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Learn what the admissions committee looks for from Nancy A. Moriber, Ph.D., CRNA, APRN, FAANA, a nurse anesthesia program instructor and former program director. Find out how to get into CRNA school by highlighting your registered nursing experience and making your application shine.
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Interview with Nancy A. Moriber, Ph.D., CRNA, APRN, FAANA
Nancy A. Moriber, Ph.D., CRNA, APRN, FAANA
Nancy Moriber graduated from the Columbia University School of Nursing's nurse anesthesia program in 1990 and has been a certified registered nurse anesthetist (CRNA) for more than 30 years. She has been invested in nurse anesthesia education since 1997 and served as the program director for the Fairfield University and Bridgeport Hospital Nurse Anesthesia Program from 2004 to May 2023.
Currently, she is an associate clinical professor at the Ohio State University College of Nursing. She has been president of the Connecticut Association of Nurse Anesthesiology (CTANA) since 2022, having joined the organization as secretary in 2019.
In the fall of 2022, Nancy received the American Association of Nurse Anesthesiology’s (AANA) most prestigious designation, the Fellows of the AANA (FANNA). She has also held multiple leadership positions, having served as the chair of the New England Assembly of Nurse Anesthetists (NEANA), NBCRNA Self Evaluation Exam (SEE) Committee, and NBCRNA National Certification Exam (NCE) Committee.
This interview has been edited for length and clarity.
Q: The list of requirements for CRNA school is quite extensive. From your perspective, what are some things students should do to make their application stand out?
Nurse anesthesia education is very comprehensive. It is a long road. It is not an easy profession for somebody to aspire to. So obviously, because it's so competitive, strong academics play a very strong role. But, the reality is that most students who apply to nurse anesthesia programs recognize the academic requirements. They’re all coming in with a very strong foundational GPA. So, how you distinguish yourself from other students is a very good question.
From my perspective, I think the number one thing for a student to do is not rush the process. A lot of individuals go to nursing school, graduate, go into critical care, and become nurse anesthetists. So, they rush the process and want to have that application in on the day they have the minimum requirement.
“From my perspective, I think the number one thing for a student to do is not rush the process.”
–Nancy A. Moriber PhD, CRNA, APRN, FAANA
Don't rush the process because you need to be in a critical care environment for 2-3 years to have a solid foundation in critical care nursing. Spend a good amount of time in the critical care setting and look to get a position in a high-acuity critical care unit. Don’t just take any position in a critical care unit because not all units are the same.
It's also very important to take on leadership roles within your unit, and this goes above and beyond serving as a charge nurse or precepting students. You need to get involved within your hospital. You need to serve on committees. You need to be on your unit committees, the hospital-based committees.
If there are opportunities for you to be involved in research and quality improvement initiatives within your unit, that's going to be very important for you to do because it will demonstrate your leadership capabilities.
Most programs today are going to require that students have their CCRN certification — a certification for critical care registered nurses. It demonstrates some commitment to continuing education and extensive expertise in the area of critical care nursing, but that's not enough. There are other certifications out there that students can achieve, and I recommend that you get certified in whatever you can get certified in.
There are trauma care certifications, and there are cardiac medical care certifications. They're all given through the AACN, which develops the CCRN certification program. There are other organizations that will provide certifications as well for students. So those again demonstrate that you have a commitment to your continuing education, to improving your nursing skills and becoming an expert in your area.
The other thing I recommend is finding a mentor, somebody who is within the profession, who has been a nurse anesthetist for a couple of years, and who can guide you through the process, tell you the pros and cons, and help with your application.
“The other thing I recommend is finding a mentor, somebody who is within the profession, who has been a nurse anesthetist for a couple of years, and who can guide you through the process, tell you the pros and cons, and help with your application.”
