Spotlight on Nurse Anesthesia

Spotlight on Nurse Anesthesia

By Natalia Macdougall, MS, CRNA, and Lisa Lewis

Certified registered nurse anesthetists (CRNAs) in the UCLA Department of Anesthesiology & Perioperative Medicine (DAPM) occupy a unique role. At UCLA, CRNAs work collaboratively with anesthesiologists. Together, they formulate an anesthetic plan and see their patients through the entire perioperative period. 

While CRNAs care for healthy outpatients, they also care for some of UCLA’s most critically ill patients, ranging from the very young to the elderly at various sites within the Westwood and Santa Monica campuses. Their caseload is just as varied, spanning complex neurosurgical cases, kidney transplants, and invasive airway procedures, to simpler procedures like cataract surgery. 

An extensive training period prepares them for this work. CRNAs are first required to work a minimum of one to two years as an ICU nurse and then complete at least three years of a rigorous anesthesia curriculum to earn a Doctorate in Nurse Anesthesia Practice (DNAP). After successfully defending their thesis and passing their CRNA boards, they are licensed to practice clinically. 

Recruiting CRNAs 

Recruiting these newly trained CRNAs, as well as seasoned CRNAs, is an important part of creating the strong team that has been built here at UCLA.  

The CRNA administrative team works closely with UCLA’s head of talent and acquisition to recruit strong candidates to the Department of Anesthesiology & Perioperative Medicine via advertising, tabling at conferences, and presenting at recruitment fairs.  A recent achievement by the administrative team was obtaining a signing bonus and relocation stipend. 

“Competing institutions had signing bonuses and relocation stipends, so after more than a year of data collecting, meetings, and advocating, we were able to obtain a signing bonus for UCLA, helping us to stay competitive with other local academic institutions,” said UCLA’s Nurse Anesthetist Manager, Debbie Paris Teho, MSN, CRNA. 

Recruitment, however, is not just an administrative undertaking, as CRNA staff like Jamilla Churchill, MSN, MPH, CRNA, make it part of their mission. Churchill describes nurse anesthesia as “the best kept secret in nursing.”

She is one of several division members who participate in outreach and recruitment efforts, providing information to interested RNs about the CRNA doctoral program. As part of a new effort by the California Association of Nurse Anesthesiology, Churchill mentors candidates applying for CRNA doctoral programs.

She is also active in diversity efforts within the profession, including the Diversity in Nurse Anesthesia Mentorship Program and our department’s Inclusive Excellence Committee. “I think our professional staff should reflect the community,” she said. 

She and other division members regularly staff information tables at the annual meetings of the California Association of Nurse Anesthesiology and the American Association of Nurse Anesthesiology to recruit CRNAs to UCLA.

Current nurses at UCLA are another area of focus. “To become a nurse anesthetist, you have to have a background in critical care nursing,” Ariane Leuenberger, DNP, CRNA, said. In June, she presented about the RN-to-CRNA path as part of the Nursing Professional Development Fair hosted by the UCLA Center for Nursing Excellence. 

Gena Dix, MSN, CRNA, and Lauren Fagan, MSN, CRNA, take a longer view on recruitment, participating in career days to introduce young learners to the field in hopes of inspiring future CRNAs.

Bringing new CRNAs into the fold

When new CRNAs join the department, they are placed into a mentorship program that spans their first year and beyond. New hires are paired with two mentors: a senior CRNA and a more recent hire. 

“It’s like a matchmaking process,” said Churchill, who spearheads the program. “Our staff are so great – they’re always open to taking on a new mentee and showing them the ropes and how we do things at UCLA.” 

Once paired, the CRNAs have frequent check-ins with their mentors, as well as social meetups outside of work at their 3-month, 6-month, and one-year anniversary. “We are fairly spread out on different sites on different campuses, so we don’t always see each other on a daily basis. The meetups help create a sense of community and help form connections,” Paris Teho said. Once they graduate from the mentorship program, CRNAs are encouraged to mentor new staff. 

New CRNAs also participate in an extensive 10-week orientation program that includes all five clinical sites at UCLA. “They’re all quite different,” Paris Teho said, “and they all have different specialty cases that require a bit of guidance.” New hires are paired with a CRNA for their first few days at each site, then are given a resource CRNA and eventually work solo as they gradually get accustomed to the workflow and culture at UCLA.

