How To Get Into CRNA School: Advice From a Nurse Anesthesia Instructor

Strong academics get you in the door, but they will not set you apart. Nancy A. Moriber, PhD, CRNA, APRN, FAANA, a nurse anesthesia instructor and former program director, explains what admissions committees actually look for and how to build an application that stands out.

This interview has been edited for length and clarity.

What should students do to make their application stand out?

Nurse anesthesia education is comprehensive and competitive, so almost everyone applies with a strong GPA. Academics alone will not distinguish you.

The single most important thing is not to rush the process. Plenty of nurses graduate, jump into critical care, and submit an application the day they hit the minimum requirement. Don't. You need two to three years in a high-acuity critical care unit to build a real foundation, and not all units are the same. Choose carefully.

Take on leadership beyond charge nurse or precepting. Serve on unit and hospital committees. Get involved in research and quality improvement initiatives, because those demonstrate leadership.

Most programs now require CCRN certification. It shows commitment and critical care expertise, but it is not enough on its own. Pursue whatever else you can, whether that is trauma or cardiac medical certifications through the AACN or another organization. Each one signals that you are working to become an expert in your area.

Find a mentor inside the profession, someone who has practiced for a few years and can walk you through the pros, the cons, and the application itself. Be open with your nurse manager too, since most programs require a recommendation from them. Set a timeline and make sure your manager understands your goals so they can support you through the process.

Pay attention to detail. Grammatical errors in an essay are off-putting. If you can't take the time on your application, what does that say about your commitment as a student? Stay on task with the personal statement and tell us what makes you unique.

If you land an interview, come prepared and be genuine. Don't read from a written statement. In the era of online interviews it is obvious when someone's eyes are tracking across the screen, and you usually stop answering the actual question. Show the committee who you are. Be punctual, dress professionally, and keep it professional. Don't address a program director by their first name. We have to set boundaries.

The students who succeed are not necessarily the ones with the highest GPAs. They are the ones with the highest emotional intelligence. The research backs this up consistently as a strong indicator of who will navigate a program well, and that is what we look for.

What kind of experience should students have before they apply?

It depends on the unit and the program. Some programs lean toward nurses from the cardiothoracic or surgical ICU. Others welcome neonatal or pediatric ICU experience. What matters is acuity. How sick are your patients day to day? The higher the acuity, the better.

You need to show you can manage intubated patients on ventilators with significant pulmonary pathology, titrate drips to manipulate hemodynamics, and use invasive monitoring like arterial lines, pulmonary artery catheters, balloon pumps, and LVADs. You can do that in a CTICU, a surgical ICU, a NICU, or a PICU. Doses differ with the little ones, but the skills transfer.

When you have done that independently for at least a year, you can start thinking about applying. For most nurses that means two years in the unit, because the first six months are orientation and don't count as true critical care experience. Critical thinking is harder to assess. Protocol-driven units like some CTICUs give fewer chances to develop it, so I tend to look more broadly than program directors who insist on cardiothoracic experience.

Can there be too much time between your bachelor's and your application?

I don't think so. I have had nurses start anesthesia school in their late forties, and as a new program director years ago I had students older than me. People don't always decide early what they want in nursing.

The hard part isn't the years. It is going from the top of your performance to the student role. If you have been in a unit for 10 years, you are an expert, and stepping back into a student seat is a tougher transition. It is not a disadvantage, just an adjustment.

The real consideration is financial. Nurse anesthesia education is expensive, and you may spend three years in a full-time program unable to work. Many people have not saved $200,000 to $300,000 to cover school and living costs. If you start at 55, think realistically about how many years you will practice afterward. That math matters. But it is never too late, and no amount of time in one place makes you ineligible.

Are there units adjacent to the ICU that help prepare for a CRNA role?

If you know early that you want anesthesia or acute care, starting in med-surg is one of the smartest moves. You see a broad range of medical and surgical patients and get a wide view of healthcare.

