Caring for Critical Hearts: Meet Sarah Cazenave, Cardiac ICU Nurse

Caring for Critical Hearts: Meet Sarah Cazenave, Cardiac ICU Nurse

Sarah Cazenave is a BSN, RN, and CCRN who works in the Cardiac Intensive Care Unit (ICU) at Children’s Hospital New Orleans (CHNOLA). She takes care of the most critical cardiac patients at the hospital. Her cousin, Brooks, was born with only half of a functioning heart and had to undergo a staged surgical plan of 3 surgeries at CHNOLA. The care he received inspired Cazenave to become a Cardiac ICU nurse at the same hospital.

Daily Nurse proudly honors Sarah Cazenave as the Nurse of the Week.

Cazenave says Brooks and the care he received inspired her to become a Cardiac ICU nurse at the same hospital that cared for her cousin. “I am so fortunate to work with many amazing individuals who cared for Brooks while he was in the hospital. It is a challenging but rewarding specialty.”

Cazenave shares what it was like visiting Brooks while he was receiving care.

“Upon entering the unit, a staff member immediately barks at me to wash my hands and then escorts me to his hospital room. My aunt, a nurse herself, is sitting at the bedside. We quietly talk about my cousin’s progress as he rests comfortably in the bed,” she says.

She recalls glancing at all the pumps, lines, and chest tubes while maintaining her distance a few feet away. She doesn’t want to wake Brooks up and recalls the complexity of the scene, making her feel nervous.

“I am scared to touch anything for fear of messing it up. After twenty minutes, I hugged my aunt goodbye and hastily left the unit. I feel relieved when I leave the hospital. Children are supposed to be running around and playing with toys at this age, not hooked up to numerous monitors and lines in a hospital bed. The whole experience feels foreign to me,” she adds.

Cazenave’s cousin Brooks, now eight years old, was born with Uhl’s Anomaly, tricuspid atresia, and pulmonary atresia. He received four open heart surgeries at Children’s Hospital before the age of four, with his latest being the Fontan in 2018. He is now a happy and healthy eight-year-old who enjoys playing with Pokemon, jumping on the trampoline, and having pillow fights.

Fast forward five years later. Cazenave now works with the most critical cardiac patients at Children’s Hospital in the Cardiac Intensive Care Unit.

Cazenave cherishes the privilege of watching Brooks grow up and is grateful for the care he received at Children’s Hospital. Brooks inspired her to become a Cardiac ICU nurse, and she is proud to work with the same amazing individuals who cared for him while he was in the hospital.

She says it’s a challenging but rewarding specialty.

“Now, when I enter the unit, it doesn’t feel foreign to me, but rather like home.”

Nominate a Nurse of the Week! Every Wednesday, features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter. 

CRNA Helped Save Martin Luther King’s Life After 1958 Stabbing

CRNA Helped Save Martin Luther King’s Life After 1958 Stabbing

By the time an assassin’s bullet killed Dr. Martin Luther King on April 4, 1968, the much-loved – and much-hated – SCLC leader knew he might never see his daughters grow up. Once he entered the spotlight during the 1955-56 Montgomery, Alabama bus boycotts, King and his family lived through his remaining years like a city under siege, constantly calculating acceptable risks and trying to anticipate the next threat.

King was a target of violence throughout his non-violent crusade for civil rights, and 10 years before his assassination, he had a very close brush with death. He continued his work for another decade, partly due to the skills of Goldie Brangman, CRNA , MEd, the nurse anesthesiologist who treated him in 1958.

Brangman worked at Harlem Hospital for 45 years and directed its nurse anesthesia educational program for some three decades, and in 1973 became the first (and to date, only*) Black president of the American Association of Nurse Anesthetists (AANA). In the December 2015 issue of the AANA Journal, she shared her recollections** of that September 20, 1958, day when King was rushed to Harlem Hospital.

