What are the key differences between a CRNA and an RN? Follow your host Jenny Finnell as she discusses these in detail. She compares and contrasts things regarding education, responsibilities, work environment, and so much more with these two roles. She dives deep into building a foundation so that you can prioritize what your patients need. What are you doing right as a CRNA or RN? It’s not going to be easy, but it will be gratifying. Tune in to learn how you can assess yourself and be better to make a difference in people’s lives.
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CRNA Vs. RN What Is The Difference?
What Does a CRNA Do?
What are the true differences between being an RN and a CRNA? In this episode, I’m going to dive in, compare and contrast things like the education, responsibilities, and work environment. Let’s go ahead and get into this show on the differences between being an RN and a CRNA. I thought this would be a fun way to compare and contrast. I’m often asked things like how was the education differ between nursing school and CRNA? What should I expect?
The same thing as far as what are truly the responsibilities and how’s it different than being a nurse in regards to day to day tasks and responsibilities as far as patient care? It would be a fun episode to dive into all these different topics and compare and contrast being an RN versus a CRNA. I also want to start this episode off by saying that you’re going to get me with my ICU nurse experience. I don’t have a wide, vast variety of nursing experience.
I know a lot of you have diverse backgrounds in nursing. You’ve been an OR nurse, a PACU nurse, a flight nurse, an ICU nurse, a med surg nurse, and all those things. I don’t have that experience. My narrow little window of being an ICU nurse prior to being a CRNA is what I’m going to speak towards. However, I encourage you, as I’m going through this episode for you guys, that you stop to think about what this looks like for you and your experience in nursing.
For those of you who are new, welcome to the show. I’m your host, Jenny Finnell, CRNA. I’m excited to have you. If you’re a repeat reader, welcome back to the show. Thank you very much. First, we’re going to discuss the education and the differences between becoming an RN and becoming a CRNA. Becoming a CRNA, I hear a lot of people say, “You can’t compare nursing school to CRNA. There’s no comparison.” What if that’s true or not true? I would like to argue the fact that you can always make a comparison.
If I had to make a comparison, there are a couple of things I want to point out first before I make this comparison. Number one is, at least for me, when I was in nursing school, I was much younger. I was also still figuring out what works for me as far as my study techniques and how I learn. Let’s be honest, back then, when I was 19 to 20 years old, I cared a lot about my social life compared to when I went to grad school. I did, but not nearly as much as I did back then.
Let’s be upfront with the fact that when you’re a young learner, you are different as far as your maturity level and ability to handle pressure. It could affect how successful a student you are. When I was a younger learner, I would crack a little easier and flounder a little bit more. I was struggling more because I didn’t know what worked for me. It took me some time in college to figure out, “I need to address the fact that I’m not getting the grades. I need to get into nursing school. Why is this? What can I do differently? How can I adapt? How can I improvise?”
If you have been a follower of this show for some time, you’ve probably heard my story in the sense that I didn’t start off being a straight A student. In fact, I never had been a straight A student. I was a student growing up who struggled, and I didn’t know why. I thought it was stupid. It turns later on in my life, in high school, I found out that I had dyslexia. I would say that my dyslexia is mild. I think it’s a strength. I know I’m going to watch my son struggle because I’m seeing it in my son, who started kindergarten in 2021.
I’m seeing a lot of similarities in my son. We’re getting help for him early on, but with that being said, I didn’t identify this issue until I was much older in my education career, and I assumed I was dumb. When I was in college and struggling with my pre-nursing curriculum, I had thought that I was not cut out for this and that I was not smart enough to become a nurse. I legit thought that. It wasn’t until I was pushed up against a wall and needed to make a decision whether to go back home to live with my parents and go to community college or try to figure out how to get good grades. I stayed where I was, which was at Ohio State and got accepted into the college of nursing.
I made a go at it. I was like, “It’s now or never. I have got to figure this out.” I tried every study technique on Google. Eventually, I figured out what worked for me. It was intense. I spent an entire summer doing a full load of relatively easier courses. I took that time with easier courses to figure things out for myself. As a young learner, I figured out early on at that point in my life how to learn effectively. Because I did this one thing, it did make grad school way easier. I see students all the time who tell me that there’s no comparison between a nursing school and a CRNA school because that’s so much harder.You are capable of so much. Believe in yourself and give yourself a chance. That also means a chance to fail because you can always adapt, learn, and adjust. Click To Tweet
Don’t get me wrong. I thought studying at CRNA school was incredibly hard, but at that point in my academic career, I knew how to study effectively for myself because it happened to me in my undergrad. Once I took that summer load of courses after my nursing school rejection, I got straight As for the first time in my life. I never looked back. I still get emotional thinking about it because there was a point in my life where I didn’t think that could ever happen. I thought it was not possible for me.
