Episode 88

Episode 88: What Are Some Things To Consider When Looking For Your First Job As A CRNA

Oct 26, 2022

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You’re now a CRNA. And just when you think it’s going to be lighter now from being an RN, you find out that it is far from the case. But that doesn’t mean you can’t control how much you can get lost in your new work. In this episode, Jenny Finnell reveals five important things you need to consider when looking for your first job as a CRNA. She also shares how you can evaluate opportunities without taking your personal life out of the picture. Along with it, you’ll learn to avoid some of the mistakes Jenny encountered that taught her lessons while on her first CRNA job. So tune in to save yourself from falling deep into stress and burnout. After all, you’ve worked so hard to get here! You might as well do it right.

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What Are Some Things To Consider When Looking For Your First Job As A CRNA

What are some things to consider when looking for your first job as a CRNA? In this episode, I’m going to reveal four things that are pretty standard that you should be considering and evaluating prior to taking your first job as a CRNA. I then have a fifth thing that I now consider whenever I’m looking for a job. It is something that I didn’t discover was truly important until I had made a mistake. I’m excited to share with you what that is. Hopefully, you do not make that mistake. Let’s go ahead and get into the episode.

I want to do this episode where I walk through the things that you should be considering and thinking about. Some of them may be self-explanatory, but I want to walk you through my thought process and share with you my experiences about all these different categories for you to consider. I want to enlighten you on the fact that there’s a fifth thing that you may not be thinking about. I also want to share that all these things are going to fluctuate throughout your career and in different life phases. Let’s go ahead and get into number one.

Work-Life Balance

Number one is work-life balance. You’re probably like, “Everyone wants to have a work-life balance,” but what does that mean? Where you need to get clear on a work-life balance is what does that mean to you? It’s going to be different for everyone, and I don’t think you should gauge yours on your best friend who’s also graduating and what they want. If you do that, you may find yourself not necessarily enjoying it because you didn’t truly accomplish what you wanted, but they’re happy.

When I say work-life balance, all positions will come with what they consider full-time FTE or Full-Time Employment. I worked at a place where their full-time FTE was 46 hours a week. I knew I was not going to like that. At the time, when I was moving from city to city, I had someone who I knew who worked there, and I was equally excited about doing regional experience. I was like, “I’ll make it work for a period of time,” but when I took the position, I told them I wanted to drop to 36 hours a week as soon as I could. I made that like, “I will take a job here, but you’re going to drop my hours down to 36 hours a week as soon as it’s humanly possible.”

I started in June, and by September, I was 36 hours a week, so it didn’t take too long. For me, when I first graduated from CRNA school, we didn’t have kids, so I had a lot of time. I was also equally incredibly motivated to make a ton of money because when you’re in school, you’re broke as a joke. I had a lot of student loans and a thirteen-year-old car. We didn’t have a house. We didn’t have much to our name, so I was okay with working a lot.

When I took my position, I did 40 hours a week. I started off as eight-hour shifts and then did 12s and 13s. All new grads at least start off on eight-hour shifts for a couple of weeks of an orientation of some sort. It’s more like, “Here’s your room, and you have a backup person if you need anything,” but it’s not like you get a full-blown orientation. You have a resource person if you need anything, but we did that for a few weeks before we completely flew, which is pretty nice. Some places don’t even give you that.

That was 8s, and then I went to 12s. They also did 13 and 14-hour shifts there. You could do 13s and 14s. You could be flexible whether you wanted 40 hours or 36 hours. You could be flexible in what shifts you worked. They were good about that. I tried tens for a little bit. I tried and toyed with all different types of shifts. Within six months, I joined an open-heart team. When I did that, I went to 24-hour shifts and 16-hour shifts.

It initially was like, “Sweet, 16 and 24. I only worked two days a week.” What I didn’t realize or even think about was the fact that when I worked at sixteen, most of them, I wasn’t leaving the hospital until midnight and getting home after midnight. The next day, I’d sleep until 10:00 AM, so half my day was essentially gone. I then had to get up and work the next day again. If it was a 24-hour shift, we did not work at a place where the 24-hour shifts would get to sleep. You essentially were almost up for 24 hours, and it was brutal.

On occasion, we’d have a slow night, but even on a slow night, I couldn’t sleep because I’d been anticipating the beeper to go off. I’d have to sleep with my coworker, who snored right next to me. We didn’t get our own room. We had to share a hot, sweaty room with a fan. I had to listen to someone snore all night long and sleep on a plastic pillow. I was like, “I can’t do it. I’m too picky. I need a comfortable bed, a not sweaty pillow, and someone who doesn’t snore, that doesn’t mind jaw thrusting or an elbow in the middle of the night like I do to my poor husband,” but I can’t do that to my coworker. It was not ideal.