–Nancy A. Moriber PhD, CRNA, APRN, FAANA
It's important for applicants to be open and honest with their nurse managers within their institutions. Most programs require a letter of recommendation from the individual's nurse manager. So, when you enter into the ICU setting, you need to set a timeline, and your nurse manager needs to understand what your future goals are so that they become part of the process and they can support you through the process.
It's also important for applicants to make sure they have a good personal statement. One that — I can't believe I'm going to say this — is grammatically correct and lacks multiple spelling errors. [Grammatical errors] are very off-putting to anyone in a program who's reading an application because if you can't take the time to pay attention to detail in an essay, then what does that say about your commitment to what you're going to do as a student within a program?
And it's important to stay on task with the personal statement question, reflecting on being unique in your personal statement. We want to know something special about you. What is going to separate you from the rest of the field?
Those are some of the core things that will help applicants stand out when they apply to programs. And then, if they're offered an interview in a program, come to that interview prepared, thinking about being unique and genuine.
One of the things that I think is very important, especially now that we've moved into the era of online interviewing, is not having a written statement. It's very easy to tell that somebody is reading because you watch their eyes go back and forth across the screen. It doesn't tell me anything about you if you're reading your statement and your answer to the question.
Many times, you end up not answering the question that's posed because you're reading something you've prepared. So, think about what you want to say but to come to an interview genuinely, be yourself. Show the program faculty and the admissions committee what is special about you — reading your answers is definitely not going to do it.
Being punctual is another thing. People show up late. Being professionally dressed is another really important thing. Don't get too familiar with the admissions committee. Don't refer to a professor or a program director by their first name during an interview. That's also a big no-no. I don't know you. You don't know me. We're not friends. Therefore, we have to set some professional boundaries.
The individuals who tend to be most successful in nurse anesthesia programs are not necessarily the ones with the highest GPAs, but they are the ones who demonstrate the highest degree of emotional intelligence.
“The individuals who tend to be most successful in nurse anesthesia programs are not necessarily the ones with the highest GPAs, but they are the ones who demonstrate the highest degree of emotional intelligence. ”
–Nancy A. Moriber PhD, CRNA, APRN, FAANA
And it's all the things that are cues to individuals with a high degree of emotional intelligence because that has been shown over and over again in the literature and research to be a very strong indicator of an individual's success.
Anesthesia programs are hard. They require a lot of physical, emotional, social, and psychological commitment from the students who enter these programs. Someone with a high degree of EI [emotional intelligence] is going to be able to navigate the program well, and that's what we look for during the [application] process.
Q: What should students or prospective students look for in the length of experience, types of experience, and even the skills they need before they apply to a CRNA program?
Depending on the type of unit applicants are coming from, their experiences will differ. Depending on the nurse anesthesia program, some programs will be more inclined to take nurses that come out of the CTICU, the cardiothoracic intensive care unit, or the surgical intensive care unit. While other programs don't necessarily negate something like neonatal or pediatric intensive care unit experience.
Again, it's the level of acuity. How sick are the patients that you're taking care of on a daily basis? From my perspective, the higher the acuity, the better. You need to demonstrate that you have the skills to handle intubated patients who are on ventilators and may have significant underlying pulmonary pathology. You can do that in any unit, but if you don't have high-acuity patients, you're not going to see that.
You want to be on a unit where, on any given day, you have the opportunity to deal with medicated drips that will be utilized to manipulate the hemodynamics of your patient. You can do that in a cardiothoracic ICU, a surgical intensive care unit, a NICU, or a PICU. Your dosage is going to be different when you’ve got those little ones, but you’re going to be able to do that.
Utilizing invasive monitoring — so, do your patients have arterial lines? Do they have pulmonary artery catheters? Are you taking care of patients on balloon pumps that have LVADs, left ventricular assist devices, or things of that nature? How much technology are you incorporating into your practice on a daily basis?
When you demonstrate that you've done that consistently for a minimum of one year independently, then you might say, "Okay, I can apply to a program." So, for most nurses, they've got to be in that unit for at least two years before they can demonstrate those skills because the first six months you're learning, you're orienting, you're with a preceptor, so you really can't count that experience as critical care.
