Episode 108: Steps Before Nursing School For CRNA With Colby

What should you do before & during nursing school to help you on your CRNA journey? In today’s episode, Colby W., a CSPA Community Member, sits with Jenny Finnell to gather insights on the steps before and while in nursing school for CRNA. Jenny shares that you need to get practical hands-on experience as a nurse’s aide, especially in the ICU, to avoid having problems after graduation. Colby and Jenny also get to touch on extracurriculars, and as Jenny suggests, student organizations are a good starting place to add to your resume and she also shares ideas outside the hospital. Join Colby and Jenny as they trek the path to prepare you early on for CRNA.

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Steps Before Nursing School For CRNA With Colby

In this episode, I’m super excited and pumped because we have a CSPA community member as a guest on the show. Welcome, Colby, to the show.

Thank you for having me.

I’m so excited to have you here. I know I don’t do this very often. I like doing this, so I would love to do it more. Colby asked the question on Instagram and I was like, “That’d be a good topic to bring on the show because you are not the only one who has this question.” Luckily, fortunate for us and for you, he was willing to come on the show and allow me to do what I would call a little coaching session on the show.

A little bit about Colby, and I will let him introduce himself so he can do a better job than I’m sure I could. He is pre-nursing. It means he has not started his nursing journey, but he is pre-med. He started as a pre-med student and now is embarking on becoming a CRNA. I will let you go ahead and give a little more background as far as why that change came about.

Thank you again. I appreciate this opportunity. I started college as a biology pre-med, and I was like, “I’m going to become a doctor.” General background about me. My mom was a nurse. She worked in the cardiac ICU for a long time. She’s awesome. She’s always been like, “You should look into nursing. I think you would like this.” I was like, “I’m going to be a doctor.”

I heard from family friends about CRNA and I was like, “This sounds interesting and it sounds like a good career path.” I went on YouTube and on Google. I tried to read and watch as much as I could about CRNA. Out of the blue, an opportunity for shadowing came up through one of our family friends. I went and shadowed this guy. He is an anesthesiologist and an MD. This was over the break, and I was like, “This is great.” He let me shadow all of the CRNAs that work in their anesthesia group. I was like, “This is awesome. This is what I want to do.”

I feel like at least from what I have seen, it’s a good blend of pathophysiology, pharmacology, and direct patient contact. I think that’s enticing. I changed my major from bio to nursing. I only had one more semester of pre-med classes to take. I was like, “I’m going to go ahead and do it.” I’m in a situation where I can do that. I’m finishing pre-med stuff this semester. I’m taking pathophysiology right now, which is a prereq in my nursing program. I applied to the nursing program. Hopefully, I will hear back good news. That’s a little bit about me.

I love the fact that your mom is a CVICU nurse. A question that’s on my mind anyway and maybe others reading is when you shadowed the anesthesiologist and then you were put into rooms with CRNAs, was it the fact that you saw CRNAs doing most of the direct patient care that enticed you to go that path versus MD?

CRNA vs Anesthesiologist

Yes. I shadowed an anesthesiologist. He was awesome and he was nice but one thing that I noticed, and this was after I’d been like, “I’m thinking about CRNA.” I was put in the OR with them and with an anesthesiologist and the CRNA. I don’t know if this is a unique thing, but in the anesthesiology group that is in my region, it’s like CRNAs do all of the actual anesthetic procedures, but they have to have an MD there to supervise them for induction and when they wake up. I was like, “I like how the CRNAs had such direct patient contact.”

Something that stood out to me was that I was like, “That’s great.” One of the CRNAs was like, “In nursing school,” and in her nursing job, I forgot what ICU she worked in. It was like, “They would be in the bed and then give the medicine. Maybe a few days later they would see results. They would get better.” The thing that the CRNA told me was being a CRNA and being an anesthesia provider is awesome because it’s like, “The patient’s heart rate is dropping. We will give this medicine.” Assuming it works, it’s going to work and you are going to see results. You can do stuff on the fly, and there’s critical thinking that’s involved, and I like critical thinking.

You like the fact these CRNAs were more present throughout the case is why you chose not to stay the MD route. Thank you for sharing that. I was curious myself. The model you mentioned is called an ACT model. It’s a direct model. There are different terminologies. It can be a little confusing, but more than likely bigger academic facilities tend to practice like that where typically, it’s a 1 to 4 ratio. It means 1 MD for every 4 CRNAs. To help educate you and the readers, there’s also a supervision model practice and I’ve worked on both. The practice I worked on can vary from facility to facility, but we had 2 attendings and 12 CRNAs on staff on any given day.

Other facilities that are supervision models that I almost took a job at, but I didn’t, I want to say there are 6 attendings and almost 40 CRNAs. It’s very different. There are also all CRNA-independent practices where there are no anesthesiologists. There are other physicians in the hospital, but no anesthesiologist physicians.

It’s called independent practice where CRNAs are the only anesthesia providers in the hospital. There are different models, and I have a whole episode. I explained some of the differences between CRNA, MD, and AAs, which are Anesthesiologist Assistants. If you all want to check that episode out, you can get more juice on that here.

Now, you are embarking on nursing, which is so exciting. I would agree. The one I love about nursing and why I think CRNAs are very special in my own mind is because we developed that empathy and that compassion and that firsthand touch when you are with them in the ICU. The ICU time is hard, but what I will say is that brings growth as a provider. It allows you to get like that six sense as they will call it, where you have no impending dooms coming. It helps you to develop a rapport with your patients and their family.

It gives you very practical hands-on experience that yes, it’s very different as an anesthesia provider, but I know for me when I go to pre-op and I can communicate with my patients and understand their fears and anxieties because I was with them all the time in the ICU. It gives you that unique compassionate way of communicating and being present. I know you said your mom’s a CVICU nurse. When you are an ICU nurse, you care for people in their most vulnerable state. That’s exactly what anesthesia does too. It’s a lot of similarities, yet a lot of differences but I think that enhances our practice overall.