That’s when I became a firm believer that everything is possible. You are capable of so much. You have to believe in yourself, and you have to give yourself a chance. That means a chance to even fail because you can always adapt, learn and adjust. Thinking about how my study techniques served me in grad school to the fact that I knew what worked, and it was still hard.
Those of you who get through nursing school and don’t figure this out or who get by, I will tell you that you will be in for a rude awakening when you hit your education in CRNA school. You’re going to get slapped in the face. It’s going to be a gut punch. You’re going to have the wind knocked out of you. It’s not because the information is much harder. It’s simply the fact that there’s so much. It’s like they take a dump truck of textbooks and knowledge and dump it right on your head. If you can’t figure out how to hold it up without crushing you, you will be crushed.
The reason why I’m pointing this out is because it’s not brand new, like a new thing. It’s studying and knowing how to study effectively and not just effectively but efficiently. Efficiency and time management are keys. It’s not just your study techniques or how effective your study techniques are. It’s the efficiency and management piece that makes a beautiful picture. Even if you have good time management, even if you have efficient and effective study techniques, CRNA school will still be hard.
The sooner you address this one piece and your academic career, as far as, do I have a good solid study technique, is it efficient? Am I good at time management? Am I organized? I promise you, if you get down to the bottom of this, the sooner, the better, the easier you’re going to feel like CRNA school is going to be. That being said, it’s not going to be easy like all the things that are worth it in life. Let’s face it. It’s like being a parent is not easy. It is one of the most rewarding things you’ll ever do, but it’s not easy.
A lot of things in life are not easy, but they tend to be the most rewarding pieces of your life, and this is one of them. This is a piece of your life that’s going to be incredibly hard but also rewarding, which is why I’m fortunate, honored, and grateful that I get to share my CRNA journey with you. That’s number one. It is education. CRNA school, it’s a lot of information coming at you quickly.
The biggest difference between nursing school and CRA school is the fact that it’s a much faster pace. When you get behind, it’s much harder to ever get caught up. The anxiety sets in, overwhelm, the panic attacks, the whole nine yards. I’m speaking from someone who did suffer from panic attacks in CRNA school. It wasn’t because of the academics. I had suffered panic attacks in undergrad. It wasn’t a new thing for me. I had dealt with panic attacks from the time I started college. It would occasionally flare up.
What I found was my panic attacks started when I would not handle stress, not cope well, bottle it all in and not have a release. Usually, after a stressful event where I put myself through the ringers emotionally, I would have a panic attack a day or two later. Typically- if you look up the science behind panic attacks, which of course I do, because I’m a huge nerd, and I like learning these things- panic attacks happen when your sympathetic nervous system kicks back in and you relax.
Your body can go into a panic attack because you’ve shut off that sympathetic surge, and you’ve started relaxing again. That’s when you start getting panic attacks. It’s not when you’re panicking. It’s usually a day or two later. If this is happening or if you’re as nervous about this happening to you, all I can say is to find a way to address it head-on.
When I have addressed things that are bothering me or causing problems in my life head-on versus saying, “It’ll be okay.” Don’t tell yourself it will be okay because that means you’re neglecting it. You’re not addressing it. Don’t get me wrong, I like to remind myself, “Jenny, it’ll be okay. You’re going to get through this.” You still have to face the elephant. You have to face whatever’s causing that. Until you do that, the problem’s never going to go away. It’ll be okay, but it’s always going to be in the room where she’s saying, “Elephant, I see you over there. Let’s have a conversation. Let’s try to get to the bottom of this so I can shrink you and not have you impactful in my life.”
That’s a piece of advice I want to share. It’s off-topic, but I thought I’d bring it up. It’s the amount of volume you’re going to deal with as far as material that you’re going to cover. The way I picture CRNA school, at least it was for me, and it is for most, is that you have to have a good foundation because you build on that foundation.
If you find yourself rusty in things like Chemistry, Physics, Anatomy, Pathophysiology, and Pharmacology…before you go and start hitting all the YouTube videos and all the books, stop. Let me reassure you that you are okay. You do not need to do that, but what I will say is to know where your weaknesses are and assess where you think, if any, you had some weaknesses in the past. Did you struggle in Chemistry? I always struggled in Chemistry.
There’s such a narrow amount of Chemistry that you need to know for CRNA school; I don’t think Khan Academy existed back when I went to CRNA School. I don’t even know if I knew how YouTube worked back then. I’m dating myself. Back in 2012, is when I started CRNA school. There wasn’t nearly the amount of known resources on the internet like there are these days, but I’m glad there wasn’t because I didn’t waste my time, which is why we developed the NAR, Nurse Anesthesia Resident, Boot Camp.
Richard Wilson has been the assistant program director and educator for several years in a CRNA program. He taught Chemistry as a pre-course. When you start your CRNA program, you are refreshed. It’s there. If you have not utilized our boot camp inside CSPA, make sure you do that. Physics is in there, too, because the Physics and Chemistry you learn for CRNA school are specific concepts. It’s not the Krebs cycle. I have the student reach out to me, and it’s like, “I’m struggling with the Krebs cycle.” I’m like, “You don’t need to know the Krebs cycle for CRNA school. Don’t even worry about that.”
