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learn and track your progress with thousands of built in rapid
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Hi success NP today we are joined by our two fabulous
guests as well as Jackie, our Co host.
We're having Anna Joe on the podcast.
She's a new graduate CRNA working in NYC and prior to re
anesthesia training, she worked as a travel COVID ICU nurse and
a CVICU nurse from coast to coast.
She's the Co founder of the Confidence Care Academy and
online educational resource for critical care nurses as well as
aspiring Crnas. And we also are joined by
Chrissy Massaro, who has been a CRNA since 2017 and she
currently specializes in cardiac and obstetric anesthesia and she
practices in the big apples as well.
She is the Co founder of the Confident Care Academy as well,
which is as I stood at online resource for acute care NP.
Welcome ladies to the podcast. Thanks so much for having us.
All right, so can you guys just go ahead and jump down, just
step down the the deep dive here on both of you.
Either one of you can take it kind of your path to becoming a
CRNA because you both are CRNA once more new, but kind of talk
about your paths and how you got to the spot where you are today.
Do you want to go for Santa since it's a little more recent
for you and I? Think we have pretty different
paths to kind of end up. Where we are.
I'll start with my story. I knew 1st that I wanted to be a
nurse and my grandfather lived with me when I was 13 to 14
years old on Mother's Day. When I turned 14, he got heart
transplant. So I was really involved in
caregiving and seeing acute heart failure from a really
young age. And my first impression of those
nurses were that they were dealing with all of these
flashing lights and then they gave me the part pillow to write
on. And then I saw my grandfather go
from Gray to pink. And I was like, this is the
coolest thing ever. I want to be a heart transplant
ICU nurse. And so I went to college nursing
school, traveled around a lot, and then that was able to start
off in the CVCQ at Johns Hopkins.
Throughout nursing school, I became kind of acquainted with
the anesthesia world because I had to work full time through
school for many reasons. So while I was working as ACNA
during my OB retention, there was this mom who had a bit of
like an unplanned C-section. Baby was having some
deceleration to their heart rate.
Man ended up getting a blood transfusion.
There was a lot that was happening that I didn't really
understand as a nursing student, but I saw this CRNA just lock in
with this mom and with their partner and caught like the
innocence as mom was throwing up was explaining everything while
I need blood products. And really just like in lock
step with this mom and her partners for what could have
been like a very traumatic birth.
And I knew I was like, this is exactly what I want to do.
So I knew from the time I was like 19 or 20 that I was
interested in the nurse anesthesia path.
And then COVID kind of threw a curveball and all of it.
I was not planning on being a travel nurse.
I ended up doing COVID crisis travel nursing for about 2 1/2
years and I started documenting that experience online.
TikTok was something that was totally foreign and new to me,
but like so many people, I was missing community and wanted to
connect with nurses who were going through a similar
traumatic thing that I was and started just making educational
concerts, documenting my COVID ICU experience.
And that was when I started to cross paths with Chrissy, who
was already a CRNA. And I will give it over to her
from here because it's kind of where our paths come across.
That was a great like synopsis of and I thought that was really
nice, Anna. Good little segue.
So my path, like Anna said, was extremely different.
I had a suspicion in high school that I might want to go into the
medical field because I loved science.
I was a total nerd for it. I'm a nerd for a lot of
different subjects, honestly, but I had kind of had a lot of
mixed advice going into college, a lot of people trying to steer
me away from going into the Health Sciences and so, but I
still wanted to help people, quote UN quote, right?
I still wanted to be in a helping profession.
I grew up with a sister with Turner syndrome and autism, and
she had a heart condition as well associated with her Turner
syndrome. There was a lot of exposure to
behavioral health in my household and my mom working in
the special education system. So my first major in college was
actually social work. So kind of like far away from
the medical field. That's kind of where I really
enjoyed learning about the humanities and social sciences.
But as I continued in my social work education, I really was
missing that nerdy piece of me that fell in love with the like
more traditional STEM sciences in the 1st place.
So out of curiosity, I just kind of signed up for general
chemistry and biology just in case.
And then I ended up getting a study abroad opportunity where I
was able to study abroad in Mexico to complete my Spanish
minor and I got to shadow physicians in Mexico.
So when I was down in Mexico in the public hospitals,
specifically the Women's Hospital in Puebla, I ended up
having this really unique experience where I had a lot of
my paperwork kind of fall through and I wasn't able to
continue on with my rotations. So I kind of got like stuck
there. The anesthesiologist in the
Women's Hospital felt bad for me.
She like knew I was essentially homeless.
Little nobody wanted to take me under their their wing.
So she adopted me for the rest of the semester and I spent the
rest of my semester in anesthesia.
And then she would also like farm me out to some of her
friends in different specialties.
But here I was like a social work major now in an operating
room with an anesthesiologist for the rest of my time in
Mexico. And it was amazing.