Determining an individual's critical thinking skills is harder to assess. The cardiothoracic intensive care units tend to be very protocol-driven, in my opinion. So, nurses have fewer opportunities to develop those critical thinking skills than in other units where it's not the same thing over and over again where you're going to deal with multiple patients. Whereas other program directors may say cardiothoracic ICU all the way, I tend to look more broadly.
Q: Is there a point at which there’s such a thing as too much time between your bachelor’s and your application to a DNP program? Is there a point at which it’s too much ICU experience?
That’s a very good question. Personally, I don’t think so. I’ve had nurses come back to anesthesia school when they’re in their late forties. When I first started out as program director many years ago, I've had a lot of students who were older than I am.
Some individuals don't decide what they want to do in nursing for many, many years. And some people haven't even decided they want to go into critical care.
I don’t think that it’s ever too much time in one unit that a nurse has to think about. I think the hard part for individuals when they go back to school is dealing with coming from the top of their performance.
If you’re in a unit for 10 years, you are an expert in what you’re doing at that point in time. And now, going into the student role, the transition can be harder, but I don’t think that it negates going back to school. It’s not necessarily a disadvantage. They’re going to have a little bit of a harder time adapting to that environment.
But I applaud any nurse who goes back to school to advance their education. There may be a point in time where, and I don’t want to say that people will be too old, you won’t have enough time to offset the cost of your education and training because nurse anesthesia education is very expensive.
So you’re spending three years in a full-time program where you might not be able to work. Many individuals have not saved up $200,000- $300,000 in order to go to school and be able to live during that period of time. And then, if you're going back to school when you're 55 years old, by the time you get out of the program, how many more years are you going to realistically work?
So that's something that people have to think about. Is it financially in their best interest to go back to school at that point in time? But I don't believe it's ever too late or that you've been in one place for too long to not be eligible to apply to a program.
Q: You mentioned the OR and med-surg. Are there other units adjacent to the ICU that might help students learn things to help them become a CRNA or develop the skills they would need for that role?
I think that most individuals coming out of school, if they know they want to go into anesthesia or one of these acute care types of roles, starting in a med-surg unit is probably one of the smartest places to be because you see a broad range of patients. You're getting an extensive overview of healthcare. You're seeing medical patients; you're seeing surgical patients. So, that's always a good place to start.
The operating room, from a skills perspective for an RN, is not the greatest environment for an RN because circulating nursing is not typical nursing, and there's not a huge amount of patient interaction. So that's the one place I actually discourage nurses from going to would be the operating room initially because you don't develop your skills as an RN that you're going to need later on. But we do see nurses go through that pathway.
They'll go to a million different units, and then they finally come back, and they decide, "I'm going to go to the ICU and then get into anesthesia." Ironically, the OR is where a lot of nurses interact with nurse anesthetists and realize, "Ooh, this is something I might want to do." And then go into the intensive care environment and spend some time there.
Every unit offers something for a potential applicant and gives you a different perspective. I don't think I've ever seen an anesthesia student come from a psych mental health unit and then go to an ICU because you're just dealing with complete opposite ends of the spectrum.
But there's not one place that I would say, no, this is not going to offer you any experience or preparation for anesthesia programs. Again, I look more toward the acuity level of the patients you're taking care of. So, it's not necessarily the unit you're in; it's the level of acuity of the patient. How sick are the patients? What are you getting to see?
So, for example, if you're in a small community hospital where the sickest patient you have in the ICU is an individual who had an MI but is recovering and out three days later, or all you're seeing are older patients who are septic, you're not getting a broad experience. It's not the unit — it's the breadth and depth of the experience that is necessary for anesthesia programs.
Q: When nurses who think they want to shadow a CRNA or find a mentor who is a CRNA, what should they look for in that experience, in that relationship?