That’s what I mean, don’t go binge all the Khan Academy. Focus on what we teach you inside the NAR Boot Camp and CSPA, and you’re going to be golden. The same thing with Pharmacology for that reason because maybe you might feel weak. When it comes to Anatomy and Pathophysiology, I highly encourage you to dive deep into our learning library. That’s what we teach in there- a lot of Pathophysiology processes that relate to ICU nursing and anesthesia.
Identify where your weak points are and hit those weak points. Don’t worry about everything else. If you want to hit everything, do the NAR Boot Camp. You’re going to be golden and maybe hit the learning library. If you think your Pathophysiology could use a tune-up; my piece of advice is to make sure your foundation is solid because they’re going to be expecting to add on to that foundation quickly. That’s what you do the entire time.
If I had to give you any pieces of study advice to make your time in your education in CRNA school smoother, don’t focus on memorizing. Focus on understanding and building out concepts. I was trying to explain this to my husband. For those of you guys who get our emails, my lovely husband, Brandon, is amazing. He writes all the emails. He’s good. I’m incredibly grateful and thankful for that. I did a spoiler alert that I’m grateful that’s not on my plate along with everything else that I do for CSPA.
By the time you read this episode, we have had our annual virtual conference. Dr. Terry Durbin is teaching the neuroscience behind learning. I’m super nerding out on this because I think this is fascinating, but I was trying to explain to him why this concept is important for students to get early on. If you think about it in regards to CRNA school: You have A, B, and C concepts, but you’re tested on the B concept. When you learn A, B, and C ideas, you’re trying to connect them. How does A relate to B? How does B relate to C? How to C relate to A? How does A relate to everything? You’re as simply trying to build a roadmap of concepts that you’re connecting.Accept the fact that sometimes, you know what works for you, but it's still hard. Click To Tweet
The reason why this benefits you in CRNA school is because you don’t have to memorize everything. In fact, you’re not going to be able to. I’m going to be honest with you. It’s too much. You can only have so much memory, but when you understand how they connect concepts, you can make good educated guesses in reference like, “If this is how C works with A, I can reference that C works like this with B. If B works with A like this, I can say that A potentially works like this with C.”
These are different concepts that you can circle and connect the dots. When you get a test question on B, even if you don’t know it, you can say, “I know A and C. How does A and how does C connect to B?” Go in this big circle in your brain and that allows you to make a good guess. A lot of times, it allows you to figure out the answer without even knowing the actual question.
That’s my biggest piece of advice as far as how to take test questions. When you study, connect the information to other concepts that you have already learned and truly understand. This allows you to be a better test taker. The other thing I did was I would not read my answers. I would read the question on the test. Blinders, don’t look at the options. Figure it out before you even look at the options. Most of the time, you can always have a quick answer in your brain.
If you don’t, that’s when you start connecting and brainstorming different ideas. Look at the answers after you’ve brainstormed some ideas around that concept, and start trying to do that whole process where you’re connecting the dots and pulling information out of your brain. If you think about your brain is like zipping a file, and you have to unzip it piece by piece. That’s what you’re doing when you’re doing stuff like that, which is cool and nerdy. I love it.
That’s the education piece between the differences between nursing school and CRNA school. It’s the fact that you are getting a lot more thrown at you a lot quicker, and you don’t have time for the basics. You’re already expected to understand the basics.
Responsibilities between a CRNA versus an RN. This may seem obvious, but maybe not. I don’t know. I want to point it out. We always have a responsibility to the patient, whether you’re a nurse or a CRNA. That’s the beauty of being a nurse. That’s why you went into nursing because you enjoy that patient connection, being at the bedside, and doing the hands-on things.
That is why you became a nurse. You want to make a difference. You want to help people and be right there present to help them. That has not changed. You still get that connection. A lot of people say, “You don’t have time to talk to your patient. Do you miss that?” I’m like, “I have five minutes in pre-op. That has plenty of time to build an incredibly deep bond and trust. They’re putting their life in your hands. The bonds you build in that five minutes of them asking you questions and you educating them are strong. It’s powerful and rewarding to know that they trust you enough to put them under anesthesia while they’re being cut open and wake them up.
I don’t know how to describe it, but you don’t have all case, chit chat, talk or interaction with them, but you always communicate with them during the case. You listen to their heart rate and assess their vitals, “Jenny, I’m having pain. My heart rate is going up to 140. You better help me.” That’s them saying that to you, but they’re actually not saying that to you. Technically, you always communicate and interact with your patient, even under anesthesia.
Even in the ICU, your patient is intubated and sedated. You are communicating with them the entire time. When they’re starting to buck the vent, you know they’re either having pain, getting light, getting agitated, or what’s going on. If your alarm is going off because their blood pressure is low, they’re telling you that they’re getting more septic, their lactic acid is increasing, and whatever is going on with the patient. They’re always communicating with you, even if they’re not physically speaking to you.