It was a completely transformative study abroad
experience. I learned so much.
I was like, OK, when I go back to the USI guess I have to like,
rework my plans as I've been in my EMT certification and I
became a nurse's aide and just kind of tried to figure out like
what field of healthcare was right for me.
Switch my major to psychology so I could kind of salvage my
credits. I finished out my biology minor
and then I ended up going for a second degree in nursing once.
Yeah. It was like kind of this crazy
zigzag that I was like getting my nurses aide experience and
working towards getting my second degree in nursing.
That's when I discovered what a CRNA was.
I never heard of this job before, but the anesthesiologist
at the surgery center who's like you should think about being a
CRNA and he put me in the ORS with the CRNA's who were the
ones who were in the cases he would be in like a pre op and
PACU area. The CRNA's there took the time
to mentor me and explained to me what their job was.
So that's kind of where I first discovered it.
Really a total mistake. And then once I was at ICU
nurse, I was more excited to go back to become a CRNA because I
really realized that being a CRNA was everything I loved
about the ICU, but none of the things I didn't like.
I didn't like being pulled in multiple directions.
I really liked one-on-one patient care and I knew that
being a CRNA would be exactly that, which it definitely is.
People think it's leaving the bedside.
I like to tell them I'm closer to the bedside than ever before.
And then, yeah, I finished Serenade.
Really. Since I've had the pleasure of
getting to go to Serenade School in 2015.
I graduated in 2017 and here we are.
It's amazing. I love that.
I love both of those stories. It's like it's meant to be.
You guys were kind of new early on for Anna and then Chrissy.
It was just kind of meant to be for you as well.
You know it's. Cool like the the truck for one
was very like convoluted and just kind of like yeah and then
I finished Spanish and I was in Mexico and then this one's just
like very like no, I know how it yeah right.
You know what? And that's so cool about
nursing. That's why we say like enjoy the
journey. Like you just kind of don't know
how you're going to get there and whenever you end up and now
you guys have created some other venue of this creative
educational space that you've spun off of your other, What I'd
like to say is like you have an education, but now you've kind
of created something that's yours from your education.
So could you tell our listeners like kind of what you guys have
collaborated on and now create it?
I'll get this to you, Chrisley to Stone.
OK. Yeah.
So I think this is kind of where like our stories pick back up,
which is this was a really nice segue once again.
So when I was an ICU nurse, again, this was 2017, things
were a little bit different back then, but I felt like I really
didn't have access to any resources that I needed to truly
understand my job at a deeper level.
The senior nurses are expected to perform at a really high
level. We're responsible for a lot of
things, especially on night shift when there's not enough
help around. We used to just have one second
year surgical resident and a moonlighting attending for 32
beds where we constantly had emergencies going on.
The amount of nights I had to just figure things out on my
own, I can't even count. After scouring the Internet,
there was nothing on YouTube, there were no textbooks that
really went deep enough. Most information online was
really designed for prescribing guidelines or it's very patient
facing and it's too superficial. There really was nothing that
answered the why behind We're Doing What We're Doing that was
appropriate for nurses. So once I got into CRNA school,
I felt like a light bulb moment happened every single time I was
in my Physiology class. I was always like, wow, had I
known this, you know, six months prior, a year prior, I would
have done such a better job. I would have been so much more
confident. I would have been so much less
anxious. I would have understood
everything so much better. And it felt really unfair that
nurses didn't have access to this type of information.
So that's really where the idea for Confident Care Academy was
born. It wasn't until I started also
building a TikTok platform that I really felt like, hey, maybe
this can be the vehicle for it. It really just started out with
me messing around on my phone in 2019, like having fun.
And then it turned into me answering questions and
realizing, hey, there's a real opportunity to provide
meaningful education here. So that's How I Met Anna, I
think around like 2020 when she was making her COVID content.
I was like, she reminds me so much of myself as a young ICU
nurse. Like I can only imagine, like it
was so hard during normal times. Like this would be so much
harder in a pandemic. And it really just like tugs on
my heartstrings seeing her and so many other new nurses going
through this period. Like I knew how hard it was even
for myself and Philadelphia as a serenade managing the crisis.
Like I just couldn't imagine being a new grad nurse.
So that's when we connected and I really liked her education
style. Well, it's very similar to mine.
And I asked her to join me and build this venture where we
could educate ICU nurses together.
That's. Awesome.
Now this flat forward five years from the time that we met on
TikTok, not 2025. We just got back from NTI, the
technical careers in conference in New Orleans and we now have
it's a community of over almost 1100 ICU nurses, nurse
anesthesia residents and just registered nurses.
There's over 60 different CE approved lectures.
You have built out an entire pharmacology library.
We have pediatric lecture, we have chemistry lectures.
We are diving into the anesthesia content.