I personally think it's very important for all applicants to shadow a CRNA, and that means coming in and spending time with them. And more than just one day, I think you need several different days, different times of the day, different cases to get a real good sense of what we're doing.
When nurses from the ICU think about becoming a nurse anesthetist, they think about, “Oh, this is this really exciting independent, autonomous role.” And yes, it is a very autonomous role. It’s a very exciting role, but it’s interspersed with a lot of time where you’re maybe not being stimulated to the extent that you would like to be stimulated. It’s like flying a plane.
We like to liken anesthesia to aviation takeoff, which is an induction when we put patients off to sleep, and then landing when we’re waking them up are highly intense times during an operation.
But if we’re doing a routine procedure, the hours in between, if it happens to be a long case, can be kind of boring, and it can also be a little lonely. We call the screen the blood-brain barrier; the blood is on one side of the screen, and all the brains are on the other side because anesthesia has all the brains.
We’re the only ones sitting up there, so there’s not necessarily anyone talking to you. So, it could be a little bit of a lonely environment, and I think that nurses need to see that and need to experience that.
You're not going to the bathroom when you want to go to the bathroom because you can't turn to the patient and say, "If you need more anesthesia, you turn the dial, and I'll be right back." That would be patient abandonment. So, you're in a captive environment, and I think it's important that nurses understand and see the whole picture, not just the exciting parts of what we do.
They have to see the not-so-exciting parts, the pros and the cons. They have to be able to experience the cons of the profession, and spending time in the operating room with someone will introduce you to that. I'm not saying that the cons outweigh the pros because they don't. I've been in CRNA for 33 plus years, and I would never want to be anything else besides the CRNA.
This is the greatest profession. It has given me experiences that I would never have had anywhere else. It's enabled me to make connections, meet people, and do things I could never have dreamed of in my life. But I step back, and I look at the things about it that are not so great, and you need to see that. You need to recognize that.
That's what mentoring will provide you. And a good mentor is going to give you the pros and the cons. A good mentor is going to tell you all the amazing things about being a CRNA, and they're also going to tell you some of the things that present challenges in our profession.
And if you find a mentor who doesn't provide you with a balanced picture of the profession, I would find a new mentor because they're being unrealistic. They're not telling you everything you need to know.
Q: Can we talk a little bit more about some of those challenges in schooling and in the profession when you finally get certified?
So, the biggest challenge for students when they're going through programs is time management. You need to have very strong time management skills in order to be successful in a nurse anesthesia program.
After you get through the first year of didactics, it's a full-time program. Students are taking, in most cases, 13 to 16 credits a semester, depending upon the various programs. There's no time to work during that period because you're so engrossed in the program, and then you start clinical, and you're in clinical 32 to 40 hours a week.
Oh, by the way, you still have classes, you still have projects, and you still have all these other things that you need to do. Time management is very, very important. Students are going to find themselves feeling overwhelmed many times. So, you've got to really learn to take things one day at a time. You make social sacrifices, so your family needs to be on board with you during this period of time. Many students will tell you they don't see their families for days on end.
We try to help students develop work-life balance, but it's a huge challenge, and that is probably the hardest part of any nurse anesthesia program.
The other challenge for students, I think is one that they struggle with the most, is dealing with all the different personalities among the preceptors they're going to work with and figuring out how to do what for who on any given day of the week. That's a big challenge that can be very frustrating for students. I think that if students are able to work through those challenges, and that's where some critical reflection comes in, and emotional intelligence plays a major role, then students do well in programs.
When we get out, we see a lot of the same challenges working with multiple different personalities in a very high intensity environment where things go wrong. It happens very quickly, and we have a limited amount of time to respond.
Being in the OR for very long periods of time, there is minimal downtime for ourselves and minimal breaks. In most departments, you get a 15-minute break in the morning, you get 30 minutes for lunch, and if you're working from 7 to 3:30, that's all the time you're getting.
