Preparing for CRNA school can feel overwhelming, especially when you are trying to balance ICU work, application requirements, GPA concerns, and interview prep all at once. In this episode, Richard Wilson, CRNA, educator, and CSPA faculty coach, answers common questions from aspiring CRNAs about how to become a stronger applicant.

This episode is especially helpful for ICU nurses, CRNA applicants, and future SRNAs who want to better understand what programs may look for beyond the checklist. Richard explains why preparation starts in the ICU, how to think through clinical interview questions, and how to choose additional courses that support your CRNA application.

If you are wondering how to make your ICU experience more meaningful, how to prepare for CRNA school interviews, or how to strengthen your academic profile after nursing school, this conversation gives you practical direction without making the process feel impossible.

Key Takeaways

• CRNA school preparation starts early, especially once you begin working in the ICU.
• Strong applicants do more than memorize facts. They learn how to explain their clinical decisions with pharmacology, physiology, and pathophysiology.
• Before a CRNA school interview, learn the interview format so you can prepare for clinical questions, emotional intelligence questions, MMIs, or a mix of interview styles.
• If your GPA needs support, focus on advanced science-based courses that address areas where you struggled.
• High-quality ICU experience involves sick patients, hemodynamic monitoring, ventilators, and the ability to understand why care decisions are being made.
• Candidates stand out when they can have a thoughtful clinical conversation instead of only reciting memorized information.

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Watch the episode here

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Welcome to the CRNA School Prep Academy Podcast

Welcome to the CRNA School Prep Academy Podcast, where we have helped guide more than 10,000 ICU nurses on their path toward CRNA school. Our mission is to combine education, guidance, and professional growth so you can move confidently toward your goal of becoming a CRNA.

Whether you are still in nursing school or you are a seasoned ICU nurse, this podcast is here for you.

In this clinical teaching episode, Dr. Michelle Ballister, CRNA and CSPA faculty coach, walks through the pharmacology and clinical considerations of succinylcholine. This is a helpful review for ICU nurses preparing for CRNA school, SRNAs building their anesthesia foundation, and applicants who want to strengthen the way they connect pharmacology to patient care.

CRNA School Preparation Starts in the ICU

One of the biggest takeaways from this episode is that CRNA school preparation does not begin the week before your interview. It starts much earlier, especially once you begin working in the ICU.

Richard explains that every shift in the ICU can become part of your preparation. Each patient assignment gives you a chance to build stronger clinical judgment, review pharmacology, understand physiology, and connect what you are seeing at the bedside to the bigger picture of patient management.

That mindset matters. Instead of walking into work only focused on completing tasks, aspiring CRNAs should approach each shift as a learning opportunity. Ask yourself:

• What can I learn from this patient today?
• Why are we using this medication?
• What does this hemodynamic change tell me?
• How does the ventilator data connect to the patient’s condition?
• What would I do next if this patient became unstable?

This type of thinking helps you develop the depth that CRNA programs often want to see. It also helps you become more comfortable speaking through clinical topics during the CRNA interview.

How to Prepare for a CRNA School Interview

One question Richard addressed was how to prepare for a long CRNA school interview, especially one scheduled for several hours.

His first recommendation is to understand the structure of the interview. A four-hour interview block does not always mean four straight hours of direct questioning. It may include multiple interview stations, downtime, emotional intelligence questions, clinical scenarios, faculty conversations, or MMI-style activities.

Before you prepare, try to learn what the interview may include. For example:

• Will there be clinical questions?
• Will there be emotional intelligence questions?
• Will there be multiple mini interviews?
• Will you rotate through stations?
• Will there be downtime between sections?
• Will the interview be mostly conversational or scenario-based?

Once you understand the format, your preparation becomes more focused. A program that asks mostly emotional intelligence questions requires different preparation than a program that focuses heavily on clinical scenarios.

Richard also warns against waiting until the last minute. If you try to cram unfamiliar clinical concepts right before the interview, you may end up relying on memorization. In a stressful interview, memorized answers can fall apart quickly.