Work Experience While In Nursing School

Let’s get into some of the things you had questions about. You want to talk about things you could do now to prepare for CRNA school. I guess I even forgot to talk about what this episode is about, but we are going to touch on you folks just starting out. What are some things you should be doing prior to nursing school if you are planning on CRNA? This is pre-nursing school, planning for CRNA. What are some steps we should be doing? Colby did a great job outlining some of these questions. I was impressed because the fact that you are thinking about these things says to me that you are doing a great job.

Essentially, he wants me to set him up for success, which I love. The planner in me is so happy with this. One of his first questions was about jobs in nursing school. I love this question because a lot of students will take that easily. It’s like a “you can study at work” job. I had friends who did it too. Instead of working in the hospital, essentially you can work and study. It’s called a work-study where you go somewhere. You do very minimal work and you can study while you are technically getting paid. It’s very tempting.

I’m not saying that it may not be what you need but I equally think that a lot of nursing students can get themselves into trouble when it comes to graduation because they have no practical hands-on experience as a nursing aid. Most residency programs that are taking ICU nurses as new grads will expect you to have some type of experience in the hospital with patient care, preferably even in the ICU.

As far as a nursing school job, once you start your nursing program, after the first semester, you don’t have to take the CNA exam. You are called an SNA, which is a Student Nurse Assistant. That’s what they called them when I went. You will hear the terms interchangeably like CNA, Certified Nurse Assistant, or SNA, Student Nurse Assistant. They mean the same thing. They have the same job, except one is a nursing student who bypassed the certification to become a CNA. That’s what I’d recommend because you don’t have to pay for the certification. After you get your first semester of nursing done, you are going to have some more knowledge under your belt.

It saves you the extra stuff of doing it now. There’s no need to do it before you start your nursing program, but once you get that first semester under your belt, you can stop working. I was a belayer at a rock climbing wall. I started the job at 2:00 in the morning at Ohio State. I hauled the drunk kids. Give up those jobs and get into the hospital. Try your best to work your way into the ICU. You don’t have to work in the ICU, but I encourage you before you graduate to spend at least a year in the ICU as a nurse’s aide.

This is also key. Make sure you are exploring different ICUs at this time. I didn’t know CRNA was what I for sure wanted to do. I did, but I doubted myself. I didn’t go into the ICU as a nurse’s aide. I went into whatever floor took me. It was the peripheral vascular disease and cardiac failure floor. I would float to the open-heart area. Every time I did, I was terrified because I was like, “These cases are so sick.” They’d have these sternotomies. We’d have to get them out to bed. They have chest tubes. It was just scary. I was like, “I don’t want to do this.”

It was intimidating. That’s why I was like, “I don’t think I’m cut out for this. I don’t think I can hang.” I got the CRNA bug when I was like, “If I don’t at least go for it, I’m never going to know.” I was like, “I’m going to see what ICU jobs are out there as an SNA.” I spent about 8 months or 1 year on that type of peripheral vascular disease floor. In my senior year in nursing, I went over to the medical ICU. That was the best decision I ever made. Maybe it was about a year and a half left in my journey total, but they took me under their wing. They were like my work parents.

It was a great, homey unit. Those nurses were so caring and compassionate. You won’t experience it everywhere which is why I challenge you not to be married to whatever you experience. If you get a bad experience in an ICU as an SNA, try a different ICU. You want to find an ICU that will support you in your personal growth. If it’s a toxic work environment, leave. Go to another ICU because they are out there.

People get obsessed with picking the CVICU and for you, it’d be cool to work with your mom. She could be your boss. That being said, it’s not about so much like the CVICU versus the MICU or SICU as it is about finding a unit that will support your growth. What leadership opportunities do they have? Do they have some funky rules where you have to give them two years of experience before you even get a reference because some units have that, too. 

They find out you are wanting CRNA, they physically try to hinder you from doing it. They are trying to make your life miserable. There are units like that. I have heard enough stories to know that they are out there. Getting this feel for how supportive this unit is while you are still in nursing school is a good way to know whether this is going to be where you are going to want to apply when you are done. The beauty of working as a nurse’s aide in an ICU is to work your butt off and that’s a long-term job interview. They are going to be begging you to come work there. That was my experience.

They are like, “I’m applying to the residency program.” They are like, “Okay, you got it. I will talk to the head leads. You got this position. You are going to come work here.” I’m like, “Okay.” I wanted the SICU. I got to float through the SICU and the MICU and then I went to a step-down from the residency. I knew the step-down wasn’t for me, but they make you go to three different units. I got put in a step-down for one of my rotations.

In the SICU, I loved the patient population because it was surgical. I got more in touch with the anesthesiologist and the CRNAs to understand the surgical aspects. That’s why I wanted the SICU but the nurses in the MICU were like, “You are not going to leave us, are you?” I’m like sad to hear that. I was like, “I don’t like this patient population. It’s morbid, sad, and depressing, but I love the staff.” I stayed, but it was a good decision because my friend worked in the SICU and it was a much more spaced out and bigger unit. It was colder and less warm and welcoming and it was fine but she didn’t have nearly the camaraderie that we experienced in the MICU, which was a much smaller unit.

Overall, it was challenging. Some of her patients could use the bathroom. I don’t even know what that’s like. We don’t even have toilets up here. Some of hers got to go home. My patients went to the nursing home on a tray. They come back with sepsis. The MICU was a very hard unit. I think people downplay it but honestly, if you get a high enough acuity Level 1 trauma center, you are going to get exposed to a lot of really sick patients. They typically come to the MICU when no one else wants them and when everything else has failed. That’s the job in nursing school. Does that help answer your question?

Yes, ma’am. Thank you so much. That’s good advice. I appreciate it.

