The most challenging career phase of a CRNA is not completing the three-year rigorous didactic/clinical rotations and passing boards. It is the time from graduation to settling in your first job as a staff CRNA. You have endured long days of lectures, clinical rotations, and studying for the National Certification Exam (NCE) to obtain the coveted CRNA credential. While this calls for celebration, your struggles are not over, real-life challenges await outside the safety of the academic setting. Like Nora Ephron once said: “Your education is a dress rehearsal for a life that is yours to lead.” As a CRNA you may find yourself working holidays, weekends, and even nights, doing cases at 2 a.m. Depending on your location, you may be alone, the only person that can keep a patient alive.
As a new graduate CRNA, I was quite naïve about what to expect from the real world. Being the first person to enter the healthcare workforce in my family and no friends in the profession I had to learn my lessons on the frontlines. As you near the graduation date here’s a list of 10 things you should know before entering the job market as a CRNA.
1) You will need to pass your NCE or board exams before you can even land a job or call yourself a CRNA. Study your textbooks, and board prep programs such as APEX, Valley, or any other preferred resource thoroughly. My go to resource to study for boards was Apex Anesthesia, Nagelhout’s Nurse Anesthesia and Morgan & Mikhail’s Clinical Anesthesiology. You should have an almost encyclopedic knowledge of anesthesia before attempting the test. It is not only stressful to have to repeat boards but also expensive.
2) Your professors won’t find you a job! They will impart a deep knowledge of anesthesia, patient care, and research. Your professors can provide references and recommendation letters — crucial while applying for your first job. Your best bet at finding a job is through your clinical preceptors, websites, job boards, and word of mouth.
3) If a job listing sounds too good to be true, it probably is. Three main factors define your job search: location, salary, and schedule. Getting your preference in all three aspects is almost impossible, for instance if the location is a desirable urban center, the pay is likely low or the schedule is demanding. Look into several jobs to understand the marketplace before applying.
4) If there’s a particular hospital you want to work at, but there are no job listings on their website, don't waste time writing to the chief CRNA or anesthesiologist. Instead, reach out via phone call to someone in the group. You may have to make multiple attempts to get to someone, it is worth it. With this strategy, you are likely to land a job sooner than later.
5) Build a rapport with your preceptors at clinical rotations, attend conferences as a student, and build contacts in the locations/hospitals/anesthesia groups you are interested in. Ask them questions about the application process and what kind of clinical experience they want a potential colleague to have. Your goal here is to transition from a student registered nurse anesthesiologist (SRNA) to an employable CRNA.
6) Keep in touch with your anesthesia school faculty, these folks will serve you as a great resource for clinical practice. Build bridges with new colleagues, and maintain connections with your former mentors, professors, and preceptors.
7) Master the “Airway” — remember ABCs of life: airway, breathing, and circulation. These are also the most important aspects of patient care in the OR, ER, or the ICU. A botched airway is never forgotten or forgiven. As an anesthesia provider, you should be the airway expert. Airway management is crucial both during intubation and extubation. A thorough proficiency of ASA’s Difficult Airway Algorithm will serve you well in all situations.
8) Arrive at your effective anesthesia plan for most surgeries, then study, fine tune, and stick to it. Remember “practice leads to perfection.” Your early career years should be spent doing reliable, effective and predictable anesthesia leading to safe outcomes.
9) If you choose to work in a private practice setting in an ambulatory surgery center (ASC), remember these surgeons are fast; taper your narcotic and muscle relaxant dosing to avoid a long PACU stay. In private practice, this is considered an overdose. You want your patients to be discharged as soon as possible.
10) If you want to work for yourself and follow independent practice, learn anesthesia billing and how money is distributed in your anesthesia practice. Your income will change rapidly over the years. This will enable you to be financially independent sooner than most of your peers.
While finding a great job and delivering excellent anesthesia care is important, what’s more crucial is to deliver safe patient care in whatever anesthetic you deliver. Wishing you the best of luck in your career in anesthesia as a CRNA.
What do you wish you had known before starting your first anesthesia job? Share in the comments.
Srinidhi Vittal, CRNA, is an anesthesia clinician based in San Jose, CA. When he is not caring for patients, he enjoys spending time with family, hiking, mountain biking, and white water rafting in the great outdoors. Sri is also an avid puzzler and has created several puzzle books for adults and children. He is a 2025–2026 Doximity Op-Med Fellow.
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