Instead, build your understanding over time. Review clinical topics regularly. Use spaced learning, mind mapping, and patient-based review while you are still actively working in the ICU.

How Succinylcholine Works

Succinylcholine is structurally similar to acetylcholine. Dr. Ballister describes it as two conjoined acetylcholine molecules. Because it resembles acetylcholine, it can bind to the nicotinic receptor and activate it.

The result is depolarization.

Unlike acetylcholine, succinylcholine is not broken down right at the neuromuscular junction by acetylcholinesterase. Instead, it has to diffuse away from the receptor and return to the bloodstream. Once it is back in circulation, it is metabolized by plasma cholinesterase, also called pseudocholinesterase.

This explains two important things about the drug:

1. It works very quickly.
2. Its duration depends on the patient’s ability to metabolize it.

In a patient with normal plasma cholinesterase activity, succinylcholine typically wears off within several minutes, with recovery often expected by around 15 minutes after an intubating dose.

What Clinical Questions Might CRNA Programs Ask?

Clinical questions often connect to your ICU specialty. Programs may want to know how well you understand the patients, devices, medications, and pathophysiology you work with regularly.

For example, a cardiovascular ICU nurse may be asked about cardiac medications, hemodynamic monitoring, vasoactive drips, or intra-aortic balloon pumps. A neuro ICU nurse may be asked about neurologic assessment, EVDs, intracranial pressure, or neuro-specific patient management.

The point is not to ask random trivia. The goal is often to understand how deeply you know your own clinical area.

Richard explains that programs may explore topics like:

• Common medications used in your ICU and why they are used
• Hemodynamic monitoring devices and the data they provide
• Ventilator changes and what they mean clinically
• How you interpret blood pressure, CVP, oxygenation, or other trends
• How pharmacology connects to the patient’s pathophysiology
• How your data helps guide treatment decisions

The strongest applicants can explain not only what is happening, but why it is happening and what they would consider next.

How to Strengthen a Lower GPA for CRNA School

Another major topic in the episode was GPA strategy. Richard addressed what applicants can do if they did not earn the GPA they wanted during nursing school.

His advice is to start by analyzing where you struggled. Since a BSN includes many credit hours, taking a few post-graduation courses may not dramatically raise your overall GPA. However, those courses can still show CRNA programs that you are capable of succeeding in rigorous science-based coursework.

The key is to choose courses with intention.

If you struggled in physiology, consider advanced physiology. If pharmacology was weaker, consider advanced pharmacology. If pathophysiology was a challenge, advanced pathophysiology may be a smart choice.

Richard also emphasizes that additional coursework should not be treated like a box to check. Programs may ask what you learned from those courses and how they improved your preparation for anesthesia school. You should be able to explain how the course helped you grow as a learner and strengthened your academic foundation.

Choosing Advanced or Graduate-Level Courses

Applicants often hear advice about taking “advanced” or “graduate-level” courses. Richard explains that these terms are sometimes used similarly, but there can be practical differences.

Some graduate-level courses require you to be accepted into a degree-seeking program before enrolling. Other advanced courses may be available without formally entering a graduate degree program.

The important point is to avoid simply retaking basic undergraduate courses unless there is a specific reason. If you struggled in A&P I, for example, retaking the same course may not be as helpful as taking a higher-level physiology course that shows growth.

Strong course options may include:

• Advanced anatomy
• Advanced physiology
• Advanced pathophysiology
• Advanced pharmacology
• Statistics
• Chemistry
• Physics
• Medical math or medication calculation-focused coursework

Richard explains that anesthesia programs are heavily science-based. Anatomy, physiology, pathophysiology, and pharmacology are especially foundational because nurse anesthesia education builds heavily from these concepts.

Statistics can also be helpful because doctoral programs include scholarly work, research interpretation, and data analysis.

Conditions That Can Affect Plasma Cholinesterase Activity

Dr. Ballister also explains that some clinical conditions can decrease plasma cholinesterase activity or slow drug metabolism.