That one’s good then. I’m not saying you can’t do something fun in nursing school. If you want to work eight hours a week at the hospital and eight hours doing something else that you enjoy, go for it but get your foot in the door in the hospital. You asked about extracurriculars. Can I ask you? What types of things do you enjoy or what are you already doing?

Volunteer Opportunities & Extracurriculars

I’m in a lot of student organizations. From my background being pre-med, I have a lot of friends who are in classes like that. There are a lot of organizations that are focused on that area but I was wondering if there are any things that are outside of school that I could be doing to not necessarily have on my resume, but do that will shape me as a person and help me to be a better applicant to graduate the nursing school.

That’s a great question and student organizations are great. It’s a great starting place. It’s the most familiar for most to get involved. That’s going to be a great addition to your resume. For something outside of the realm of school, there are a couple of different paths you can take and both are equally rewarding and can challenge you as a person and help you grow, which is what these schools are looking for.

You can go completely outside of the hospital and maybe your passion is providing meals for people who are homeless. Maybe can volunteer at a soup kitchen. I have had students who run teddy bear drives for pediatric hospitals and get stuffed animals donated to those hospitals. It could be anything that you feel passionate about that you would feel good that you are contributing. It could be anything. It could be mentoring kids like the big brother, big sister program or for high school students who don’t come from the best areas or volunteering to go to high schools and talk about the career path of nursing.

It’s finding ways to get involved in the community and to give back in an area that you are going to love. In the hospital, there are multiple ways to volunteer. You can volunteer through the Red Cross. You can look for ways, once you are done with nursing school, to get involved with the AACN which is the America Association of Critical-Care Nursing. I always highly recommend getting involved in that pathway as well.

I think to start, if there are volunteer opportunities through your hospital that you are already potentially looking to get a job there, that’s a great resume booster. Equally, on occasion do different volunteer aspects outside of school in an area that you are passionate about and that you want to give back to.

Networking Opportunities

The next one is networking. I love that you mentioned this. I feel like I preach this all the time. Is it working? I hope it’s working because this is an area that I equally fell short on and didn’t know the value of it until much later on in my career. By the blessing of the Lord, I happened to know someone who was two years ahead of me in CRNA school.

We were friends in college. I didn’t seek her out because she was a student. We knew each other. We hung out in college. We had a few mutual friends, and I’m like, “Why have I not reached back out to her?” She’s in school in the program I want to get into. I need to reach out to her.” I did that and I had already been rejected at the time I reached out to her. I had faced my first rejection.

I was like, “I need to start figuring out other ways because what I’m doing is not working.” She was tremendous. The help she provided me, she gave me a study guide that she used. She’s like, “I will put in a good word for you. I will talk to the program director.” I’m like, “Thank you. That’s amazing.” I’m not saying that that’s going to get you in and they don’t play favorites like that, but what I have been told specifically from them. If they have a current student who’s a good student who puts in a good word and who says, “I know someone who’s applying and this is their name, and I highly recommend them.” They’re going to take that reference very seriously.

It doesn’t mean that you are a shoo-in, but they ask for three references. If you have a current student give you that vocal word-of-mouth reference, that’s going to tee up them to think, “I would trust them because they wouldn’t recommend someone for this program. They know what the program is like if they don’t think that they would be good students.”

Networking is huge with students. Also, touching base with faculty. Let them know who you are. Your first time meeting them, and maybe they might not remember you, but you should hopefully, remember them and have met them before at an open house or at different events. If the school you are going to is local and they have an in-person open house, go to that. In a lot of these schools that I saw, it was Emory. They had a little exposition for the College of Nursing. They had a booth at that exposition of Emory’s CRNA program. Again, it’s a great way to meet these faculty who were already going out and about and doing career exploration events.

Sometimes, this can be harder to seek out, but this is why contacting the schools early and seeking out, “When’s your next open house? Do you guys do any events around the city? I’d be interested in attending and meeting.” Sometimes these faculty are like, “Let’s step in during office hours. You come and we will talk.”

That’s the golden ticket. If you can get them to say, “Come in my office and we will sit and chat.” Not everyone will have the time and they don’t typically always do that, but a lot of faculty will. If you have a nursing student reach out to them who’s gung-ho and wants some FaceTime with them, they will bring them in for a one-on-one to sit and chat.

That is such a great way as an icebreaker and a non-threatening way to meet someone. I’m sure it’s still nerve-wracking, but it’s not your interview. What’s cool about that is if you stick with that and you go every year to their open house and they get to know you by name, and when you show up on that interview day, they are going to be like, “Hi, Colby. It’s nice to meet you.” I think that’s a cool way to play it. The fact that you have the time now to build that relationship is awesome.

Similarly, once you get out of school, some of these networking events can be quite costly. That’s why I recommend open houses first and anything free through the College of Nursing. When you are out of school and you have a nurse’s salary, I do think you should invest in going to conferences, whether that’s through your state association or the national association.

Extra Classes For CRNA School

I do think that’s very worthwhile but again, I don’t think that needs to happen until after you are done with nursing school and you are at least getting an RN salary to help compensate. It is $400 or $500 plus travel. It was not cheap. The next question is about extra classes for CRNA schools like Biochem and Ochem. Can I ask what you have? I know you are a pre-med.

Do you want me to tell you all of the specific science classes?

We can do that but do you already have biochem or Ochem or are you questioning what chemistries you need?

I have General Chemistry 1 and 2, and Organic Chemistry 1. I’m taking Organic Chemistry 2 and I’m taking General Biochemistry. I’m also taking Genetics. I don’t think that Genetics will have anything to do with CRNA school. Those are the “upper level” classes.

I can already tell you have way more than most nursing students will ever have. That’s why you said any additional. Pre-meds usually have more than they need. You definitely do.

It’s pretty toxic, but it’s okay.

