You’re in! But we all know that it’s not going to be a walk in the park, and the going can get tougher from here. Today, Jenny Finnell talks about the fear and anxiety around starting or being in a CRNA program. She also shares tips on what to do when the fear sets in, keeping the balance between life and school, managing stress, knowing when to speak up, and more insights on what you can expect and may need to prepare for to set you up for success as a Certified Registered Nurse Anesthetist.
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How To Handle Anxiety Around Starting CRNA School
When Anxiety Sets In
We are going to discuss dealing with anxiety or fear around starting your CRNA program, or even when you’re in it. Many students reach out to me, whether they have yet to start or already started, and even a year-end, but they’re in what I call the thick of it where they’re being tested. Their anxiety, being overwhelmed, and fear is high. They have bad days that sometimes knock them down and don’t know how to get back from that. First, I’m going to discuss how to handle the anxiety around starting your CRNA program, the Imposter syndrome that sets in, and the fear and the overwhelm of like, “Can I do this? Am I ready?”
I also want to reiterate that this is a completely normal feeling. I would vouch to say pretty much everyone who gains acceptance in a CRNA school probably feels this way at some point or another prior to starting their program. You’re excited, but there’s a little piece in the back of your brain that’s like, “Is this for me? Can I do this? Am I smart enough? Am I capable? I’m getting ready to change my life.” Change is scary. We’re creatures of habit, whether we like it or not, we tend to fall into routines.
You’re getting ready to uproot your life and your routine and start all over again as a novice, a beginner, and a learner. Financially and time-wise, it’s scary because you’ve never experienced this type of strain before both on your time and also on your finances. There’s a lot of fear of the unknown, whether or not you’re going to be okay. I totally feel for you and may give you a big virtual hug. It’s okay to be overwhelmed. Take a big deep breath because I can feel it for you. Your chest is getting tight. You feel like the walls are closing in and you’re scared.
Know that’s a normal emotion to experience, but I also want to reiterate that you will be okay. Do you know why? Because you’ve always been okay. You wouldn’t have made it here if you didn’t have the strength and ability to pursue CRNA. I want to remind you that you were chosen for this. These schools are good pickers. They pick students they know can be successful in their programs. That is the whole point of having the application and the interview process because they saw it in you. They know you have what it takes.
You have to work on believing that yourself, which is a struggle sometimes. Sometimes other people have more belief in what you have in yourself and that’s a problem. You need to stop and reflect on why you feel that you can’t handle this or you feel fearful and address that why. I speak a lot as far as asking why more than once. You might say, “Jenny, why do you feel afraid that you can’t handle this?” You can say, “I don’t know if I’m going to be smart enough or be able to get the knowledge that they’re teaching me.” Why is that?
Maybe because in the past, I haven’t always been the best student. Why does that scare you? What is it about that past history that you think will hinder your ability to be successful in the academic realm? I don’t know. Other than the fact that I fear of the struggles I had in the past is going to affect me in the future. That’s not a realistic fear. I’m fearing the past and that’s not okay. The past doesn’t define who I am. I can always work towards my ability and capability going forward.
[bctt tweet=”Change is scary. We are creatures of habit. Whether we like it or not, we tend to fall into routines.” via=”no”]
Maybe I’ve struggled in the past and things haven’t always come easy, but look where I got. I’m here. I showed up. I did the things and succeeded. Why would I not believe that I’m equally as capable of continuing to do that? You should and you can believe in that. It’s up to you to set that mindset to give yourself the chance to succeed. You wouldn’t have gained acceptance in a CRNA school if you didn’t believe in yourself. I know you do, but you’re letting that fear kick in, and now you’re questioning things. You’re scared.
As a human, when you’re feeling the emotions of fear, your natural tendency is to stop. If you were afraid of being hurt, you wouldn’t proceed. You’re afraid. You’re letting that fear stop your ability to move forward. You need to address that now prior to starting school or even when you’re in school. Address this fear if it starts coming up for you. I want to remind you that you were picked and chosen. You can do this. Schools are very good pickers. Even if you don’t believe in yourself, know that these programs seed in you. They don’t just pick anyone. That’s why getting into the CRNA school is so competitive.