Examples discussed in the episode include:

• Hypothermia
• Liver failure
• Renal failure, especially with uremia
• Severe liver disease
• Acute infection
• Pregnancy
• Plasmapheresis
• Older age, especially in males

Since plasma cholinesterase is produced by the liver, liver dysfunction can be especially relevant. Pregnancy can also decrease plasma cholinesterase levels, partly due to increased blood volume and dilutional effects.

Some conditions may increase plasma cholinesterase activity, including obesity with diabetes, hemochromatosis, and thyrotoxicosis.

For CRNA school preparation, this is a strong reminder that pharmacology is never isolated. Patient physiology, disease states, temperature, and history all influence how a drug behaves.

Why Medical Math Matters for Future CRNAs

One area many applicants overlook is medical math.

Richard explains that anesthesia providers often calculate, dilute, and administer medications in high-pressure clinical environments. In the operating room, you may need to mix medications, calculate drip concentrations, double-check pump rates, or prepare vasoactive medications quickly and safely.

Because of this, comfort with medication calculations is important. If math is a weak area, building stronger medication calculation skills before CRNA school may help you feel more prepared for the academic and clinical demands ahead.

This does not mean every applicant needs a formal math course. But if med math makes you nervous, it is worth addressing before you enter a more intense training environment.

Are Chemistry, Organic Chemistry, and Physics Helpful?

Richard explains that anatomy, physiology, pathophysiology, and pharmacology are typically more central than general chemistry, organic chemistry, or physics. However, chemistry and physics can still be valuable.

Chemistry can support your understanding of medication structure, drug behavior, and how medications interact in the body. Physics can help with concepts like flow, pressure, vaporizers, ventilator circuits, endotracheal tubes, and vascular movement.

If you already performed well in the core science courses and want to keep strengthening your application, physics or chemistry may be reasonable additions.

The main point is to be strategic. Choose courses that support your future learning and help you become a stronger CRNA school applicant, not courses that only look good on paper.

What Makes ICU Experience Strong for CRNA School?

Not all ICU experience looks the same. Richard explains that strong ICU experience is usually connected to patient acuity, clinical complexity, and your ability to understand the care being delivered.

Programs may look at the type of ICU, the patient population, the level of acuity, and the kinds of monitoring and therapies you manage. High-quality adult ICU experience may include consistent exposure to:

• Mechanically ventilated patients
• Hemodynamic monitoring
• Arterial lines
• Swan-Ganz catheters
• Stroke volume variation monitoring
• Vasoactive medications
• Complex respiratory physiology
• Unstable or high-acuity patients

Adult ICUs such as CVICU, MICU, trauma ICU, neuro ICU, and cardiothoracic ICU can all offer valuable experience, depending on the acuity and patient population.

For pediatric or neonatal nurses, the same principle applies. The key is not simply the unit name. It is the level of patient complexity, the monitoring involved, and your ability to explain what you are doing and why.

How to Make the Most of Your ICU Experience

Richard encourages aspiring CRNAs to be proactive in the ICU.

Do not wait passively for assignments. When appropriate, advocate for learning opportunities. If a patient you have cared for has stabilized and another high-acuity patient is available, ask if you can take the more complex assignment. If you hear about a challenging admission coming in, express interest in being involved.

This does not mean pushing beyond your readiness or scope. It means being intentional about growth.

When you do get those assignments, study them. Learn the medications. Understand the ventilator mode. Review the disease process. Ask why a specific monitor, intervention, or treatment plan was chosen.

Over time, this helps you develop the clinical ownership that CRNA programs want to see.

Where CRNA Interview Candidates Often Struggle

Richard says one of the biggest areas where candidates struggle is understanding their own craft.

Many applicants can memorize a fact. They can name a receptor, recite a normal value, or repeat something they reviewed the night before. But they may struggle to have a deeper clinical conversation.

The strongest interviews often feel like educated discussions. Faculty are not just looking for someone who can answer one question. They are listening for how you think, how you connect concepts, and how well you understand the care you provide in the ICU.

For example, it is one thing to know that norepinephrine affects certain receptors. It is another thing to explain when you would use norepinephrine, why it makes sense for a specific patient, what you are watching for, and what you might consider if the patient does not respond as expected.