They are hard classes. Most nursing programs, and it’s so different, that’s why I ask specifically about those classes because of some nursing programs…I even have a cousin who went to a really well-known four-year college, and they give her an Intro to Chemistry. I’m like, “That’s not even a real course.”

That’s here at my university.

I’m like, “What is this?” I told her, “If you are going for CRNA, you are going to have to step it up a notch.” She just laughed. Those are the issues that you see. Some nursing programs don’t even have their nursing students take a thorough Chemistry course and so then you would need Chem 2 or Ochem. Typically, some schools require Ochem. Some nursing students only have Chem 1 and Chem 2, and they have no Ochem or Biochem. These schools like to see either one or the other. You usually don’t need Biochem and Ochem, but they would like to see you take one or the other if all you have is Gen Chem.

Anesthesia school is mostly Ochem. I will say that. I never took biochem, so I guess I can’t speak to that, but I do remember in anesthesia school. The chemistry we did cover the most tended to be Ochem but the basic concepts of chemistry that you learn in Gen Chem are in there too. That’s why it’s a blend of both. With Genetics, you are right. That won’t help you, but it’s still a science course. Make sure you focus on that. As far as the rest year, you probably have Math.

I don’t have Calculus. I have College Algebra and Statistics.

There’s only one program and I want to say it’s UAB. It’s either that one or one of the other schools out there that require either a Pre-calc or Finite Math. It’s weird. Pre-calc is what you would pick versus Finite Math. They are Precalculus math courses, but like for you having algebra, I would assume that that would fall in the Finite Math category.

Again, if you ever applied to a program that required real specific Math requirements, I would ask if your Algebra counts. 9 times out of 10 or 9.9 times out of 10, it will count towards your math. They don’t require calculus and things like that. Usually, Algebra is fine. I’m sure you have plenty of Biology, Anatomy, and Pathophysiology since you are in that right now.

I have taken Biology 1 and 2 and Anatomy 1 and 2.

You are covered there, but as far as any extra classes, you mentioned Stats. Some schools only require Undergrad Stats. Some schools require grad Stats. Most schools don’t require grad school Stats, but for the outliers that do, you would need to get a graduate level Stats course, but that’s not the majority of schools. Understanding your school’s requirements will help you with that. I know you were concerned about the courses expiring and you mentioned Stats. That is something to keep in mind depending on how long you need to work after school.

I don’t know if your programs require 1 or 2 years of ICU experience, but some schools require that. There are science courses within those five years and that’s hard. You have to have done it at CRNA school, especially if you took it during your freshman year. Reach out to them and ask because I feel like they only have that requirement for very specific courses give or take Stats. Maybe they only care about Chemistry or A&P Anatomy and Pathophysiology. Maybe they don’t care about stats. Reach out to them and see how current the specific courses need to be. Let them know that you are applying and that by the time you apply, it’s going to be cutting it close. They will let you know what the expectations are.

What about Physics 1 and 2? Do many CRNA schools require Physics?

I have only run across a couple who don’t necessarily require it, but they recommend it.

As you say, if it’s recommended, it is required.

I’m trying to think of what school it is. I need to start writing this stuff down when I start reading these websites. I don’t think it was Newman. I can’t remember anymore what school it was. There was one site that it came across that did say something about Physics, which I was surprised about because again, it’s not very common to see that as a prereq. I wouldn’t take anything until you narrow down what schools you are going to apply to and see what they specifically require.

This is another good reason why to go to open houses because these are good questions to ask directly to the program. In 123 or 126 schools, it’s impossible to know all the little nuances for every single one when it comes to courses. That’s why it’s always best to get this type of information directly from your program because they’re going to know best.

Similarly, they might say, “You could take Physics,” but then you are like, “What Physics? Where?” That’s another thing that we see students struggle with. They might get a recommendation, but then they still don’t know where to take it. Should I take it online? Should I take it at a community college? Do I have to go to a four-year college?”

Recently, we had a faculty Q&A session office hour through our Guarantee Program. This question got brought up, “Should I take my classes out of a four-year degree or a community college?” When it comes to picking where to take your extra classes or any classes you need, it’s up to you. Community college is more affordable. They have more online courses than going to class. Do what fits best for you but everything else being equal, if they look at a community college versus a four-year degree, they will side with a four-year degree being the brick-and-mortar school probably having more challenging courses.

If you got a B-plus in this chemistry, but they got an A, they’d say, “That’s probably equivalent.” I know people probably don’t like to hear that, but don’t shoot the messenger. It doesn’t mean that a community college is a no-go and that they are not going to consider you. I’m saying they understand that there is a difference usually between a community college and a brick-and-mortar type of school. That helps with extra classes. The biggest hurdles. Let’s get into grades. I told you to let me know what your grades are if you are okay with sharing.

GPA For CRNA School

That’s fine. My overall GPA is 3.6. My Science GPA is 3.9. Are we counting Psych as Science?

No.

I think it’d be 3.95 is what I calculated, but I don’t know if you do two decimal places.

What I can say is you are fine in the GPA route. Depending on the school. In some schools, the average GPA for acceptance is 3.7. That’s on the high-end. It means half below, half above, 3.7 is the average. There are some schools whose average for acceptance is right around 3.4. That’s on the low end of what I have seen. Across the board of all CRNA schools, the most common GPA is 3.5. That’s the average. The average is 3.5.

I have been seeing more and more schools trending upwards. I think it’s due to the competitive nature of how many applicants there are. When I started mentoring back in 2019 and the pandemic hit, I was like, “I have no idea what’s going to happen. I think people are not going to apply. They are so distracted. They are going to see a giant dip.” It was like, “Everyone applied.” It turns out it was a record year for applications. It stayed a record. It means these schools are seeing usually more applicants than they ever have in previous years. That’s what I have been hearing from all the faculty I have been speaking to.