That’s what’s the nerdy cool part is about being a CRNA. It’s because you get to use your critical care knowledge and skills to assess what is going on, what they’re telling you, and what their body is telling you. That is a responsibility of a CRNA- your patients will be asleep under anesthesia. You have to understand what they need despite them not being able to physically tell you what they need.
Your responsibility is to keep the patients safe, keep them hemodynamically stable, and keep them free of pain as much as possible. The beauty of being an anesthesia provider is that your main goal is to make sure they wake up, are hemodynamically stable, go to sleep smooth, and wake up smooth. They’re going to recover smoothly and not going to have a lot of pain to deal with when they do wake up.
Maybe you’re not even waking them up. Maybe you’re taking them back to the ICU, but you’re making sure you drop them off as stable as possible. You’re assessing their labs, all their fluid status, and all of that stuff. Ultimately, the patient’s safety is your priority. It’s the same thing when you’re a nurse. That’s always your priority. It’s to make sure the patient is safe and their needs are being met.
This looks different depending on what type of nurse you are. Even in the OR, they may not be doing a lot of direct patient care, but they’re working as a team collaboratively to make sure that the patient’s needs are being met. They’re communicating and collaborating to make sure, “This needs to happen so X, Y, and Z can happen.” Your responsibility is still the same. It’s carried out in a different manner, depending on the role you’re filling, whether you’re an ICU nurse or CRNA.
As an ICU nurse, I was advocating for the patients all the time because they were being sedated. I had to speak up and address what I thought they needed. You’re doing the same thing as a CRNA. If the patient wasn’t intubated and sedated, I could have a conversation with them and educate them. That was part of my role as an ICU nurse. You’re also educating your patient in pre-op and PACU. They may not remember in PACU, but you pass on the education to the PACU nurse. You’re still technically doing all those things, but you’re doing it in a different way. That’s a similarity and a difference all in one.
Let’s talk a little bit about the work environment. This is probably where it differs the most. This is one of the areas that differ the most. I’ll go into the scope of practice. The work environment as a CRNA can vary from hospital to hospital, practice to practice, and specialty to specialty. You don’t have to work in an operating room. You can work in a fertility clinic, ophthalmology clinic, dental clinic, plastic surgeons office, med spa, plasma facials, or Botox injections.
That’s far removed from the operating room, but you can also work at an academy clinic, which is like a pain clinic. You could work at a surgery center, a regular level one trauma center, and all different varieties of settings. You can even go into education or be more politically involved in the national association and things like that. There are a lot of different types of work environments CRNAs can work in.
I would say the most commonly thought is in an operating room to some extent or an outpatient procedure. Maybe CAT scanner, MRI, or IR. Those are the primary ones. Maybe EAP labs, doing cardioversions, and things like that. Typically, you’re working where people need sedation. That’s the work environment. People need to be sedated for one reason or another and you’re there to provide safe sedation, monitor their vitals, and make sure that they are maintaining their airways. They’re exchanging, they’re oxygenating, and their blood pressure, all their vital signs, fluid status, all that is good.
The challenge of this is it varies case by case. If you’re doing a big bowel case, their fluid needs are going to look a lot different than someone who’s coming in to have a colonoscopy. It’s the same thing if you go up to OB and do a C-section. That’s a spinal anesthetic versus what you place for the labor epidural. You’re still providing anesthesia when you place a labor epidural. You’re still assessing the patient, asking them questions, checking on them, checking on the epidural, and assessing whether it’s effective. It looks different than putting someone under general anesthesia in an operating room and managing them like that.
I had a 24-hour shift for a while. In one day, I would do two open-heart cases in that 24-hour period; sometimes even three open-heart cases. I would go up to OB and do three or four epidurals. Maybe I come back down to the OR and do an add-on lap appy for a six-year-old, or a cold leg would come in the middle of the night.Don't tell yourself everything will be okay without addressing your problems because that means you're neglecting them. You have to face it, or it's never going to go away. Click To Tweet
My shift was different, and I could do OB, paeds, and hearts all in one day. You try to tell me what nursing specialty where you can do such a wide variety of patient cases in one day. It doesn’t exist. You can’t go do an OB case, jump into an open-heart room and jump into a six-year-old lap appy all in one shift. We’re privileged to be able to have the expertise to manage a wide variety of patients. I would say ER nursing or flight nursing maybe sees a wide range of patients. It doesn’t necessarily mean you’re taking care of a pregnant person and a child in one shift, but you could, if they come in needing an emergency of some kind.
I feel like our specialty is unique in the sense that you see a wide range of patient populations. You have a wide range of knowledge because, let’s face it, doing a case on a six-year-old versus a pregnant person versus an open heart on a 65-year-old is vastly different physiology and needs. You have to understand all of that and what anesthetic is safe to deliver for each one and what their needs are going to be for pain control, fluid, how to dose an epidural safely, and how to dose a spinal safely. You’re using a lot of different skills all in one day.