So, if you drop a patient off at the recovery room, you have to go to the bathroom, but you have to be in the operating room. You're doing that in the four seconds before you run back to the holding area to get your next patient to go to the OR. That can be challenging as a professional because you've got to figure out how to navigate that type of environment. You get used to it, but not everyone enjoys that. Not everyone wants to be in that kind of environment.
There are some political challenges for CRNAs in any setting. The majority of CRNAs in the country work in what's called an ACT model, an anesthesia care team model. So there's an anesthesiologist and there's a CRNA, and maybe there are students and there are residents.
And in that ACT model, the politics of the anesthesia professional world can surface. So, while states have different regulations for nurse anesthesia practice, we are certified by the NBCRNA to practice to the full scope of our education training.
And the standard of care is the same for nurse anesthetists as it is for anesthesiologists. So, our standard of care is no different. What we're trained to do is no different, but what we're allowed to practice in many situations is predicated by the state in which we live in and the healthcare system in which we work in.
So that can be a little bit frustrating for individuals, and I think that is the greatest challenge right now we're seeing in nurse anesthesia.
Q: So, you talked a little bit about this before, but what are some of the greatest rewards of being a nurse anesthetist?
The greatest reward is when I meet my patients in the morning, and I still practice clinically, and they say to me, "So you're the person that's going to put me off to sleep," and I say, "No, I'm the person that's going to wake you up."
It's a lot harder to wake someone up than it is to put somebody to sleep. That's the easy part. You push the medication, someone goes off to sleep. It's maintaining that patient during that case, waking them up, and getting them through to the recovering room and seeing them stable, pain-free, and appreciative.
That is the greatest reward, and I get that reward every case I do. It's that sense of, "Wow, I made a difference in this person's life. For me, that is the greatest reward of what I do. I mean, just taking care of people, having that one-on-one interaction.
There isn't a lot of interaction between anesthesia care providers and their patients. You meet them in the holding area. They don't seek us out like an individual seeks out their surgeon; they get who they get. So, you have a very limited period of time to develop a relationship and create a rapport with somebody. And when someone thanks you in the recovery room, it's just so rewarding. It really, really is.
I think the autonomy of nurse anesthesia is a benefit, and I would say one of the greatest rewards. We are good at what we do, and I think that that's important.
What are some of the other amazing benefits? Obviously, the financial rewards are there. People know what nurse anesthetists make, and CRNA salaries are going up right now across the country. The average salary around the country for a 40-hour a week position is about $225,000 a year. Depending upon where you work, maybe a little less, maybe a little more, depending on how many hours you work.
Obviously it could be very lucrative, which is offset obviously to some extent by the cost of nurse anesthesia education because it's pretty high. But we are very well compensated. So that's a really nice benefit of our profession.
What else can I say? As I already said, the relationships that I've been able to make with not just other CRNAs, but anesthesiologists, surgeons, operating room nurses, it's a family in there. It's a very unique environment. It's a fun environment. Some people may tell me I'm crazy, but I think it's a great place to spend the day.
Q: What advice would you give a nurse who is thinking about putting in their application in a few years for CRNA school?
So, my advice would be this, slow down your process and be very, very methodical. Make sure that you maximize your experiences and your time in the ICU, that you maximize the relationships that you make. That's with your leadership within your unit, and then with a mentor to help guide you along the way.
Make sure that you gain as much additional experiences as you can. So, the things we talked about: the leadership experiences, the involvement in quality improvement, and all that stuff. But I think the most important thing is to really stop and smell the roses, enjoy yourself along the way.
The process is going to be just as important as the outcome because the process is going to define who you are as a nurse. It's going to build the resiliency that you're going to need. It's going to help to build that critical thinking, your leadership skills, all the qualities that are essential in a successful applicant, and then in a high-quality nurse anesthesia care provider.
So just have fun. Have fun, enjoy it. Being a nurse is great. I always say, "CRNA, you got the RN in the middle." We're all RNs. We don't lose that when we apply anesthesia programs.
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