With that being said, I think the reason why we are seeing the GPA tick up is that now they have a bigger application pool to look from. It’s not that GPA is everything. It sure heck is not. I need to get back to a student who got rejected and they have a high GPA. They thought they had a solid application, a solid interview, and they are like, “I don’t understand.” What I have to say to this is there is usually always a reason. They didn’t get any feedback.

That is so depressing.

Yeah, especially if you are like, “I don’t know. What else could I possibly do? Stand on my head and count to 5,000.”

That’s so tough.

My thought process around a situation like that is if you have a solid GPA. You have a solid application. You think you have a solid interview if there’s probably something you are missing or maybe not recognizing. I say this in the most humble, kind, and empathetic way possible that I have seen great candidates get rejected because the faculty thought that they had either ego or maybe they thought that they knew everything already. They were worried about whether they were going to be teachable.

They saw them as someone who maybe didn’t have the highest emotional intelligence. We all lack in that realm. At some point, that’s something that you build upon, but it’s about being aware of your body language, your demeanor, and how you are coming across. Are you getting defensive? Are you insisting that you are right?

Do you want to work with someone who’s more humble and can be more teachable and moldable or someone who’s insistent that they can’t be wrong? I’m not saying this is the case, but it came to my mind. I’m like, “That does sound odd,” but usually, it’s that they missed something completely. I had a student who was baffled. He was like, “I don’t understand.”

He went on to get accepted, but the only reason, and we ended up digging up and finding out is because he tested out of Algebra in high school because he was a good student. In college, he tested out of it. He went on to nursing school, graduated all that, and had a 4.0. He had great grades. He went to apply to school, and they completely rejected him. He didn’t even get an interview. It turns out that he didn’t take algebra in college. He is like, “I tested out of it.” It didn’t matter. He still needed it.

That put him in a non-qualified applicant pool on the applicants and they don’t necessarily reach out and say, “You don’t have this course.” They expect you to follow the prereq. If they say you need Algebra, don’t make assumptions. Who knows what the story is with that, but I equally think that if you think you have done everything right and you have good grades and you still don’t get in, you have to then take a humble approach and say, “Is there something I could improve upon?”

Whether that was my interview and whether you thought you were knocked out of the park. Maybe they thought you were defensive. That’s when you get some feedback from a mock interview and can gauge. I have done mock interviews where people are clicking pens. I don’t know if they even realize they are doing it or if they are slouching back. That is not how you interview for CRNA school. You never know. Maybe culturally or maybe whatever it is. Maybe they don’t think anything’s wrong with that, but the way that the faculty sees it, it is.

It is all the body language.

I have seen students who culturally too don’t make eye contact or maybe their English is not super clear or they talk fast so they can’t understand them very well. They think everything went smoothly, but they can’t even understand them. Sometimes you say, “Slow down a little bit. I know your nervous energy is coming out.” I can just speak, but you are not aware when you are nervous. You come out of a situation like that and you are like, “I think I’m doing pretty good.” From their side of the curtain, they are like, “I need a drink.”

Who knows what it is, I guess GPA is not everything, but you sound like you have a solid GPA. The reason I went on that tirade is that I don’t want you to think that you are golden because of this GPA. It’s very solid. Your Science GPA is almost perfect, which they are going to love. Overall, above the benchmark of what they typically accept for average schools anyways. GPA is not going to hold you back at all. More than likely, you will get an interview as long as your resume has more than five words on it and you meet the requirements.

I was going to ask, do nursing classes count as your Science GPA? I would assume Patho counts as a Science GPA. Also, what about pharmacology?

They do look at Pharmacology. Now, I will say most schools only look at your core courses, which are things outside of the college of nursing. That’s why a lot of these CRNAs get hosed because they are like, “I got a 4.0 in my BSN.” I’m like, “It doesn’t matter.” Maybe it does but it doesn’t matter the way the Science grades do. You could have a 4.0 and an overall 3.6, but your Science GPA might be a 3.1. They are like, “Are you going to hang with all the science courses we have because we are going to throw them out? It’s like a fire hose here.”

That’s their worry but there are always ways to get around that like taking a current graduate-level course and doing well. Proving that you are ready and able to stand up for a graduate-level science course rigor. They do look at nursing courses for sure as you mentioned like Pharmacology, Anatomy, and Pathophysiology but for the most part, when you figure out your Science GPA, other than those few things you mentioned, they only look at your biologies and chemistries.

Overcoming Imposter Syndrome

The things that are typically out of the college of nursing won’t start with a NUR. I’m not saying you should brush off your nursing courses at all, but they still look at it overall. For the most part, it’s not like your nursing classes don’t matter at all, but they don’t impact your science GPA as much as your prereqs do. The imposter syndrome is so sad here. Let’s talk about this. I have a whole episode on this. It’s with Nurse Mo. It’s from quite a ways back. What’s going on?

School and life are hard. I don’t know if everyone feels this way, but sometimes it’s like, “Am I good or smart enough for this?” Just feeling that. I got on by favors or whatever. I’m not saying that this has happened, but sometimes I feel like I can experience that. Is there any way that you recommend getting over that urges? I guess positive affirmations and stuff like that.

The thing about positive affirmations and don’t get me wrong. They have their place and their value, but I do think you can’t tell yourself something that you don’t believe. You can say something all day long, but if you don’t truly feel it, it’s not going to do you any good. I do think practicing even a simple smile and positivity in your life brings in endorphins and it makes you a happier person if you are willing to have a sense of gratitude every day.

Even when things are going wrong, you are like, “The reason why I’m stressed is that I have a lot in my life. I’m fulfilled. This is what fulfillment feels like. I’m full, but I am so well. It’s so good. Having a different mindset on the imposter syndrome, I had a unique perspective on this that I liked. Everyone experiences this feeling, and the gist of what I learned from it is if you were not experiencing imposter syndrome, you are not in the right room.