I remember at the time when they asked me to do these shifts. I told the chief CRNA at the time, “We want to get pregnant soon. I don’t want to be doing 24 hours when I’m pregnant.” They were like, “When that happens, let me know. It will be fine.” The first month that I did 24s, we got pregnant. It was shortly after I started 24 that I found myself pregnant, and I essentially didn’t get to stop doing 24s until I came back from maternity leave. During my entire pregnancy, I was doing 24-hour shifts. Imagine how freaking hard that is. That is not fun. Also, at sixteen, I was dying. Luckily, it was our first child. I would not do that now.

I made it through and had the baby, but I remember being like, “I’m not doing this. I’m not going to miss an entire 24-hour day with our baby. It doesn’t fly with me.” To be on the heart team, you had to do 24-hour shifts, that were part of the requirement. It was being on the call team, as they called it, but I said, “I don’t want the call, and I don’t want 24-hour shifts, so you can either lose me or keep me, but give me what I want.” I didn’t say it that way. I fluffed it up to sound a little bit nicer.

They gave me what I wanted. I was the only CRNA kind of grandfathered onto that heart team that came back and did eight-hour shifts. Initially, I went to 10s then to 8s, but I didn’t do call and 24-hour shifts. I was like, “No. I want to be home, snuggle with my baby, and call it a day.” The 24-hour shifts were miserable. As I said, I was never that CRNA who could sleep. Some of my coworkers could sleep for a few hours. I legit don’t sleep, and it was miserable. I want to point this out because work-life balance can be different depending on where you work. Don’t be afraid to ask for what you want.

I hear people complain a lot and see people say, “I work at a place that never gets breaks.” I was like, “Are you asking for a break if you need one? Are you actively seeking out a position where you’re asking coworkers what the environment’s like and see if they get breaks routinely?” If you’re picking a place where the environment is like that, that’s going to be miserable. Seek it out. If you ask for what you want and seek out an environment that’s going to be conducive to the work-life balance you’re looking for, you’ll find it, but it may not be the first one you come to. Maybe you start off in a new graduate position, and you’re like, “This is what I’m learning, and I don’t want this,” then you go and find someplace that you do.

Do not be afraid to leave. There are plenty of opportunities out there. People are begging for me to come work for them, but not just me. It’s not me that they want. It’s because I’m a CRNA, flat out, that’s it. People are begging for CRNAs to work now. You will be fine. You have plenty of options. You do not need to stay at a place that doesn’t give you the work-life balance you desire. You can find it. Will it be at the first location that you desire? Maybe not, but are you willing to drive an extra fifteen minutes so you can have your dream job? That would be fine. Pop on the show.

You do not need to stay at a place that doesn't give you the work-life balance you desire. You can find it. Click To Tweet

Work-life balance is going to look different in different phases of your life. As I said, I didn’t mind the 24-hour shifts, 16-hour shifts, late shifts, overtime, or any that before we had kids, but after we had kids, I was like, “No. This is not my priority.” I’ve dreamt of becoming a mom. I always knew becoming a mom was a big priority to me as far as I wanted to make my job work for me so I could be home. That was always a big goal of mine, even when I was deciding to go back to CRNA.

I remember thinking, “That’s going to be beautiful because then I could work part-time, still make a good income, and be home more,” which is what I wanted. I didn’t have that as a kid. My parents worked 50 to 60 hours a week. We were always in daycare. We never had family meals together because they didn’t have time. We had family time. It was very rare. I knew I didn’t want that. I love my parents, and they worked to give us what they could, but I knew for our own family, I wanted something different. I wanted to have that time.

I watched my parents struggle. They worked so hard to make so little, and it seemed like it was never enough. They always had to work for more. They were never around. I became a CRNA, so I knew I could be around more. I wanted to make sure that whatever job I took, that they knew that was my priority and that was what I was after.

Depending on where you work, the culture could be different. Sometimes the culture is work and work. You can be like, “No.” I implore you to empower yourself to be like, “No, I don’t want to work. It doesn’t mean I’m lazy, not good enough, or any of those things. It means I care about family. That’s my number one, and that’s my time.” There’s no shame in that. Anyone who tells you differently is probably secretly miserable. They’re a slave to money, which is where I found my parents. That’s what they were. They were constantly working more to make more. Did they get to enjoy their time? No, they were not happy.

The answer for me is, “No, thanks.” I would rather make less money and have more time. I honestly think if there was a good thing that came out of the last few years, it’s the fact that people have their eyes open to “Life is short. Life can be bittersweet, and why am I working 60 hours a week instead of spending time with my children who are growing up in a blink of an eye or spending time with my elderly mother who, God only knows, what if next year she gets cancer?” You don’t know. You’re not promised tomorrow.

What you do with your time now can impact the rest of your days. It’s being intentional about how you want to spend your time, and work is one of those avenues. Don’t get me wrong. I love what I do and being a CRNA. It has nothing to do with that, but I equally am working so I can live. I’m not living to work. Remember that.

