may have specific criteria or views on what constitutes relevant experience. Being proactive in understanding these nuances can significantly impact your application’s success. ICU experience standards are set by the COA (Counsel of Accreditation), which you can review here.
If high-acuity ICU experience is unavailable in your immediate area, it’s worth considering a commute to access this experience level. By making an effort to work in a higher acuity ICU, you not only gain the essential experience sought by CRNA programs, but you also showcase your dedication and commitment to your career goals.
When selecting a CRNA program, consider its location relative to major hospitals, especially Level 1 facilities. Remember that if your chosen school is near a Level 1 hospital, you’ll likely compete with applicants with experience in that setting. In most instances, CRNA programs prioritize the quality of your experience over its quantity. It’s crucial, therefore, to find various ways to demonstrate the depth and quality of your professional background and skills as a candidate. This approach can significantly enhance your competitiveness in the application process.
It’s important to note that certain units typically do not qualify as ICU experience in the eyes of CRNA programs. These include the Catheterization Lab (Cath Lab), Operating Room (OR), Post-Anesthesia Care Unit (PACU), and Step-down units. While exceptions can be made, they are rare, and relying on such units for your ICU experience is generally not advisable if you aim to strengthen your CRNA application. The likelihood of these experiences being considered equivalent to ICU experience by CRNA programs is relatively low.
STEP 4: Besides Your Clinical Experience, Taking on Leadership Roles and Engaging in Your Community is Crucial for Your CRNA Program Application
CRNA schools seek candidates who not only excel academically but also have the potential to become ambassadors and advocates for their institutions and the CRNA profession at large.
Pursue Additional Certifications: Aim to acquire extra certifications relevant to critical care, such as CMC (Cardiac Medicine Certification) and CSC (Cardiac Surgery Certification). The CCRN (Critical Care Registered Nurse) certification is essential if you have at least 1750 hours of ICU experience, as it’s often considered a benchmark for competitive applicants.
Engage in Leadership and Educational Roles: Get involved in leadership committees within your unit, take the initiative to mentor or precept nursing students, participate in volunteer work, or contribute to research projects. These activities demonstrate your commitment to learning and leadership in the field.
Show Eagerness for Continuous Learning: Actively seeking learning and development opportunities strongly indicates a dedicated and driven professional. This approach enhances your application and positions you favorably for obtaining strong letters of recommendation.
Job shadowing is a crucial component in strengthening your CRNA school application. It’s highly recommended to engage in this activity extensively; on average, a competitive candidate dedicates 40 hours or more to shadowing. Even if a program lists shadowing as a recommendation rather than a requirement, it’s still vital to pursue it. There have been instances where programs have declined highly qualified candidates due to their lack of shadowing experience. This experience is a testament to your dedication and understanding of anesthesia. CRNA programs are rigorous; they seek candidates who demonstrate a deep commitment and genuine interest in anesthesia.
Given the demanding nature of CRNA schools, programs are keen to select fully committed ones. The admissions committee might also have reservations if you don’t show certainty in your desire to become a CRNA.
Finding shadowing opportunities can be challenging, especially with new protocols introduced after COVID-19. Here are some strategies to secure these experiences:
Start with Your Current Workplace: Your existing hospital or place of employment can be the first place to seek shadowing opportunities.
Reach Out to Local Hospitals or Surgery Centers: If your workplace doesn’t offer these opportunities, approach other local medical facilities. Hospitals and surgery centers often have CRNAs on staff who might be open to being shadowed.
Utilize Online Platforms: Use of social media groups and online forums dedicated to nursing or CRNA professionals. Posting a request for shadowing opportunities in these groups can yield positive results.
Remember, showing initiative in finding and completing shadowing hours reflects positively on your application and demonstrates your proactive approach toward your CRNA career aspirations.
If you’re encountering obstacles in finding shadowing opportunities, reaching out to your target CRNA programs for assistance can be beneficial. These programs might provide valuable recommendations or alternative methods for securing a shadowing position, like contacting your local CRNA state association.
It’s essential to be proactive and persistent in your efforts to gain shadowing experience. Ideally, begin your search a year before your application. This foresight and consistent effort can significantly enhance your chances of securing the necessary experience.