“People seem really pleased with the program and how it helps them assimilate into life as a CRNA at UCLA,” she added.

Education and outreach

“Being an academic institution, an important recruitment and retention tool is the emphasis placed on education,” said Assistant CRNA Manager Natalia MacDougall, MS, CRNA. Each year, the CRNAs participate in a skills day at the UCLA Simulation Center. “We have guest lectures, and the CRNAs practice clinically important skills such as placing central lines, working with the fiberoptic scope, and practicing difficult airway techniques, among other things,” said MacDougall, who developed and launched the event four years ago.

“Our next Skills Day will be held in February.  I’m excited to be collaborating with our anesthesia and ICU colleague Dr. Brannon Altenhofen, who will help teach the CRNAs how to perform gastric ultrasounds.” In addition to the CRNA Skills Day, MacDougall has been working with the Simulation Center to host mock codes, which will be piloted in January 2027. 

About once a month, division members also provide education for other departments, noted Assistant CRNA Manager Alan Zamora, MSN, CRNA. “Sometimes, they’ll reach out to me and say, ‘Hey, Alan, we need someone to deliver an in-service on pediatric airway management and delirium, or moderate sedation, or OR emergencies,’” he said. 

These education requests often grow out of the CRNAs’ ongoing interaction with staff at various facilities. Most recently, Leuenberger was asked to present to the PACU nurses at the Santa Monica Surgery Center about post-anesthesia pain management and recovery, which she did in mid-July.

The CRNAs also offer two day-long courses each year: one on procedural sedation and one on ambulatory post-anesthesia care. “The courses are usually attended by 60 to 70 UCLA RNs from various departments throughout UCLA Health,” Zamora said. 

This year’s procedural sedation course, held in April, was led by Nathan Yamagata, MSN, CRNA, who co-planned and taught the course with Jennifer Katsura, MSN, CRNA, Cesar Rivera, DNAP, CRNA, and Margaret Strickland, DNP, CRNA. “The course is part of their training so they can get certified to provide procedural or moderate sedation,” Zamora said.

The ambulatory post-anesthesia care course will be held later this fall. It will be led by Zamora, with three additional CRNAs also presenting and facilitating the hands-on airway skills portion.

In both courses, nurses learn a range of skills such as placing oral and nasal airways, mask-ventilating a patient, being able to recognize if the airway is compromised, and knowing when to intervene and when to ask for help. 

In addition to teaching numerous courses, the CRNAs at UCLA are also actively involved in research. Most recently, Zamora and MacDougall assisted with research in anesthesia for orbital blocks led by Zhuang-Ting Fang, MD, MPH, at the UCLA Stein Eye Institute, and co-authored the resulting published studies on novel anesthesia mixtures used for eye surgery.

Sharing expertise within DAPM

Members of the division also contribute to a range of efforts focused on sharing clinical insights and fostering belonging within DAPM.

In February, Paris Teho participated in a specialized bronchoscopy procedure using a photosensitizing agent. The photodynamic therapy, used to treat certain lung cancers for which radiotherapy isn’t indicated, “was a new groundbreaking therapy at UCLA,” she said. 

Everyone involved in the case attended a training beforehand. “There were unique considerations, because the dye makes the tumor and the patient completely photosensitive,” Paris Teho said. The patient had to remain in complete darkness throughout the perioperative period, including during transport from one area to another. Afterwards, she relayed pertinent information regarding anesthetic and procedural considerations to the department and published it in the DAPM C8 intranet resource. 

On an ongoing basis, members of the division serve on the DAPM Quality Improvement and Quality Assurance (QI/QA) Committee. 

Given the nature of the job, the CRNAs have a unique perspective to contribute, said Natasha Goodman, DNAP, PhD, CRNA, who has served on the committee for several years. So Hee Lee, DNAP, CRNA, and Yamagata are also on the committee.

“We have a slightly different role as CRNAs,” Goodman noted. “We work collaboratively with the physicians, so sometimes we see system issues that are unique to our role, or that might be shared with someone else in a collaborative role, like a resident.” In addition, because CRNAs rotate to five clinical sites, they can help determine if an issue is facility-wide or site-specific, and may also be able to see how an issue is already being handled at another site, she said. 

The CRNAs “are frontline,” said Paris Teho. “Because we do a lot of cases on a weekly basis, we have a lot of insights on clinical scenarios that may be happening, based on our experience being in the OR and doing so much direct patient care.”

