As a doctoral student in Penn’s Doctor of Nursing Practice (DNP)-Nurse Anesthesia Program, Kendall Smith has spent his fair share of time in and around the operating room. During shifts that spanned anywhere from eight to 24 hours, he was often the first person in the surgical suite and the last to leave.
“It’s been far from easy but well worth it,” he says.
When Smith graduates next week, he’ll move one step closer to becoming a certified registered nurse anesthetist (CRNA), an advanced practice registered nurse role responsible for administering anesthesia to patients, typically during surgical, diagnostic, or obstetric procedures. Eventually, he says he hopes to build a career that divides his time between patient care, research, and educating the next generation of CRNAs.
Forging a path
Smith, from Accokeek, Maryland, first visited Penn in 2009 in search of an undergraduate institution with a strong nursing program. “I wanted to go to the best nursing school I possibly could,” he says. He began in Penn’s Bachelor of Science in Nursing program in 2010.
During his time as a Quaker, he has been an active member of Penn’s community, as a three-time graduate associate for Hill College House; a participant in Penn Health-Tech Rothberg Catalyzer, in which students compete to create innovative health care solutions; and a member of Wharton’s Real Estate Club, among others.
As an African American male, Smith is also part of a unique slice of the health care field. In 2020, men made up about 40% of nurse anesthetists. About 2% of nurse anesthetists identify as Black or African American.
“When you look at national statistics and take into context where our country has been historically and in recent years, it starts to paint a picture of the challenges I’ve navigated as often one of one,” Smith says. “As an underrepresented minority, it has been my aim to highlight the importance of representation within nursing, anesthesia, and health care leadership overall. There is an enormous need and opportunity for change and optimization of patient care and research.”
He found support through family, friends, members of his doctoral cohort, and groups on campus that seek to enhance quality of life for graduate and professional students of the African diaspora, including Penn’s Minorities in Nursing Organization and the University’s Male Association of Nursing. He served as president of both organizations from 2012 to 2014.
“Finding mentors and those who have allowed me to pursue my interests and passions has been one of the best components of coming to Penn,” says Smith. “I remember sitting at Joe’s desk in 2010 telling him I wanted to go to anesthesia school. Fast forward eight years and I was sitting in his class learning the physiology of anesthesia. Now I consider him a friend, mentor, and great teacher.”
When Smith earned his bachelor’s degree in 2014 from Penn, the program he’s about to finish didn’t yet exist. The DNP-Nurse Anesthesia Program began in 2016 and this year graduates just its third cohort. After working at Duke University Hospital as an RN in an intensive care unit, Smith returned to Penn in 2018, which is when he first met the DNP-Nurse Anesthesia Program director, Dawn Bent, who Kendall says has been one of his biggest supporters.
“Kendall is one of those students; he finds opportunities for himself,” Bent says. At the start of the program, “students are usually getting their feet wet, figuring out what they need to do. He was already looking for other ways to work with other providers. He’s always seeking out different opportunities to make himself better.”
Pushing the field forward
Given the rigor of this program, it’s not always easy for students to carve out extra time. Thirty-three of the 36 months are spent in clinical rotations, beginning after an initial three months of what Smith describes as “knowledge and skills boot camp.”
“Some programs are front-loaded, where students take classes first and then head into clinical,” he says. “We’re doing both at the same time. We’re rotated slowly in, one day, two days. By six months, we’re in full swing.”
For the most part, no two days in the operating room look alike. Depending on the clinical site, specialty rotation, and surgical department, Smith participated in anywhere from one case to more than 10 in a day, ranging from colonoscopies to heart surgery.
Responsibilities ran the gamut: He counseled patients about their anesthesia. He placed intravenous catheters and intra-arterial lines. He administered general anesthesia, spinal anesthesia, epidural anesthesia, and regional anesthesia as part of a highly specialized clinical team.
“It’s a continuous wheel,” Smith says. “Something could go wrong at all times. When you start to think it’s going to be easy, that’s when issues happen. Some patients need a breathing tube, and some don’t, and you always have to individualize the care given to the specific patient, type of surgery, and what’s going on at that particular moment.”
Bent, who herself has been a nurse anesthetist for 17 years, describes the weight placed on the shoulders of those just learning this field. “You must always think critically on your feet. You can’t leave any stone unturned,” she says. “If all things aren’t right with the patient, we’re the ones saying, ‘Hold on, stop, let’s think about this.’ You have so much responsibility.”
She sees a successful career ahead for Smith. “It’s a long road being in a full-time program like this,” she says. “I’m really excited for what Kendall’s future may bring. It surely looks bright.”
Smith is enthusiastic about the direction Penn’s program is taking and about his short- and longer term plans. After a few years of clinical work to become what he calls a “great and competent CRNA,” he wants to turn his attention back to innovation, teaching, and research.
He might focus on chronic pain and the disparities among individuals who suffer from it—something he’s studying now, as the recipient of a training grant from the National Institutes of Health—or pivot to something like health disparities in the operating room, looking at the range of approaches to anesthesia and how those differ by population and region.
“A goal of mine is to build upon the outstanding work that CRNAs already do and show the nation and world the broad scope of what we can do,” he says. “CRNAs can do research and be policymakers and leaders within health care as a whole. That’s why I came to Penn in the first place, to have a platform and to build a skillset to be able to do it all.”
Kendall Smith is a 2021 graduate of the Doctor of Nursing Practice (DNP)-Nurse Anesthesia Program at the School of Nursing at the University of Pennsylvania. In 2020, he was awarded the Supplement to Promote Diversity in Health-Related Research grant from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. After graduation, he will begin work as a certified registered nurse anesthetist in North Carolina.
Dawn Elizabeth Bent is the program administrator of the Doctor of Nursing Practice (DNP)-Nurse Anesthesia Program in the School of Nursing at the University of Pennsylvania.