An essential consideration during this process is the specific requirements of CRNA programs regarding shadowing. Many programs have a preference or even a stipulation that some of your shadowing should be conducted with a CRNA instead of an anesthesiologist (MD). This is due to the unique roles and perspectives that CRNAs bring to the field of anesthesia, which differ from those of MDs. While gaining insights from an MD can be valuable, ensuring that you also shadow a CRNA is crucial to meeting the specific needs of certain CRNA programs.
STEP 5: Navigating GRE and CCRN Requirements for CRNA School
When preparing your application for CRNA school, understanding the role of the GRE (Graduate Record Examinations) and CCRN (Critical Care Registered Nurse) certification is crucial. Here’s how to approach these requirements:
GRE or CCRN Requirement: Most CRNA programs require either the GRE or CCRN certification. In some cases, the GRE might be specifically required for applicants with lower GPAs, typically in the 3.2 – 3.4 range. If the program you’re applying to emphasizes the GRE or CCRN, excel in these areas to distinguish your application.
Target GRE Scores: Aim for a competitive benchmark for programs that require the GRE but don’t specify a target score. A score of 300 or above and a 3.5 to 4 in the analytical writing section are generally considered strong. While some schools might lower their minimum GRE score requirements, many competitive applicants often score above 300. Think of a 290 or 300 on the GRE as analogous to having a 3.0 GPA in terms of competitiveness – it might get your application considered, but aiming higher (preferably above 305) can strengthen your candidacy.
Compensating for Lower GPA: A robust GRE score can counterbalance a lower GPA. For instance, if your GPA is around 3.4 or less, a strong performance on the GRE can help mitigate concerns regarding academic performance. Some programs specifically request GRE scores from applicants with GPAs that meet the minimum requirement. In such scenarios, excelling in the GRE becomes an opportunity to enhance your overall application profile.
Remember, while meeting the minimum requirements is essential, always strive to exceed them where possible. This approach increases your chances of acceptance and demonstrates your commitment and capability to excel in a rigorous academic environment.
STEP 6: Strategies for Maximizing Your GRE Score and Utilizing CCRN Effectively
Investing in a GRE Tutor: If you’re finding it challenging to achieve even the minimum GRE score required by your CRNA program, consider hiring a tutor. Many tutors offer score guarantees or your money back, which can be a worthwhile investment for boosting your score.
Prioritizing Academic Enhancements: If your GPA is a concern and the GRE isn’t a primary focus of your target program, only consider taking the GRE after exploring other options. Prioritize enrolling in graduate-level courses relevant to your future degree, aiming for top grades to bolster your academic record. This approach demonstrates your academic capabilities and helps improve your GPA and earn graduate credits. Additionally, if advised by your program, consider retaking specific undergraduate courses to strengthen your academic standing further. This should be your first course of action before taking the GRE, as detailed in Section 2 regarding the importance of GPA.
Leveraging Your CCRN Score: While most CRNA programs may not emphasize CCRN scores, it’s beneficial to find out if your chosen program does. If they value the CCRN certification, and primarily if you’ve scored well (such as 80% or above), it’s advantageous to highlight this achievement on your resume. Though it might not be a deciding factor, a high CCRN score can certainly add to the strength of your application.
Focusing on academic improvements and strategic test preparation can significantly enhance your CRNA school application. Whether it’s excelling in graduate courses, retaking undergraduate classes, or maximizing your GRE score with the help of a tutor, each step plays a vital role in showcasing your dedication and readiness for the rigorous demands of CRNA training.
STEP 7: Strategically Selecting Graduate-Level Courses for CRNA Preparation
Graduate-level courses, especially in the sciences, can significantly bolster your application for CRNA school. This step is highly recommended for all applicants, but it becomes essential for some, depending on their academic background and the requirements of their targeted programs.
Consult Your Target Programs: Contact the CRNA programs you’re interested in before enrolling in any courses. This step ensures you invest your time and resources in courses that align with their specific requirements and preferences. Avoid taking irrelevant classes or missing out on essential ones by getting this information directly from the source.
Understand Program Prerequisites: Besides classes recommended by your target programs, be aware of any prerequisite courses that are mandatory for applicants or enrollees. These prerequisites can vary significantly between programs. For instance, AdventHealth’s CRNA program requires STATS 215 and a college-level Chemistry course to be completed before applying. Additionally, they require a specific course – Chemistry & Physics for Nurse Anesthesia – to be completed by December 31 of the year preceding enrollment.