That’s a big difference as far as a work environment like in the ICU. Don’t get me wrong, I saw a wide range of patients who had GI bleeds, septic shock, chronic renal failure, tons of respiratory failure. There’s a wide variety of different types of cases in the ICU, but my role as an ICU nurse was relatively the same day in and day out. I did the same things every single day. I saw the same types of patients. I didn’t see a giant range in age. Maybe the youngest would be in their twenties, and the oldest would be in their 90s. That’s a wide range.
We didn’t do babies. We did occasionally have some sick intubated, pregnant people, especially during the H1N1 when that came out back then. As an ICU nurse, for the most part, my shifts felt pretty routine and predictable. You knew exactly what was going to happen, but I knew what my responsibilities were every single day that I went in. When I go in as a CRNA, especially as the 24-hour CRNA, I don’t know, it’s like, “What am I going to get now? What’s going to come on my plate?” It could be a buffet of all different types of cases.
I liked that it kept me on my toes and mentally challenged. That’s also why, when I hear people say, “Anesthesia can be boring.” I’m like, “I don’t know who you heard that from or why you think that, but in my opinion, you haven’t challenged yourself to see enough of what we do because there are plenty of things that you can do as an anesthesia provider that is truly not boring.” If you’ll put yourself in a colonoscopy center and sit there for your entire career, I would think that that would be boring, but you’re making that choice for yourself. If you don’t like that, don’t do that.
The way I am with my career and my experience as a CRNA is I challenged myself. I went from doing a level one trauma center where I was doing open-heart, OB and paeds as much as I possibly could. I took a job doing outpatient surgery, but I did a lot of regional blocks. I hadn’t done that since school. I challenged myself to do a new skill because I hadn’t done it since school. I went and started doing 30 blocks in an eight-hour shift, which was incredibly challenging. It got me good quickly at them, but it wasn’t for me.
I decided I didn’t like the outpatient surgery center world. I went, and I was like, “I’ve always liked paeds, but I’ve never done just paeds. What would it be like to work at an actual true paeds hospital?” There I went. I do it now, and I love it. I love working with kids. I’m a paeds CRNA now. I also took a 1099 position at an adult hospital. It’s a small OR, maybe ten ORs, all adults, and a general variety. I’m going to get my taste of adults again.
I mix it up a little bit and stay fresh. This rural location will allow me to do my regional blocks. I’m going to refresh those skills again. Always look for ways to keep your practice fresh and your skills up. You will never get bored if you do that. There are many opportunities out there that it’s easy to allow yourself that.
That’s the work environment as far as compared to nursing. Depending on the nursing environment, your environment can be different than that, but I’m speaking from the ICU world, that it was predictable when I’d go in. I’d have 1 or 2 patients, and I had a routine that I practiced day in, day out, whereas as a CRNA, don’t get me wrong, anesthesia can be a routine but it can also look different. To go out to do OB and over to do a general case is a different type of routine. They’re both routine-ish type places, but you don’t do the same thing all day long every single time. You bounce around; that’s what I’m saying in anesthesia. It’s very different.
Patient populations, I spoke to that a little bit. As an ICU nurse, I saw medically acutely sick patients. I worked in the medical ICU. If you work in the CVICU, you see fresh open hearts or maybe fresh triple As or vascular patients of some kind, but that’s what you see. That’s what you’re used to. You don’t see a huge wide range of patient populations. You don’t see a two-day-old baby or a week-old baby for pyloric stenosis and go off and do an OB case and come back and do a general robotic case all in one day on all different types of patients.
Something to be said is, as a CRNA, most of the patients who come back for surgery have been worked up, meaning they’ve had PAT, Pre-Admission Testing, and all those things. You still get emergencies from the ICU or ER that come back emergently to the OR like trauma or someone who has a dead guy in ICU who’s sick. There are things that are necessarily not planned or expected. The patients are not primed and ready to go. They’re near death. You do see someone get that thrown into the mix to where you could have a beautiful lineup, and they delay or cancel your case. Maybe you’re the CRNA whose case cancels. Now you have the open room. You get the trauma coming up, or whatever’s going to come in from the ER.
Acutely, your ship can change. I’ve also had times as a CRNA where I might have a nice AV fistula room where it’s nice and easy all day. They’re like, “We need you with the ruptured AAA coming next door. We need to pull you from this room with someone else here. We need you over there.” I’m like, “Let me brace for impact. I’m going to leave my nice cush room to take a train wreck. I got it. It’ll be fine.” I’ve also had that happen, depending on if you’re an open-heart team or something like that.
If you’re the CRNA who does a lot of paeds, you could be pulled from a room to go do a case that comes in that they want you for. I always was like, “I’m honored. Thank you for thinking of me. I’ll come to do it.” I never had a problem with that. It’s to be expected and something that you should always strive to be someone they can go to, to take the mess that comes. That’s patient population.