I want you to believe in yourself. As far as doing all the things, getting through school successfully, juggling the finances, your personal life, and having what feels like very little time compared to what you’re used to are baby steps. This is not about going from 0 to 100. This is about small little tiny adjustments to your personal schedule, financial schedule, or budget, and to your ability to adapt your study technique. You have to try to learn how to adapt. You can’t adapt until you’ve at least tried.
The Tough Gets Going
While it may seem scary, know that you’re going to figure it out. I always like the saying, “Everything is figureoutable.” I have to repeat that to myself quite often. One of my, I would call it, a weakness and a strength because I can argue it both ways. I’m good at arguing is that I’m impulsive. Sometimes, I can get myself into trouble from being impulsive because I go all in. Before I’ve thoroughly thought things through, and I get into it and I’m like, “This stinks. This is hard and challenging. This isn’t working,” but what’s beneficial about doing that about my impulsiveness is I figure it out. I get scrappy and gritty. I’m in the mud. I’m like, “This stinks and hurts, but I’m not going to stop now. It’s too late to turn back.”
It’s only one way out and that’s forward. I have to remind myself of that often when I feel overwhelmed or feel scared with what I’m taking on. With my impulsiveness of me, sometimes I bite off more than I can chew. There are times when I have to admit that and try to strategize so I can recover from that. It’s the same thing in CRNA school. You’re going to be taking on a lot more than what you’re used to, but you will adapt. You will find ways to adjust.
Managing Time To Manage Stress
It’s always about seeking out ways to cope and strategize so you can keep moving forward. Your schedule is super heavy and putting 60-plus hours in a week. You’re lacking in self-care. How can I build in self-care into an activity that I already have to do? A lot of times what I would do in school is I would take my notes at the gym. I would study while I worked out. I got that physical energy out. I felt good because I wasn’t neglecting my studies. That’s a win-win.
It’s little things like that, you’ll get through that. Other things, too, is relationship-wise. I got to a point in school where I wasn’t communicating so much with my significant other because I was exhausted. I was tired at the end of the day. I didn’t feel like, “How was your day?” I might’ve had a bad day, but I won’t talk about it because I was already stressed. I don’t want to hash it out, cry, and experience the emotions around my stress. I want to talk about it and want to go cry in the shower. That’s not healthy.
What would happen is eventually I would break where I would completely lose it and let it all out. All my feelings and emotions would overwhelm him. What I started doing probably midway through the program, I should have done it sooner, is we would make a point at dinner time to at least discuss my day. If it got to be too emotional where I couldn’t discuss it, he would give me that space to know that was the end of the conversation, but he would be there for me.
It made me feel good knowing I could at least vocalize how I felt without knowing that there was a stopping point when I got to the point where I couldn’t take it anymore or I was overwhelmed that I could at least let him know, like, “This was my day and I’m stressed about it. This is why and I can’t talk about it anymore,” but he knew where I was versus me not talking about it and him not knowing why I’m quiet and more guarded. I’m shut off. He knew I had a bad day.
We started adapting that into our dinner routine every day and that helped midway through to the very end of the program for him to know where I was at, emotionally and mentally, within my schooling. It helped our relationship. I made another mistake where I didn’t have these open discussions ahead of time, which I always preach you should do. A lot of times, I preach what you should do because I’ve made so many mistakes and learned from those mistakes.
I discussed with him that this was going to be a big-time commitment and that my studies are a priority. It was one of those things where I said it, but I don’t think we hashed out the how, the why, or the true understanding because it still happened. He still asked me all the time to do things. I had to always say no. Eventually, that ate at me, got to me, and it made me angry, resentful, and bitter. I blew up. If I had to say we had any major argument in grad school, it was over that. It’s funny I remember it now. If you’ve followed the show, you may have heard me mention it like me and my husband were married for several years.
We’re together since we were eighteen. It’s crazy. It’s more than half of my life at this point. That being said, we don’t routinely fight. This is probably getting totally TMI, but I grew up watching fights. I always knew as a child that I didn’t want to marry into that. I don’t want to deal with my anger by fighting because I thought it was toxic. I didn’t like it. It didn’t make me feel good. I got fortunate when I met my husband. He is the sweetest guy ever. We don’t routinely fight, get mad, or even say bad words to each other because it’s not respectful. We own that in our relationship.