Understanding and fulfilling these prerequisites strengthens your application and demonstrates your proactive approach and commitment to meeting the program’s standards. By strategically selecting and excelling in relevant graduate-level courses, you position yourself as a well-prepared and competitive candidate for CRNA school.
If you find yourself in a situation where it’s been 6 to 10 years since you last completed a science course, it’s wise to enroll in a new class, even if it’s not explicitly required by your target CRNA program. This step is crucial for a few reasons:
Stay Updated with Current Knowledge: Academic standards and content in science can evolve. Taking a recent course ensures that your knowledge is current and relevant.
Demonstrate Ongoing Academic Engagement: Completing a recent science course shows CRNA programs that you are actively engaged in your academic development and committed to maintaining your knowledge base.
Address Undergraduate Grades: If you received grades of C or lower in your undergraduate science classes, enrolling in a graduate-level science course can effectively demonstrate your improved capabilities. For example, AdventHealth’s CRNA program requires a minimum of a B grade in their prerequisite classes. Excelling in a graduate-level course can show that you have grown academically and are prepared for the rigorous coursework of a CRNA program.
Stand Out Among Other Applicants: Even if retaking an undergraduate course with a lower grade isn’t mandated by your prospective program, doing so can help you stand out. Your updated grades will be compared against those of other applicants, and higher grades can significantly enhance your application.
In summary, updating your science education, mainly if your previous grades were not strong or your coursework needs to be updated, is a strategic move in strengthening your CRNA school application. It showcases your commitment to continuous learning and ability to succeed in a demanding academic environment.
If your GPA hovers around 3.4 or meets the minimum requirement of your target CRNA program, it’s essential to strategize effectively regarding additional coursework. After consulting with your chosen program about your GPA and its implications, consider the following when selecting “bonus” classes:
Prioritize Relevant Science Courses: As discussed earlier, science courses often carry more weight in the evaluation process. Opt for courses that will benefit your CRNA preparation rather than less relevant ones like Nursing Theory. Focus on subjects that will enhance your understanding and skills in anesthesia-related areas.
Ensure Course Credits Are Transferable: If you’re investing time and money in a graduate-level course, ensure that it offers tangible benefits. Choose courses whose credits will count toward your CRNA program. This approach demonstrates your dedication and academic prowess and gives you a head start in your CRNA studies.
Courses like graduate-level Statistics or Pathophysiology are often valuable choices. They strengthen your academic profile and align closely with the CRNA curriculum.
However, be aware that not all CRNA programs accept transfer credits. Verify with your targeted schools whether the courses you are considering will be credited toward your CRNA degree.
By carefully selecting courses that are relevant to the field of nurse anesthesia and transferable to your intended CRNA program, you maximize the value of your additional academic efforts. This strategy can compensate for a lower undergraduate GPA and position you as a committed and capable candidate for CRNA school.
To thoroughly understand the requirements and preferences of your target CRNA program, a helpful starting point is the website www.coacrna.org. While not every school lists details such as the average GPA of accepted students, this resource can provide valuable insights into what various programs look for in candidates. Use this information to form a clearer picture of your path to acceptance. However, it’s crucial to directly confirm these details with the programs you’re interested in to ensure accuracy.
Pro Tip: Attending an open house event hosted by your desired CRNA program can be an excellent opportunity to get your questions answered. These events often provide direct access to faculty and current students, allowing you to gather firsthand information and insights that might not be readily available online. Open houses also offer a glimpse into the program’s culture and environment, helping you assess how well it aligns with your personal and professional goals.
STEP 8: Mastering the CRNA Program Interview
The interview stage is crucial in the CRNA program application process. Even the most outstanding application can falter without a strong interview performance, so preparing thoroughly and starting early is vital.
Begin Preparation Early: Don’t wait for an interview invitation to start preparing. Start honing your interview skills when you begin working in the ICU or right now if you’re already there. Early preparation allows you to develop and refine your responses over time, reducing stress and improving confidence.
Understand the Scope of Preparation: Simply reviewing your resume isn’t enough. CRNA program interviews often delve beyond your resume to assess a range of competencies. Being prepared means having a deep understanding of your own experiences, skills, and goals and being able to articulate them effectively.
