Below is this months Student News article in the AANA NewsBulletin.  I apparently created quite the commotion last month, so we'll see what this month's article will bring...

Join the Club: The Benefits of AANA Membership

Introduction

In June of 1931, Agatha Hodgins, along with 47 of her fellow nurse anesthetists, founded the first national organization of anesthesia providers in the United States.  The National Association for Nurse Anesthetists (NANA) was incorporated the following year and in 1939 was renamed the American Association of Nurse Anesthetists (AANA).  Today, over 40,000 Certified Registered Nurse Anesthetists practice in the United States and upwards of 90% of those individuals belong to the AANA.  This solidarity has given nurse anesthetists a powerful voice in the medical community and on Capitol Hill.  The profession has prospered as a result and every member of the AANA, through their membership fees and charitable contributions, has played a vital role in its success.

Now, I don’t need to tell a bunch of full-time graduate students how important money is; life reminds us of that fact on a nearly daily basis.  But money is just as important to the health of a professional organization as it is to a struggling SRNA.  Why?  Al Pacino, playing the role of Tony Montana in the film Scarface, said it best: "In this country, you gotta make the money first. Then when you get the money, you get the power.”  In other words, our professional association must remain financially strong in order to successfully promote and advocate for CRNAs across the country.  The AANA relies heavily on annual membership dues to accomplish this goal.

The AANA Student Membership Fee is something you may give little thought to paying each year while in school.  After all, $100 seems relatively insignificant compared to the amount of money we anesthesia students spend on books and tuition.  After a while it’s like, “just put it on my tab!”  Nevertheless, this may change once our student years are behind us since, as new graduates, we will be focused on reducing – instead of rapidly accumulating – our loan debt.  It’s therefore important that we understand exactly how our AANA membership dues are being utilized so that we fully appreciate the importance of our yearly contribution and continue to support our professional organization for the duration of our careers.

Breakdown of dues

Unlike student dues, all of which go directly to the AANA, CRNA member dues are divided among a handful of professional initiatives.  Of the $645 collected from each AANA member on a yearly basis, 36% is returned to individual state associations to help fund the necessary components of an effective professional organization at the state-level.  State associations are vital to the overall health of our profession, as these organizations stay abreast of the local issues affecting CRNA practice within their borders.  State associations are thus able to quickly take action when needed as well as alert the AANA of any political or practice issues that require the attention of our national organization.  The AANA also offers assistance to state associations with special financial needs by allocating an additional 10% of membership dues to the State Organizational Development/Strategic Reserve Fund.

Thirty percent of all membership fees collected by the AANA are used for advocacy of the nurse anesthesia profession.  This goal is accomplished in a variety of ways.  For example, the AANA strives to heighten awareness of the profession through national public relations campaigns that educate the public on the role and value of nurse anesthetists.  Practicing CRNAs are provided with informational brochures and videotapes to educate their patients on this topic if desired.  The AANA also strives to improve the quality and safety of the practice of anesthesia by supporting the CRNA credentialing process and establishing standards and guidelines for practice.

One way that the AANA accomplishes this goal is by providing members with a variety of opportunities to earn the 40 hours of continuing education (CE) credits needed to qualify for bi-annual CRNA recertification.  The association maintains the CE records of each CRNA as an additional service to its members.  In addition to educational growth, these conferences and workshops improve career satisfaction by providing members with the opportunity to travel to new cities and network with other CRNAs.  The AANA advocates for student members as well.  The organization funds student scholarships, procures government financial aid money for nurse anesthesia students, and hosts faculty development programs.  Other services provided by the AANA, such as professional liability insurance, online educational opportunities, and support for CRNA-led research, are listed on the Member Benefits page of the AANA website.

While educating the public of the value of nurse anesthetists is a top priority of the AANA, the association also works diligently to ensure that its members remain informed clinically, academically, and politically.  This is accomplished via events such as the AANA Annual Meeting, electronic mailings, and various publications.  The cost of printing and distributing information (like the AANA NewsBulletin you’re currently engrossed in) accounts for 9% of the $645 annual membership fee.