It's really turned into this place that has a resource and a
community for all of these nurses who we like.
We wish that we had had that and now we've really created the
product and created the community that we wish.
Yeah, that's too. We also do a podcast as well.
I just finished the RNA training, so we're about to kick
that back up about August. But it's been so fun to see
something that went from like a friendship and then meeting
someone on the Internet. You know, we met online and now
it's run into like not only an online community, but in real
life community are people who want to know like the why and
understand like at the at the cellular level what's happening
for all of our patients. That's been really fun to see.
We have lots of fun pockets that we do that we're excited about.
That's great. I was going to say it, Jackie, I
don't know if you want to take this one, but I thought next a
good question would be kind of along the veins of like changing
your mission, right? So you go from working for these
big institutions as a CRNA and now you're kind of shifting to
creating something that's more mission driven for you
personally, right? And I think that's a really neat
moment in a nurse's career when kind of like what Jackie and I
experienced with our success in P business as well.
Like we went from being nurses, nurse nurses to nurse
practitioners to now being like, no, this is something that we're
passionate about because we want to help.
Kind of looking back and reflecting back on helping those
that are behind you. I think that's a really neat
place and your career and your kind of spot for where you guys
are building. Can you tell a little bit about
kind of what that process has been like for you guys to create
and with the the nurse in mind? Right.
So I'm no longer thinking about just building myself up, but now
I'm thinking about building up others.
Think for me, this has been a very long journey because it
takes a lot of years to really build your expertise, right?
Earlier I misspoke. I said 2017 was when I was
nurse, it was 2013. So you know, think about like
how many years has really gone by since then and how it it goes
from you personally struggling just to get through your day
where you're just so afraid of messing up to then suddenly like
you're precepting for the first time, like a year or two in and
you're like, who am I to be teaching anyone anything, right?
And then you go to like the next level where your challenge in
school and you're like, Oh my gosh, I don't know anything
again, right And then. Exactly, exactly right.
You take on new challenges continually as you go in your
career, taking on your specialties, cardiac anesthesia,
OB anesthesia, all these things are like these little learning
curves. Eventually you get to a point
where you're like, OK, I, I'm comfortable in my career.
I know what I'm doing. It is so rewarding to preset
people one-on-one, but you can create such a bigger impact when
you are able to teach to a larger group of people and when
you know that they really get it.
And then they get to disseminate that same education to their
kids, right? Their adult kids.
You get to impact so many more people at once.
So as much as I love being a good clinician and taking
excellent care of one patient at a time, right, like I said, I
hate being torn in multiple direction at the same time.
I feel like I still have that social work brain in the back of
my head where I'm always looking at the macro, right?
Like it's so nice to help one person at a time, but when
you're an educator, you get to help influence the entire
ecosystem and potentially like thousands of patients, right?
Instead of just one at a time in your career.
I think things are probably really interesting for Anna
because she's been kind of straddling 2 roles recently.
So I'm going to hand this to you, Anna, because like you've
been in this really interesting position where you've been a
learner recently in CRNA school, but still educating and
influencing people who are behind you.
So this has been like a really interesting process to watch.
Do you want to like, spin on it a little?
Yeah, well, not to be sappy, but when you go way back to nursing
school, whether it's your undergrad or Baptist of science
in your ADN, we all learn some nursing theory.
We learn about like the novice to expert circle.
And it's been very interesting to kind of straddle both
positions of being a nursing educator and then also being
with a new preceptor every single day in an operating room
because often in CRNA training, you go to a new hospital every
month. I'm very excited moving forward
to have a little bit more like clear of a clear path in terms
of every single thing. I am the one taking care of my
patient and then also educating people who come behind me.
And we just finished this book, Christy and I at the Gap on the
Gate. We love reading books together
and I think it's really helpful to look at every single
experience as like, what can I learn from this and what can I
take away from this positively? There have been some
interactions with some people who are not great preceptors.
Some people are incredible clinicians and are not great
teachers. Not everybody who's a good
clinician is a good teacher. And then I can take even though
somewhat negative experiences and then moving forward have
better interactions with all of my learners who are going to
confidence. I love teaching and I'm really
excited to have my own individual learners, one-on-one
in the OR. And then, like Chrissy said,
like we get I get so much of hearing the story and stuff.
I finally understand what Miller known does.
I understand what a fast Friday asteroid inhibitor is and I
understand how that's going to be an IO dilator.
And now I preset my orientee and we take better care of our
patients. We understand that I have the
sick. So you need to understand that
it's going to like remain in the system for.
So in terms of to get back to your real question, because
we're all yappers here. Like.
How do you design everything with a nurse in mind?
I think just as Profit Care Academy is designed for nurses
and then everything that we do kind of has sources in mind.
