Behavioral skills can help someone flourish in school, work, home, and social settings. A registered behavior technician® (RBT®) works one-on-one with children, teens, or adults, addressing unique challenges so people can learn new skills and increase their capacity for communication, autonomy, and connection.
What’s it like to be an RBT working with children on the autism spectrum? We interviewed Simone Burgess, an RBT with the BAYADA Pennsauken Center for Applied Behavior Analysis, about her work. What follows is our interview, edited for length and clarity.
How did you become interested in working as a registered behavior technician? What drew you to it? How long have you been doing it?
I was grappling with my career path when finishing my psychology degree.
Coincidentally, I had a friend who was an RBT and recommended the role to me. I began watching clips of how parents worked with their children on the autism spectrum. The hook for me was how your work with someone can elicit a calmer demeanor, behavior changes, and progress.
I’ve been an RBT for one year, and I enjoy it so much that I recently applied to Rowan University’s master’s program to become a board-certified behavior analyst® (BCBA®). I’ve also started educating with the BAYADA RBT® Academy, helping others certify as RBTs.
Briefly explain what you do as an RBT. What types of patients do you serve? What ages are they, and how are they approved for the program? What do you provide for them?
As an RBT, I work one-on-one with children using Applied Behavior Analysis (ABA), a type of therapy considered the gold standard for learning and skills practice for individuals with autism. Before coming to our center, children are diagnosed with an autism spectrum disorder (ASD). Then, they undergo an assessment with a BAYADA Board Certified Behavior Analyst to evaluate skills and goals and to determine their unique ABA program. As RBTs, we collaborate with BCBAs on all aspects of care and receive supervision. Some RBTs work with children with developmental disabilities; our center works primarily with children on the spectrum.
Our center’s setting for an ABA session is nothing like a clinical therapy office. It’s full of toys for engagement and supplies for painting—clients’ art projects adorn the walls. We do a lot of Natural Environment Teaching (NET), letting each child choose their activity or guide them to one. Within NET, I’ll prompt children to respond through visualization or narrate what they are working on.
Children are at the center for half or full days. Tasks like independent eating or bathroom usage are, naturally, essential parts! Some children are new to environments other than their homes, so the plan to help encourage independence varies based on the child. We always offer food without forcing it to prevent unintended fear. I work with 2-3 clients per day.
Each child’s needs and ABA programs are different. One child has difficulty transitioning to discrete trial training (DTT), an ABA methodology that breaks down skills into small components, like flashcards. I patiently wait until she’s ready. When she gets there, we offer praise, a significant part of ABA therapy.
Did you need to get additional education to become an RBT?
All RBTs complete the Registered Behavior Technician® certification and 40-hour training, which includes lectures, Q&A, observing clients, and skill-based assessments. Guided by a BCBA, we assess how trainees apply their knowledge to clients, equipping them with plenty of support and suggestions for improvement. While you don’t need a background in mental health to be an RBT, getting the right training is essential.
What do you like most about working in your job?
I worked with one child who had limited language. With ABA, his language has progressed so much that he can communicate his wants. His anger and frustration decreased when he learned communication skills through Natural Environment Teaching. Seeing improvements and the desire children have to become independent is so meaningful. ABA isn’t about changing our clients—we are trying to help them have more appropriate skills for life. Also, you never know what to expect, and no two days are the same. I find this part so fun!
What are your biggest challenges?
Children feed off your energy, leading to increased behaviors, so staying calm and uplifting is key. This includes having a neutral face and tone and keeping your body and mind centered as you navigate high-intensity moments.
What are the most significant rewards in your work?
The biggest reward is watching children as they start versus seeing their progress a few months later. I even enjoy watching the changes with clients I’m not working with. It feels like something we all get to celebrate.
Is there anything else that is important for our readers to know?
The job requires a lot of multitasking—I’m constantly inputting notes based on my sessions while providing instruction and close attention. Being an RBT is something you have to have a special heart for. Ultimately, your bond with the children you work with makes the role so fulfilling.
Two distinguished clinicians, Mona Potter, M.D. and Kathryn Boger, Ph.D., ABPP, both Harvard-trained and with nearly two decades of experience in academic medicine, embarked on a mission to revolutionize the pediatric mental health system. Their journey began when they co-developed the McLean Anxiety Mastery Program (MAMP) at McLean Hospital, and then they were determined to apply what they had learned to a larger scale.