Lastly, the remaining 15% of member dues are applied towards the administrative management costs incurred by the Chicago and Washington, D.C. offices of the AANA.  Anyone who has visited the AANA website, attended the Mid-Year Assembly in Washington, D.C., or registered for an AANA-sponsored event has benefitted from the services provided by these offices.  I have personally interacted with a number of individuals employed at both locations through my work with the AANA Education Committee and am convinced that our staff is the best around! 

Conclusion

For over 80 years the AANA has served to protect and promote the work of nurse anesthetists.  The organization offers student and practicing CRNAs opportunities to learn, travel, and network with others.  More importantly, it has created a profession that is greater than the sum of its parts and, in doing so, has given CRNAs a powerful and united voice within the healthcare community and world at large.  This collective strength has led to many political victories and professional advancements for CRNAs since Agatha Hodgins and her colleagues first established the organization.  Nonetheless, more challenges loom on the horizon.  We must face these challenges head-on by investing in our profession as members of the AANA following graduation.  Only then can we safeguard the health of our patients and the nurse anesthesia profession.

The Truth Regarding Academic Remediation and Dismissal

For students, the fear of dismissal is a constant concern that only adds to the stress of anesthesia school.  We breathe a small sigh of relief at the end of each semester but when a classmate’s desk remains vacant the following week that uneasiness can return with a vengeance.  No matter our performance record, at one point or another we’ve all asked ourselves, “Will I be next?”

At the AANA Assembly of School Faculty held in Orlando, Florida this past February I had the opportunity to listen to the Program Director of the Uniformed Services University, Commander Robert Hawkins, DNP, MBA, MS, CRNA, speak on the topic of student remediation and dismissal.  He provided those in attendance with statistics related to anesthesia school attrition and described a number of remediation plans available to assist struggling students.  By the end of the presentation I realized that much of our fear as students is driven by inaccurate information and misconceptions surrounding the dismissal process.  Learning more about the subject of attrition calmed my anxiety and improved my understanding of the many paths to academic and clinical success.

Research

In 2005, an attrition rate survey tool was distributed to all existing nurse anesthesia programs (n = 101) within the United States¹.  Of the 93 schools with graduating students, 67% (n = 62) responded.  The researchers reported that 9% (n = 135) of the 1,499 students enrolled failed to complete their respective nurse anesthesia programs.  Voluntary withdrawal accounted for 35.5% (n = 48) of the 135 non-graduates.  Factors leading to withdrawal included personal concerns, unsatisfactory academic or clinical performance, and lack of knowledge related to the time commitment or role of a CRNA.  Academic dismissal accounted for 30.4% (n = 41) of attrition and was most often caused by poor academic preparation.  Poor study habits, insufficient undergraduate preparation, and lack of motivation were cited as contributing factors of academic dismissal.  Lastly, 15.6% (n = 21) of the 135 enrolled students were removed due to inadequate performance in the clinical arena.  Poor clinical performance and theory transference were most often at fault, though lack of motivation or interest in the profession, class size, and family issues were also listed as reasons for dismissal.  The remaining 18.5% (n = 25) of students failed to graduate as a result of impairment, academic dishonesty, health problems, or other non-specified issues.  The authors noted that attrition rates tended to increase in programs of longer duration (p = 0.031) and these events most often occurred 12 to 18 months following enrollment.  They hypothesized that increased stress levels stemming from the initiation of clinical training or increased clinical demands may be, at least partially, at fault.

Attrition: A Lose-Lose Situation

Nurse anesthesia students and their families make incredible sacrifices for the opportunity to attend CRNA School.  The cost of our education goes beyond just tuition payments, clinical fees, and textbook purchases.  Expenditures such as forfeited income, increased time commitments, moving expenses, and stress on our marriages and families must all be accounted for.  Oh, and let’s not forget the added cost of hair dye needed to disguise all those new gray hairs framing our exhausted faces.   Clearly, nurses sacrifice much for the chance to become a CRNA and stand to pay dearly should they fail to achieve this goal.  