In 1958, King’s would-be killer was not a white supremacist but a mentally ill 42-year-old Black woman stirred by the conspiracy theories, anxiety, justifiable paranoia, and mistrust that spread through terrorized Afro-American communities during the “long, hot summer” era of the mid-1960s. Convinced that the civil rights leader was a “communist” and a “flimflam artist who pimped the community,” she armed herself with a pearl-handled letter opener and attended the book signing. When she neared King, she aimed right for his heart and managed to drive her makeshift knife six centimeters into his chest.

King was rushed to nearby Harlem Hospital with the letter opener still in his chest. His treatment was initially delayed when a bizarre political debate erupted. Being anxious over his reelection chances, New York Governor Harriman initially urged hospital staff to transfer Dr. King to Columbia-Presbyterian or Mount Sinai Hospital.

As the AANA article put it, the governor was worried “that Harlem Hospital was not fit to treat Dr. King, but he also wanted to show respect for the Black community by endorsing Harlem Hospital and its staff.” The vacillating politician was finally persuaded that the future Nobel Peace Prize winner was in good hands.

By 1958, King was already a widely recognized public figure at the center of the increasingly heated debates over segregation and racial injustice. Brangman recalled that their patient was engulfed by a crowd even as he was rushed into surgery. “To this day,” she said, “I don’t understand why they allowed so many people in the OR.” The team examined his wound and found that the weapon had penetrated King’s sternum. Brangman said the tip of the letter opener was tightly lodged between Dr. King’s innominate artery and aorta. Her team was on edge, knowing that “Every breath would move the blade.” She is confident that “The time saved by [performing the surgery] then and there at Harlem Hospital did save King’s life.”

The AANA article reminded readers that the danger of the situation was exacerbated by the fact that CRNAs had little technological assistance in the 1950s, so thoracic surgery did not necessarily include mechanical ventilation or paralysis.

Brangman recalled, “You bagged them in those days; you could sense [respiratory] changes like compliance that way.” They used manual blood pressure determinations and monitored their patients by “listening, looking, and feeling. You had your hand on the patient the entire time.”

Once Brangman and anesthesiologist Dr. Helene Meyer placed King under anesthesia, surgeons worked for over two hours to remove the letter opener. The surgery left King with a scar, a constant reminder and warning that he could be taken at any moment. As he told a friend, “Each morning as I brush my teeth and wash my face, I am reminded by the cross-shaped scar on my chest that each day could be my last day on this earth.”

Thanks to Harlem Hospital’s team, King survived his first significant brush with death for ten crucial, history-making years, and millions of Americans breathed a sigh of relief. A white admirer from White Plains, New York, was moved to cheer the minister’s recovery in a letter that became famous:

“I read in the paper of your misfortune and of your suffering. And I read that if you had sneezed, you would have died. And I’m simply writing to say that I’m so happy you didn’t sneeze.”

The earnest missive delighted King, so he shared it with various audiences over the next decade. In fact, during his final speech in Memphis, Tennessee, he read it aloud once more and added, “I want to say tonight that I, too, am happy that I didn’t sneeze.”

While King may have been unaware that in 1958, his CRNA’s skilled “listening, looking, and feeling” helped preserve his life, nurse anesthetists can take pride in knowing that one of their own played a key walk-on role in history.

**A special thank-you to Ebony magazine for saving and sharing the 2015 AANA story on Brangman.

Unlock Your Potential: Master the 8 Steps to Becoming a Successful CRNA

Unlock Your Potential: Master the 8 Steps to Becoming a Successful CRNA

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:

  • Identify Potential CRNA Programs: Start by selecting a few CRNA programs you’re interested in applying to. If you need help figuring out where to begin, here’s a comprehensive list of CRNA programs across the US to help you start your search.
  • 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 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.

A Day in the Life: Certified Registered Nurse Anesthetist

A Day in the Life: Certified Registered Nurse Anesthetist

For this edition of A Day in the Life, we interviewed a certified registered nurse anesthetist (CRNA) to profile what these nurses do so you can decide if it’s a specialty for you.