Dr. Potter, a board-certified child and adolescent psychiatrist, saw firsthand the positive impact of effective treatment for children and adolescents struggling with anxiety and OCD. “Providing children and teens with the right treatment can be “life-changing,” says Dr. Potter.
Together, they co-founded InStride Health, which provides mental health treatment for children, teens, and young adults based on a program rooted in academic medicine to make high-quality care more accessible to families. Since its inception, InStride’s program has made significant strides, operating in eight states. With a recent influx of Series B funding, the company is poised for further expansion, forging new partnerships with health plans to extend its insurance-based virtual specialty treatment for pediatric anxiety and obsessive-compulsive disorder (OCD).
InStride integrates clinical expertise, exposure coaching, and support into daily life to engage kids, teens, and young adults. It pairs them with a psychiatrist, a therapist, and an exposure coach, who provide real-time support using everyday tools like text, video, and a chat-enabled mobile application.
InStride takes a three-pronged approach to supporting youth struggling with anxiety disorders and OCD:
Addressing gaps in mental health treatment
Incorporating care into everyday life
Delivering lasting results
In honor of National Children’s Mental Health Awareness Day, Daily Nurse spoke with Dr. Potter and Dr. Boger about their work at InStride Health and the role of nurses in championing pediatric mental health. What follows is our interview, edited for length and clarity.
Nearly one-third of youth in the U.S. will struggle with anxiety disorder or OCD by the age of 18, creating significant economic challenges for kids and their families. Talk about how InStride Health is addressing gaps in their mental health treatment.
We built InStride Health to increase access to quality pediatric anxiety and OCD treatment. Over our two decades of clinical work, we witnessed firsthand the challenges that anxiety and OCD can bring to the lives of children and their families. We’ve also seen how the right treatment can change lives and, sadly, how hard it is for families to access this treatment for their children.
Here are some ways in which we at InStride are addressing the gaps:
We take insurance. Much of specialty pediatric anxiety and OCD care is private pay. We aim to ensure that all kids and families have access to high-quality care.
We have no waitlist. For the limited specialty pediatric anxiety and OCD clinics that do take insurance, the waitlist can be up to 6-12 months long. We get these kids and families into treatment rapidly so the problems don’t get bigger while the family waits.
We can work with the full spectrum of acuity/severity. Our model is built to support individuals whose anxiety or OCD is causing significant impairment in life (i.e., school avoidance, social isolation, family disruption, physical symptoms, etc.); we can also work with individuals with mild presentations.
Our care meets families where they are. Many specialty pediatric anxiety and OCD treatments are not accessible to families due to location. Our fully virtual model allows families to access care no matter where in the state they live and offers flexibility in when and how we engage.
We operate as a multidisciplinary care team. Our psychiatrist, therapist, and exposure coach work closely with the child, teen, or young adult and with their family and outpatient team (school, pediatrician) to ensure that everyone is on the same page.
Our treatment is purposefully time-limited. We work with families for up to a year through three phases of care. This allows us to have a more intensive start, in which we work hard to build new skills, followed by step-down and maintenance phases, where we empower the child and their environment to integrate those new learnings into their lives so they can continue to make gains beyond graduation.
What are other difficulties patients and their families encounter getting treatment?
It’s hard enough managing the myriad of day-to-day decisions, stressors, and competing obligations of parenthood; navigating the mental health treatment world to find the right care for a child can get overwhelming very quickly. Each decision point has its unique challenges.
These are some of the common questions families ask:
Where should we start? Who can we turn to for help? How do we know that we are getting the correct information and guidance?
I can’t find a therapist who takes insurance. Do I have to pay out of pocket to get good mental health care for my child?
We need help now, but most therapists have a long waitlist! What can we do while we wait?
How do we know if treatment is working?
What is my role as a parent or caregiver?
What kind of coordination should happen between the school and the pediatrician? And what is our role in that?
How do we know if we need to consider medication? How will that impact our child’s development?
How will we know when we’re finished with therapy?
What can be done to provide the best care for patients?
The good news is that there are known treatments that work. To provide the best care, however, we must ensure that we use them. When treating pediatric anxiety and OCD, research and clinical experience demonstrate that cognitive behavioral therapy (CBT), with an emphasis on exposure therapy, is highly effective. Yet many youth with anxiety and OCD do not receive exposure therapy. CBT should be active and goal-oriented, with clear goals and a system for tracking progress.