[bctt tweet=”The past doesn’t define who you are. You can always work towards your ability and capability going forward.” via=”no”]
I wouldn’t say we did this in grad school, but when I got upset, I got frustrated and felt resentment towards him. I remember thinking, “I need to address this now because I love him. I don’t want to feel resentful towards him or doing something that he thinks is a kind gesture to invite me.” We had to hash that out. I had to explain to him that as much as I appreciate him inviting me and doing all these things, I’m starting to feel angry that I have to say no all the time for things that I want to say yes to. We laughed about it, it was all good, and he understood.
What would have helped this that I have the insight now is, and talk about this in our bootcamp, to block your time. Allow your significant other to contribute to your time blocks so you know when a designated time is to hang out with them and to schedule things that you can do outside. Obviously, things come up, and things change or it doesn’t always work out.
If you at least set aside a dedicated space for your significant other, when they do ask you, they will know like shouldn’t ask because this weekend they have blocked off for study time. Maybe next weekend I can find some for us to do because we have that blocked off for our time. Hopefully, it works out to where you truly can take that space for each other.
At the beginning of every week, like on a Sunday, and obviously prior to that Sunday, you should already have a month blocked out, but get down to the nitty-gritty the week before. On Sunday, you hash out. This is all on my to-do list this week. This is where I think I have personal times, couple times, meal prep time, whatever it is, you find important. I call it your fundamental needs. Whatever your fundamental needs are, you block out that time during your week and you let your significant other know, “This is time I have for you, honey.” If you have something you want to do together, let’s plan it for this time or it could be the opposite. This is a busy week for me and I’m going to have to work through the weekend.
There’s going to be no me and you time other than maybe like a Netflix show before bed. That’s all we got for this week. They know that week they can’t ask you. That could have alleviated some of the issues I had in school. You’re going into unknown territory, uncharted, unknown, and that is simply scary. There’s no way that I can reassure you that you’re going to have everything figured out because the reality is you won’t. I also know equally as well that you will figure it out, survive, adapt and conquer. You didn’t get into grad school to put up your white flag and say, “I quit.” You’re going to have to get gritty and find a way to persevere.
Setting Your Limits
That being said, you have to rely on your support and know when to ask for help. Those are big things. If there’s something like your pride or whatever it is like, “I can do it.” No, if you feel that way, like, “I’m going to be okay. I can do this.” I’m like that too. My pride sometimes gets in the way where I don’t want to ask for help because I feel like I should be able to handle it, but I don’t. I suffered the physical consequences and have a mental breakdown. I have to check myself sometimes because when I get so overwhelmed, it takes so much on my plate. I have to recognize when I’m doing that and say, “I think it’s time to hit the brakes a little bit.”
How can I take more off my plate? How can I delegate? How can I say no? It’s about setting boundaries. I’m going to be perfectly honest with you. Sometimes setting those boundaries feels hard and icky to say no. If you’re a people pleaser, hands up, I’m there, I’m a people pleaser. It is what it is. I enjoy pleasing others and making people happy. It brings me joy. That’s a big part of who I am but sometimes, at the sacrifice of my own happiness. I have to be cognizant when I’m stepping over that boundary. Even though might meet mean saying no or not taking the time to answer someone’s question right at the moment, I have to say no.
This is my family time. This is my evening. I’m not answering questions after this time. I only answered questions this way. I have to set boundaries. Otherwise, it eats into my personal time and my time with my family, and that feels icky. That’s when you start building resentment and that’s not what you want. You don’t want resentment towards school and things that you enjoy doing. Setting boundaries allows you to still enjoy what you’re doing while also still having some personal time to enjoy outside of your school. That’s my recommendation, too, is to recognize when you’re doing that and set boundaries.
The Right Mindset
It’s not always going to feel good. It’s going to feel hard and icky to set boundaries and say no, but at the end of the day, you can’t fill someone else’s cup when your cup is empty. You have to fill your cup before you can pour it into others so remember that. I’ve already touched on mindset a little bit, but the mindset is huge. This comes into play when you start your clinical or even the academics and say, “You don’t get the skill that you hope to achieve in clinical, or get a hard critique from your preceptor,” whatever it may be. You have something happen that makes you question again your ability or who you are, your self-worth.