While students are well aware of the ramifications of dismissal, it may come as a surprise that our faculty members and universities also suffer as a result of SRNA attrition.  Educators become invested in the success of their students and faculty morale is greatly tested by each instance of SRNA withdrawal or dismissal.  In addition, remediating struggling students is a time consuming and exhaustive process for many educators.  Providing these additional resources for struggling students is also a costly endeavor for universities.  Should the remediation process fail, schools stand to suffer even greater financial losses since academic institutions rely on tuition fees for revenue.   Finally, because the attrition rates of each program are reviewed by the Council on Accreditation, a student’s failure to graduate can have lasting implications on an institution. Although student remediation and attrition negatively impacts a wide network of individuals, our profession has a responsibility to protect the public.  This task requires our educators graduate only the safest and most competent of providers.

Remediation

While the removal of a student may seem sudden to his or her classmates, the SRNA was likely offered numerous resources and opportunities to succeed.  All effective remediation strategies consist of common components and goals². First, students must identify and acknowledge their deficiencies.  Faculty members should partner with these individuals to clarify the emotional components of the problem.  Together they must then match remediation activities to the specific problem and establish objective criteria and timelines for completion.   The student is also encouraged to partner with a mentor who is able to provide academic and emotional support during this transition period.  The goal of these efforts is to restore the student’s performance to expected levels.  Consistent evaluation of and adjustments to the chosen remediation techniques should be performed until the goal of remediation is attained.

Although commonalities between remediation strategies exist, each plan must be tailored to the individual student’s needs.  SRNAs commonly struggle with either didactic or clinical demands, though personality conflicts, lack of professionalism, or behavior problems may also lead to dismissal on occasion.  Didactic remediation courses may benefit students with inadequate knowledge or preparation, test anxiety, or poor time management.  If, on the other hand, students fail to apply their didactic knowledge in the clinical setting or continually perform skills incorrectly, clinical remediation in the form of case studies and simulation lab experience may be more appropriate.  In either instance, students must have the desire and ability to modify their behavior if they are to improve their performance and continue their anesthesia training. 

The Student’s Role

Given the expectations and stress we carry as nurse anesthesia students, it is only normal to feel a certain degree of fear throughout the schooling process.  However, we must not allow that fear to paralyze our academic efforts.  Instead, we should refocus that energy towards practices that will ensure our scholastic success.  This includes continually assessing our performance, identifying deficiencies and, most importantly, seeking assistance before it’s too late.  Asking for help may prove difficult for some but it is an important skill that all safe and capable anesthesia providers must cultivate.  In order to aid this process, we should strive to support our classmates by offering our assistance and providing encouragement whenever possible.  After all, it takes a village to educate a CRNA. 

I would like to thank Commander Robert Hawkins for his willingness to share his knowledge of remediation with the AANA Assembly of School Faculty attendees and his support for this article.

References

1.      Dosch M, Jarvis S, Schlosser K. Attrition in nurse anesthesia educational programs as reported by program directors: the class of 2005. AANA Journal. August 2008;76(4):277-281.

2.      Kimatian S, Lloyd S. Remediation and due process for trainees: setting the stage for future success. International Anesthesiology Clinics. Fall 2008;46(4):113-125.

I was incredibly proud to see the May article of the AANA NewsBulletin in print.  One of my best friends, Adam Leonard, guest authored an amazing article in which he discusses his recent mission trip to the Dominican Republic.  As I prepare for my very own mission trip to the country next month, I am thankful for Adam's unique perspective; it reminds me just how fortunate I am to be given this opportunity to see another country while giving back and doing work that I love.

*Note: With finals and graduation on the horizon, the month of April got away from me and I'm just now posting last month's article.  The April NewsBulletin article can be found here. 