In addition, we need to appreciate the degree to which kids are impacted by their environment and ensure that we incorporate parents/caregivers into care. We also need to make sure that we are providing a “surround-sound experience” for the youth by communicating closely with the school, pediatrician, and any other outside providers.
Kids, teens, and young adults do best when they are seen and understood as individuals with unique strengths and abilities. Taking a strengths-based approach can help empower youth to actively engage in treatment and to step outside of their comfort zone as they try out new skills and strategies to manage their emotions and build resilience.
Your work at InStride Health is based on your decade of experience at McLean Hospital. What makes your treatment model unique?
While at McLean, we had the privilege of designing a program based on what the kids and families needed and then iterating on that model for almost a decade, reviewing the outcome data and incorporating feedback from patients, families, and clinicians.
While many aspects of our treatment are effective, three that stand out are:
Parent/caregiver involvement, with close communication with schools and pediatricians.
There is an emphasis on exposure therapy out in the real world where fears occur, with coaching between sessions to reinforce learning and build skills.
Our deliberate recruitment and training of talented clinicians and coaches who care deeply about doing right by these kids and their families.
How does real-world, real-time exposure coaching benefit patients?
The young brain struggles with generalizing learning across different environments, making applying knowledge from one setting to another difficult. Engaging in exposure therapy in real-world scenarios, where anxiety and OCD triggers manifest, facilitates more effective acquisition of new learning and skills building. InStride exposure coaches support virtual exposures out in the real world- at stores, restaurants, schools, or in the neighborhood- during scheduled sessions, and they are also available for between-session coaching to support effective skill use in the moment. This proactive, real-world approach aids in developing new neural pathways in the brain.
Nurses, nurse practitioners specifically, have a significant opportunity to provide appropriate treatments for patients with mental health needs, specifically kids and young adults with anxiety and OCD. What must they know to make informed judgments about assessment, treatment, and referral?
An important initial step is to conduct an assessment to determine the diagnoses and biopsychosocial evaluation, coupled with education about the manifestations and behavioral impacts of anxiety and OCD. Anxiety and OCD can present in a variety of ways, and having a solid understanding of the presentation and contextual factors helps to determine the right treatment plan.
When considering whether medication should be part of the treatment plan, it is generally recommended to try therapy (CBT) as the first-line intervention for mild to moderate presentations. If the youth is having difficulty engaging in therapy, or if the symptoms persist despite engagement in therapy, it is reasonable to consider adding medication to help access the therapy, with SSRIs as the first line. For youth with more severe presentations for whom the intensity of the anxiety is causing significant impairment in life, it is recommended to start both therapy and medications together. In addition, when there is a greater impact on functioning and/or distress in the family system, they may benefit from more intensive services that include multiple touch points per week to help stabilize symptoms and gain momentum in treatment.
Measurement-based care provides visibility into whether and how individuals are responding to treatment, allowing for more informed decision-making. This entails collecting data from the child and parents throughout treatment, discussing progress directly with them, and adjusting treatment according to the data and conversations.
What role should nurses play?
Data are clear that there are not enough mental health clinicians (psychiatrists, therapists, counselors) to meet the psychiatric needs of youth. Nurses offer relief to this stressed system through the multiple roles they can play in providing mental health support, including advocating, educating, prescribing, and triaging. Because nurses often serve as trusted points of contact for youth and their families, they can identify signs of mental health concerns, provide education, and support prompt intervention planning. Nurses can conduct assessments with children and families and refer them to other mental health professionals or provide direct support, depending on their training and interests. For example, school nurses can provide critical contributions to health curricula and can educate students, parents, and school faculty and staff about mental health conditions, symptoms, and available resources. They can also help coordinate with community providers to create a support system for the student.
By raising awareness, understanding, and support, nurses contribute to reducing stigma, improving overall mental health literacy, and helping children and families receive essential care.
What should we be doing to improve mental healthcare for children?
We need to treat mental health problems in the same way that we treat physical health, and we need to improve access to effective care. We’ve witnessed so many children and families encounter barriers to accessing mental healthcare. We’ve seen parents waiting on long waitlists while their child’s condition worsened. Families have also shared their sacrifices, including draining their retirement savings and depleting their child’s college funds to get their child the right mental healthcare. Some families also resort to traveling long distances, crossing state lines, or temporarily relocating. We’ve also worked with families whose children can access treatment, but it hasn’t been backed by research or provided relief. It has been heartbreaking to witness.