Familiarize Yourself with Different Interview Styles: CRNA interviews can vary significantly from one school to another. While some may focus on personal questions to gauge emotional intelligence and situational responses, others might test your knowledge in Pathophysiology and pharmacology or present mock code scenarios. Be prepared for diverse questioning styles, including potential written tests similar to the CCRN, math problems, emotional quotient (EQ) assessments, or even impromptu essays.
By recognizing the importance of the interview and beginning your preparation well in advance, you’ll be in a strong position to showcase your capabilities and commitment effectively. This proactive approach can significantly enhance your chances of impressing the admissions committee and securing your place in the program.
A deeper understanding of a CRNA program’s interview process can significantly enhance your preparedness. Here are some strategies to consider:
Leverage Program Open Houses: Attending open houses is more than just an informational session; it’s an opportunity to gain insights into the program’s interview style. Explore with current students to get a firsthand account of their interview experiences. This can provide valuable tips and expectations for your preparation.
Network with Faculty and Staff: Open houses also offer a chance to meet the program director and faculty. Engaging with them helps make a positive early impression and familiarizes you with the people who might be interviewing you. Recognizing a friendly face during your interview can ease your nerves and add comfort to the experience.
Integrate All Aspects of Your Preparation: Every part of your application journey is a stepping stone towards the interview. Practice articulating your experiences, handling criticism, responding under pressure, and showcasing your competencies. The more you refine these skills, the more natural and confident you will appear in your interview.
Support Your Resume with Confidence: While your resume might get your foot in the door, the interview is where you bring it to life. Be ready to confidently elaborate on your experiences and skills, demonstrating how they align with the demands of a CRNA role.
Remember, It’s a Two-Way Street: While the program evaluates you, remember you also assess them. Given the significant investment of time and money required for a CRNA program, ensuring it’s the right fit for you is important. Prepare to ask clear and respectful questions about any aspect of the program you need more information on. This addresses your concerns and shows the interview panel your thoughtful consideration and interest in their program.
As we wrap up this journey through the intricacies of getting into CRNA school, I hope you feel empowered and equipped with the knowledge to take this exciting step forward in your career. Remember, the path to becoming a CRNA is as rewarding as it is challenging, and every step you take brings you closer to achieving your dream.
Clinicians need to have a better understanding of the potential impact of patients’ anxiety sensitivity, or “fear of fear,” according to an article published in American Journal of Critical Care (AJCC).
When a patient has anxiety sensitivity, they misinterpret nonthreatening symptoms as threatening, assessing the potential meaning across physical, social or cognitive domains. These “what if” thoughts may trigger a spiral effect, stimulating the nervous system and resulting in stronger sensations and further catastrophic misinterpretations.
It may lead to a patient avoiding activities they associate with anxiety-related sensations, such as physical activities or social situations. While in the hospital, they may resist interventions, such as repositioning or being weaned from sedatives. They may avoid physical or occupational therapy or struggle with efforts to help their recovery.
“Patients with anxiety sensitivity may falsely believe that their symptoms are the early signs of something bad, such as a heart attack, cognitive decline or social isolation,” she said. “It’s important for clinicians to be able to identify the difference between anxiety sensitivity and other medical conditions,” says Leanne Boehm, PhD, RN, ACNS-BC, FAAN, assistant professor at Vanderbilt University School of Nursing, Nashville, Tennessee, and investigator at the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University Medical Center.
For example, patients who have difficulty weaning from mechanical ventilation should first undergo a detailed workup to search for any underlying medical causes before anxiety sensitivity is considered as a primary cause.
ICU clinicians should be aware of patients’ possible anxiety sensitivity so they can use clear communication and implement pain management or relaxation techniques to mitigate distress and improve patient outcomes.
The Anxiety Sensitivity Index (ASI-3) is one tool clinicians can use to measure the extent of a patient’s physical, cognitive and social concerns about their anxiety. Providing basic psychoeducation to ICU patients on common symptoms may temper anxiety sensitivity, reassuring them their feelings are not unusual and putting their symptoms into context.
After discharge from the hospital, patients may continue to experience anxiety sensitivity and need increased assessment time, detailed explanations and extra demonstrations before participating in physical therapy or other activities.