Keesha Duncan, DNP, CRNA, is the northeast regional director of advanced practice providers at Envision Healthcare , a chief anesthetist at Hackensack University Medical Center, and she co-authored chapter (7) in “Scholarly Inquiry and the DNP Capstone” written by Cheryl Holly.

Duncan answers our questions about working as a CRNA. What follows is our interview, edited for length and clarity.


Keesha Duncan, DNP, CRNA, is the northeast regional director of advanced practice providers at Envision Healthcare, a chief anesthetist at Hackensack University Medical Center

How did you get interested in being a certified registered nurse anesthetist (CRNA)? What drew you to it? How long have you been doing it?

I worked as a cardiothoracic intensive care nurse (CTICU RN) at St. Vincent’s Hospital in New York for almost six years. I soon realized I wanted to venture into advanced practice nursing.

The question at that time was, “What specialty?” I decided on anesthesia, much accredited to my mentor, Michael Greco, Ph.D., DNP, CRNA, who encouraged me to shadow a certified registered nurse anesthetist. I did, and I was utterly fascinated by the skill and dexterity displayed by the CRNA.

I quickly knew that this specialty was my calling. Therefore, I began to embark on the journey that led me to where I am today. I’ve been practicing as CRNA for close to 16 years.

Explain briefly what a CRNA does. What types of patients do you serve? What do you provide for them?  

CRNAs are advanced specialized nurses trained to provide anesthesia during a procedure or surgery. Some have additional training in pain management and perform functions that treat chronic pain.

I serve the adult, pediatric, and obstetric populations in my career and am proficient in placing labor epidurals and spinal anesthesia for C-sections. Furthermore, I administer general anesthesia or moderate to deep sedation when needed and perform or participate in peripheral nerve blocks.

Did you need to get additional education for this position? 

I needed additional education to transition from an ICU RN to a CRNA. I was a diploma RN, so I had to go back and obtain my BSN to apply to CRNA school while working full-time and being a single parent.

I received my MSN with a concentration in anesthesia when I graduated from CRNA school in 2007. I also graduated with my doctorate in nursing practice in 2012.

What do you like most about working as a CRNA? 

When I decided to go into anesthesia, I feared losing the special time I had talking and getting to know my patients. But as a CRNA, you don’t lose that bond. The reward you feel when you care for patients during their most vulnerable and scariest times still exists.

Interested in getting a job s a CRNA? Then check out the Daily Nurse Career Center to begin building your nursing career.

USU Nurse Anesthesia Students Brave Gunfire for Trauma Training Exercise at FBI Academy

USU Nurse Anesthesia Students Brave Gunfire for Trauma Training Exercise at FBI Academy

The Black Hawk helicopter lands in a field behind the FBI Academy, its main rotor sending up a massive plume of dust and grit.

A handful of Uniformed Services University (USU) Graduate School of Nursing (GSN) Registered Nurse Anesthesia students hunker down over the litter they’re carrying to protect themselves and their “patient” from the helicopter’s powerful downwash.

Given the “all-clear” signal, the team gets up and moves to the Black Hawk, staying low under the awesome power of the blades as they evacuate their casualty. The students, using hand gestures to communicate, then work with Navy Cmdr. Ken Radford, USU’s Nurse Anesthesia program director, to intubate the training mannequin, their simulated patient. The first student is successful; Radford offers them a fist bump, and it’s time for the next student to step up and give it a try.

These GSN students are taking part in the Trauma Culmex training exercise held in conjunction with the FBI’s elite Hostage Rescue Team in Quantico, Va., just days before their graduation from USU.

Radford says GSN faculty have provided training for the Hostage Rescue Team medical personnel in the past, which helped to open the door for the nurse anesthesia students to receive their own educational opportunity on the FBI Academy grounds.

“This is the first time that we’ve held this simulated trauma experience so this is an incredible opportunity for them to round out their training,” Radford says.