Honestly, I love living a life where I connect with other
largely women in an audience. I love living a life where I get
to help nurses in the online education space.
I love teaching nurses in the clinical space, and I love
making personal content online. That's also going to resonate
people. So kind of most things in my
life I see are like, are designed for like the nurse in
mind who was somebody who just like, has a lot of shared
experiences. So yeah, I love it too.
It's great. I just am very happy that we all
get to experience like this moment because the culture
shifting like whereas when we are nursing school is very like
nurses eat, they're young, you had to survive.
And you know, we all had good and bad experiences with nurses
and like if we have had this experience when we were younger.
Where we could look to. Christian and or you know,
success and P for those resources versus I mean that
would have been a game changer. So I think we all experienced
that high or that satisfaction that, you know, was talking
about when someone could say, yeah, or I totally get it, or
you inspired me to go into Women's Health after precepting
with you or something like that. Basically, the mindset of nurses
has to change in order for us to adapt and grow our profession.
To a certain extent in the medical model, they're very
supportive of one another. And kind of, and, and put, I
think partially because it's mostly male dominated.
Like they tend to kind of work in this way of like we're
supporting one another, whereas nurses are female dominated.
And I think to a certain extent we tend to hold one another
down. And I think that's beginning to
change. Like I think we're just
realizing like we can't survive that way.
Like we need to in order to grow to support one another.
And I think I'm seeing that more and more as I look online.
It's just like people are like, no, we're fighting that.
Like we're bucking that system of nurses eating their job, Like
we can't. We're not going to survive if we
do that. We thought we needed to climb on
top of each other to get ahead. And I think now we're realizing,
no, we need to stand with one another side by side.
That's how we move the needle. That's how we get ahead.
Yeah. It's a bigger sense of community
to with having all of these resources to look up to experts
and anesthesia and whatnot. It can be a little isolating
thing going from a nurse to a nurse practitioner or CRNA,
where you have more autonomy, yes, but you kind of don't have
anybody else to kind of lean on so much, depending on where
you're practicing. Yeah, that's perfectly said.
Communities what we need. I think we're trying to fight
that because we just feel too isolated.
I will say back to what Chrissy said earlier about nursing and
anaesthesia and advanced practice rules and leaving the
bedside versus not leaving the bedside.
People will often ask like, do you regret choosing CRNA?
Do you regret or do you miss anything about being an IC
nurse? And I'll say that I feel closer
to the bedside than ever doing anesthesia for people,
especially like OD anesthesia. Like that's such a nursy thing
to just be like sitting beside somebody playing your favorite
music, like while they're having their birth experience.
I will say that I miss just like giggling with the Gurlians on
night shift, like with like a whole group of like 10-15
people. That's maybe the only thing that
I really miss. And I think that's something
that nursing community does really well, is that just like
shared experience of like taking care of all your patients
together side by side. But I agree with you.
I think that we are slowly changing the culture and also
making it a more welcoming place.
I want to talk a little bit about changing the culture and
how important it is for us to go out of our way to find
incentives to do this at the institutional level.
Sandra, you brought up just a moment ago how the medical model
does a really good job at this. I.
Hate to interrupt a good conversation, but I have to tell
you about the sponsor for the Success NP Podcast.
Picmonic is a quick and effective aid to help you pass
your NP boards. They utilize 2 minute videos
that connect difficult to remember facts with
unforgettable characters. By tying facts together into
ridiculously memorable stories, you'll be able to retain the
information for testing. They help reinforce what you
learn and track your progress with thousands of built in rapid
review multiple choice quizzes. The use of the intelligent space
repetition algorithms automatically adjust to your
learning needs, so you'll be reminded to review the right
information at the right time, increasing long term retention.
Picmonic is also integrated into the true learned Question me so
you can study exactly what you need and test your knowledge.
Check them out today if you're preparing for board link in the
show notes. And one thing that I've learned
from working in academic Centers for a very long time now is that
this is actually designed intentionally in their own
system and pay structures. So in order for a residency
program to exist to get federal money for reimbursement so that
the hospital can keep running off of Labor that is essentially
free and paid for by the federal government and the Medical
College, in order to appoint the physicians, in order to give
them their promotions to assistant professorship, to
professorship, to tenure ship, they have to either do research
or teach. So about half of the physicians
in the hospital system will teach.
And in order to teach, they need to be evaluated by their
learners, their medical students and their residents.
Evaluate how effective they are at teachers.
And if you are a mean preceptor, if you are a mean man, you are
not going to get your promotion, you're not going to get your pay
raise, right. So this is actually designed all
the way at the top from the Center for Medicare, Medicare
reimbursement CMS, all the way down to the bottom.
Like this is very intentionally structured and we don't have the
same type of pay structure incentives in nursing.
There is no reward for being a nice teacher.
Often times this is just one more thing added to someone's
plate. We don't take the time in school
to teach people how to precept, to teach people how to teach.