Research specific to anxiety sensitivity in the critical care setting is limited, and future studies should incorporate assessment and management techniques across the critical care recovery continuum.
The American Association of Critical-Care Nurses (AACN) is bringing the lessons learned from its proven nurse leadership and innovation program and its Healthy Work Environment (HWE) initiative to help nurses at hospitals around the country improve the health of their workplaces.
AACN Clinical Scene Investigator (CSI) Academy is a unit-based program using implementation science to leverage direct care nurses’ expertise and build additional skills, preparing and supporting them as clinician leaders who effect positive changes that improve patient, nurse, and hospital outcomes.
Building on CSI Academy’s successful 11-year history and the documented benefits of sustaining an HWE, AACN has established a special version of its 12-month, team-oriented CSI program that will focus on the implementation of “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards).
The initial cohort is underway in Los Angeles, with nurses from Los Angeles General Medical Center and Cedars-Sinai Medical Center. Nurses from Ohio, Oregon, Delaware, Texas, and Washington hospitals will participate in other regional cohorts launching through spring 2024. The program will eventually encompass 80 teams with three to four nurses each.
The HWE standards are the cornerstone of AACN’s comprehensive HWE initiative, a long-term commitment to creating environments where nurses can provide the highest standards of safe, compassionate patient care while being fulfilled at work.
Findings from AACN’s most recent National Nurse Work Environments study indicate healthcare teams who have implemented the HWE standards or are in the process of doing so report better results than those who have not. Teams implementing HWE standards reported higher nurse well-being scores, improved staffing with an appropriate skill mix, and higher quality of patient care, among other outcomes.
“A healthy work environment is an essential element to nurse recruitment, satisfaction and retention, while also improving patient, nurse and hospital outcomes,” said AACN Chief Clinical Officer Vicki Good, DNP, RN, CENP, CPPS. “While the positive impact of HWEs has been demonstrated through decades of research, the nursing community still struggles to translate evidence into practice and gain sustained support for HWE implementation. We aim to change that.”
A grant from the AACN Innovation Fund is underwriting the program, with participating hospitals paying a fee of up to $1,500 per unit and providing paid time away from patient care for nurses to participate in the program and attend CSI Academy workshops and sessions.
CSI Academy encourages participating teams of nurses to immediately apply what they learn in a capstone project that improves outcomes in their units. Over the past 11 years, participants have reported achieving significant results, including:
Reduced length of stay, ventilator days, infection rates, delirium, pressure injuries and falls
An average median return on investment of 605% per team
Nationwide, more than 512 nurses at 105 hospitals in 15 states have completed the CSI Academy program since its launch in 2012. The program has touched over 1.2 million patients and over 7,200 nurses, with an estimated positive fiscal impact on hospitals of $111 million.
AACN offers access to its online collection of CSI Academy innovation projects― including project plans, clinical interventions, data collection tools, outcomes, and references ― as part of the program’s goal to inspire and empower as many progressive and critical care nurses as possible. With over 115,000 unique downloads of project materials, the CSI innovation project library has become a resource for hospitals, healthcare administrators, and clinical leaders seeking solutions that improve outcomes and reduce costs.
To learn more about bringing CSI Academy to your hospital or health system, visit the CSI Academy FAQ page.
An analysis of 10 years of health data showed that risk factors for needing mechanical ventilation changed for patients with newly diagnosed sepsis as more time passed after onset.
In the study, 13.5% of patients with a new diagnosis of sepsis required initiation of mechanical ventilation. Over half of these patients required mechanical ventilation within the first 24 hours after sepsis onset, while initiation occurred after 24 hours in 47.4% of patients.
Robert Freundlich, MD, MS, MSCI, associate professor, department of anesthesiology, and chief of the anesthesiology informatics research division at Vanderbilt University Medical Center, Nashville, Tennessee
“Requiring mechanical ventilation is often a pivotal point for patients with sepsis, and their risk of respiratory failure may vary with time,” says co-author Robert Freundlich, MD, MS, MSCI, associate professor, department of anesthesiology, and chief of the anesthesiology informatics research division at Vanderbilt University Medical Center, Nashville, Tennessee. “Identifying patients at high risk and implementing targeted interventions in a timely manner has the potential to significantly improve outcomes.”
