Background & Goals
Presently, there are 124 nurse anesthesia programs in the United States, including Puerto Rico. The majority of these graduate programs are housed in predominantly White institutions; eight are in Hispanic-Serving Institutions (HSIs) and none are in Historically Black Colleges & Universities (HBCUs).
In 2006, there were 94 nurse anesthesia programs nationwide. In addition, there were 37,000 nurse anesthesiologists, 6% came from marginalized racial and ethnic backgrounds, and 94% were majority White. As the number of programs has grown, the number of nurse anesthesiologists has increased as a result. However, the population of nurse anesthesiologists has not kept pace with the changing demographics of America. Since that time, according to the American Association of Nurse Anesthesiology’s 2020 Profile Survey Reporting, of the 59,000 CRNAs, the majority continues to emerge as White with only a 12% aggregate number of diverse professionals. The racial and ethnic composition of Nurse Anesthesiologists comprises 88% White, 4% Hispanic, 3% African-American/Black, 4% Asian/Pacific Islander, and 0.7% American Indian/Alaskan Native.
The Immersion Model of Diversifying Nurse Anesthesia Programs (Immersion Model) has worked to increase the racial and ethnic diversity of the pool of applicants seeking admission into most of the 124 nurse anesthesia programs, extend pipeline mentorship programs to nursing students of color, and increase professionals with PhD and doctorate degrees with nurse anesthesia subspecialties. Empowering diverse nurses with information and mentorship regarding becoming a certified registered nurse anesthesiologist (CRNA) directly increases the pipeline to a rich applicant pool. Despite the many factors of systemic racism that are often at play, this pipeline was designed to translate to an increase in the racial and ethnic diversity of nurse anesthesia student cohorts, nurse anesthesia faculty, and anesthesia content experts.
The Immersion Model is built on two constructs, mentorship, and early professional socialization, and is executed through three pipeline initiatives. The overarching goals are to expand access to diversity pipeline initiatives, perform a manpower analysis to support initiatives with increased funding, and build a collective of PhD researchers as well as CRNAs of color leading and practicing in anesthesia subspecialties.
The first initiative builds on the professional socialization of diverse registered nurses interested in nurse anesthesia. Early professional socialization is implemented before and during the stages of application, interviewing, and admission into a graduate nurse anesthesia program. The Diversity CRNA Information Session & Airway Simulation Lab Workshops are held at select graduate nurse anesthesia programs across the country. Also, providing the participants with a comprehensive experience as they consider graduate nurse anesthesia programs.
During the three-day event, historically excluded marginalized diverse registered nurses are provided with a direct opportunity for engagement with diverse nurse anesthesiologists, nurse anesthesia program faculty, and currently enrolled nurse anesthesia students. Beyond the networking opportunities, the Diversity CRNA Information Session & Airway Simulation Lab Workshop is designed with intention as it provides exposure to the profession through content that is relevant to the practice of anesthesia. The Information Session & Airway Simulation workshop is a three-day event that includes presentations on the admissions process, optimizing essay construction, nurse anesthesia program curricula, clinical preparedness, balancing family and finances, ideas for doctoral program scholarly projects with an equity lens, and opportunities for participation in live mock interviews. The mock interviews are conducted with participating nurse anesthesia program faculty who are committed to providing constructive feedback to the participants. Mock interviews have served as a reliable method to boost confidence and interview preparedness through practice, critique and a facilitated group discussion.
The Airway Simulation Lab Workshop provides the attendees with hands-on exposure to simulated clinical anesthesia techniques. While working with CRNA preceptors, participants are taught, through demonstration and return demonstration, about the use of a variety of airway management devices and other anesthesia equipment. This level of engagement provides the opportunity for nurses of color to grow in their knowledge base and have tactile experiences that will support their learning and understanding of airway anatomy, airway management, and anesthesia equipment that is commonly used in practice.
The second initiative is the Diversity CRNA Historically Black Colleges & Universities and Hispanic-Serving Institutions (HBCU & HSI) Schools of Nursing Tour. The goal of this initiative is to inform nursing students earlier in their careers about the nurse anesthesia profession. In addition, to encourage their pursuit of higher education in doctoral nurse anesthesia programs, and to offer access to a network of diverse nurse anesthesia professionals. This program is a full-day event where diverse nurse anesthesiologists engage with nursing students about their professional career trajectories. Towards the end of this one-day program, a hands-on Airway Simulation Lab Workshop is offered as an opportunity for exposure and hands-on experience that is integral to the eventual understanding of anesthesia equipment. The simulation lab workshop supports their curiosity as that is necessary for the development of an interest in, and an appreciation for, the clinical aspects of nurse anesthesia practice.
The last initiative, the Diversity CRNA Advanced Practice Nurse Doctorate Symposium, is designed for diverse marginalized advanced practice nurses, registered nurses and nursing students interested in pursuing a doctorate degree (PhD, EdD, DNP, or DNAP). A panel consisting of doctorate-prepared and diverse Nurse Anesthesiologists, Nurse Practitioners, Family Nurse Practitioners, and Nurse Midwives share details of their journey and provide the participants with an overview on the process associated with building a body of scholarly work.
Evidence of Success
For over a decade, the Diversity in Nurse Anesthesia Mentorship Program has mentored 658 nurses of color who matriculated into and graduated from 92 graduate nurse anesthesia programs.
This mentorship has supported an increase in racial and ethnic representation in the nurse anesthesia workforce from 6% in 2006 to 12% currently.
In 2022, there are 166 nurse anesthesia students of color enrolled in nurse anesthesia programs who have participated in past Diversity CRNA events. Eight of these diverse nurse anesthesia students attended a Diversity CRNA HBCU & HSI Schools of Nursing Tour when they were senior nursing students in 2016.
The Immersion Model is innovative by design and has emerged as a reliable method to challenge bias, close demographic gaps in representation, and increase the racial and ethnic diversity of the nurse anesthesia profession. Three Diversity CRNA initiatives, by utilization of this model, have demonstrated success over time by positively impacting the growth of diversity in the nurse anesthesia profession. Today, as a result of this model, there are more racially and ethnically diverse nurse anesthesia program faculty, along with an increasing number of advanced pain management fellows, PhD researchers, and doctorate-prepared CRNAs. Presently, over half of the nurse anesthesia programs across the country are making policy changes to decrease structural barriers to admission such as those inherent within the process and evaluation of standardized testing. By adopting a holistic approach to the evaluation of academic preparedness, evaluation of admission criteria, and processes for application review, we have seen an increase in the racial and ethnic diversity of the student applicant pool and ultimately the nurse anesthesia student cohorts across the United States.
This innovative model was designed and implemented to lead and support the growth of diversity in the nurse anesthesia profession. Through strategic initiatives, valued partnerships, regular evaluation, and organizational growth, the Immersion Model, and the work of The Diversity in Nurse Anesthesia Mentorship Program has made a profound measurable impact. These initiatives will continue as an example and a force toward positive outcomes for communities of people who have been marginalized and historically underrepresented for far too long.