Overtime calls, whether it’s a requirement or voluntary, almost every place I ever worked at, except for one, has all been on a voluntary basis for overtime, weekends, and holidays. I know that’s not always true. I have seen it on the CRNA Moms Facebook group because I’m cool like that. It’s a good group. If you’re on Facebook, once you become on SRNA, join that group. It’s a great group. I’ve seen people post things like they don’t have that. Their job requires them to work certain holidays and weekends. It doesn’t always exist, but knowing it does equally exist if you seek it out. I can’t speak for all areas of the entire country.

I know that it has to be possible because there are some here. That means there has to be some out there, but maybe research that. Before you pick what state you want to practice in, maybe you can research that and talk to CRNAs about their work-life balance, what different jobs they’ve held, and the flexibility of those jobs. You can work at a surgery center. You don’t have to work at a hospital because if that gives you the work-life balance you desire, then work at the surgery center.

Know that you can seek it out. There’s so much opportunity out there. That’s number one, work-life balance. What do you think will work for you? Also, know that no matter where you are in life, maybe you’re in CRNA school now and you already have three kids, and you’re like, “It’s all about my time now. I get it. I’m right there with you mama or dada.” I understand.

Look for a job that’s going to give you incredible flexibility, something that has a high vacation, no mandatory holidays or weekends, or anything like that, and has flexibility in the shifts that you work, meaning you can work 8s, 12s, 13s, 24s, or 16s, whatever you want. Look for a place that gives you flexibility. Maybe you’re more like me when I was done with school, where I’m like, “I don’t have anything. I have my husband and my dog.” When I graduated from school, I was like, “Give the hours. I want the money.”

At that time in my life, I wanted experience and money. Those were my two top priorities when I graduated from CRNA school. After we had kids, it became work-life balance and money. It’s funny, after our son got to be about a year old, I started getting incredible homesickness, and I never thought I’d be that person because, as a child, I couldn’t wait to get out of the house and move away. Not like, out-of-state move away, but enough distance to where it wasn’t super convenient to go home. I was like, “Get me out of here. I want to be free. I’m a butterfly. I’m going to fly away.”

Growing up, one of my favorite memories and the most impactful things I had in my life as a child was my grandmother and my grandparents. They routinely would watch me every summer. I realized how precious that was because my grandma passed away, and I was nine weeks pregnant with our son, our first. I remember thinking, “I wish she had met her great-grandchild.” It was bittersweet.

I realized after about a year we had our son, I was like, “I want him to know his grandma. I wanted him to know all of his grandparents, both grandma and grandpa.” Don’t get me wrong. I said grandma because that’s who I spent most of my time with because my grandpa always worked. That being said, I developed severe homesickness where I felt like I was missing out, like FOMO or Fear Of Missing Out. I didn’t want that for our children.

I ultimately knew after fighting it for well over a year that we had to move back. I had to move a bit to be closer to family. At that point in my life, instead of pay and work-life balance, it became location and work-life balance. I didn’t care about the money anymore. I’m like, “Whatever you pay me if you’re near where I can be closer to family, and you give me my schedule, I’m yours.” In fact, you can still buy me that way. Give me the schedule I want and keep me in a decent location where I don’t have to spend tons of time on the road, and I’m yours. Don’t get me wrong. I want to make money, but I would take a job paying less if it kept me close to home and gave me the schedule I wanted. That’s what I care about the most.

As you can see, my priorities and what I’m looking for in a position as a CRNA have shifted quite a bit. We’ve only been parents for a couple of years. In a couple of years, my priorities have shifted three different times. Recognize that that’s going to be the case, but that’s not always going to be. What you’re going to find is maybe that dream job you first took out of school may not be your dream job once your priorities change. Are you going to be able to shift your priorities and stay at the same location? Maybe or maybe not.

As I said, I had a demand that I come off the call team and the eight-hour shifts. I loved being on the open-heart team. I was going to be incredibly sad to leave that because I loved it, but I was willing to leave. I was willing to say, “I’m not going to be able to be on the heart team anymore if I can’t get the hours because my priority now is my baby.” Luckily, the chief CRNA that worked there had three kids of her own and was super sweet, and she got it. She’s like, “I understand. I was there once too.” It worked in my favor where they made an exception.

Don’t be afraid to ask for what you want. Don’t suffer because you feel like you can’t ask. They can only say no. If they say no, you say, “I’m going to start looking. Bye.” That’s the reality. I think they know that, especially in this day and age, there are so many options out there that if they can’t accommodate what you’re looking for, they know you can go somewhere else. Trust me. They do not want to lose you, especially if you’ve worked hard there and made a good name for yourself as a team player, etc. They’re going to more than likely give you what you need or want within reason. You can’t say, “Increase my pay to $500 an hour.”

Within reason, if you bring back a market study and say, “This is what I can get paid to work here, and I’m considering taking it, but I don’t want to leave here,” then negotiate. There’s a funny story, and I can’t get into details. I was not trying to do that, but that’s essentially what happened to me. I got a pay raise because, essentially, there’s another place that was begging for me to come work. I was like, “That’s a lot of money. I should do it.” I did, and now I got a pay raise at a place I want to be more often. It was a win-win. I was like, “This is cool.” I had no idea. It wasn’t even what I was attempting to do, but it goes to show that places are in desperate need. If they think they’re going to lose you, they will find a way to keep you.