It means you need to challenge yourself to feel uncomfortable. Maybe you are not capable, which is a sign that you are challenging yourself to grow and to become capable always. You will always start at the bottom of the barrel. We all had a starting point. We work our way to the top, and if you ever get to the room where you are like, “I don’t need to work anymore,” then find the next room that’s more challenging. When you do feel uncomfortable and with whom you do feel like you are not as knowledgeable or qualified. Put yourself there so you can eventually get there.

That is what life’s all about. Imposter syndrome is a sign that you are challenging yourself to what you need to do to be fulfilled. If you put it in that perspective, it’s not a bad thing to feel it. It only means you need to embrace it versus pushing it away. When you push away and say, “No, I can’t,” you are not pushing yourself toward personal growth. I always love the phrase, “No, not yet,” or, “No, doesn’t mean never.”

I say it to our kids all the time, “No, doesn’t mean never, but not yet.” It’s hard for a four-year-old. I have to remind myself of that too because things don’t always turn out the way that I wish they did. You can work hard at something and not have the results you want. You have to say, “I can either do two things. I can feel defeated and walk away or I could show back up tomorrow and I can try again.” Those are your two choices.

How you frame and how you feel about the defeat embraces the actions you take the next day. Not internalizing it and making it feel like it’s you that’s the problem. You are not the problem. Life in general produces situations and an environment that can be challenging. You do the best that you can and that is something to be proud of. To show up for yourself and what you want to achieve in your life is something to be proud of.

That is good advice. I like how you said that you can either walk away or you can come back the next day and try to hit it even harder. That’s wise.

Also, a different strategy too. That’s why I said before the person who’s like, “I don’t understand. I have done everything right and I still didn’t get acceptance.” I’m like, “The harsh reality of that situation is maybe not everything was right.” It’s hard to hear, especially when you put all your blood, sweat, and tears into something but we will all experience these defeats. If you don’t understand how to take it and this person, again, I’m sure they are beating themselves up personally but that’s not conducive to moving forward.

What they said is they wish they didn’t get their hopes up. That’s a terrible place to be. Instead of feeling defeated, that’s a sign of defeat. That did hurt. I had that hope and that excitement that this was going to be it for me, and it wasn’t. I feel defeated. I feel like I got punched in the stomach, but how badly do I still want this? Can I figure out a way to improve? Can I figure out with no feedback and by assessment and by asking my peers?”

One of the things I was challenged to do is I have done coaching myself on my own mental status because I have had my periods of ups and downs. One of the things they had me do in this coaching was they said, “Go to one of your closest peers that you trust that if they gave you negative feedback, it’d be a loving mutual friendship.”

I went to one of my closest friends whom we lived together in college and went to nursing school, grad school, and all of that. I said, “What’s one of my weaknesses?” It was insightful and it was exactly what I need to hear. She’s like, “You are one of the hardest workers I know, but you tend to take on too much. You tend to put too much onto your plate. You tend to have all these wild ideas and you tend to go after them all. You end up spreading yourself too thin.”

I’m like, “That’s good.” From that, what I started practicing was the ability to say no, and also the ability to set boundaries. Also, realizing that when I say yes to one thing, I’m saying no to something else. That was huge. The fact that I say yes, I equally say no. To stop and think that way, I now can say, “I know you need this or you want this from me, but I have to say no. If I say yes to you, I’m saying no to my children or I’m saying no to my own personal time.

It doesn’t feel good to say no especially when you think you are being helpful. That was a hard boundary that I had to create within my own life to make sure that I could be sustainable and I could sustain what I want to achieve. Similarly, I think a lot of people will face that in their journey to becoming a CRNA. That was an off-tangent topic.

No. That was good. It’s very insightful and I relate to that.

I’m glad that helps. Don’t beat yourself up. You are doing a great job. One day being in a position, I don’t think the imposter syndrome will ever go away if I’m being perfectly honest. At least, if you are doing it right, it won’t. Again, you are always going to strive for the next thing. It’s going to be like you are a CRNA and they want to put you in open heart case, and you are like, “Me? Okay. I have never done it but let’s do it.”

I will never forget it. They pulled me out of a room one day. I was in a nice room. It was super easy, but I was an open-heart CRNA and I did all the big vascular cases. They had a ruptured AAA coming in. They are like, “You are in there.” I’m like, “My day goes from this to like that.” I was nervous. I was like, “What is this?”

I had done a handful in school, but I had never been on my own in one of those cases. It ended up being fine. It was a lot of fun. I was drenched with sweat by the time I was done but it was fulfilling and rewarding. Also, a good outcome for the patient too. Put yourself in those. You are going to always experience that where you are like, “Okay. Here we go,” and knowing that you are going to learn and grow as you challenge yourself.

That goes with imposter syndrome. I don’t know if we have a set time limit or anything for this, but I was going to bring up the next point. When I was shadowing as I said earlier, one of the CRNAs was like, “I’m going to give you some advice. Don’t tell anyone in nursing school that you are going to be a CRNA because then they are just going to think you are a jerk or something.”

I thought that was interesting. I don’t know if it’s true or not. He said that he had some friends in school that were like, “I’m not going to wipe butts. I’m not going to do whatever in the ICU. I’m going to go and be a CRNA and make all this money and stuff.” I’m not trying to be a prideful type of guy and I’m trying to be humble and everything but I was going to pick your brain about that and what you think about that.

Isn’t that toxic?

That’s what I’m saying. It’s very toxic.

What I can say to that is like when people give you this type of advice or when they are giving you this, it is because it’s their experience. It doesn’t mean it’s going to be yours. Whenever someone gives you some bias like that…I had a CRNA in one of my last weeks in clinical say, “I was going to hate my life for six months and I was going to be so stressful.” I went home and cried. I was like, “I’m almost done with school and they say I’m going to hate my life for six months.”

I then realized that she was projecting her anxiety and her experience onto me which is not right. Recognize stuff like that because you can’t make that what your experience is going to be like. I did not have that experience. As far as it is true, it probably depends on the person. It probably depends on whom you are hanging out with, and whether that’s going to be the case.

