As a practicing CRNA for nearly eight years, Gabriel Restrepo loves his work, but hasn’t been satisfied with only focusing on the clinical or pharmacological aspects of anesthesia.

“I knew I always wanted to learn more about the policymaking process, novel anesthesia educational teaching techniques, how to improve patient safety, and how to get more involved with standards of care, protocols, procedures and regulations,” he says. “I want to make anesthesia better for everybody. I have a passion to get involved.”

Over the years, he’d regularly see VCU Nurse Anesthesia’s booth at CRNA conferences, and got to know Dr. Suzanne Wright, the Department’s professor and chair. “My dream was to complete my doctoral degree in nurse anesthesia at VCU,” Gabriel says.

And as these luck-would-have-it stories tend to go, a VCU Health recruiter who had his CV reached out one day with a job opening for a CRNA at the health system’s Community Memorial Hospital in South Hill. He took the job in 2017, moved from Maryland to Virginia, and shortly thereafter enrolled in VCU’s post-master’s DNAP program.

So why return for additional nurse anesthesia education?

“That’s a great question,” Gabriel says. “I’m going to be 52 this year. And everyone keeps asking me, ‘What are you doing going back to school? You get no monetary compensation or rewards, and it will take a lot of your time.’ But for me, there are multiple levels as to why: At the professional level, the theories and concepts offered in the doctoral curriculum path will enable me to become a more proficient clinician. The knowledge I gain will help me advance the nurse anesthesia profession and improve the health of our communities. And at the personal level, through the motivation and instruction of VCU’s talented faculty, I want to become the best professional and person I can be.”

“I know that path requires the next step, which is to obtain a doctoral degree in nurse anesthesia.”

That step has been more than two decades in the making. Growing up, Gabriel saw no future for himself in his home country of Colombia, South America. So in 1997, at age 27, he moved to the U.S.

He spoke no English and had no support or family nearby. Around his new home of Stamford, Conn., he held a number of jobs — “you name it, I did it” — as a construction worker, a landscaper, and a painter. Then he moved to restaurants. At first washing dishes. Then a runner. Then a waiter.

As his income grew, he decided to invest in himself, enrolling in a program at the local community college to become a paramedic. That requires starting out as an EMT. One day, the emergency department director at the Stamford hospital he routinely visited took notice of his educational track, and pushed him to become a nurse instead of a paramedic. She said he could do more with his career, and explore a greater number of opportunities.

The idea took root. Already enrolled at the community college, he shifted his mentality — and then, his course of study. He graduated in 2002 with an associate’s degree in nursing. He worked as an RN on various floors at Bridgeport Hospital — all while taking online classes for the BSN he earned in 2009.

During his time at Bridgeport, he met many CRNAs, who pushed him to pursue a career as a CRNA “because they saw I was interested in their work,” he says.

So, he kept up his education, completing all the requirements — ICU training, becoming a critical care nurse — to apply for a nurse-anesthesia program. He earned his certifications, built experience, and racked up required references. He applied to and was accepted to the University of Maryland’s Nurse Anesthesia program in 2011, graduated with honors in 2013, and has practiced as a CRNA since 2014. 

VCU Nurse Anesthesia’s post-master’s Doctor of Nurse Anesthesia Practice (DNAP) program prepares CRNAs to assume leadership positions in education, management, and clinical practice, with a curriculum focused on patient safety and human factors, ethics, quality assessment and improvement, health care systems and organizations, leadership, evidence-based practices, policy/advocacy practice, research, and adult education.

It’s also designed for full-time working CRNAs like Gabriel, and has the flexibility of one- to three-year completion options. The fact that classes are online (in non-COVID times, there are three on-campus sessions each year) wasn’t new for Gabriel, who had taken online classes since web-based learning even first began to emerge.

“When I started my education in 1999, I had to work to sustain my family, I couldn’t just say, ‘Oh, I’m going to college.’ So I’ve been forced to take so many online classes over the last 20 years,” says Gabriel, who will graduate with his DNAP in May 2021. “At VCU Nurse Anesthesia, the technology has been great. You’re able to login and see conferences, recordings, and review material at any time. It really makes a big difference in how you learn.”