Salary As A CRNA

Let’s get into pay because we’ve already been talking about money. What does CRNA make? It’s hard because it depends on where you live. If you live in Manhattan versus Mansfield, Ohio, it’s going to look dramatically different. Also, buying a house in Manhattan and buying a house in Mansfield equally look dramatically different. The cost of living is very different.

I’ve been traveling to work. I’m 1099 as a CRNA lately. Gas is always so much cheaper, and it’s only an hour away from where I live, but it’s a smaller city or a smaller little rural hometown, so you can get gas a little cheaper down there. It depends. Don’t be like, “They make $250 an hour, but their house is $1.5 million for a 1,000 square foot home.” I’d take less pay and have a better house. You pick where you live and where you live is where you live. The cost of living is very different depending on where you live.

In some cities in this country, it’s almost impossible to ever own a home because it’s so expensive it is to even buy. Is that what you want? You might make a lot of money per hour, but it doesn’t make up for the difference in the fact that the cost of living is so outrageously expensive. California’s beautiful. I’m slightly jealous, but not really because I’m like, “Forest fires and cost of living. I’ll just go visit.” I’m happy with vacations out there instead. Ohio’s safe too. There are not lots of natural disasters out here other than tornadoes. We don’t get hurricanes, earthquakes, or forest fires. We probably do to a smaller extent, but Ohio is cool. I like Ohio.

I’ve been practicing for a couple of years, and the pay range has dramatically changed. W-2 rates as a new grad are anywhere around $85 on the low end. I’m sure there’s probably lower, so don’t quote me on that, but $85 is a pretty low end these days. Back when I started, I was at $80 to $85. If you’re getting paid $85 an hour now in 2022, it’s very much so on the low end. I would say $96 is probably where people tend to come in now, $90 to $96 per hour for a W-2 position. Some places are $100 to $110. Know there’s a range. There’s going to be something different everywhere. I can’t possibly quote you in every single facility all across the country. I’m trying to give you ballpark figures here.

In California and Manhattan, for a W-2 position, it’s probably $130 to $140 an hour, maybe, but then you look at the cost of living, and it’s probably still equivalent to making $96 an hour in Ohio. It’s all relative is what I’m getting at. You’re looking at right around a $200,000/year salary for a W-2 position. Over time, things like that, it’s probably a little bit more.

In my first year out of school, I made $196,000. That was a couple of years ago. That was with me working some overtime. My base pay would’ve only brought me in about $170,000, so I made an extra almost $30,000 from overtime, so there’s that. I wouldn’t say I worked a ton of overtime. It was once a month that I did maybe a 24 and maybe one extra 8 a month. That was a lot for me, by the way. I’m not someone who’s greedy. I’ve never been a big proponent of working 60-plus hours a week. It’s not for me unless I’m working on CSPA.

If I’m working on CRNA School Prep Academy, I’ll put a 100-hour week into this business to get this business rocking and rolling. That’s different. When you’re paid per hour to do something versus something you can build on over time, it feels different in what you’re working towards. I have never been a big proponent of putting in tons of hours as a CRNA. I’ve known some CRNAs for years who worked 60-plus hours a week and made a ton of money. They probably pay a ton of taxes, but they pay off all their student loan debt, like hundreds of thousands of dollars in a few years, because they work that much overtime.

A monitor inside a patient's hospital room

First CRNA Job: When you’re paid per hour to do something versus something you can build on over time, it just feels different in what you’re working towards.

When I was in Toledo, $135 was the weekend rate. I’m sure it’s much higher now. It’s probably more like $150. I work PRN now, so I don’t know what the weekend rate is where I work. Sometimes they give you overtime. You get paid a certain amount for overtime. We got $200 to take a call, and if we didn’t get called in, we still got the $200. You would take calls in four-hour increments from home, so it wasn’t that big of a deal. Maybe it’s higher now. Maybe it’s $300. I don’t know.

The pay can vary. Even though you have a base salary after your CME money, which is your mandatory education after your QPI bonus, which is if you didn’t waste all your narcotics, do all your good charting, join a committee, and you show up, you get a QPI bonus, which is quality improvement. All of it beefed together, your bonuses could equal an additional $5,000 or $6,000 a year. Education is a couple of thousand dollars, and then, over time, it can accumulate depending on how much you do. There are a lot of ways to make additional money on top of what your base W-2 rate is.

A nurse talking with a patient in their hospital bed while writing things on a clipboard

First CRNA Job: There are a lot of ways to make additional money on top of what your base W2 rate is.