Outreach and giving back

While CRNAs work hard in the operating room and spend a lot of time teaching, it is not uncommon to find them participating in community outreach programs. This year, Leuenberger co-moderated the sixth annual DAPM Womxn’s Symposium with Maxime Cannesson, MD, PhD, Chair of Anesthesiology & Perioperative Medicine. The April 2026 event was open not just to DAPM but also to students and faculty at the UCLA David Geffen School of Medicine. 

“We talked about the importance of understanding belonging and what it looks like in our practice day to day, both in the operating rooms and within our department,” Leuenberger said. 

Current CRNA doctoral students from several local nurse anesthesia programs rotate through the division on a regular basis. While student nurse anesthetists from the USC Keck School of Medicine and Kaiser Permanente have participated for many years, the division will also begin hosting students from the inaugural class at the UC Davis Nursing School.

“We’re training the next generation of CRNAs,” Zamora said, characterizing the division’s participation as a way to give back to the field.

Many members of the division also share their expertise by participating in medical mission trips. This includes Paris Teho and Katsura, who provide anesthesia for hernia surgeries in Honduras each year; Brianna Ortbals, MSN, CRNA, who has traveled to Guatemala and El Salvador to assist with cleft lip and palate repairs and other pediatric surgeries; and Jina Kim, MS, CRNA, who went to Guatemala last fall to work on a range of ear, nose, and throat surgeries.

Support for patients 

For the last several years, Huy Vo, MSN, CRNA, has been exploring how the perioperative environment can be shaped to support patients through the transition into anesthesia. “The point is trying to create a sense of safety and presence,” he said. “I’m really interested in how we can make a really intense medical experience feel a little more human.”

Depending on the patient and clinical context, Vo may incorporate signing bowls, lavender, music, or light projectors into the perioperative environment. The approach is individualized, he noted. “I’m always considering the patient, their preferences, the procedure, and the context. But to be honest, most patients want all of it.”

Regardless of the specific modalities, “every patient gets the same underlying approach,” Vo said. “There’s presence, there’s clear communication, there’s this careful, titrated pacing and attention to the transition from being awake to being anesthetized.”

Vo’s approach is grounded in his long-standing yoga and meditation practice and his background in palliative care.

With both adult and pediatric patients, Vo will sometimes invite them to interact with the singing bowls themselves to help them become more familiar with the sounds and environment before anesthesia. He also frequently creates towel animals—monkeys, pigs, rabbits, turtles, elephants, and swans—that can accompany them into the operating room. 

Vo has seen that his methods can also soothe other personnel. “The operating room is really cold, bright, and fast,” he said. “That doesn’t just impact patients; it impacts the people who work in that environment. If we can slow that process down and make it less sterile, and be more mindful, it creates an environment of safety for our nervous systems.” For Vo, the individual modalities are secondary to a broader question: how can the perioperative experience be designed in a way that better supports patients?

Supporting providers 

About once a month, Vo provides blended sound bath and meditation sessions for perioperative staff. In July, he did so for DAPM practitioners at Ronald Reagan UCLA Medical Center. In August, he hosted a similar session at UCLA Santa Monica Medical Center. 

Vo is currently working with K. Elliott Higgins III, MD, Director of Health and Well-Being for DAPM, to develop a class on embodiment and practical regulation skills for providers.

“We walk into these rooms carrying a lot of responsibility,” he said. “We’re focused, vigilant, making quick decisions, managing risk, and just responding to whatever is happening in front of us. And then the case ends, and we’re immediately moving into the next thing.”

Vo explained the intention of the class, asking, “Are there small, accessible practices that can help us transition out of sustained vigilance and come back to ourselves a little bit?”

A rewarding role

Being a CRNA “gives you a unique perspective on the human experience,” said Goodman. 

“It’s truly an art and a science getting someone through the nerves of being there for a surgery,” Leuenberger added. “You have the opportunity to meet them and alleviate some of those concerns and then you carry that through with the medicine to optimize their experience not only intraoperatively but also postoperatively.”

She said, “What I love best about being a CRNA is showing up to a place like UCLA where there’s high-caliber medicine with brilliant minds always available for a consult and assistance. At the end of the day, we all have the goal of helping people and providing safe patient care.”