This is a mindset thing because you’re always going to be tested in life. Whether you’re in grad school, working as a CRNA, a parent, a spouse, a mother, sister, or brother, you name it, you’re going to be tested and have these feelings around, “Am I enough? Am I doing enough? Am I a good person? Am I deserving? Am I worthy?” Naturally, as a human, you question that about yourself, which if you don’t take the right mindset around it and give yourself grace when you even least deserve it, you will eat at your core. That’s not what you want because we’re all human. We all make mistakes and have flaws.
We need to own those flaws and be okay with them. The people who love you will also be okay with those flaws because they have flaws too, and you still love them. Think about it that way. You have a friend and maybe that friend sometimes annoys you, but you still love them. It’s the same thing with your spouse. Maybe your spouse can annoy you sometimes, but you still love them. Every human being and every relationship, you accept the good and the bad that comes with it, including your own children.
Your children are going to mess up quite often. To be teenagers, they’re going to be icky sometimes, but you still love them. As humans, when you love others, you accept the good and the bad. Why not practice that with yourself? You have to love yourself in a way that you accept the good and the bad. That’s a mindset issue and you need to start addressing that. If you’re finding yourself, beating yourself up and recognizing it, that’s part of the whole thing. If you recognize when you’re doing it, it’s going to allow you to deal with it.
[bctt tweet=”It’s always about seeking out ways to cope and strategize so you can keep moving forward.” via=”no”]
It doesn’t mean you’re going to probably stop doing it because as humans, naturally we always gravitate towards stuff like that, unfortunately, but you can train your brain to quit it. You can train your brain when you start going there to recognize and say, “Stop right now. Don’t do it anymore.” Cut off that voice, address why you’re doing this, and go from there. That’s what I’ve had to do.
What I suggest you do is be more cognizant when you’re getting into that place of self-judgment and accept the fact that no doesn’t mean never or no, not yet, that in time it will come. Even if you didn’t perform your best, do your best, you messed up, or had a bad day and your attitude was crappy, you have bad days too and that’s okay.
Voice It Out
Even the best CRNA, attending, anyone has a bad day or their attitude sucks. We preach attitude all the time and you should be aware of that. If you’re having a bad day and it affects your attitude, give yourself a little bit of grace and try to show up better next time. Don’t beat yourself up over having a bad day and not being the best that you could be. We’re all going to be in that place at some point. Me as a preceptor now, I can’t speak for all preceptors, but I would like to think that the majority of them can recognize when a student is maybe having an off day that they’ve been with before.
The hard part is if you’ve never been with a student and the first experience you have with a student is when they’re on their off day, you’re questioning, “Are they always like this? Is this out of the norm?” Sometimes, you don’t know because you’ve only had one opportunity to work with that student. That can be a little hard and a little tricky, but what I recommend for you to do is if you feel out of sorts or you have something personal going on, you have to speak up.
You can say, “I’m here to learn. I’m excited for the day. This is how I prepped, but my dog is sick and I’m in the hospital last night. I’m fatigued and tired. If I seem off, that’s why, but I’m here. I showed up. I’m here to do this, but I wanted to give you a heads up that I might be more emotional than normal.” I get it. We’re all human. We’ve all had pets. Whether it’s a pet or a relationship issue, you don’t have to go into details. You can say, “I have something personal going on in my life right now that’s causing me a lot of stress. I’m here to do my best, but I want to let you know that if I seem a little off or distressed, it has nothing to do with now. I’m going to do my best to be here and be present.”
Give him a heads up because we’re all human. I would hope that if they have any heart at all, they would be like, “I got you. We’re going to get through this day.” They remember what it was like being a student and having those difficult times where they were dealing with some personal issue or whatever it may be, yet they had to still go to clinical all day long and fight through the tears.
Not because they were sad during clinical but because they had something going on in their personal life that was causing them a lot of emotional distress. Reach out to your programs when this happens to you. They want you to be successful. The last thing they want you to do is to have something bad happen because you’re dealing with some personal issue that you didn’t speak up about. Now it’s caused a bad test grade, a bad clinical experience, or whatever it may be. You need to let your programs know.
