CRNA | Hardest CRNA School Topics


The journey to becoming a CRNA is never smooth sailing. But just like the best goals out there, you have to face tough challenges to make the reward sweeter. In today’s episode, we have Nurse Anesthesia Residents Cordero and Monica commiserating with you on your CRNA journey by sharing some of the hardest and most difficult concepts and topics they have learned in CRNA school so far. From local to regional anesthesia to research and more, Cordero and Monica show us that the path to becoming a CRNA is indeed challenging yet filled with valuable experiences. Tune in and know that you are not alone. Let this episode inspire you to keep going on your CRNA path.

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The Hardest Topics In CRNA School With Guest Hosts Cordero & Monica, Nurse Anesthesia Residents

I have a very special episode lined up for you. It is part of our guest host series where I am bringing current CRNAs on the show for you as a guest host on the CSPA Podcast. My thought process behind doing this is I wanted you to know from a variety of current students who are at different stages of their CRNA journey and allow you to step into their world and hear them talk about what it’s like to be a current student, dealing with things like difficult preceptors or different anesthesia topics, clinical topics, maybe even things like time management, stress management and things like that.

These episodes are going to be gold. I hope you enjoy it as much as I always do hearing from current students. I know for a fact that the reason why CRNA School Prep Academy is where it is now and why I have learned so much is from diving all-in and listening to current students along with CRNAs share a wealth of information and taking all of that information and compiling it into the system that we have created. I know that you’re doing the same thing by tuning in to the show week after week, developing your own method, strategy, and system for success. I hope you enjoy these guest episodes. Let’s go ahead and get into the show.


In this episode, Monica and I are going to be talking about some of the hardest or most difficult concepts that we have learned in CRNA school so far. Before we get into the episode, we do want to thank Jenny and the staff at CRNA School Prep Academy for giving us a platform to share this information with you. Let’s get into the episode. We’re going to talk about some of the toughest or hardest concepts or topics that we’ve learned in CRNA school so far. I am eighteen months into my program. Monica is coming up on 24 months soon. We’ve pretty much been through all the didactic stuff. She’s almost done with it.

Our school is semi-front-loaded. I’m going to continue to say that. I am still in a cardiac anesthesia class and a theoretical class for my DNP project. I would say the majority of the full classes have been taken, yes.

We’ll talk about some of the tougher didactic concepts to learn when you get into school. I have a top-three list here. I’m going to see if Monica thinks these topics are hard as well or if she thought they were easier and we will see where the conversation goes from there. Before we get into the rest of the episode, be sure to like, share, subscribe, comment, and put “Nurses Rock” in the comment box. Give us five stars. We appreciate all the support. Let’s get on with the episode. Topic number one: One of the first things we took in my anesthesia principals class and anesthesia pharmacology class was learning about volatile anesthetics.

I was literally thinking that.

I was like, “What are we learning?” It was four weeks.

“Washing in and washing out.” “What do you mean washing?” They said they had no idea. I was like, “Why am I learning this?”

It’s all theory. It’s four different theories.

That pisses me off. I know a lot of us are pretty factual people, type-A personalities like, “We got to know it.” Our teacher starts out the lecture by, “I want to start off by saying this is all theoretical, X, Y, Z,” but then they give you 150 pages worth of a PowerPoint on volatile aesthetics. I was like, “What?” “It goes inside your lungs, but then you measure from your lungs and that tells you how much is in your brain.” I was like, “Huh?” When you then get into specialties like pediatrics specialties, the values change, which makes sense, but then it’s a more difficult concept to understand. It’s all over the place. Everything is theory-based. They have all these rules on people that certain gases would be less effective in or more effective in.

Surgeries that are good or not good for it.

If you’re obese, It’s going to stick to more fat. You’re like, “Ah.”

It’s insane. Whenever you think about anesthesia, you need to know the gases.

That’s what we do.

We spent four weeks on that. I remember we were learning it at the same time. We were geeking out.

We were learning about it. I went to visit him where he goes to school. We were in the car and going out. As we were both having this test that was coming up, we were hitting each other hard. It’s probably one of the most comfortable tests that I’ve ever taken besides the fact that mine was mixed with opioids and stuff like that. That’s a whole other story. It was like, “Holy crap.” You didn’t think that this was what it was going to be like. It’s funny because I remember doing my shadowing before I started school. Everyone kept talking about a MAC and I was like, “The hell is a MAC? Who’s MAC?” It wasn’t until we finished that it made so much sense, then you remind yourself of solid theory, and you’re like, “Okay.”