Scope of practice. Other than the work environment, the scope of practice is what’s the most different and is the most enjoyable part of my job. Other than the fact that I get to see a variety and I get to do a bunch of different things with different patient populations, the scope of practice is my favorite piece that is different from being an RN.
As an RN, especially in the ICU, you do a lot of critical thinking. You get to think, “This is happening. This is what’s going on and what they’re on. This is their disease process. What can I come up with that they need?” You’re doing that whole process as an ICU nurse, but you’re also heavily relying on what are my order sets. I’m going to tell the doctor this, what is he going to say to me? Maybe even anticipate what that says to me. You become used to relying on someone else, like the head of the chain of command, to assess your thought process.
I’m not speaking for every nurse. Please don’t take it that way because you could be the opposite. Where I was, several years into my ICU career, I still was like, “This is what I think.” I’m thinking for myself, but I’m also confirming it. I’m having someone say yay or nay all the time to me. As a CRNA, you are the one saying yay or nay, calling the shots, and having the final say on what needs to be done and what’s going on. You still have a team to collaborate with if you have questions, but you may or may not need to do that. You have the knowledge and the power to say, “I either need to ask this question or no, I know the answer, and I’m going to move forward.” You own that decision.
It’s empowering and incredibly rewarding. This is where the whole autonomy piece comes into play with being a CRNA that you’ll read on Google. If a CRNA program asks you why you want to be a CRNA, don’t say autonomy. Explain what autonomy means to you and why, and how you would use it in your CRNA practice. Explain how you use it in the ICU too, how you think through the disease process of your patient, the drips they’re on, the vital signs you’re seeing, and what it is they need.
Have that piece of, “I’m critically thinking through what the patient needs from me. I’m coming up with my decision to make this judgment call. I may still have to ask a doctor about it, but you’re still asking because you’ve thought of it. When you’re in the operating room, you’re making these judgment calls and assessing all the time. You’re also assessing whether you need to say something to the surgeon, attending, or OR staff.Don't focus on memorizing. Instead, focus on understanding and building out concepts. Click To Tweet
If I had a problem in the OR and I knew it was a big problem, I would call my reinforcements in a heartbeat, “Get your butt in the room, and you’re at the bedside. This is about to go down. I need all hands on deck.” You always trust your gut instinct to know whether you need to escalate care. You also have to be good at asking and delegating what other people in the room need to be doing for you and for the patient. You get good at being bossy, which is the fun part. No, I’m kidding.
You have to understand what the patient needs so you know what to delegate. That’s where you start these skills in the ICU as an ICU nurse, and I’m sure in other areas of nursing, you do as well. I’m speaking from my ICU experience, but it amplifies as you become a CRNA. When you start off in CRNA school, trust me, you’re going to be intimidated or may be scared. That’s okay. It’s okay to not want to walk into the OR on your first day, demand everyone’s attention, and bark out orders to everyone.
I don’t expect you to, nor should you, but I encourage you to find your way, voice, and path and watch your CRNA and what they do. Learn from them about how they speak up, how they communicate, what they ask for, what they don’t ask for, and what they delegate. Pay attention to those things because that’s exactly what you’re going to be doing when you’re on your own.
This process starts while you’re getting your bedside skills. It is becoming comfortable delegating, speaking up when the patient has a need and asking for things because you’ve had a thought process that led you down that path. It all starts there. When I say you don’t necessarily need to escalate it, delegate it or ask a question is because you don’t. If the blood pressure is dangerously low and you want to start a Levophed drip, you know that’s what is going to be the best for the patient. A Levophed drip is going to squeeze them and not give them any beta. Potentially, it could put them at worse heart failure and if you’re squeezing the pipes but not giving the pumps some extra oomph, start a Levophed drip. Draw it up, get it ready, hang up, string it, and go.
I’m not saying you don’t notify the surgeon and the attending that you had to do it. You do it. You don’t wait for an order and a pharmacy to mix it up. You get it ready. What if they’re acutely hypertensive and all you have in the room is a bottle of nitro. Dilute it down to 20 mcg per ml and give 20 mcg. Get the pressure down quickly and acutely, but it’s not going to last. You don’t have to ask permission to do that.
Have education and skill set, and know how to safely use and titrate that drug. There are other times when you do use your skillset to ask questions. You’re getting ready to exploit your patient, but you’re like, “Something does not feel right about this. It seems a little weak.” Maybe they’re already a respiratory cripple, but you’re like, “I don’t think they’re going to fly.”
Call someone to the bedside, whether it’s another CRNA, your attending, whoever is available, and say, “What do you think about this? This is why I’m questioning whether this patient’s going to be okay extubated.” They can say, “I agree with you. I’ll be here. Let’s go ahead and take the tube and see. If we have to re-intubate him, we will. Maybe we won’t extubate at all. We’ll take them over to the ICU and let him recover more slowly.” Whatever the decisions end up being, you’ve now had a second opinion on your thought process.