The operating room is the one place I discourage nurses from starting. Circulating nursing isn't typical nursing, there is little patient interaction, and you don't develop the RN skills you will need later. Ironically, the OR is where many nurses first watch CRNAs work and decide this is the path for them, then head to the ICU.

Every unit offers a different perspective. The exception is going straight from a psych mental health unit to an ICU, which are opposite ends of the spectrum. Otherwise there is no unit that offers nothing. Again, it comes down to acuity. In a small community hospital where the sickest patient is recovering from an MI, or where you only see older septic patients, you don't get the breadth and depth that anesthesia programs want. It is the experience, not the unit.

What should nurses look for when shadowing or finding a CRNA mentor?

Shadow a CRNA, and do it across several days, different times, and different cases to get a real sense of the work. Nurses from the ICU picture an exciting, autonomous role, and it is. But it is interspersed with long stretches that aren't stimulating.

We liken anesthesia to aviation. Induction and emergence are the takeoff and landing, the high-intensity moments. The hours between on a long case can be slow and a little lonely. We call the drape the bloodbrain barrier: the blood on one side, the brains on the other. You are often the only one up there. You also can't leave when you want, because turning to a patient and saying "turn the dial if you need more" is abandonment. You are in a captive environment, and nurses need to see that reality, not just the exciting parts.

I am not saying the cons outweigh the pros. They don't. I have been a CRNA for more than 33 years and would never want to be anything else. But a good mentor gives you a balanced picture, the challenges along with the rewards. If a mentor only sells you the highlights, find a new one. They are not telling you everything you need to know.

What are the biggest challenges in school and in practice?

Time management is the biggest one in school. After the first year of didactics, it is a full-time program, often 13 to 16 credits a semester with no time to work. Then clinical adds 32 to 40 hours a week on top of classes and projects. Students get overwhelmed. You learn to take it one day at a time, and your family has to be on board, because many students go days without seeing theirs. We try to build worklife balance, but it is hard, and it is the toughest part of any program.

The other big challenge is working with many different preceptor personalities and figuring out what each expects on a given day. That is where critical reflection and emotional intelligence matter most. Students who work through it do well.

The same challenges follow you into practice: many personalities, high intensity, and little time to respond when things go wrong. The OR offers minimal downtime, usually a 15-minute morning break and 30 minutes for lunch on a 7-to-3:30 shift. You learn to navigate it, but not everyone enjoys that environment.

There are political challenges too. Most CRNAs work in an anesthesia care team model alongside an anesthesiologist, sometimes with students or residents, and the politics of the field can surface there. We are certified by the NBCRNA to practice to the full scope of our education and training, and our standard of care is the same as an anesthesiologist's. What we are trained to do is no different. But what we are allowed to do depends on the state and the health system we work in, and that is the greatest challenge facing the profession right now.

What are the greatest rewards?

When I meet a patient and they say "you're the one putting me to sleep," I tell them no, I'm the one waking you up. Waking someone safely is the hard part. Maintaining a patient through the case, bringing them back, and seeing them stable, pain-free, and grateful in recovery is the reward I get every single case. You have a short window to build rapport with someone, since patients don't choose their anesthesia provider the way they choose a surgeon, and a thank-you in recovery is enormously rewarding.

The autonomy is a reward too. We are good at what we do. The financial side is real, with CRNA salaries climbing across the country and a typical 40-hour position averaging around $225,000 a year, more or less depending on hours and location. That is offset somewhat by the cost of education, but the compensation is excellent. And the relationships across the OR, with other CRNAs, anesthesiologists, surgeons, and nurses, make it a unique and genuinely fun place to spend the day.

What advice would you give a nurse planning to apply in a few years?

Slow down and be methodical. Maximize your time and experiences in the ICU, build relationships with your leadership and a mentor, and gain the extra experience we talked about, the leadership roles and the quality improvement work. Most of all, enjoy the process. It will be as important as the outcome, because it defines who you are as a nurse and builds the resilience, critical thinking, and leadership a strong applicant and a high-quality CRNA needs. And remember, CRNA has RN in the middle. We never lose that.