The event was conceptualized by Dr. Matthew Welder, special assistant to the USU President for operational medicine and Radford, and executed by Air Force Lt. Col. Janet Sims, director for Simulation and Navy Lt. Cmdr. Lauren Suszan, director of Clinical Education, for the RNA program at USU.

The Trauma Culmex was developed to fulfill the registered nurse anesthesia student trauma simulation curriculum requirement in their last semester of clinical education. Students take part in training and exercises focused on providing care in austere environments for both injured service members and military working dogs.

Radford says providing his students with a chance to close out their training with the event helps to get them in the right mindset for an operational deployment.

“Our mission is to train anesthesia providers that can provide anesthesia care in austere settings and this was a way for us to round out their education as they approached graduation,” Radford says. “It’s really incredible.”

Inside one building, its walls still spattered with the bright paint of simulated training ammunition used to mimic live bullets during exercises, USU students work on crisis actors made up to look like they have a host of traumatic wounds. Instructors analyze the decisions of the soon-to-be-graduates as they manage the series of injuries their patients experience.

Sims checks in on one group, making sure all of the many moving parts of the trauma culmination exercise are running smoothly before heading back outside. There, a team of four load their patient onto a military ambulance, climbing on and providing care as the vehicle drives off. Sims says their mission with the exercise is to prepare independent military anesthesia providers to give care in any operational and austere environment. She adds that partnering with the FBI and the Hostage Rescue Team was a natural choice to help meet this mission.

“USU students are well-prepared to provide medical care in fixed medical facilities with adequate staff and equipment,” Sims says. “However, operational readiness courses (like this) help prepare them for anesthesia care in the field.”

As students go from one exercise scenario to another, flash bangs go off, the rattle of gunfire echoes nearby, and FBI teams train only feet away in the next room.

“(The students) are taking care of patients with minimal equipment in a building of opportunity, transporting patients and dealing with all that comes along with that — lack of supplies, lots of noise, flash-bangs going off, gunfire, helicopters taking off and landing,” Sims says. “We also have to take care of the military working dogs as CRNAs (certified registered nurse anesthetists) when we’re deployed because they are one of the team and if they get hit, we take care of them until we can transfer them to a higher level of care.”

At another location students are being introduced to a retired military working dog and a half dozen “wounded” canine mannequins. The real dog waits patiently as the new group files in to learn about working with an injured military canine in the field.

“The experience has been great,” says Army student Maj. Andre Brown, adding that he and the others didn’t initially know what to expect before arriving for the exercise. “They hadn’t really given us any information before we got here. It was ‘hey, get a hotel at Quantico, meet at this place and these are the times we’re going to start.’ Then we get out there and it’s like ‘here’s your scenario, go — how would you react?’”

Brown says one of the day’s impactful lessons was learning about how to give care to an injured military working dog.

“I knew enough to get the dogs from point A to point B but here we’re learning more effective care, and a more effective means of how to do things,” Brown says. “… Everybody has been super knowledgeable with helpful tips that I hadn’t even thought about.”

Sims says this year’s collaboration with the FBI and the Hostage Rescue Team is essentially a test run for future trauma culmination exercises. She says the university currently has the “Gunpowder” exercise which helps expose USU students to a variety of challenges they may come across in the field, training them on tactical field care, tactical combat casualty care, prolonged casualty care, and forward resuscitative care.

“Unfortunately, the timeframe (for Gunpowder) does not align with most of our nurse anesthesia students as they attend a 21-month clinical rotation at various locations throughout the country” Sims says. “We’ll see how this exercise goes and obtain feedback from the faculty cadre and students and add or remove content to make it most beneficial to train and assess their trauma anesthesia skills.”

Navy student Lt. Cmdr. Joseph Dimarucut says taking part in the Trauma Culmex has been an amazing experience. Particularly, he says working to intubate a patient from within the confined space of a helicopter stands out to him as a valuable lesson that couldn’t be practiced in a hospital.