If you are hanging out with mentally toxic, negative, not growth-mindset but rather shrinking-mindset people, you are going to probably experience those types of attitudes toward becoming a CRNA. For me, what I did is I gravitated toward the people in nursing school who were equally on the path to CRNA. Find out who they are. Everyone else can go on their merry little way, plug your earbuds in and tune them out. It doesn’t matter. They don’t need to be your friends. Get along so that they are not fighting every day. Find the people who are going to support you and your goals and you would equally support them.

You have to find like-minded people that aren’t toxic like that.

I wish nursing wasn’t like this and I don’t know if it’s like this. If you noticed this in med school, why would we even create that culture? It’s annoying. I don’t think it’s something that I as one person can break, but I do truly believe a group of people in a community can come together and try to break this toxic mindset that nurses have. I think it’s going to take time but nursing is such a wonderful profession and the community itself is wonderful, but there are a lot of old-school thoughts and stuff like this that needs to be put and laid to rest.

We need a culture shift and a culture change. As somebody here who says like, “I’m just a nurse.” That is the most toxic thing you could ever say. You have the education and you are directly in a patient care clinic. You are not just a nurse. I had an SRNA that I was mentoring in clinical and I asked her, I’m like, “Why did you go to CRNA school?” She’s like, “Do you want to know? Is this a test?” I’m like, “It’s not a test. Just tell me. I want to know. I’m curious.” She’s like, “I’d go to the attending rounds and stuff and I’d say, ‘Why do we choose this modality over this modality?’ More than once I was told, ‘You are just a nurse. You don’t need to understand why. You just need to take directions.’”

I never had that happen to me. Luckily, there was mutual respect, but not in all work environments. As I spoke to you, try to get that feel for what the environment’s like before you take a job there. She was like, “I knew I had it in me to make the call, to make the decision, to know the treatment, and to understand what I want the outcome to be. I pursued CRNA because I desired that. I didn’t want to be seen as someone who couldn’t make decisions because I knew I could.” That’s what empowered her. “I’m going after CRNA to get more autonomy and be able to make more decisions myself.”

As far as getting CRNA yourself, nursing school is probably not as big of a deal. Just be cautious when you are in the unit. Again, similar to me, I knew who my pals were at that point. The girls I went to nursing school with all want to be CRNAs. We all end up at the same hospital. We all went to Ohio State. Some were sprinkled in the SICU. The SICU and MICU were the two units where we all came from, but we had each other from nursing school to the ICU.

We didn’t have the need to share it with our coworkers because we didn’t have to. It wasn’t necessary but I equally knew that our unit was supportive of nurses going back for grad school, and we weren’t the only ones pursuing CRNA either. There were other ones going back. Building rapport with your charge nurse and your nurse manager is key but it wasn’t necessary to share it and blast it to the world. We stuck to each other. We helped each other. We gave each other notes. We studied together. We were our support group at that point. As far as keeping it to yourself, I don’t think you should. I think you should find someone in nursing school to team up with who is on the pursuit.

Thank you.

The GRE For CRNA School

You are very welcome. We talked about stats expiry. When should you start studying for the GRE?

I don’t know if that’s important.

It depends on your own timeline and if you know you need to take it for the schools you want to apply to. Don’t take it more than two years early because it will expire. GREs are only good for two years of scores. Ideally, you want to take it within the year of applying. I would give it a year because sometimes you might have to take it more than once. They are not fun tests, but they are looking for a score above 300. Most schools are. Some are high up to 305 is what they are looking for.

They look for the 50th percentile for both Math and verbal and those numbers can somewhat fluctuate every year. I can’t give you hard numbers. Most of the time, it’s 152 in Math and 150 in verbal. It shifts right around the 150-152 mark give and take or averages. If you do better than average, the better. If you get 310 or higher on your GRE plus a 4.5 in writing, that’s going to be good.

If you can get a 4.5 in writing and a 310, you are going to be set. If you get 298, depending on your school, if their requirement’s 300, you need to hit the 300. Some schools have as low as 292 or something like that, but that’s not very common. I would say the most common low GRE score I see on a school requirement is 298. The majority are 300 or 305 is what they require. Take it about a year out from applying to school is what I would advise you.

Thank you. Pertaining to our next talking point. I know you say on all your social media and your show that it’s sometimes recommended to take a graduate-level Pathophysiology course or a Pharmacology course. I think that’s interesting. Is that something that you would recommend doing as soon as possible outside of nursing school or is that something that you would recommend doing close to the application?

For example, the school I went to had a grad A&P course. It is what you would take when you started the program. That was one of the first courses you would take and it’s hard. They preferred their students to have it out of the way before they started their program. For you and your GPA, do not take an A&P course just to take it. I say that because it’s expensive and it’s time-consuming. You don’t need it for your GPA.

If you get an A in this current course you are in, to me, your knowledge is there. You don’t necessarily need it for the knowledge base. You will be taking it to take it. I think that could be a waste of money and time versus waiting to see where you are going to school and having a more direct vision of what the prereqs are. If they have a course like that that you can take before you gain acceptance, take it. It will lighten your burden when you are in school and you are going to put those dollars towards your tuition that you are going to graduate with versus throwing an extra $3,000 out in the world and then you have to take it again at that university.

You create double work. I would first wait to figure out what your school requires and if it’s something that you can take before you start. A lot of them have a role-specific A&P course that’s for the anesthesia program that you cannot take until you gain acceptance. That’s why I tell you don’t just go take one. If you had a lower Science GPA, I would recommend that you go take one because it’s going to boost your Science GPA, which will help you in the interview and help you get in. You don’t need that. The last thing was choosing ICU as a new grad.

Best ICU Experience For CRNA

I know you have a bunch of episodes on this, but I wanted to pick your brain about that.