When you are in a situation where you have to react and do something quickly, you are the one calling the shots, giving the drugs, and asking for things. Another example would be when I had a patient extubated after they turned the bed 90 degrees, and the surgeon got in there and extubated the patient. Here I am trying to mask the patient by shoving the vent so I can physically do it without having to go gadget arms. They spasm badly. The wrench spasm, like turn and diss out the whole nine yards.
I had to look at the PA, the Physician Assistant, and I had a vial of succs and a syringe, but I didn’t have it drawn up. I had a vial and I had a labeled syringe. I go, “Grab that syringe that is labeled Succinylcholine, drew 1cc, and pushed it.” She did, and the patient broke the spasm. In the meantime, I also said, “Call the attending to the room. I would need to read it with the patient. I want another set of skilled hands there in case it goes down. I wasn’t able to break the spasm or something. God forbid worse were to happen like he would breathe down or code.” By the time I broke the spasm, the attending had gone into the room. We could reintubate and done. Go on with a happy little case. It’s no big deal.
I had to use my delegation to give orders because I had my hands full. I was all by myself trying to manage a spasm, giving positive pressure to hope that I could break the spasm. I decided that I was not going to break the spasm. I have to give drugs quickly before he desats even further and potentially, breathes down in codes. I had delegated that task to the physician assistant who was right next to me at that time.
That’s another example. It always helps to hear examples of your thought process about what you do. Think about it. If you’re at the bedside in the ICU and something’s happening, you’re going to delegate someone else to do something for you, especially if your hands are tied and you can’t do it because you’re doing something else. You’re going to say, “I’m in here. Help me stabilize this patient. I need to drop some epi. Can you start chest compressions?” Whatever the situation may be, you start doing those things as a nurse.
The scope of practice for a CRNA, you were taking care of that patient. You were in the room with him the whole time. Depending on the type of practice, you were going to sleep by, with you in the room as the sole anesthesia provider, you’re calling on, or you’re going to have another anesthesia provider at your bedside to make sure everything goes smoother in induction. If I have two people in the room for induction, typically, you’re masking the patient down while the other person pushes drugs.
I work at a paeds hospital. They typically don’t come back with IVs. I’m masking the patient down and wrestling them. Once they’re calm enough or under enough gas, I have the attending start the IV, push the drugs, intubate, and you go on. Now, in waking up, it’s the same thing. In some places, you’re going to have the attending come to the bedside, and they hang around in case you need them for anything. In other places, you’re waking up routinely by yourself and only calling the attending to the bedside if you have a problem.
It depends on the type of practice you work at as far as how that goes, but you are otherwise in the room, and you were doing the whole case by yourself. You’re waking them up by yourself. You’re taking the PACU by yourself and giving them a report. You’re going over to pre-op and doing your own assessment.
The attending would typically see the patient in pre-op and put in the pre-op assessment, but you’re still responsible for doing your own pre-op assessment to some extent. Whether that’s looking up the patient and the case previously, so you know what you’re walking into if you don’t have time doing a quick airway assessment when they roll in the door. Asking your pertinent questions and going off to sleep versus walking over to the PACU after your last case and doing a full-blown assessment.
It depends on where you work and what time you have. At the end of the day, it’s your responsibility to assess the next patient and do the whole case from start to finish. That’s the responsibility scope of practice. You do A-line, central lines, IVs, epidurals, thoracic epidurals, labor epidurals, spinals, blood patches, and all kinds of fun hands-on stuff. Sometimes they come in from the ER because they’ve had a spinal tap, and now they have bad headaches, so you do a blood patch. Maybe they had a wet tap with an epidural, so you do a blood patch.
There are a variety of procedures that you can do as a CRNA. As far as anesthetics go, there are inhalation induction, IV induction, and awake intubations. There’s various equipment to manipulate someone’s airway. When I would do my lungs, we went into it with a double-lumen tube. One of my responsibilities was to take the fiber optic scope after we were intubated and confirm the placement of the tube. I would be manipulating that scope down the tube and confirming placement. There are a lot of fun hands-on things. If you like hands-on, pharmacology, and pathophysiology, you will like being a CRNA.
That covers the scope of practice and role. This goes into the fact that you have full responsibility from start to finish of the anesthetic. Your scope of practice is not inhibited. You don’t have to answer it. You answer to yourself as far as if you make a decision, that’s your decision. You take ownership of that, and you don’t rely on someone else to oversee that in a way. That is what I’m trying to get at. You also equally know when you need to ask questions, and asking questions is a safe way to practice. You should ask questions and confirm.You went into nursing because you enjoy that patient connection and being at the bedside doing hands-on things. You want to make a difference. Click To Tweet
Sometimes I use my Vargo app or ask someone on their app to look something up. I want to confirm what I think is the right dose. I always double-check my doses. I triple-check my vitals. What I do when I get out of vial, for example, I grab another slot. I look at it and look at the title. I draw it up. I look at the vial one more time because there’s that confirmation bias where you think you see the vial you think you selected. You’re always doing things in your practice to make sure what you’re doing is safe. At the end of the day, you have a big role and potential for mistakes. It exists in big roles.