On a Mission: An SRNA’s Experience Abroad

A number of nurse anesthetists routinely travel to developing countries to provide those in need with life-changing anesthesia services. While most of us can only imagine what this experience must be like, a handful of nurse anesthesia students are given the opportunity to serve on medical missions in the midst of anesthesia school.  My close friend and classmate, Adam Leonard, recently returned from such a trip.  The travel stories and photos he shared upon his return served as a welcome reminder that our daily struggles as students will ultimately prepare us to handle any situation in any practice environment.  Adam has agreed to share his experience in this month’s column and I hope that his story will inspire other SRNAs to seek opportunities abroad and serve as a reminder that anesthesia school, while immensely challenging, is worth the effort.

By Guest Columnist Adam Leonard, RN, BSN

Throughout the developing world, access to safe anesthesia is a scarce commodity.  Many organizations in the United States assemble teams of surgeons, anesthesia providers, and operating room staff to deliver safe anesthetics in these underdeveloped parts of the world.  In October of 2010 I traveled to the Dominican Republic (DR) to administer anesthesia on a medical mission with one of these non-profit organizations. We traveled to a remote area in the Western side of the nation, not far from the Haitian border.  The facility consisted of a small clinic, with two small operating rooms in which to work.  Our strongest analgesic was PO acetaminophen and the power supply to the clinic was unreliable leading to frequent power outages in the operating rooms.  The days were long and hot, the conditions and equipment were sub-standard, and it was one of the greatest experiences of my SRNA career.

The opportunity to work in the developing world and deliver anesthesia offers some fantastic professional, educational, and developmental opportunities to an SRNA.  I worked with Amy as she developed her platform for the Student Representative position to the AANA Education Committee.  The issues that she focused on; raising the awareness of nurse anesthetists and improving health and wellness in the nurse anesthesia community are both addressed when we consider international volunteer work.  Additionally, international volunteer work provides an educational experience for SRNAs that cannot be replicated in the United States.

Raising Awareness

Accompanying me on this trip was one of my classmates, our CRNA mentor and a medical team comprised of an ENT surgeon, a general surgeon and OR staff.  During the course of our five-day trip we anesthetized over 20 pediatric patients for ENT procedures and just as many adults undergoing a variety of general surgical procedures.  The ENT surgeon had never worked with CRNAs before as his practice in the US is staffed entirely by anesthesiologists.  His trepidation working with nurses was obvious in the beginning of the week.  He had multiple questions about my training and CRNA practice in general.  He was surprised to hear about our history and scope of practice and he was impressed by the anesthetic outcomes he witnessed that week in the operating room.  This was an excellent opportunity to educate medical professionals about CRNAs and CRNA issues.  I was proud to be able to represent our community in such a manner. 

The local doctors and nurses also had questions for me about my CRNA training and our scope of practice.  One of the locally trained anesthesia providers sat with me in the operating room one afternoon and asked me about my anesthetic techniques.  We traded ideas about induction and emergence.  It was interesting to hear him talk about drugs we no longer use with any frequency in the United States, such as atracurium and halothane.  This too was a great experience educating others about our profession.

Improving Wellness

There is nothing like anesthesia training.  It demands of a great deal of our time and energy.  It is highly stressful and requires us to spend time away from our families and loved ones.  I remember preparing for the trip thinking it was one more thing I had to accomplish in my quest to graduate. In the DR my mentality changed from just trying to “get through” another clinical day to feeling like I was working for a higher good.  Despite the long hours and difficult working conditions, I felt my work was improving the lives of others.  I was so inspired by the dedication and the hard work of my coworkers and the local people working at the clinic.  Despite a language barrier we all showed great teamwork in providing outstanding care to the patients we treated.

Going to the developing world helped me regain my perspective on what truly matters in my life; my family, our health, and the opportunities available to me.  I didn’t realize how much I was taking all of these things for granted.  It is only when I was confronted with people without such good fortune that their relevance became so apparent.  This trip reenergized me, it reminded me of one of the main reasons I became a nurse in the first place; to help those in need.   When I returned to the United States I was more relaxed, having gained a renewed perspective on my anesthesia training.