If you choose to do something like PRN, you make a lot more per hour than the W-2, but you don’t have the benefits, and you don’t have to work any weekends, holidays, or any of that. You’re not obligated. You can do whatever shifts you want. The downside about a PRN is if they’re fully staffed, you may not be needed that much so your hours can be very inconsistent. Likewise, if they’re short-staffed, you’re going to be in high demand, and they’re going to be like, “Work and work.” You’re going to be like, “I didn’t take this PRN position to work full-time.”

If you’re a PRN, your hours are going to fluctuate, but that’s the reason why you take the PRN. You don’t necessarily need a consistent income. You need your hours. That part about it is nice. Most people I know that do PRN have husbands or significant others with medical benefits or a steady income. Their income is more of as needed. They don’t rely on that one income because it’s not a reliable income. Be cautious. It sounds tempting, but I would make sure that you think that through. It’s like feast or famine when it comes to hours as a PRN.

There’s 1099. There are various types of 1099s. They could have a 12-week contract where they want you for 10 hours, 8 hours, or whatever it is, Monday through Friday. You have to give them at least 32 or 40 hours a week, or whatever it is. I found a rainbow 1099 position where it’s a PRN 1099. It’s a PRN, meaning I work as much or as little as I want, and it is what it is. I don’t have a set schedule. I don’t set hours. I can work that day and that day, and that’s it, and they’ll take me. That’s pretty unique. It’s not as common, but they are out there.

The thing about 1099 is it can be predictable for three months. Once you get in the rhythm of finding new contracts and maybe even extending the contract, it’s not a huge deal, but you essentially have to be prepared as 1099 to maybe have a period where you might have a month or two without work. Credentialing takes a ton of time. You would start your three-month contract somewhere. If you plan on going somewhere else, you better be starting credentialing because that takes a lot of time.

I also had a nightmare experience getting an RN license out of state. I don’t want to do that again. That was a complete nightmare. I was like, “What?” It was Pennsylvania, and it was incredibly hard. They didn’t even care about your CRNA license. They care about your RN license, which is completely backward. I had to get fingerprinted five different times. They treated me like I was a criminal. If you think if I were a criminal, I wouldn’t have an active RN license in Ohio, but whatever. It was such a nightmare, and it took forever. It was all this back and forth. It’s not a pleasant experience. I got on it temporarily relatively quickly, which costs more money, but it took over six months to fully figure out how to get a real license there.

Consider that if you do 1099, you may have additional hoops to jump through. You also have to be very cognizant. You don’t get benefits like health or anything like that. You have to pay for your own malpractice. Now, I don’t work more than 1,000 hours a year. It’s what the policy was. It’s $70 a month or $800 a year or something. It’s not awful, but it’s still an expense. I have to drive an hour there and an hour back. When gas was up to $4.50 a gallon, it was adding up. I was spending over $200 a month on gas, but it’s come down, luckily, since then.

They might lure you in with this high per-hour thing. Time is valuable. I always consider my time now. If I’m doing it twice a week, that’s four hours of my time. What’s my time worth in dollars? You’ve got to know your time in dollars and then take the money for gas, malpractice, extra benefits, or whatever, then take 30% away from what they’re paying you for taxes.

If you consider all those things, you chop off a pretty good chunk per hour of what they’re paying you versus an actual W-2. I hate to say that, but it is a headache. Let’s be real. It’s nice because of the flexibility, but it’s annoying. I’ve got to have an LLC, a bank account, and a credit card. It’s doable, but it’s more work and effort. That’s something to consider there. You want to make sure you’re keeping separate savings to put your taxes in because you don’t want any Uncle Sam coming after you. That’s covering pay.

Retirement and benefits are going to look very different. I know a facility that offers a diddly-squat per hour. Their hourly rate is incredibly low compared to the area standard, even the entire state, but their benefits are so good that people flock there to work because their retirement is the OPERS. It’s the state retirement system. It’s not nearly as good as it was several years ago, but for the most part, if you put in your 20 or 30 years, you get to retire with the same income that you made as a CRNA. That’s pretty cool.

People are now like, “When I retire, I’m going to take a giant pay cut compared to what I’m used to making as a full-time employee.” In that system, if you do it right, you get to retire and make the same amount as your highest-paid year as a CRNA. That’s a heck of a benefit. People take the lower per-hour pay knowing that they’re going to be set for retirement. You have to consider that. In other places, retirement is a 3% match. If you’re not putting your percent into it, like $18,000 or something like that a year, they’ll match 3%. If you’re only putting $10,000 in there and they’re giving you 3%, you’re missing out on a chunk of that 3%. If you’re maxing out at 18%, you’re getting the full 3% they owe you for the match.

If you’re putting less than that or not maxing out your retirement at a place that gives you any match, you’re leaving money on the table. Consider that coming out of your income because you need to be doing that. There are things like 403(b), which, even as a PRN, you don’t have access to the 401(k), but you have access to the 403(b), which you should be investing in. It’s like, “Why not? It’s a good mutual fund for you to invest in.” That’s managed by the hospital system, so it’s going to be good. There’s that.