I remember that too when I was shadowing. They were like, “The MAC is 50%.” I was like, “What are you talking about?”

They explained it.

If you’re one of those people without their shadowing, you cannot understand volatiles and MAC in two cases in a day.

When you fear shadowing, you cannot understand volatiles and MAC in two cases a day. Click To Tweet

If you want to understand it, go home and read about it.

You need to open up a textbook.

You could open up YouTube and stuff like that and find somebody to explain it to you. I think it was like you had to have all those other building blocks on pharmacokinetics and pharmacodynamics in order to understand the verbiage and what’s going on. It’s one of those things that’s so nerd. You have the stacking effect of things and everything that you’ve learned already.

You need to know about the volume of distribution.

You had to do a quick little YouTube session. If you’re shadowing to get a basic idea of it, I don’t think that you’re going to understand in its entirety unless your parents are CRNAs or something and they’re breaking it down to you.

It is volatile. Was that hard for you?


How do you feel about local anesthetics?

That was also challenging. I got it down pretty quickly though. I would say regional anesthesia. You learn the brachial plexus and then there are all these other plexuses. I was like, “No way.” To be honest, once I get to my regional rotation, that’s going to be one of the things where I have to dust off again because that was definitely challenging. It has a lot of anatomical landmarks and things like that, but I think it’s between that and then being able to utilize an ultrasound machine knowing the depths, gains, etc., what exactly you’re learning about, and what this block could be beneficial for.

That’s interesting that you say that because I think every program has a different way that they may teach that because it’s very hard to simulate it. We had checkoffs on lower extremity blocks. We had to study what are you blocking at each part of the leg to get anesthesia for whatever part of the leg and procedures for it. I think that helped a lot.

Our regional class was like an accelerated class in four weeks and it was pretty crazy. We even learned about ocular blocks.

Those were- the ocular blocks were weird.

I was like, “I’m not doing that.”

I remember seeing the picture. I was like, “You spin the needle where!?”

I said, “I’m not an ophthalmologist. Let’s go ahead and call doc for this because I’ll tell you how much local anesthetic to use but I’m not poking on somebody’s eye.”

We can say regional because when you think about regional anesthesia, you also have to incorporate local anesthetics. You have to know the differences in the durations of action, then when you start talking about using local anesthetic for post-op pain versus anesthesia pain.

CRNA | Hardest CRNA School Topics
Hardest CRNA School Topics: When you think about regional anesthesia, you also have to incorporate local anesthetics with it.


I can admit that it’s a difficult concept to understand like they’re placing this block. We’ll do another video about this. Understanding that aspect of the block and then asking yourself, “Am I going to LMA this patient? Am I going to MAC this patient? Do I need to tube this patient based on this block?” It’s its own thing. I wish programs would make that class a little bit longer and a little bit more in-depth. Nobody would want that because that would increase the amount of school time. Personally, that’s something that I want to make sure that I’m going to get trained in when I graduate. That’s something I do want to be proficient in because it is the new wave of doing a lot of regional anesthesia.

Get away from opioids and all that.

That’s something that I want to explore. To answer your question, it’s definitely a hard topic.

Another one that I think is weird and I think some people get this intuitively a lot more than I do or I did. Sometimes I still struggle with it. It is the changes in vasculature, specifically PVR and ICP cerebral profusion, and thinking about all of the factors that can increase PVR, decrease PVR, increase cerebral blood flow, and increase ICP, like how the volatile anesthetics affect.

That’s under volatile anesthetic. Are you talking about it in general?

I’m talking about these vascular changes. You’re doing well because you’re studying PVR. You are like, “I can list thirteen things right now.”


Can you not?

Yes, but it’s not just because I’ve been studying it. Honestly, I think what’s going to help put that into perspective for you is whenever you get into clinical more on the cerebral blood flow and things of that nature, depending on the procedures that you’re doing with like carotids and stuff like that. It’ll make much more sense. You have to see it. You have to be put in a situation. You’ll be worried about ICP and CPP whenever you’re in your neuro case. You’ll see that being put into perspective as well. I think it’s difficult. Sometimes it depends on what specialty you came from because I came from a little bit of neuro and cardiac. I did a lot of entries. I do feel comfortable with cerebral blood flow, ICPs, CPPs, and things of that nature, but it is a difficult concept.

I got another one that may be difficult then, research DNP.