And education in itself is its own degree, right?
You can get a doctorate degree in just learning how to be an
educator in EDD. Like it is not something that
comes natural to most people and we don't really incentivize it
for nursing. So, you know, you also touched
on the community piece, how this can be very isolating, becoming
an NP, becoming a CRNA. So we don't have our homies to
Kiki with on night shift, right? We don't have our red, we don't
have our bed. Well said, Well said, Christy.
Everything is incentivized to take you under their wing,
right? We're given the tools or
structures to do so, whereas in the medical community there is
like, again, the tools in place to do so.
So, you know, how do we create that?
Well, on the back end, of course, it's really nice at at
in programs like Success in PA and Confident Care Academy.
We're creating our own communities.
That's great. We really are a Band-Aid
solution to a systemic problem though, And I really think that
in our own institutions, we do need to be creating formal
preceptor programs and formal reward structures for teaching
people and nurturing people in the field.
And institutions that do this find a lot of success.
I'm glad that my current institution does do this.
For our new CR and ES, we have formal mentorship programs.
We have formal preceptor classes where we're actually taught like
a structure that we're supposed to precept.
And I do think it helps, but this is definitely not the norm
in the nursing world at all. And I definitely hope that that
changes. Absolutely.
I'll add it as someone who just completed training just to agree
with you Chrissy on the medical model being tied off into one
specific academic institution and then just levels of buy in
from said institution in relation to nursing higher
education. So I have not completed acute
care MP program or like some people like others have.
However, there's often you go to many different hospitals and
there's no facility level buying into your education.
It's so often they're less. Like Chrissy said, there's less
sort of incentive to invest heavily in the education of the
APRN learners as we have now. We're looking at budget cuts to
Medicaid, Medicare, and then also the Grad Plus funding,
which is what enables graduate learners to go to medical nurse
practitioner in CRNA school. I'm interested to see what
changes happen in the future and I hope that we get institution
level buy in to APR and education.
So for example, for CRNA school, it tuitions $200,000 and I'm
only eligible for 60. I'm not going to be able to go
unless I get my tuition essentially bought by a
hospital. And then if I train all this
exclusively at that hospital, there would be incentive bin for
my education at the institution level buy in.
So I think a return to the primary site model would be
really beneficial for us as learners.
And then like Christy saying systemic level buy in so that
there's rewards for positive behavior outside of just
recruitment for staff. I have no other programs for APR
and education. They don't even guarantee you
clinical site often. Like sometimes you have to go
out and find those yourselves, which is, that's not wording
buying, you know? No, no.
All good points for sure. I think a lot of the questions
that people have are kind of like going from an ICU nurse to
CRNA. What's the difference?
What's your day-to-day pros, cons maybe.
I know that's like a lot to ask, but maybe summarize.
Do you want to take this one? And I think this is a great one.
Yeah, sure. Preparing contrast since it's so
recent for you. Yeah.
So it's really fresh for me. What's different in your day in
and day out between being an ICU nurse and being a nurse and
atheist or in the same trainee? So I was a ICU nurse and like
all of the different IC news uploaded to every ICU.
When you go in to be an ICU nurse, you get your one to three
patient assignment and then you are participating in their plate
of care for the course of the day.
When you are a nurse anesthetist or a nurse anesthesia trainee,
you could be doing anywhere from one case to 17 cases in a day.
If you're doing GII love that every day is different.
So one day you'll be doing OB, you'll be doing epidurals and
spinals or C sections, even pre op consents, and then going
through your B on OB all day long.
The next day you might be doing robotic appendectomies, like a
bunch of robotic surgeries. The day after that, you might be
doing hip replacements and knee replacements.
I love the variety. So one thing that keeps
everything fresh and I feel that anyone who is a travel nurse
before choosing their ATR injury will agree.
I love the variety. I like changing it up.
So people will often say who are not nurse anesthetists, they'll
say anesthesia is boring. I disagree really strongly.
I think that it is not boring at all.
You are going to have such different days and there's so
much variety in anesthesia. I think eventually, if you've
been at CNA for 10 years, like Chrissy, you will find things
routine, but I don't find anything boring.
So your day's going to vary a lot.
Instead of caring for one to three patients as a nice new
nurse, you're caring for anywhere from 1 to 17 patients
in a shift. And I'll hit her up to Prithee
because there's a lot of questions layered in that
question like, yeah, in the transition.
I guess one of the biggest differences is also, and I
mentioned sometimes you have just one patient for the entire
day, like if you have a really big cardiac surgery case, a
really long spine surgery, difficult to access brain tumor,
right? And sometimes you do have a ton
of really quick cases for patients that are relatively
simple. So as an ICU nurse, I felt like
you have so much involvement with the patient and their
family and you're with them for 12 hours straight and sometimes
you have them three days in a row and sometimes they're on
your unit for three months, right?