A total of 35,020 patients met sepsis criteria, and 28,747 patients were eligible for inclusion after exclusion criteria were applied. The dataset spanned July 10, 2009, to Sept. 7, 2019.
Of all eligible patients, 3,891 (13.5%) required mechanical ventilation within 30 days after sepsis onset. Of these, 2,046 (52.6%) required mechanical ventilation within 24 hours of diagnosis. Mechanical ventilation was subsequently initiated for 441 (11.3%) patients from one to two days after sepsis onset and 312 (8.0%) patients from two to three days after diagnosis. The remaining 1,092 (28.1%) experienced late respiratory failure or required mechanical ventilation three to 30 days after diagnosis.
Patients requiring mechanical ventilation had higher baseline illness severity and a higher prevalence of 27 of the 35 comorbidities on the Elixhauser Comorbidity Index, which measures the overall severity of comorbidities.
They also had a higher in-hospital mortality rate (21%) than patients who did not require mechanical ventilation (7%). Further analysis revealed that of the patients who received mechanical ventilation before but not after sepsis onset, only 35 (4% of 822) died before hospital discharge.
Factors independently associated with an increased likelihood that mechanical ventilation would be needed included race, systemic inflammatory response syndrome (SIRS) score, Sequential Organ Failure Assessment (SOFA) score, and congestive heart failure. Risks decreased with time for the SOFA score and congestive heart failure and varied for four comorbidities and three culture results.
The researchers recommend future proactive studies focusing on the effects of fluid resuscitation and other care processes on the need for mechanical ventilation in this patient population. Noninvasive ventilation and high-flow nasal cannula may also impact the need for intubation and mechanical ventilation and should be evaluated.
Improved organ donation practices and greater program visibility led to a sustained increase in referrals, donors, and transplanted organs at a Georgia hospital, thanks to a focus on enhanced staff education and family communication.
Co-author Jesse Gibson, MBA, BSN, RN, TCRN, is the trauma program director and chair of the Donation Advisory Committee at the trauma center, serving 18 counties in a predominantly rural area. Part of a five-hospital health system, the medical center serves more than 2,600 trauma patients annually, with 95% having blunt trauma. Since the initiative was conducted, the hospital has been nationally verified as a Level I trauma center by the American College of Surgeons Committee on Trauma.
“By investing in staff members and partnering with bedside providers, our facility improved the organ donation experience for nurses, physicians, donors, and families,” Gibson says. “The outcome of that investment has been a hospital culture that values and celebrates organ donation as a standard of care for patients and families and an important part of honoring end-of-life wishes.”
The performance improvement initiative began at the end of 2017 to address concerns about lower-than-expected metrics related to the medical center’s organ donation process. Initial reviews of patient care revealed deviations from best practice, including missed referrals, care team members initiating discussions about donation with families, and misconceptions about the donation process.
The Donation Advisory Committee helped clarify language and revise policies related to end-of-life care, partnering with the hospital liaison at its organ procurement organization to increase physician and staff education and provide visibility for the process. Beyond engaging staff to reinforce the expected practice, a transitional language guide was provided to physicians and advanced providers to assist them in any initial discussions that may arise with families. A series of organ donation presentations in 2018 and 2019 provided staff education. They encouraged a dialogue about the process and review of the most recent organ and tissue data, metrics, and expectations.
To improve the program’s visibility, the project team arranged for a “Donate Life” flag to be raised on the main campus each time a family authorized organ donation. The team also implemented an “honor walk” to recognize the donor and family as donors are transported from the inpatient area to the operating room for organ procurement, with staff members lining the hallway to show respect and support. In 2019, the hospital held its first donation remembrance celebration, attended by families of organ donors and the clinical staff members who cared for them.
Since the project began, the number of organ referrals, donors, and transplanted organs has increased yearly, except for a slight dip in 2020 during the early COVID-19 pandemic. The number of organ referrals doubled, from 169 in 2015 to 320 in 2021. The number of organ donors in 2021 was 31, with more than 22 donors in 2015, 2016, and 2017. Similarly, the total number of organs donated in 2021 was 102, up from 16 in 2015. The rate at which an appropriate requestor initiated the conversation about organ donation with the family increased from 52% in 2015 to 90% in 2021.