I love research in the sense of reading it and being like, “This is interesting. I love this. I’m going to apply this to my day-to-day and my practice at clinicals.” All the background stuff that goes into research, you all researchers out there, kudos to you. Statistics was not one of my greatest classes and that goes a lot into it. Personally, I feel like I’ve always struggled with grammar, and being in an NA doctorate-prepared program has enhanced that, especially my vocabulary. It’s still something that doesn’t come very easy to me. I will agree with you on that. Research is time-consuming.

It’s important. You can’t halfway do it.

Research is time-consuming and you can't just do it halfway. Click To Tweet

You could get away with it.

We had to read some of our classmate’s stuff. You can tell if people have whipped this up quickly or if it was well thought out.

It’s one of those things where you’re like, “It’s not a science class.”

“It’s easy.”

Also, the way these teachers are grading.

They’re not playing around.

I got points deducted because of my references. I put a little extra space in it and it was an accident. It’s taken very seriously. I do want to add one more to the list.



That was our last test.

You have to think about it. There are people who came from pediatric specialty and they’re probably like, “Whatever.” We’ve been working ICU with adults. Everything that we know how to do and every drug that we’ve given has been on an adult. Adults from 18 to however old, 90 or 100 years old, but then pediatrics. There are specific age groups. In each age group, there are different MAC requirements. There are different dosing for drugs based on their weight, different tube sizes, and different formulas. It’s like, “Whoa.”

They may not have a bunch of comorbidities like your adult patients do have, but they have some issues you haven’t heard about ever in your life, especially congenital heart defects and things of that nature. For me, that was a struggle. I do my pediatric rotation next and I’m excited to get a lot of these questions answered in my head on how to apply anesthesia and see it firsthand. I’ve done some pediatric cases. You asked me in the last video do I still get nervous when I’m doing a pediatric case. That makes me the most nervous.

You’ll get better with it as you see more of it, I’m sure. You said some of these kids are sick with their congenital diseases and things like that, but their normal anatomy and physiology are different.

It’s a different volume of distribution.

Even premature compared to an infant compared to a neonate. All of them are different, but they’re close in age. It’s crazy.

Even the didactic portion. Hearing from them, in my opinion, the didactic is completely different. You have to be careful about your drug dosing. In the cases that I have done in clinical, you’ve got to be on the money. It’s a range. You have to be very careful and make sure that your calculations are on point. Even for the didactic portion, it was one of those where it was like, “This is a completely different language for me.”

I can agree Peds was a beast.

All of CRNA school is hard, but I definitely agree that regional, pediatrics, volatiles, and research are tough.

CRNA | Hardest CRNA School Topics
Hardest CRNA School Topics: All of CRNA school is hard, but regional, pediatrics, volatiles, and research are tough. It’s definitely tough.


I was trying to think about an episode for us to talk about that. I don’t think I’ve ever heard anyone talk about the harder classes in CRNA school. Everything is hard, but these are the things you can’t prepare for until you start getting into class. Sometimes people ask us, “What can I do to prepare?”

Don’t do anything, first of all. You could start on your own and you’d be like, “Huh?”

If you could get a head start on learning what innovation means because whenever I first heard that term, I was like, “What is innovation?” It’s foundational to so much of what we do. It is understanding innovation and nerve communication.

Don’t do that. Don’t listen to him because he didn’t open a damn thing.

Some people are like, “Give me something.”

Everyone felt like that. I remember one of my mentors had sent me notes and I was like, “I’m going to open this.” I closed that up so quickly because I was like, “I have no idea what I’m looking at.”

It’s a foreign language.

It overwhelmed me and it made me more anxious. Take a vacation and enjoy your time with your family because you are about to have no life and that’s fine. It’s part of it. Don’t do anything.

Go back to the other episodes. We had one about how to study, some study methods, and tools that you can use. That’s one of those timeless episodes that you can always go back to because those are some of the things that we suggested guys this far and I think that we’ve been pretty successful so far in school. Any closing words for the people?

Good luck to those who are looking into applying, even thinking or considering about CRNA. Thanks to all of you who support us.

Talk to you next time guys.



Important Links

Have you gained acceptance to CRNA school? Congratulations! Prepare with the #1 pre-anesthesia curriculum, as recommended by CRNA program faculty. Start the NAR Boot Camp today: https://www.cspaedu.com/bootcamp


FREE! CRNA School Interview Prep Guide: https://www.cspaedu.com/uc9a5ih4

Get access to planning tools, mock interviews, valuable CRNA Faculty guidance, and mapped-out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy:  https://www.crnaschoolprepacademy.com/join

Book a mock interview, personal statement, resume and more at https://www.TeachRN.com

Join the CSPA email list: https://www.cspaedu.com/podcast-email


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