You get to know patients really well as a serenade.
I often have only 15 minutes to get to know my patient.
I read about them, I meet them, we chit chat, we catch up and
then I'm putting them to sleep right.
Like it is very interesting how you have to be super, ultra,
ultra, ultra thorough and at the same time you have a very
limited time to get to know them.
And then you're responsible for everything, like everything
about them, like you can't miss anything at all.
So the stakes are definitely really high in that way.
I know like as a new grad ICU nurse, one of the hard is
learning time management and you're trying to manage like
looking at the labs and the orders and reading the HMP and
understanding the plan of care. And now it's time for morning
routes. And like it's a lot of
responsibility in the first like 3 hours of your shift, you get
to document everything as a Serena, you have to know like
every single thing right off the bat within the 1st 5 minutes of
meeting them. So it's like definitely a little
bit of a mindset shift, but you'll get really good at it.
You can get really good at anything that you do every
single day. So just as a challenge or just
cuz it's new doesn't mean that you're not capable.
It just means you haven't done it yet, so.
Don't think I love that. That's good.
I love that. I might steal that, Chrissy.
It's all ripped. I just was asking because I was
like I always hear people say if I would have done it again, I
would have been a C RNA. I always hear people say that
and I always have kind of in the back of my personal mind.
I don't know if it's asked this question.
I'll have to check Instagram to see if anybody asked any
questions. But can an NP become AC RNA?
What's the path? So if I were to like, hey, I
have a doctorate and you know, in nursing and now I decide I
want to be AC RNA or even I'm just from the nursing spot, kind
of walk us through the steps just briefly for someone that's
like, OK, I'm thinking about it. What?
What can I do to get there? People do it, it's going to be
easier for some people than others depending on what type of
nursing experience you had before you were an NP and also
what type of NP you are right now.
But at the end of the day, all C RNA schools require you to be an
ICU nurse at the time of application.
So if you are a family nurse practitioner working in primary
care, you're going to have to go back to the bedside in the ICU
and get your ICU experience. And most places will still want
you to have two years of ICU experience.
That being said, I do know some acute care M PS that are working
inpatient in an ICU and Serenade schools have accepted that and
said, OK, that counts like you're actively managing
critically I'll patients in an ICU like, you know, close enough
other people have had like, oh, they were an ICU nurse, they
went to NP school, they became an MP.
They were away from the like, from that role for a little bit
and then, you know, they, they go back to the ICU and then they
apply right away. I've seen that happen a few
times as well. But you will have to get into
the ICU one way or another and, and be an ICU nurse when you're
applying for sure. So that's the only like,
downside. It can kind of feel like a step
backwards for some people. But yeah, if it's something
you're really truly interested in, I encourage you to network
and shadow and see what it's like in the operating room.
Spend time with CRNA, see what it's really like one-on-one in
person. It is a very rewarding career
and it's a career you can do for a very long time.
I don't know of any bedside nurses who are in their 80s that
are still working in an ICUI. Do know a lot of Syrian aides
that are still picking up for the in their 70s, in their 80s,
like they're doing it for their cruise ship money, like it, you
know it's good for them, right? You're going to have until
you're 80. I love that.
I don't know it's it could be worth just going back for that
one or two years. I see all sacrifice in the grand
scheme of things, for sure. I was just going to add to the
path. Some CRA programs may accept a
handful of your nurse practitioner credits.
Many places will not accept more than like one or two classes.
I see it's in the round of often like a help assessment class or
a doctoral research level class, or like their microbiology or
their Biostatistics. You're going to have to go
through the entirety of a CRNA curriculum, which is all three
years, but you may have one or two semesters that are a little
bit lighter because they accept your Biostatistics or your
HealthEquity class or something like that.
Versus for CRNA who go into acute care practitioner, often
it's a postmaster certificate completion program which can be
completed in a shorter level of time.
However, it's very doable. I know of a couple of people
even right now who just finished their CRNA training who are
former years practitioners who are former.
If you tenders practitioners, it's very, it's very doable, but
it's a three-year process. Going back to the application
process, so we had a question about how to make your resume
stand out when you apply to CRNA school given that like a lot of
the requirements are the same for every ICU nurse.
What, what would be the way to make you stand out?
I guess I would say I think that.
Here in ethical application is one of the most stressful part
crna yeah, because it is like here's everything that I've ever
done and here's all my work on a piece of paper.
Please tell me I'm good enough. And then somebody just looks
like piece of paper and rejects you or accepts you.
It's so hard to feel that your entire self worth is just listed
on a word to two page piece of paper.
And we all have the same on paper, right?