If you're not maxing out your retirement at a place that gives you any kind of match, you're leaving money on the table. Click To Tweet

Depending on whether you’re PRN or 1099, you don’t get the CME benefits, QPI, or anything like that. What I’m trying to leave you with is you have to run the numbers, hardcore write them all down, and figure out what makes the most sense. You’d be surprised. You look at what they make per hour as a W-2 and what you make as a PRN. Now that I’m paid as a PRN, they bump me quite a bit, and it works out.

Prior to that big bump, I was probably making less than a W-2 because if you consider the benefits, retirement, and things like that, I was probably making as much as someone who was a W-2. They bumped me significantly, and I’m still making more per hour, but it shakes out differently depending on if you consider all those other factors that go into it as far as pay. Retirement can be a huge thing. It seems so far from a distance, but if you don’t think about it now, you could be regretting that later when you’re like, “I hardly put anything in my retirement, and now I have nothing. I’m used to living off $8,000 a month, and I have to retire on $5,000 a month.” That’s going to hurt.

If you have paid off cars and everything else, maybe not, but it’s still going to feel different when you’re used to living on $8,000 a month, and now you have to go down to $5,000, even though as a CRNA, you’re more accustomed to living more at $10,000 or $12,000. Keep that in mind. I can’t forget about saving for retirement, even as a CRNA. If you’re a highly paid provider, you need to be smart about saving now so you don’t have to work until you’re 70 years old. You can if you want to.

Scope of Practice

Let’s get into number three, which is the scope of practice. As I mentioned when I first graduated, that was important to me. I knew I wanted to work at a place that allowed me to do open heart as a CRNA and relatively early. I could have gone work somewhere else where CRNAs did open heart, but I knew it was like a team of six people. Typically, you didn’t get a chance to even be considered for the open-heart team until you had been around for five-plus years. I’m like, “That sting. I want it now.”

I sought that out, where I knew I could get a job at a place where as a new grad I could join the open-heart team. When I changed positions when I moved to different cities or whatnot, I was like, “What have I not done as far as my skill set?” I’ve done OB. If you read my previous episode, I had a love-hate relationship with it. No thanks, I’m done with that. I did some peds, also. At the time, I was like, “I don’t mind peds,” but I didn’t have tons of experience where I was like, “I want more.” I already had enough to where I knew how I felt about it.

One of the things that I didn’t have a lot of experience with was regional, like peripheral nerve blocks. I sought that out. I found a place where the CRNAs were assigned to a block room, so you would do 15, 20, and sometimes 30 blocks in a single 8-hour day. It was a lot. It’s a little fast-paced. I did that and found myself not being super happy there. Not because of the regional experience, the regional experience was great, but there were things that were bothersome to me.

Through that experience, it led me to what I’m going to talk about as the last piece that I want you to look for when you’re looking for a job as a CRNA. Essentially, with the scope of practice, I truly feel and believe that if you seek out what you want, you will find it, and that goes for your experience. You don’t have to do it all. A few years into my career, I was like, “I want to do it all. I want to do OB, peds, regional, neuro, and everything. I want everything,” but you don’t get to truly specialize in one thing, and you’re spread thin. To truly specialize in cardiac, you mostly have to do cardiac. If you want to truly specialize in OB, you mostly do OB. If you want to specialize in regional, you mostly do regional. Remember that.

It doesn’t mean that because you spend a couple of years of your career focusing on regional, you can’t do OB. You easily can. It’s the same thing if you did OB for a couple of years, but now you’re like, “I want to go back and do some peds,” then do some peds. Keep that in mind. When you’re doing something like OB, can you pick up contingent somewhere else where maybe you occasionally work on some peds, so you have some under your belt?

When I took the job to do regional, I had not had regional since I was a student. I had not done a single block. I told them that during my interview. I’m like, “I’m game for learning on the job, but I have not had a single block. I can show you my numbers in school. I’ve done central lines and things like that. I do A-lines and ultrasound-guided IVs and things like that. I’m familiar at least with the ultrasound, but I haven’t done regional blocks.” They were like, “It’s cool. We’ll do on-the-job training. We do it routinely. It’s pretty standard. It’s no big deal.”

That being said, I took a job at a peds hospital. One of the reasons why I got that position is A) They were probably pretty desperate, B) I had done some peds at Toledo, and I was able to get good recommendations from that hospital. I was able to mold my experience because I got a little bit of a lot of different things, but I put my focus on one area.

I took 1099, and I’m not planning on doing open heart there. The fact that I had that experience, if I needed to cover EP lab and do some cardioversions and things like that, it’s no big deal. I did that all the time. They were excited to see that experience because they don’t typically put their 1099 locum people in those types of cases. They knew if they were in a pinch, they could because I felt comfortable doing those types of cases. It was my second week there, and I did a fem pop. I was like, “Cool. I haven’t had one of these since a couple of years ago.” It was nice to do a vascular case again. They knew that I had the experience to feel comfortable doing it.