That depth is what helps applicants stand out.

What Makes an Applicant Stand Out Negatively?

Richard also explains what can hurt an applicant during the interview.

A candidate may struggle if they cannot explain the care they provide in their own ICU. Saying “that is what the protocol says” or “that is what I was told to do” may not be enough if the program is trying to assess clinical reasoning.

Programs want to see that you understand the why behind your actions.

You do not need to know everything. But you should be able to speak clearly about your patient population, common medications, monitoring tools, ventilator management, and the clinical reasoning behind the care you provide.

This is why ICU preparation matters so much. The stronger your daily learning habits are, the more prepared you will likely feel during the CRNA interview.

Does International ICU Experience Count?

One question Richard answered was about ICU experience outside the United States, such as experience in the UK or Canada.

He explains that international ICU experience may still be considered as part of the applicant’s overall background. However, some programs may not view it exactly the same as U.S.-based ICU experience because they may not be as familiar with the structure, acuity, or clinical processes of that healthcare system.

This does not mean the care is better or worse. It simply means the program may have less context for evaluating that experience.

If you have international ICU experience, be prepared to explain the level of acuity, patient population, monitoring, ventilators, medications, and responsibilities involved in your role. The clearer you can make your experience, the easier it may be for a program to understand its relevance.

Does International ICU Experience Count?

One question Richard answered was about ICU experience outside the United States, such as experience in the UK or Canada.

He explains that international ICU experience may still be considered as part of the applicant’s overall background. However, some programs may not view it exactly the same as U.S.-based ICU experience because they may not be as familiar with the structure, acuity, or clinical processes of that healthcare system.

This does not mean the care is better or worse. It simply means the program may have less context for evaluating that experience.

If you have international ICU experience, be prepared to explain the level of acuity, patient population, monitoring, ventilators, medications, and responsibilities involved in your role. The clearer you can make your experience, the easier it may be for a program to understand its relevance.

Practical Final Advice for Future CRNAs

CRNA school preparation is not only about building a checklist. It is about becoming the kind of ICU nurse who understands patient care at a deeper level.

Start where you are. Use your ICU shifts as learning opportunities. Choose additional courses with purpose. Prepare for interviews early. Practice explaining clinical concepts out loud. Learn how pharmacology, physiology, pathophysiology, and patient management connect.

The goal is not to sound perfect. The goal is to show that you are thoughtful, teachable, clinically curious, and ready to keep growing.

Related Topics to Explore

What Is A CRNA? How Do You Become A CRNA? Plus CRNA Salary Information and the Top 10 Best CRNA Programs! – Learn what CRNAs do, how to become one, and what salary and program details matter most before applying.

CRNA School Cost: A Comprehensive Guide to Paying for CRNA School — Explore realistic costs and financing options for future CRNAs.

Why Your CRNA School Interview Matters Most – Discover why your interview can make or break your CRNA application and how to stand out when it counts.

CRNA School Competition: How Hard Is It To Get Into CRNA School? – Understand what makes CRNA admissions so competitive and how to rise above other applicants.

How to Find a CRNA to Shadow + Questions to Ask When Shadowing a CRNA — Get the CRNA Shadowing experience you need for CRNA school requirements plus learn what to ask the CRNA during your shadowing experience 

Why Choose CSPA Over Other Prep Programs? – Learn how guidance rooted in real CRNA admissions experience helps remove the guesswork and gives you clarity tailored to your unique & specific goals, background, and timeline.

Important Links

Join the Free CSPA Community! Connect with Aspiring CRNAs, Nurse Anesthesia Residents, practicing CRNAs, and CRNA Program Faculty Mentors who are ready to support you. Get real answers and expert guidance in a welcoming space that’s free from misinformation and negativity. You don’t have to do this alone! Join Now: https://www.cspaedu.com/community

Get access to application & interview preparation resources plus ICU Educational Workshops that have helped thousands of nurses accelerate their CRNA success. Become a member of CRNA School Prep Academy: https://community.crnaschoolprepacademy.com/join-cspa

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