It’s fine and you are right. There are a lot out there. This is also a very interesting topic because I feel like this is something that can vary based on whom you listen to. I have heard so many nurses think they need CVICU and they have to have it. Many of them will have MICU experience and then leave to go to CVICU and start at the bottom of the barrel as new nurses again. They have to build that relationship with the manager again. I’m like, “Why did you leave? If you had a good MICU or a good SICU, stay put and have that recourse. You can ask for that reference letter. It’s not like you can say, ‘I’m six months in, but give me a reference for CRNA school now that I’m in CVICU.’”

Be careful. It’s about what you enjoy and what you will be passionate about. As I spoke about finding the support, the growth, and the leadership roles. Some nurses are like, “I don’t have any options to do research here. I don’t have any options to do leadership committees.” They hinder you and you have to work here for a minimum of two years before they even give you a reference letter. The residency is 2 or 1 year long. If your residency is super long and you can’t apply to CRNA school until your experience after residency, that could be a big deal versus going to a unit where their residency is only six months or less and now you start acquiring that.

Once you are on your own as an ICU nurse, that’s when they start your experience. I can’t speak for all schools on that but I have heard that if you are paired up with another nurse, they might not count that toward your years of ICU experience. Be aware of that and I can’t speak for all schools because I don’t remember that being the case when I applied, but again, maybe I wasn’t aware. I don’t know if that’s a similar case for all schools or just unique. MICU, SICU, CVICU, and even PICU, the Pediatric ICU is fine as long as you know your school 100% takes it. The only units I say to avoid are ER, Cath lab, PACU, and pre-op.

I don’t know why people even think that those are ICUs, but they do. I had a PACU nurse who mentors PACU nurses reach out to me and say, “Can you talk to my group of students so they can learn how to go to CRNA school after they graduate with whatever certification PACU nurses get?” I’m like, “They are going to hate me because I’m going to say, ‘You can’t get to CRNA school with a PACU experience. You are going to have to go to the ICU.’” I’m like, “Sure. I will educate them because that’s a huge mistake that they are being misled thinking they can get a PACU certification and go to CRNA school.”

I will tell you right now if our patient is really sick, they are not going to PACU. They are going back to the ICU. Bringing a patient over to PACU that is unstable, highly unlikely. It’s not very common. I’m not saying that patients don’t get sick over there. They can. They could be intubated or they go code. Things happen in the PACU, but you are not titrating drips for a very long time if at all, or managing ventilators very frequently. You are holding a lot of airways and doing things like that.

ICU Level 1 Trauma, if possible. Level 2 is fine too. Level 2 is the same acuity as Level 1. The biggest difference between the Level 2 and Level 1 is a Level 1 is typically in an academic facility that does research where Level 2 typically does not. That’s not always the case, but I’m only saying. Like Columbus for example. Ohio State Level 1 and Riverside Level 2. Riverside’s still a very good hospital. It’s just not as academic. It doesn’t have as much research, but still very sick. Use your best judgment.

In community hospitals, you can get sick patients there too, but it leaves the imagination to play. Where these faculty don’t know every facility under the sun, so they see this hospital. They see that it’s not a trauma-ranked hospital, and your resume is very vague. It says how long you have worked there in the respiratory ICU. You are like, “How often do you see ventilators? How often do you do active drips? Are you challenging yourself here?”

What I always say to people is if you are in a unit where patients get transferred out because they get too sick, follow them. Where were the ambulances going? Drive there and put in a job application. That’s where you want to go. Follow where the sick patients are going and that is a good unit. People are like, “That’s so far away from where I live,” and things of that nature. I have empathy for that and I do feel bad, but the reality is these schools are going to pick the students who get a good experience for their interviews. Another reality is the fact that a lot of these CRNA schools are in these hubs and cities that are around higher-level trauma hospitals which is helpful if their applicants are coming from there.

If you live an hour outside of that city and you are working at a small remote hospital, you might still get in, but knowing that you are not probably putting your best foot forward and if you are going to be willing to travel and commute to class an hour away, they will equally question why you are not willing to travel to get the experience. Maybe that means moving a half hour outside of where your comfort zone is so you only have a half-hour drive and so now you have families for half an hour and work for half an hour. I think of all those things before graduation. It’s not always ideal, but it’s temporary. Does that help?

That is good. Thank you so much. I appreciate it.

You are welcome. I didn’t mention neuro. Neuro is fine. Just make sure it’s a high enough acuity neuro. If they do ICP bolts, they can have patients on PRISMA in neuro units. Looking for units that have things like CVVHD, ECMO balloon pumps, Swan-Ganz, A-lines, and different advanced life support measures like RotoProne beds, or HFOV, High-Frequency Oscillating Ventilator.

When you are working as a nurse’s aide, this is another good time to judge the acuity. You can make that decision as to whether this is going to be an ICU that’s going to challenge me. Not only do the patients have to be challenging, but the environment has to be conducive to your growth. Don’t pick the real high acuity and have a toxic work environment. You are going to be miserable. Thanks, Colby. This was a lot of fun. I appreciate you coming to the show. Is there anything else you want to touch on before we wrap up?

Not really. That was all I had. Is there anything you want to talk about?

No. I think we have covered quite a bit of the topic. This is also insightful for me because it allows me to see where someone like you was coming from, and I’m excited for you to embark on your nursing journey. Your mom is going to be thrilled.

She is. My parents are very supportive.

That’s key too, having the support, and as I said, finding peers equally to support you. Finding students who would also cheer you on. A lot of times by going to open houses, you can network with students too.

Thank you so much. I appreciate this opportunity.

You are very welcome. It was a pleasure to chat with you.

Important Links

• What Does It Mean To Be An Opt Out State? What’s The Difference Between AA, CRNA and MD? – Past episode
• Imposter Syndrome with Nurse Mo– Past episode

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