An Educational Experience

This trip reinforced for me why we nurses make such incredible anesthetists.  Conditions such as these, with no end-tidal monitors, no mechanical ventilators and marginally reliable equipment, made me solely focus on the best monitor I had: my patient.  I judged how anesthetized each patient was based on how forcefully the bag filled and emptied on my gas machine. I measured respiratory rate in the same manner.  As I turned up the dial on my vaporizer, it was amazing to see my patient’s respirations slow down and decrease in tidal volume.  I estimated blood pressures by palpating pulses when our blood pressure cuff failed on us in the middle of a case and I never paid such close attention to my patient’s urometer in all my anesthesia training.  It was a trip back in time and I felt like I was delivering anesthesia under some of the same conditions that our foremothers dealt with on a daily basis.

I also learned to give an entirely different anesthetic than I normally would in the US.  On opposite ends of the anesthesia spectrum there are two basic types of providers: “pushers” and “gassers”.  The pushers give lots of narcotics up front in the beginning of the case and give very little vapor.  Gassers, on the other hand, rarely touch narcotics and run their patients very deep on the gas.  During my training I have leaned towards the former technique.  I really enjoy the heavy narcotic up front, leading to a really smooth emergence with excellent tube tolerance and very little coughing. At the clinic, however, there were no narcotics to administer, so I was forced to learn a straight gas technique.  I really enjoyed expanding my base of knowledge with this type of anesthetic and feel I am better provider because of this experience.

Conclusion 

I encourage all SRNAs and CRNAs to get involved in international healthcare.  As anesthesia professionals we have a skill set that is valuable and scarce.  This enables us to make real differences in the lives of the underserved in developing nations.  By providing safe anesthesia to these communities, we can considerably improve their perioperative outcomes.   I call on my soon-to-be CRNA colleagues to invite a student to join them on their next volunteer experience abroad.  Nurse anesthetists have the ability to enrich the education of an SRNA by serving as a preceptor on a medical mission trip.  I am so thankful to my preceptor for facilitating this life changing experience.  

For those interested in national and international volunteer work, a list of organizations looking for anesthesia personnel can be viewed on the AANA website at http://www.aana.com/ProfessionalDevelopment.aspx?id=25656.

Thank you so much to Amy for giving up her column for a month so I could write about an issue so important to our profession and to me.

This months article was written using notes from an interview with Mark Odden, a CRNA.  Please don't let the fact that the author (i.e. me) hasn't been able to secure a job keep you from heeding Mr. Odden's advice!

Contract Considerations: Finding the Right Job Following Graduation

In 2003 I left my undergraduate university with a business degree in hand, eager to put my years of hard-earned knowledge to use.  I had secured a well-paying position in an exciting career field – I was on my way!  It wasn’t until a few months later that I began to notice the cracks in my chosen profession’s perfect façade.  Only 4 promotions stood between my entry level position and the President of the company, leaving little room for upward mobility.  My salary was comparable to that of my peers, but the accompanying benefits package left much to be desired.  The one up-side was that I was able to save most of my earned income, though this was not a difficult task considering that I worked late into the evening and thus had no opportunity to spend money.  I was unhappy and worst of all, by failing to identify my career needs and ensuring that those needs were met by my company and my employment contract, I had no one but myself to blame for my employment situation.

I learned my lesson and, after returning to the classroom to pursue my nursing degree, I scoured my hospital employment contract for any undesirable clauses.  This wasn’t an easy task given that the nursing profession is so vastly different from a career in business.  Likewise, the professional considerations of nurse anesthetists vary greatly from those of our nursing colleagues.  What should our CRNA career priorities be?  Should we focus on reducing our educational debt by accepting a well-paying position following graduation or should clinical learning opportunities be the most important factor in choosing a job?  How can we best ensure that our actual career experience will meet our expectations?