We all have a couple of advice. You experience good grades,
community involvement, volunteering, maybe just it's
hard to say, but except that you look for same as everyone else
on paper. One thing that we do recommend
is shadowing extensively. You want to know that this is
something that's worth taking out 200 three $100,000 for want
to know actually what the world is.
And then we also say to go to your state level and if you can
afford it and it's really your realm of like financial reason,
go to the annual A, A and a conference 3 going to network
with people who are yours and SSS.
You're going to get to know the political landscape in the
places where you want to go to school.
It's really good for networking. Also, if you are not close to an
A and a conference, we say to get involved in your nursing
critical care conferences. So go to things like NTI, get
involved in critical care nursing conferences.
This is going to show that you are an engaged member of the
profession now, which will foreshadow that you're going to
be an engaged member of the profession when you graduate CRN
school. And those are the people that
you're looking to bring into the profession, people who are not
kind of just go clock in, clock out, make their money and go
home. We want to get people who are
going to be involved are going to help get the profession
forward proceeding. What do you have to add in terms
of like resume, let's. Say one thing that I.
Very. Rarely see on people's resumes
or applications. That I think really does help
you stand out is research experience.
This is something that a lot of nurses don't have at all in
their repertoire, and a lot of people just simply don't want to
put the time into. They would.
It's very common for people to accumulate a million micro
credentials like CCRNCMCCSC, like, just, you know, name, name
that micro credential. They've added that letter to
their name. Yeah, yeah, yeah.
And they just keep taking tests. But believe it or not, that's
not what most program directors truly value.
Like, yes, your CCRN is often a requirement for those who are
listening. That's your critical care
registered nurse exam. Yes, if there's another
certification that's truly representative of who you care
for in your unit, great, go for it.
But it is much more important to show professional engagement.
So like Anna said, the conferences is a great way to
show that. Shadowing a lot, showing you're
really serious is a great way to show that.
Research is a way to show that you are serious about making
your current profession better, even where you are right now.
It's a great way to get involved, and it's a great way
to prepare yourself for the doctoral work that you'll be
doing in CRNA school. All of the programs are DNP
programs right now. So this is something that's a
very unique way to stand out that most people don't do.
But if you really want a little extra boost that's going to help
pull you out of the paper pile, I think that's a great hack.
That is good advice. I was thinking while you were
talking if they were all doctoral program.
So you answered that question And then if and I heard this, is
it true that if you are AC RNA you can work as a nurse
practitioner as well? I've heard that said.
I didn't know if it was true and somebody told me that I was
like, I don't know if that's true or not.
If if you work as AC RNA, you cannot go be a primary care
nurse practitioner or can you definitely not just work as
ACRNA? And is that state specific or is
that just across the board? That is across the board because
we are not credentialed or board certified trained nurse
positioners, right? And we're not trained in either.
Exactly. There are a few states that do
give us prescriptive authority outside of the operating room.
So that might be what that person was referring to.
I believe two of them that come to mind are in New Hampshire and
Idaho. So for example, if I wanted to
work in like an acute pain clinic and do something that's
relevant to my scope and prescribe like pain medication
outside of the operating room, that would be acceptable, but it
would be inappropriate for me to see patients.
I'd like a primary care provider, for example.
Yeah. Yeah, I thought this.
States where I trained in New Mexico, that was the case as
well. We had prescriptive authority
outside of the operating room. So like Chris has said, it was
relevant to the practice of anesthesia.
But you could open ketamine clinics, you can open pain
clinics. You will occasionally see CRNAS
with prescriptive authority also dabbling in the prescribed in
Botox world. That's not particularly relevant
to the practice of anesthesia. And it's not something I think
that there's an entire decades of training that goes into
injecting the face. So I'm going to leave that to
people who have done decades of training in injecting the face.
But yes, as you, you can, if you have prescriptive before be in
the state that you're practicing in.
You can open a pain clinic, you can open a Keton clinic, you can
work with me to pain things like that.
Yeah. Perfect.
OK. So how do you see the roles of
Crnas evolving in the next 5 to 10 years?
That's a good question. Well, we just got sort of
curveball with this House bill that just passed for it, CMS,
Medicare, Medicaid cuts. So the answer depends on whether
this bill gets passed in the Senate or not.
But I think as reimbursement will likely get cut for
hospitals and facilities, I think we're going to see a very
big financial strain on every single department.
And that includes anesthesia, the medical direction model,
where in a lot of larger institutions we have one
anesthesiologist working with two cyranes at a time or three
cyranes at a time is extremely burdensome from a cost
perspective. It's extremely expensive.
So I do think we're going to see more relaxed supervision ratios
where institutions that were quite spoiled and keeping us in
a one to two ratio will now be moving to 1 to 4.
Institutions that were in one to four ratio might move to a
medical supervision model, have up to 8 rooms at once that
anesthesiologist is supervising. We might see more collaborative
anesthesia teams where rather than an anesthesiologist
supervising CRNA's, each provider is just providing their
own care in the room 1 to 1 and there's just one or two people
out in case of emergencies for health.