His advice to those considering the DNAP? “I see a lack of involvement from many nurse anesthesia professionals. I tell students at my hospital: ‘Listen, you’re overwhelmed with clinicals and other studies and more, but never forget that in the future, you may want to take your career farther. And if you don’t get involved now, you’re going to have to fight those battles,’” Gabriel explains. “One of the ways to get involved is to move to the next level of your education with the doctoral program. Let’s all get on the same level so that we can continue pushing policy in favor of the anesthesia profession.”

And if you still think the DNAP path is too difficult or challenging, keep in mind: In 2012, deep into his education to earn the requirements to become a CRNA, Gabriel became an American citizen.

Gabriel’s doctoral project: Drug screening anesthesia patients

Every post-master’s DNAP student must complete a doctoral project, which is intended to demonstrate integration and synthesis of concepts learned throughout the program and practice experience. Gabriel has witnessed firsthand many anesthesia patients who, at the time of procedure, have illicit substances in their system. But there’s no standard of care around testing and treatment, which is a problem he wants to solve. Learn more about Gabriel’s doctoral project.

A blog post years ago drove Jean Snyder into action.

The story was about a mother whose son died during a routine surgery. “I’m going to get choked up telling you about it,” Snyder recalled in a recent interview. The boy arrested on the table, the cause: the anesthesia provider used the wrong medication, and further failed to dilute it. The boy was given one-hundred times the necessary dose, had it been the proper medication in the first place.

“I can still remember my husband walking into the room while I was crying at the computer,” Snyder says. “This poor mother lost a child because an anesthesia provider made an error.”

She took her anger and sadness and turned it into the Error Recovery and Mitigation Aide, or ERMA. A clear box attached to the middle of a traditional needle reservoir, ERMA allows a practitioner in any high-risk area to see all the syringes and vials used during a procedure in real time through the plexiglass. They can recognize errors early, pre-disposal, and address issues faster. Once the procedure is complete, a trap door allows the waste to fall into the reservoir.

But there was a problem: Snyder had the prototype, but didn’t know the next step.

Living in Williamsburg at the time, she phoned Suzanne Wright, PhD, CRNA, then a professor and now chair of the VCU Department of Nurse Anesthesia. Wright encouraged Snyder to write a whitepaper on the device and get her post-master’s DNAP in the process.

Snyder is a 1983 graduate of Niagara University, and earned her master’s degree in nurse anesthesiology from the University at Buffalo in 1995. She graduated from VCU’s post-master’s DNAP program in 2016.

After earning her licensure as a CRNA in the mid-1990s, she worked for several health systems, and in 2006 began work as an independent contractor. Realizing a business opportunity and opportunity to save clinics additional cost, the entrepreneurial bug bit, and led her to start her own practice. As co-founder of Goodwin & Snyder Anesthesia Associates PLLC, she and her business partner provide anesthesia services to three Tidewater-area ambulatory surgical centers. Their contracts supply CRNAs to the ASCs with the oversight of an on-site surgeon. (She and Howie Goodwin also own a ketamine and infusion clinic in Newport News, Ecstasis, where they treat post-traumatic stress disorder, treatment-resistant depression, and complex regional pain syndrome).

For her DNAP capstone project, Snyder further refined the ERMA and built evidence to back it up through a whitepaper that outlined the many stories of anesthesia errors that could have been prevented with such a product. The whitepaper, she said, “showed why we need ERMA.”

Today, she holds a patent on the device along with her former employer. And yet, she gained much more from her DNAP experience than the evidence to back up ERMA.

“I went in thinking I would just develop ERMA and save the world,” she says. “What I didn’t realize is that the DNAP would give me parity. I now have a door into C-suites to talk about providing anesthesia services, or to explain the ERMA device. It’s the sad truth that, in many cases, you need more than a nursing degree to get your foot in the door. The DNAP makes a difference, and gives you the credentials you need to make change happen.”

She also didn’t want the program to end. “I learned so much by how the VCU faculty handled themselves and how they worked with students and communicated with us,” she says. “I try to mirror those behaviors when I work with [my peers] and employees. I have learned so much about the whole process of dealing with other people by how they dealt with other students.”

“I am committed to empowering all nurses, but especially CRNAs, to be heard as subject matter experts, to be business owners, and to empower them to step into leadership positions,” she says. “Nurse anesthesia has given me so much in my life, and a career I’ve not had one moment of regret about. I believe firmly in nurse anesthesia as model for the future.”

“It’s time to build our organization up and profession up —because there are plenty of people out there trying to tear it down.”