Similar to heart health, we need to think about intervention at all stages, including prevention, early intervention, active intervention, and maintenance. As mentioned above, a school nurse can contribute to a health curriculum to help educate students on how overall health includes attention to mental health, as well as ways to build resilience and identify when it might be helpful to seek support. This same school nurse will often be the first point of contact for a student who might be struggling, and that relationship could be the difference in identifying needs and seeking support.
We also need to understand that mental health is a continuum, and the brain is susceptible to disorder just as any other organ in the body. We often talk about how we wish that anxiety disorders had a different name from the worry, stress, and fear that most people feel at some point – noting that when a youth meets the criteria for an anxiety disorder, typical management approaches that usually work for those everyday worries, stresses, and fears (e.g., get reassurance, cut down or avoid stressful situations) can perpetuate an anxiety disorder. The brains of those with anxiety disorders process the world differently. There is an attention bias to threat (they are more likely to see and respond to the threat in a situation) that requires a more active, behavioral approach for treatment to be effective (and, at times, biological intervention through medication). Being able to help parents recognize in themselves, as well as their children, the difference between worry, stress, and anxiety disorders can help tailor interventions to be effective for the whole system. Helping them understand that treatment can improve functioning and reduce suffering can help them know what they are working toward.
Is there anything else to share?
Nurses are the glue that holds together the support system for pediatric mental health. With their robust medical training, compassionate relationship building, and steadfast commitment to advocating for their patients, nurses play an essential role in championing pediatric mental health.
Gabrielle “Gibby” Ryan, RN, BSN, CCRN, has worked as a staff nurse in the Cardiac Care Unit at Children’s Nebraska Criss Heart Center for nearly five years. As a lifelong patient of the center herself, Ryan brings a unique perspective to her work every day, with a deep understanding of the challenges and experiences heart families may face.
Ryan was born with Tetralogy of Fallot, a complex congenital heart defect, and underwent her first surgical repair at 10 months old, followed by a second at 13 years old. Ryan continues to be a patient of Children’s Nebraska Criss Heart Center through its Adult Congenital Heart Disease program, under the care of cardiologist Angela Yetman, M.D.
While completing nursing school alongside her twin sister, Lexie, at the University of Nebraska Medical Center’s College of Nursing, Ryan reconnected with her childhood surgeon, Kim Duncan, M.D. He suggested that she apply for a nursing position at Children’s Nebraska’s Criss Heart Center, which was expanding its cardiac care team in anticipation of the opening of the Hubbard Center for Children in 2021.
Both sisters were hired and started at the hospital within three months of each other, with Ryan beginning in June 2019, and her sister in September 2019. They both still serve in the same unit together.
Ryan cites her parents’ experience many years ago as the inspiration behind her caring approach to the patient families she serves today.
“I know it’s hard for families to trust someone they don’t know,” she says. “I try to keep that in mind when caring for a sick child and their family. Our unit at Children’s is really great, and it’s an honor to have families trust us.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com 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.
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.
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.
“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, DailyNurse.com 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.
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.
During the most challenging time of year for patients and their families in the University of Iowa Hospital’s Pediatric Emergency Department, ED nurse Joe Schmuecker, RN, has gone above and beyond to spread a little holiday cheer over the last five years.
Every Christmas, Schmuecker sets up a homemade red mailbox for children in the pediatric department to send letters to the North Pole. Then, Schmuecker and a team of his colleagues answer every letter.
For Schmuecker, it’s a chance to connect with patients and bring a little joy within the stress of a hospital visit.
Daily Nurse is proud to name Joe Schmuecker our Nurse of the Week for his dedication to positively impacting his young patients and helping to spread joy throughout the holiday season.
Schmuecker says he wants to give kids a sense of normalcy in the hospital.
“This whole project started to bring out the holiday spirit in our department and to create some positive moments with patients and their families,” he says.
He expects 75-100 letters to be stuffed in the mailbox each year. The letters ask for the child’s name, age, what presents are on their wish list, and – most importantly – if they should be on the naughty or the nice list.
Schmuecker says the team has gotten the replies down to about five minutes each, but when they fill out a full page, it’s not just a quick response. It’s a very thoughtful letter responding to what the kids said. And then, if he got to work with that patient, they throw some things in there that would make it more personal and believable for them.
“The letters that stand out to me the most are the ones where the child checks the ‘I’ve been naughty’ box, though the kids do have a chance to explain why they think they’ve been naughty,” says Schmuecker. “There are also the letters that ask for selfless acts, like having their sibling not be sick. Those messages stay with you.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com 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.