And they were going to see a lot more of that in the future for
the progression for sure. I'll add for people who are
maybe listening for the first time about anesthesia politics
specifically, that the average age of an anesthesia provider,
whether there's KRNA or physician anesthesiologist, is
over the age of 50. The need for surgical care in
the United States is rising as we have an aging US population.
And then like Chrissy said, we're facing potential massive
Medicare and Medicaid cuts to reimbursement for hospitals
nationwide. So I completely agree.
I'll just echo what Chrissy said.
I do not believe that we have the finance first.
First of all, there's not a need to.
Continue in a medical direction model from a patient safety
perspective, we have the data that we have indicates that
Crnas provide very safe care. So as Bundy becomes tight and
then we have fewer providers who are available to provide this
care, I believe that the role of Crnas is only going to continue
to expand in the future. I had the opportunity to train
in a collaborative anesthesia team model for the majority of
my training in New Mexico, which is where both Crnas and
physician anesthesiologists are direct providing anesthesia.
And then there's one physician anesthesiologist who hangs out
of the numbers. It will give breaks to everyone,
and they can help with difficult airwinds or concussion or
blockchain providers. That model is efficient, it's
safe, and I think we're going to see a lot more of that in the
future. Yeah, I'll say, I'll say that I
think it'll be the same for NPS just working in the different
areas as well like you're describing.
We're going to have to step up because I get the population of
physicians and primary care is just not lucrative and they're
just not going into these areas to work anymore.
And so nurse practitioners are going to be the ones kind of
filling those holes in those gaps in care.
And again, we have shown to to provide very good care.
And I think kind of going back and echoing what you're saying
about kind of being in a more collaborative space with
physicians and collaborating with one another as nurse
practitioners and having more nurse educators to help fill
those gaps in those gaps in education that we may kind of
step into the workplace and just feel like, whoa, I don't feel
prepared for this. I think it's only going to
increase the demand for other nurses to educate in the special
ways that they do. So I think it's just going to
demand an increase in all these these these specialties in these
different areas of potential creation for MP's and other
nurse creators. I think it's going to be really
cool. I just wanted to say that I have
family, family members that have taken your course and they just
wanted to echo the sentiment that it helped them tremendously
and so they wanted to say thank you.
Yes, the Conflict Care Academy crew, it's so many bright and
brilliant nurses and yeah. That's.
So cool. All right, so for the last part
of our episode, we do rapid fire.
Are you ladies ready for rapid fire?
All right, so, OK, What is your favorite type of food?
Either one, Chrissy. It's rapid.
It's just got to come. Down.
Everything Asian food. If it's Asian, I like it.
All the continent of Asia, all of it.
Mexican food. Mexican, Mexican.
All right. And then what was your first job
ever? So like you're like a Batty
crna. This is the pinnacle.
This is the top nurse creator. What was What were your humble
beginnings? Cashier in a grocery store.
Wall bounds. They're out of business now,
believe. Seven years.
That's a lie. Four years.
Felt like 7-4, not like 7. And dog ears, yeah.
And then if you could go back and not have to learn a subject
in school, what would it be? Would it be like, you're like
this one I was just glad to graduate from and put it to bed.
Like which was it, Chrissy? Yeah, go back.
To the nerd. Yeah, the nerd.
Chemistry. I did not enjoy chemistry.
Just finish it, put it to bed. Chemistry.
Well ladies, this has been so much fun.
Thank you for coming on the podcast.
Thank you. For those that want to find you,
where can they find each of you? You can find us both at the
Competent Care Academy website, competentcareacademy.com.
You could join our platform, join our membership, and then of
course, we also have an Instagram and a podcast,
Confident Care Academy. You can find us on YouTube,
Spotify, Apple Podcast. You could find myself at Chrissy
Crna on all platforms. And Anna, I'll let you give your
handles. Yeah, you can find me on all
platforms at Anna JRRNA. By the time this is published,
will probably be Anna JCRNA. How about?
And then essentially Copicare Academy on all platforms, come
hang out with us, yeah. Awesome.
Well, guys, thanks for hanging out with us on the podcast
today. Thank you so much.
We really had a great kind of. Yeah, and as always, we have a
success MP quote of the day. Nothing in the world can take
the place of persistence by Charles Schwab.
And so guys, to stay persistent, the journey from whatever you're
going from, from nursing all the way to CRNA to NP, just stay,
stay on it. Don't give up.
And yeah, thanks for hanging out with us on this episode.
And subscribe and check you later.
Thank you SO. Thanks for tuning into another
episode of Success and P. We hope today's discussion has
shed some light on the diverse career options or taught you how
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practitioner. Remember, whether you're
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