I always say this, “You get into the CRNA school, but your life doesn’t stop. The stresses of your life will still happen regardless of whether you’re in CRNA school.” I pray that for all of you, nothing totally dramatic or terrible happens during your time in school. Even in my short time in school, my classmates, for example, had to go through the death of a sick parent who had cancer. Our dog got sick and for me, that was stressful because I loved my dog. I found out he had no immune system. He was immunosuppressed and had mange.
It was insane. It was also expensive to have a sick dog. That being said, there’s always something. My car broke down once and I was like, “If I can afford to fix my car.” I had a brother-in-law who was sick and had issues going on. We had to temporarily take him in and that was stressful. Things like that happen because life will still happen. You have to recognize when it’s important to reach out. I had to reach out in school because it got to me was I had a preceptor who was hard on me. It made me question whether I should be doing CRNA.
It’s unfortunate when that happens. I’m speaking this and telling you this with you because it even happens to a lot of people. They might not speak up about it, but this particular situation was multiple occurrences where I felt like I was being bullied. It got to me and I wasn’t able to put that barrier up and say, “Jenny, you’re okay. You’re doing fine. It’s just them.”
That’s typically how I cope with stuff like that where I’m like, “They treat other people like that too. It’s all good, whatever. I’ll brush off my shoulder.” 9 times out of 10, I still am like that. If someone’s nasty to me, whether it be a surgeon, coworker, or anyone for that matter, I’m like, “I’m not your cup of tea and maybe it’s not your day. I’m going to still be happy. I’m still me. I’m still going to keep going. If I did something wrong, call me out, and tell me about it. I’ll apologize and move on.”
Passive aggressiveness never does anyone any favors. If I do something that makes you mad, freaking tells me. I’ll work on it. If I don’t know, I don’t know and I’ll keep pissing you off so tell me and get over it. Sometimes, if it happens enough, it does start making you question whether you are the problem. Things like, “You’re too nice. You don’t have the backbone to do this profession.” Who would say that? It said to me. I do have a backbone. You push me, but at the same token, when I’m in a professional role, I am kind, courteous, and lenient because I’m a team player. I’m open to input and suggestions. I don’t fight.
[bctt tweet=”No one else is going to decide your future. That is up to you.” via=”no”]
We’re all here for one reason to take care of the patient. I don’t need to fight. I’m here to work together as a team. If you make me mad though, ask my husband, I’m a tiger sometimes. Blame it on my dad, Irish temper, whatever you want to call it. I do have a short fuse, but I also know how to control that fuse, especially when I’m at work and that’s my professional role. When I’m at home, I might lose it more than I should, but it is what it is. That being said, it got to me where I was like, “Am I too meek and mild? Do I not voice my opinion enough? Am I not cut out for this?” Would I potentially lead to patient harm so I’m not willing to speak up?
That’s what made me question. It was hurtful. Little things like this over time built up so I did reach out at a certain point and I was reassured that I’m okay. Everything is going well. Every other preceptor I’ve ever had in the history of my clinical was like, “Great job.” It was this one person. It was an isolated event. That was reassuring for me.
I also remember getting to a point when I was pretty close to graduation. I was definitely in my senior year. I did challenging off-site cases and sick patients. I remember I didn’t get an IV, I got asked a question, and I didn’t know the answer to it. Little things like that. Nothing major. For the most part, I was prepared, did fine, and my preceptor gave me a compliment. He said, “Nice job. It’s always up in pleasure to work with you.”
I said, “I didn’t do a great job.” It came out so quickly out of my mouth, like, “No, I didn’t do a great job.” It’s because I’d already started telling myself that and beating myself up over little things like not knowing the answer to this question, not getting my IV, feeling sloppy, slower, or maybe slobbering the ambo bag with a spitty glove or whatever it was. I don’t even remember. He immediately was like, “Why don’t you do that? Why did you essentially shut down my compliment?”
I’m like, “It’s a good point. I don’t know and you’re right. I shouldn’t have done that. I’m sorry but thank you for the compliment. I appreciate that.” It was one of those things. It was an eye-opening moment. How much and how often have I been doing this throughout my schooling? Maybe if I hadn’t been doing this to myself the whole time, I wouldn’t have experienced as much stress or as much self-doubt if you want to call it that.