Since I’m not yet a CRNA (insert frowny face here) and can’t personally speak to nurse anesthesia employment considerations, I’ve consulted an expert.  Mark Odden is the Chairman of the AANA State Organizational Development Committee.  He also serves as a clinical instructor for SRNAs attending the University of Iowa and utilizes his anesthesia training and MBA degree as the founder and President of Odden Anesthesia Services, an all CRNA group based in northern Iowa.  Mr. Odden is therefore uniquely qualified to dispense career advice to student nurse anesthetists and was kind enough to offer some insight to SRNAs as we prepare to reenter the workforce.  With his approval, I’ve shared his career advice for new graduates below.

Personal Considerations

We have made countless sacrifices – as have our loved ones – on the road to becoming nurse anesthetists.  Once we attain our objective, we must refocus our attention on pursuing a career path that meets our needs and the needs of those we care about.  Mr. Odden suggests that each SRNA consider what is best for his or her family and use that information to drive their job search.  Your status as single or married should also be taken into consideration before committing to work and live in a rural area versus a younger and more single-friendly urban setting.  Finally, examine the proposed work schedules of the jobs you are interested in.  What is the length of a typical work day?  Will you be expected to work call shifts or weekends and, if so, how often?  This information is invaluable for those interested in maintaining a work-life balance following CRNA school.

Career Considerations

You’ll quickly begin to realize that your personal preferences – such as your desired location and schedule – affect your income.  It’s important to keep in mind, however, that your initial salary isn’t nearly as important as your income growth potential.  Ask your potential employers to detail the current salary range for CRNAs at their institution and find out what factors are taken into account when determining salary raises and bonuses.  It is also critical that new graduates seek out opportunities for professional growth in order to solidify the knowledge they amassed as students, so don’t be afraid to continually challenge yourself.  It’s like the saying goes, “if you don’t use it, you lose it!”  This is easy if you practice in a setting that enlivens you.  Whether you’re passionate about regional anesthesia or the pediatric population, determine what excites you as an anesthesia provider and search out practices that allow you to pursue those interests. 

One common question that many students want to know is whether they should seek to gain employment through a hospital or an anesthesiologist-owned practice.  The answer is the always frustrating “it depends.”  Hospital employees are forced to deal with the politics and bureaucracy inherent in most hospitals, but because large organizations are often slow to change, there comes with it a sense of stability and dependability.  Conversely, anesthesiologist-owned groups tend to be smaller organizations and may therefore offer a greater sense of camaraderie between their anesthesia practitioner employees.  Keep in mind that, when faced with budget cuts, either type of employer may choose to alter or do away with certain benefits that originally attracted you as an employee.  The likelihood of this occurring depends on the leadership of the organization so it’s imperative that students assess the culture and feeling of each group as they proceed through the interview process. 

Professional Considerations

In order for CRNAs to enjoy a life-long career in anesthesia, the profession itself must remain relevant and vital to the health care community.  Doing so requires the financial support and involvement of individual CRNAs, including new graduates.  It is important, then, to ascertain the level of support offered by potential employers.  Will your professional dues be paid by the organization and, if so, is this benefit guaranteed to continue in the future?  Will your work community support you in your efforts to become involved at the local, state, or national level?  Attempt to garner additional vacation time for professional training workshops and meetings.  After all, staying abreast of new advancements in anesthesia will benefit your employer immediately and your career for years to come.   

Ensuring the right “Fit”

Once you’ve decided what you want in a job, you should ensure that the organizations you’re considering will meet your needs.  The best way to do this is to interview in person and make an effort to seek out and talk to the nurse anesthetists on staff – not just the one or two CRNAs who were chosen to speak with interested candidates.  Locate the grumpy CRNAs for an honest dialogue.  Discover what the employed CRNAs like most – and least – about their work setting.  Inquire about the culture of the organization and the relationship between the medical and nursing staff.  If possible, shadow a few CRNAs for a day.  Note whether they are encouraged to administer induction drugs, perform nerve blocks, and take on challenging cases, as these signs indicate that the nurse anesthetists are valued members of the anesthesia team.  Get a good feel for the personalities of the CRNAs that you’d be working with.  Most importantly, remember that you are interviewing the organization in addition to being interviewed yourself, so don’t be afraid to ask a lot of questions.