I compared the fact that no one wants more responsibility in life like, “I’m going to give you all this responsibility. Have fun.” The reality is the more responsibility you take on in life, usually the more reward that comes with it. I said, “Things that are rewarding are also usually hard.” That includes responsibility.
The reason why CRNA has such high responsibility is also equally the fact that they have a lot of job and career satisfaction that comes with it. It’s not walking in the park, rainbows and sunshine. It’s a big responsibility, but it’s also incredibly rewarding and satisfying to be that person for your patient. That’s the role in the scope of practice to round that all up.
We’ll get into the basics to finalize this whole episode. I did a whole episode on what a CRNA makes. You can go check the episode out. It was episode 69 that I did that. The pay is there. CRNAs, not only do they have a lot of responsibility, they’re also compensated because of that.
I’m not crazy about Facebook. You probably know that if you know anything about the history with my Facebook group that we used to have. Now, it’s just for CSPA students. I don’t like Facebook, but every now and then, Facebook will ping you and have the perfect thing for you to see. I’ll be like, “How do they know that? It’s creepy.” They pinged me on a post that I had in the group I hardly ever visit anymore. It was on what a starting RN salary is. I was like, “I’m curious.”
I went in there, and it ranged from $24 an hour all the way to $46 an hour for a new grad starting position for an RN. That’s a wide range, the $20 range. It depends on where you live. The highest range was California and New York, Manhattan, because of the cost of $2,000 a month for an 800-square-foot apartment where I have an entire home for that much in Ohio. The cost of living goes into the salary rate, but $24 an hour is what some places are still starting out at. When I started as a nurse, it was $24 to $26. It was still low.
I started out back in 2009 at $22 an hour. By the time I started my anesthesia training, I was at $24 an hour, and I live in Ohio. It’s not the crazy cost of living or anything like that by any means. I remember feeling like that was not enough. In CRNA, you’re looking, on average, for a new grad to be right around $90. Maybe closer to $100, depending on where you live, but $90 an hour is typically what most CRNA are making even as a new grad. You get closer to $100 an hour with more experience.
My first CRNA position was $86 an hour. By the time I left that original position, I was closer to $88 an hour. When I took a regional position, I went to $90 an hour. It’s funny because when I took my paeds position, I took a little bit of a pay cut. I went back to like $88 an hour. If I would have been W-2, I would have taken a pay cut by a couple of bucks, but I decided to stay PRN. I made more like $110 as a PRN. They bumped us to $120 as a CRNA.
Depending on whether you’re a W-2 or PRN, it depends on your pay. I also took a 1099 position for the first time. I experienced in 1099, we’re a loop-hoop and it’s $180 an hour. It depends. That 1099 position is an hour away. I drive an hour there and an hour back. The way gas prices are, you can subtract something from that hourly rate, but it’s still 100% worth it to go do. It’s a different experience.
If you want to compare the pay, that’s the comparison, but there’s really no comparison. On average, CRNA is making well over $100 an hour than a W-2 nurse. You’re looking at $26 an hour versus $60 an hour more. I’m making $180, but it depends on where you work. If you’re making $100 an hour versus $26 an hour, you’re making anywhere from $50 to $60 more an hour, which is equivalent to about $100,000 more a year on average. That fluctuates depending on what your actual hourly rate is.
If you’re traveling nursing, I’m not going to get this episode in what travel nurses make. I know that’s also up in the air and a huge debacle right now. I can’t speak to what travel nurses are making and what the average is anymore. I know for a while, it was high, but I also know that’s been coming down. I don’t know what the future holds for that.
CRNA is not all about the money. I know that sounds cliche and like, “Okay, Jenny.” It is more about the career itself. By picking a career that you’re going to be satisfied in and enjoy, the pay is a huge perk. It’s not everything. I promise you that nothing you do in life will ever be worth a lot of money if it makes you miserable. I can 100% guarantee and put money on that. Would you want to clean up poop all day if you made $1,000 an hour? I would probably do it for $1,000 an hour, but I would hate it. I’m being silly with you guys.
Ultimately, at the end of the day, there is a big financial reward for becoming a CRNA, but it’s about the job. It’s about taking away someone’s fear, anxiety, and pain away. It’s about having the skill set to save someone’s life, to do all kinds of cool procedures, epidurals, spinals, airways, A-lines, and central lines. It’s a lot of fun. I hope you guys enjoyed this episode. As always, thank you for reading. Be sure to leave a review. I appreciate you so very much, and I will see you guys next time. Bye.
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