I would’ve recognized when I was beating myself up unnecessarily. I even think of an example. I had a student who did a great job. She’s only been at our site for the third day. That’s a specialty rotation like Peds. That’s a big specialty rotation and it’s extremely nerve-wracking as a CRNA to go into your Peds rotation, especially if you don’t have a Peds background prior to going into anesthesia school.
She did great. Our attending asked her some questions that she didn’t know or mixed up a little bit, but she still did a great job, especially considering it was her third day. I told her such at the end of the day. She didn’t come across that she was questioning any of that. She seemed pretty like, “Thank you,” and everything, but that was me. I would usually say, “Thank you.” If I got anything wrong, meaning if the attending asked me any question and I couldn’t 100% answer it, I would feel bad about myself. I wouldn’t speak up about that but I ultimately would. That is toxic. That is what led me to the place of blocking the compliment.
That’s what led me to a place of saying I didn’t do a good job automatically. I got so used to when I didn’t do something 100% that automatically reflected on that I wasn’t good enough, I wasn’t enough, I wasn’t doing my best, or I wasn’t putting my best effort in. That’s the stuff that will eat away at you. You have to recognize when you’re doing that and also understand you will have people in your life as a preceptor who is not nice and not good preceptors. You have to accept the fact that occasionally you will run into people like that. You do have to brush it off your shoulder and know that’s that one person and you’re going to be okay. You’re not going to be everyone’s cup of tea.
It’s okay if you don’t like me. I don’t expect everyone to like me. I will be perfectly honest. I don’t like everyone I meet, but am I respectful? Yes, 100%. I don’t care how mean and asked you are, I will always be respectful because I think that’s a natural human courtesy to be respectful. It doesn’t mean I have to ever associate with you again or even try to speak to you again. It doesn’t mean I’m mean or nasty in return. I’m going to be bigger than that. I’m not going to do that. I’m not going to lower myself to that level.
I will be polite as possible back. What I’ve found by adapting that mindset of killing meanness with kindness, a lot of times, these people who are routinely mean tend to eventually be nice to you over time because you’re never mean back. They’re not fighting you anymore. They’re like, “It’s hard to be mean to someone who’s nice.” Think about it. If someone is nice to you, even when you know you are a B-something, it’s hard to be mean back over time. Maybe initially, they get weird and people like being mean.
Some people would get high off showing their dominance. I don’t know what it’s like being a bully. Luckily, I’ve never been one. That being said, when I have found people who tend to have that tendency to do that, over time, if you’re as nice as possible trying to interact as least as possible, obviously you have to care for the patient, but it lessens up. They get less and less mean because it’s not as fun. They know they don’t get a rally out of you or an emotion out of you. You’re like, “I have nothing to say to that.” I’ll walk away like, “Thank you for your input.”
If you don’t give them any flare back, it doesn’t get them that high that I think a lot of them seek when they are like that. That’s my biggest piece of advice. Luckily, once you are a CRNA, you work with an attending, or if you’re an independent practice, you’ll occasionally have a CRNA come and help you with induction or whatever it may be your practice. For the most part, you practice pretty independently. It’s your interaction with the surgeon and things like that. The priority is doing the case. They have to communicate with you and you communicate with them, but it’s way easier.
As a student, you lose sight of that because you’re so used to having to work with a preceptor and being under the beating eyeballs with like, “What are you doing?” You are always on edge like, “I don’t want to make a mistake because they’re going to watch and see it. What if I’m incorrect?” You’re always under a lot of pressure as a student, but you’re not as a CRNA as much. You get more space to independently think, and it’s so rewarding once you get there. Hold out, it is coming and you got to stay the course. If you’re feeling like you’re not enough, you have to speak up and say something. You have to recognize when that’s happening.
If I have listened to that advice like I don’t have the backbone to do this, what if I want to quit? That’s sad to think that someone else would have that impact on my future. Hundred percent no way. No one else is going to decide my future. That is up to me. I hope that you embrace that same concept. I hope you enjoy this episode. Hugs and stick with it. You’ll be okay. You’re going to start school and rock it. Even if you don’t rock it, it’s okay. You’re going to rock you because you’re there. You’re showing up and that’s all you can do. Cheers. You got this and I’m here for you. I’ll see you guys next episode.
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