A New Chapter! Transitioning from SRNA to CRNA

Article Summary:

Transitioning from SRNA to CRNA involves adjusting to independent practice, increased responsibility, and new professional expectations. It becomes easier when you:

• Clarify onboarding logistics and expectations before your first day
• Ask questions, seek feedback, and learn department workflows
• Build trust by working as part of the perioperative team
• Remain flexible as scheduling and case responsibilities evolve
• Prioritize personal wellness to sustain safe, effective practice

With time, patience, and daily practice, new CRNAs grow into their role and begin to thrive.

You’ve started or are about to start your first job as a CRNA. With some 120 years of clinical experience among us, even through the eyes of a department chief, your APEX team knows what it takes to smooth the transition from trainee to credentialed practitioner. We’ve been there ourselves and have observed and directly facilitated the onboarding of many freshly minted CRNAs. We’d like to share some thoughts that might resonate with you about this professional transition and what life as a CRNA looks like.

Understanding the Mental Shift in Life as a CRNA

Before we get into the details of transitioning from SRNA to CRNA, we’d like to invoke a favorite metaphor, the nine-inch plank. Visualize a wooden plank 2 inches thick, 9 inches wide, and 12 feet long. It’s lying on the floor at your feet, and you decide to walk across it. No problem, task completed successfully and with ease. Likely, without a perceptible change in hemodynamics.

Now let’s take the same plank, raise it 30 feet off the ground, and perform the same task. While the plank you just negotiated with aplomb has not changed, the task is now substantially more onerous, with consequences quite different from the original one. The difference, of course, is all in the mind, as we have instinctual responses that make us wary of consequences if we err. It’s this very mechanism that many new CRNAs experience as they sort out the transition they are going through. The comfortable plank of the waning trainee years may, during those first days on the new job, feel like you are on an elevated plank.

Building Confidence During the CRNA Transition

We want to help you feel confident in making the transition and acclimating to your new position, lowering that “plank” you are about to traverse to a manageable height. Here are some thoughts to keep in mind as you officially embark on what is destined to be a challenging but satisfying journey.

The First Day(s) and Early Onboarding as a New CRNA

1. Before you put your scrubs on and have a stethoscope in hand, you should have had the requisite conversation with your institutional contact about when and where to show up and who you should connect with on your first day. Surprisingly, in part because everyone is so busy, this information may not have been formally articulated. Know where the locker room is, how to get scrubs, and how, if not already obtained, to get that name tag. Be where you should be early, not late, and be proactive!

2. Ask in advance if there is a formal or informal onboarding process and, if so, what that entails. One way to reduce anxiety is to gather as much information as you can before you show up on your official first day. The more unknowns you can eliminate, the better off you will be.

3. If possible, we advise that you arrange to have a CRNA staff member who can help you get settled in with all the many logistics that must be dealt with. Hopefully, this has already been set up by leadership, but if not, be proactive in having this accommodation. This will pay dividends and make that first day showing up as a CRNA go much smoother and efficient as you get a lay of the land. You will be meeting new faces and begin to appreciate the nuances of the department, events made smoother by another staff member.

4. Importantly, recognize you are part of a team, so be all ears, open to suggestions, and recognize that from this first day on, you are embarking on a journey characterized by learning and adapting to a new culture.

5. Anxiety, like that plank being elevated, can be controlled by talking to others and learning from them. Remember, you are not here to prove your worth above others on day one. There are members in the department who have much to offer you; take advantage of that by asking questions, seeking constructive criticism, and expressing gratitude for the guidance. Asking questions, even if you already have a sense of the answer, is a great way to build relationships. 

6. Be flexible and fit into what is being asked of you. The way that scheduling of cases and departmental duties takes place varies greatly among institutions. Remain open-minded and adaptable. There will be many opportunities in the weeks and months ahead to become more vocal about case and duty assignments.  

7. While you may want to jump right in and take charge of a room with a select group of cases, be patient with how leadership and your mentor manage this as they are in the best position to get you rolling. 

The weeks and months ahead

Once those first days of your new job are behind you, and your onboarding is in the rear-view mirror, you are running your own room with a level of autonomy and complexity that varies greatly among institutions. Here’s what you should be keeping in mind in these critically important next months on the job:

1. Continue to promote your role as part of the team. When possible, ask if you can help anyone with whatever they might need. Consider offering to do  a preop, starting an IV, helping set up a room, or assisting in getting a patient back to the room. Offer help whenever you’re free and able to provide a second set of hands.This builds camaraderie and helps to establish that you are a trusted and valued colleague.

2. Develop and nurture professional relationships with those throughout the perioperative environment by introducing yourself. Recognize that everyone in this arena is critically important in ensuring safe patient care, and ultimately to your success. The preop nursing staff, the PACU crew, the OR room staff, those who clean the environment, stock the rooms, and otherwise make the place run safely and efficiently. Learn their names and compliment them on the job they do when it is appropriate.

3. Demonstrate your clinical competence by providing the top-notch, evidence-based care you learned and used in your training program, but be open to suggestions, where appropriate, to incorporate new ideas and techniques into your practice. We’ll reiterate here that your learning is just beginning!  

4. Demonstrate a passion for life-long learning by reading the journals and discussing case management with your colleagues. When an interesting or novel case nuance or condition comes up, go back to the texts and establish a solid understanding of what you should know. Seek opportunities for learning new techniques or revisiting interventions that perhaps you were introduced to in your training program, but could benefit from having it demonstrated. Be flexible and adaptable, but also self-critical and safety-conscious.

5. As you gain experience in the department and get to know everyone, continue to build positive professional and personal relationships. There’s a lot to learn about the organization you are now a part of that goes beyond hands-on patient care.

6. It is essential to take care of yourself mentally and physically during this phase in your career, where transitioning may sometimes be stressful. “Wellness” is a term often tossed about but not necessarily understood or practiced as it should be. We urge you to consider and nurture the major domains of wellness, which are:

• Physical: exercise, eat right, & get sufficient sleep
• Mental: value lifelong learning and foster critical thinking
• Emotional: an awareness and management of your feelings
• Spiritual: seek meaning and a higher purpose in our lives
• Social: connect and engage meaningfully with your community
• Environmental: social consciousness of our connection to nature

It may sound like fluff, but far from it. The importance of wellness can easily be sidelined during this transitional phase in your life. But take the time to nurture your wellness—if you don’t take care of yourself, you won’t be able to take care of others.

Final Thoughts on Your First CRNA Role

Your first job as a CRNA is an exciting time. You’ll be putting into motion knowledge and tools you spent three tough years honing, providing great anesthesiology services. Along the way, you’ll be acclimating to a new schedule, developing new personal and professional relationships, and becoming part of and embracing a new culture, and putting into motion knowledge and tools you spent three tough years honing. Take it a day at a time, and you will not only survive, but thrive!

Remember, education is constant; it doesn’t end after graduation. Ongoing learning and reflection are essential as your scope, confidence, and responsibilities continue to evolve. APEX’s evidence-based CRNA continuing education is designed for real-world anesthesia care.