It goes to show that you cannot do it all, but in the beginning, especially if you open your experience to being broader and then narrowing in your focus, once you get that broader experience, you might serve yourself better to go from place to place. Do not be afraid to apply to a position that you have no experience doing. If I had no peds experience, I still would’ve applied. It would have been a longer onboarding and adjustment.

Healthcare professionals in an operating room

First CRNA Job: Once you get that broader experience, you might serve yourself better by going from place to place. But do not be afraid to apply to a position you have no experience in.

It still was a pretty big adjustment, if I’m being honest. It was a lot. I remember thinking, “What did I do?” It was very intimidating. It was a lot to orient at a true peds hospital where there are these one-kilo babies. Even with a couple of years of experience, it was a lot. I’ve been there for a few years now, and I love it. Doing all weight-based dosing again, too, is something that, unfortunately, in adult land, sometimes you get more custom into typical doses and don’t think weight-based all the time. Now, to me, it feels like second nature. It’s no big deal, but it was a big adjustment to go from not having that mindset to thinking about it 24/7 when you’re working with peds.

Don’t let your experience deter you from seeking out opportunities in your career. Remember, if you want work-life balance, seek that out first, and depending on where that ends up falling, then you mold yourself to fit that need. If that ends up being a surgery center, cool. It’s a surgery center. If it ends up in a peds hospital, it’s a peds hospital. Pick your number 1 and number 2 priority and feel how that’s going to fit in. You can’t hit all of these in one fair swoop. You’re never going to find a place that gives you work-life balance, pay, and scope of practice, and it’s in the perfect location. To find all four in one place, you found a unicorn job, so hold on to it.


It is hard to find all that plus number 5, but number 4 is location. Who wants an hour commute somewhere? If you already live rural, you’re probably already used to commuting quite far to your job. It’s probably something you’ve accepted if you live where you live to be close with the family that you’re going to have a commute, and that’s okay. That wasn’t like what I grew up with. I was used to usually living pretty close to where I worked and didn’t mind living in a more suburb-ish lifestyle.

I don’t mind a 30 for 45-minute commute, but 1 hour, especially if it’s a bunch of freeway driving to me and I consider my safety even, “Do I want to be driving here in the winter?” I don’t mind Ohio winters. When it’s icy, it’s dangerous to drive semi-trucks and all that stuff. No, thanks. I consider the location because, to me, that’s the time that I’m going to be taking to get to work, and time cuts into my free time.

If I have to spend unpaid time driving into your facility, that’s less free time that I have for myself and my family. I consider that when I’m looking at a job because, as I said, my number one priority is work-life balance, and that location takes up my work-life balance because it takes up my time. Don’t get me wrong. I’m swayed to sacrifice for a period of time. I took 1099. That’s an hour away, but that’s temporary, and I’m not doing that forever. I don’t want to. I don’t even want to drive there in the winter, and that’s where I’m at. I was upfront about that. It’s not worth my time or my safety to do it.

You might want to think about location. How far are you okay with driving to commute back and forth to work? What is your time worth? Would it be worth moving closer? Do you prefer to live further away so you can have a property you want or be closer to your family? Knowing that it may shift. You may be okay with a short commute now, but when a family gets older and you need to be closer to take care of them, maybe you’d be okay moving away and having a further commute, whatever it ends up being, or vice versa.

Maybe you’re okay living further away now and then living closer once you have kids because you don’t want the commute anymore. You want to make sure you get home to snuggle those babies a half-hour sooner. Honestly, some people I’ve talked to don’t have a choice because you’re from where you’re from. If you’re from an area where the closest hospital is around 40 minutes, then you’re going to have to accept the fact that you have a 40-minute drive unless you’re willing to move further away from family. You have to accept what you have or work with and pick what your priorities are.

Ask About The Environment

Let’s go into the very last one. Number five is something that I didn’t necessarily think about. I thought about all of these other things all the time when looking for a job and things like that. Number five is one of the things that I didn’t consider until I had an experience that left me feeling otherwise. I was lucky enough to get my first job out of school.

Don’t get me wrong. It wasn’t all rainbows and sunshine. It wasn’t all perfect. People didn’t always get along, but for the most part, it was a good place to work. It was a good work-life balance, relationship-wise, with the attendings and the CRNAs. It was a pretty good place. My biggest pet peeve of that place was the higher-ups or this corporate stuff were gouging us with nickels and pennies. I feel like they’re always taking things away. “You’re losing your CME money or vacation.” I always felt like they were taking things away, which was annoying.

They probably haven’t been able to do that now because of the way things have shifted. They’re going to have to pay up to keep their staff. They always had tons of locums too. You’re gouging us. People are getting mad and leaving, and you’re hiring locums who are a lot per hour. That doesn’t make sense. We’re dealing with that, which I’m sure you’re well aware of because pretty much all medical professions deal with stuff like that. For the most part, the work-life balance, environment, and scope of practice were all cool.