Other Advice

Once you’ve signed on the dotted line, you should consider hiring a financial planner.  You will likely earn more as a CRNA than you have in the past and, with the uncertain future of the health care system, it’s more important than ever that new graduates learn how to properly manage their income.  A financial planner who is familiar with the opportunities available to nurse anesthetists can also educate their CRNA clients  about many lesser-known financial opportunities available to those in the profession.  Practicing nurse anesthetists should also consider investing in malpractice insurance.  Organizations may differ on the types and coverage of malpractice insurance they offer, and purchasing malpractice insurance may be the only option for CRNAs who provide independent anesthesia services.  Finally, never talk business in front of our nurse or physician colleagues.  Doing so will only introduce jealously and resentment into an otherwise favorable working environment.  If you must discuss business-related topics, do so with your CRNA co-workers in private.

Conclusion

In tough economic times such as these, it’s tempting to accept a job – any job – without first considering your goals.   Doing so may lead to personal, professional, or financial discontent, outcomes which could easily have been avoided.  So as we begin to distribute our resumes and embark on the interview process, it’s important that we are as prepared to ask questions as we are to answer them.  

I would like to once again thank Mark Odden for his contributions to this month’s Student News Column and his continual support of and enthusiasm for student registered nurse anesthetists across the country.

Dollars and Sense

The annual arrival of tax season brings with it an acute awareness of one’s financial situation.  As full-time students, our bank accounts may not be as robust as they once were but thankfully this won’t always be the case.  We will soon graduate and gain employment as CRNAs, where in all likelihood our earning potential will far exceed the number printed on our previous paychecks.  While we should enjoy our newfound and hard-earned salary, our long-term financial health demands that we construct debt-repayment, savings, and retirement plans as well.  

Jeremy Stanley, a Certified Financial Planner and Wealth Advisor at LPL Financial, has graciously agreed to serve as this month’s guest columnist.  Through his work with numerous CRNA clients over the past decade as well as his participation in SRNA financial management training, Mr. Stanley is well versed on the financial opportunities available to those in our profession.  He presented this information to students and practicing nurse anesthetists at the annual meeting of the North Carolina Association of Nurse Anesthetists last September.  Here, he addresses the unique monetary challenges faced by SRNAs and outlines specific financial goals designed to position nurse anesthesia students for financial success following graduation.

Guest Columnist Jeremy Stanley, LPL Financial

Working with CRNA’s and SRNA’s for many years has given us a clear understanding of the financial constraints of going back to anesthesia school.  Making this transition is a good long term financial decision but can cause financial hardships in the short term. (Going back to anesthesia school can present a unique financial challenge.) 

Many of our clients have found that a financial plan helps them to crystallize their goals and prepare for the lifestyle of which they dreamed.  There will undoubtedly be roadblocks and speed bumps along the road, but a plan will help you steer through them and get back on track.

Although each one of the following areas can be a page long in itself, the following is a brief understanding of areas that will be important to you as a CRNA. Even though each of these objectives may not be at the fore front of you mind now as a SRNA, they will be as you transition to a CRNA.

The most important for most SRNA’s will be debt management:

Debt Management 

For many SRNA’s, debt management is often a major obstacle. Student loans, credit card and car loans can quickly overload a budget; the key is to have a debt reduction strategy.

Here are 2 debt reduction strategies which you can try out for yourself.

Snowball method: This is where you pay off debt starting right from the lowest outstanding balance to the highest. Here's how it works.

·         Determine how much additional money you can pay monthly toward your debt

·         Create a list of all your debt accounts from lowest to the highest balance.