“It’s a good culmination of everything that we’ve learned put into practice and what we’ll expect to see in the field,” Dimarucut added.

Hurrying past FBI agents rappelling down a wall, the next group of USU graduate nursing students carries a litter holding a simulated patient, an instructor following closely behind. They arrive at an open field and soon the sounds of a helicopter’s rotor chopping through the day’s warm air once again grows louder. The dust hits them, they get up and hurry for its open doors and the training begins all over again.

Michigan Becomes 20th State to Allow CRNAs to Work Free of Physician Supervision

Michigan Becomes 20th State to Allow CRNAs to Work Free of Physician Supervision

Practice authority for advanced practitioner nurses took another stride forward on May 10 when Michigan became the 20th state to opt out of federal regulations that require physician supervision of Certified Registered Nurse Anesthetists (CRNAs).

The American Association of Nurse Anesthesiology (AANA) reports that the governors of 19 additional states and Guam have exercised such exemptions. Adam Kuz, MS, CRNA, president of the Michigan Association of Nurse Anesthetists (MANA).

Gov. Gretchen Whitmer’s action in signing the opt-out ensures Michigan’s patients have access to value-based, high-quality care and optimizes healthcare teams across the state, according to Adam Kuz, MS, CRNA, president of the Michigan Association of Nurse Anesthetists (MANA).

In March 2020, to maximize healthcare resources during the outbreak of the COVID-19 pandemic, Gov. Whitmer enacted an executive order removing physician supervision for CRNAs. In July 2021, she signed HB4359 to remove supervision requirements for CRNAs in the state nurse practice act, and HB4359 is now permanent.

Highlights of the law include:

All of the following apply to a registered professional nurse who holds a specialty certification as a nurse anesthetist:

(a) In addition to performing duties within the scope of the practice of nursing, his or her scope of practice includes any of the following anesthesia and analgesia services:

          (i) Development of a plan of care.

          (ii) Performance of all patient assessments, procedures, and monitoring to implement the plan of care or to address patient emergencies that arise during implementation of the plan of care.

          (iii) Selection, ordering, or prescribing and the administration of anesthesia and analgesic agents, including pharmacological agents that are prescription drugs as defined in section 17708 or controlled substances. For purposes of this subparagraph, the authority of a registered professional nurse who holds a specialty certification as a nurse anesthetist to prescribe pharmacological agents is limited to pharmacological agents for administration to patients as described in subdivision (b), (c), or (d), and his or her authority does not include any activity that would permit a patient to self-administer, obtain, or receive pharmacological agents, including prescription drugs or controlled substances, outside of the facility in which the anesthetic or analgesic service is performed or beyond the perioperative, periobstetrical, or periprocedural period.

(b) He or she may provide the anesthesia and analgesia services described in subdivision (a) without supervision and as the sole and independent anesthesia provider while he or she is collaboratively participating in a patient-centered care team.

(See full text of Michigan House Bill 4359 at

“Removing barriers to CRNA practice allows Michigan hospitals to select the anesthesia delivery model that maximizes their workforce and increases access to safe, affordable care for all patients,” said former MANA president Toni Schmittling, DNAP, MBA, CRNA. “By signing this important legislation, Michigan recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification.”

Anesthesia services are provided predominantly by CRNAs in Michigan’s critical access hospitals, which offer surgical services in 99% of its rural hospitals. They comprise 68% of the state’s anesthesia care providers.

“The AANA applauds Gov. Whitmer for recognizing the important role CRNAs have in the delivery of safe anesthesia care in Michigan,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Increased demand, limited resources, and a state with diverse populations, both rural and urban, dictate that a system capable of meeting the needs of all Michigan residents be maintained. By signing the opt-out letter, this has been achieved.”

Throughout the COVID-19 pandemic, nurse anesthetists across the country have, in addition to providing top-of-the-line anesthesia care, served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients. Instrumental in addressing the deadliest part of COVID-19, CRNAs have become highly sought-after anesthesia care providers.