It wasn’t on my radar that I would ever be unhappy for that reason, but then when I took my position to get some different experience and had a good friend who worked there who’s like, “You’re going to be amazing,” I did not find it to be the case. It’s not the fault of the place. Without going into too much detail, I wasn’t happy. I felt torn for a while and thinking like, “Maybe it’s all me. Maybe it’s not made for me. Maybe this is my fault.” There were some big things where I was like, “No, I shouldn’t be okay with this. I’m upset because this is legit not okay, and nothing’s being done about it.”

I finally found my backbone, and within six months, I was like, “I don’t think I can work here anymore.” I never intended to take the job and only work there for six months. No, that’s a pain in my butt. I don’t want that. I want to plant my butt somewhere and grow. I don’t take a job and peace out unless it’s an intentional 1099 or something. I did not intend for this to happen, and I was upset. I wanted to settle in somewhere, be happy, and not have to move again. I want to get comfortable.

I found myself knowing that I wasn’t going to be okay there and that it wasn’t my thing for various reasons. I found myself looking for another job in the middle of the pandemic, where operating rooms were closed. I put in my 90-day notice before I even had a job. I don’t know if operating rooms were reopened yet or closed. I was like, “This might not be the smartest idea, but I did it because I had to do it.” My straw blew off, and I was done. Luckily, I was able to get four job offers within a month.

Number five is asking about the environment. This means, “What’s the longevity of your staff?” That’s probably the most important question I found out that you need to ask, “What’s your most senior CRNA that works here? What’s your turnover?” You have to ask that question. If I had asked that, it would have been a pretty big red flag knowing that there was one senior CRNA for ten years. Other than that was three years. In my short period of time, there were other 3 or 4-year CRNAs that got let go. It was like, “Wow.”

Ask about the environment, the longevity of the CRNAs, and why people leave. That’s telling because if you have CRNAs who have been there for 20 and 15 years and there are multiple 20 and 15-year CRNAs, that’s a good indication that that facility takes care of their CRNAs, the environment is friendly to CRNAs, and that you’re also going to want to stay there for 10 to 15 years.

The most important aspect of this entire episode is, number five, finding out about the environment. The best way to do this is to talk to current CRNAs. It’s so easy to find a CRNA who works somewhere, who knows someone. When I left the position, I was unhappy. The staff was great, and the CRNAs that I knew were not bad at all. I went to my coworkers and said, “Do you know anyone who works here and here? Can I please have their number so I can connect with them to see if they’re happy?” I don’t want to make a mistake again. I want to be happy. I want to like where I work. That’s what I did, and it served me well.

Find out about the environment. The best way to do this is to talk to current CRNAs. Click To Tweet

When I went and interviewed, I asked those hard questions, “What’s the most senior CRNA that you have on staff? What would you say the most common reason is that people leave?” I want to know because it will give me a good indication of whether or not I will feel the same way. I wanted to find a job where I could stay put. It doesn’t look great on your resume to have you bounce around every year from hospital to hospital. I want to grow roots and feel part of the team. The only way to do that is to stay put for a while and get the experience.

My big takeaway from jumping around in different jobs is to find out what the environment’s like, talk to CRNAs working there, and find out if they’re happy. If they’re not, find out why. If they are, find out why. That is by far the best way to find out. One of the other things I made sure I asked about in my interviews was communication, “What’s the communication like here?” That was a huge pet peeve that I dealt with, and I had no idea that it was so incredibly important. It causes so much of my stress and anxiety with that. I was like, “What is your communication? What are your team-building activities? How often do you get together outside of work as a group or as a company?” That’s important. It plays a bigger role in your satisfaction than you might realize, so I asked those questions in my interview.

At the place where I work, I was blown away by the chief anesthesiologist and what he had to share with me. It’s a small world. That same chief anesthesiologist happened to be someplace where I trained in school. I didn’t know-know him, but I knew him because we had worked together. Our paths crossed when I was in anesthesia school. It was funny. I was like, “I know you.” He’s like, “Yes.” It was a long time ago. He had a whole mouthful of things to give me on how he works towards what I had concerns about. That was reassuring to me, knowing that he knew what I thought was important was important, and this is what they do about it. That’s where I was when I was on my job interviews.

That solidified the fact that even though I wasn’t 100% comfortable going all to peds, and I even told the chief CRNA, I’m like, “I don’t know. I’m nervous.” I feel like I’m making this big leap into peds where I never honestly anticipated being a peds CRNA, but I’m so glad I did. That chief CRNA was completely understanding. She’s like, “I get it if it’s not your thing, but let’s see how it goes.” That also was reassuring, knowing that they were incredibly open, flexible, and accommodating to what my fears were. It’s nice to hear someone’s like, “Human to human, I get it.” It’s a big shift.

It’s been great. The staff and the environment are great. It makes my life so much more enjoyable. I could have the crappiest day because of the patients, but if the staff and environment are enjoyable, it’s okay to go back the next day. I want to leave you with that as a thought. I hope you guys enjoyed this episode, and I will see you next episode. Thank you so much for reading.

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