·         Pay the minimum on all your debts.

·         Increase the payment towards the lowest debt balance.

Once you pay off the smallest bill, take that payment plus the increase and pay towards the next higher balance and repeat the same for all your bills.

Debt Avalanche: This is a reduction plan in which you start paying off high interest debts first and then move on to the ones having low interest rate. Here's a step-by-step approach.

·         Determine how much additional money you can pay monthly toward your debt

·         List your debts in order from the highest to lowest rate.

·         Pay the minimum towards each account.

·         Increase the payment towards the highest interest account.

Once the highest interest debt is paid off, start paying extra towards the account with the next higher rate and repeat the same for other accounts as well.

Insuring Your Future

Although most of us are aware of the need for health insurance coverage when determining our risk-management needs, many of us fail to consider the possibility that we could become disabled. A disability income insurance policy can help replace income lost because of an injury or illness. In the event that you become disabled and are unable to work, the benefits provided by disability insurance can help replace a portion of your earned income.  Keep in mind that not all disability policies are created equal, know what is covered before you purchase.

Today, virtually all heads of families should carry life insurance. Most financial advisors also recommend automobile, health, homeowners, personal liability, professional liability and/or malpractice, disability, and long-term-care insurance. 

Plan to Save

Investing is a lifelong process, and the sooner you start, the better off you may be in the long run. The first part of that process is developing consistent savings habits. Regardless of whether you are saving for retirement, a new house or that once-in-a-lifetime vacation, you will need a dedicated focus on saving. Regular contributions to savings or investment accounts may help with this process; and if you can automate them, they are even easier.

Once you begin saving on a regular basis, you’ll need to start making important decisions about how to invest your money. Regardless of the financial stage of life you are in, you will need to consider what your investment objectives are, how long you have to pursue each objective and how comfortable you are with risk.

All investing involves a certain amount of risk. In determining the amount of risk your investments should carry, consider weighing your ability to tolerate price fluctuations against your need to earn a certain rate of return. Keep in mind that time plays an important role in this decision. For a retirement that is 30 years away, you can probably tolerate more risk because you have the time to make up any losses you may experience early on. For a shorter-term investment, such as saving to buy a house, you probably want to take on less risk and have more liquidi liquidity in your investments.

Planning for Retirement

Retirement may be the end of your working years, but it’s just the beginning of what should be the most important phase of your life.  When will yours begin … at age 55, 62, 67?  What kind of lifestyle do you want to have?  Will you spend more time traveling, visiting family, volunteering, exercising, painting, writing … teaching?  How can you prepare for this stage, and when should you start?  Wouldn’t you like to know if you are on track to make this happen?

Most people focus on the day-to-day activities.  Few people realize that they should plan for their retirement as if they were preparing to take a long vacation.  You can expect to spend from 15 to 30 years or more in the retirement phase of your life.  What will you be doing?  Where?  For how long?  How much will it cost?

You make travel arrangements weeks or even months before taking a trip, so you can get the flights, car rentals and hotels that you want.  You plan where to go, how long to stay, what clothes to bring, and how much it will cost.   

Make travel arrangements at the last minute and you will surely sweat the details.  It works the same way in planning for your retirement years.  Creating and implementing the right plan can make your life less stressful and more enjoyable, because you will have taken out a lot of the uncertainty about the future.  There will be roadblocks and speed bumps along the way, but a plan will help you get through them and back on track.

A Disciplined Strategy and Your Financial Advisor Can Help

One of the hardest things about investing is to discipline yourself to save an appropriate portion of your income regularly so that you can meet your investment goals. Also, if you are not fascinated with investing, it is probably difficult to force yourself to review your financial situation and investment strategy on a regular basis. Establishing a relationship with a trusted financial advisor can go a long way toward helping you practice smart financial management over your lifetime.

Jeremy Stanley is a Wealth Advisor with LPL Financial.

Securities offered through LPL Financial, Member FINRA/SIPC.