A two-and-a-half-year-old patient was rushed to the Waverly, Iowa, emergency department after swallowing a handful of his parent’s pills. His body was not oxygenating properly, and quick intubation was necessary. Even though the child did not need anesthesia, the Emergency Department staff called Certified Registered Nurse Anesthetist Tyler Tuttle (23DNP). “Securing an airway on smaller kids is hard, especially when you don’t intubate kids often,” says Tuttle. As one of five CRNAs contracted to work at Waverly Health Center, a critical-access hospital in Waverly, Iowa, Tuttle regularly intubates children – sometimes 15 a day for tonsil removals. He secured the child’s airway and the stabilized patient was transferred to University of Iowa Health Care in Iowa City.
“I don’t know what else would have happened,” says Tuttle. “Without anesthesia in these rural areas, what does that mom do with the toddler? Drive an hour and a half away [to access care]?”
Seventy miles southeast of Waverly lies the small town of Manchester. When a six-month-old baby came into the Regional Medical Center with a potential epileptic episode, CRNA Sabrina Vitale-D’Angelo’s (23DNP) colleague called, and she raced in. Within five minutes, they had established multiple intravenous access points and helped ensure the baby was ready when the flight team arrived for transportation to Iowa City for specialized care.
“I think a lot about what would have happened if my colleague and I weren’t there,” says Vitale-D’Angelo. “We don’t have a lot of providers who are really specialized in pediatrics, and when it comes to the airway, that’s our expertise.”
CRNAs like Tuttle and Vitale-D’Angelo are critical to the health of Iowa’s rural communities. As the sole provider of anesthesia services in 75 percent of Iowa’s hospitals, CRNAs are pivotal in keeping rural hospitals open and providing care for Iowans needing surgery, labor and delivery services, and chronic pain management. “Without CRNAs, rural hospitals would cease to exist,” says Cormac O’Sullivan, PhD, ARNP, CRNA, FAANA, clinical professor and director of the University of Iowa College of Nursing Doctor of Nursing Practice Anesthesia Nursing program. The revenue generating services rural hospitals rely on to stay afloat often require anesthesia, he explains, and “without CRNAs, those procedures don’t happen.”
Vitale-D’Angelo agrees. “Without us present, it would be really hard for individuals in these rural communities, like this beautiful town of 5,000 people I now call my hometown, to find healthcare.”
The UI College of Nursing anesthesia nursing program began in 1994, and the first class of five CRNAs graduated in 1997 with a Master of Science in Nursing. In 2010, the program became the second CRNA program in the country approved to offer a Doctor of Nursing Practice.
The program is highly regarded and is ranked #3 nationally in the 2025 U.S. News & World Report Best Graduate Schools rankings.
The anesthesia nursing program has graduated more than 250 CRNAs, and two-thirds are practicing in the state of Iowa. The rigorous, 36-month program offers intensive clinical experiences at University of Iowa Health Care facilities and in CRNA-only practice sites in rural Iowa.
The emphasis on rural practice began in the late 1990s and sets the Iowa program apart from others. “Students spend a minimum of three months in rural practice during the program,” says O’Sullivan, and that exposure makes a difference. “Many of them find they like the area and return to live and work there.”
This is precisely how Tuttle put down roots in Waverly. Tuttle and his family moved from southern Utah to Iowa for the program and did not intend to stay. “I always thought I was going to move back towards the Las Vegas area or southern Utah,” he says. And he did, taking a CRNA job in Utah after graduation to be closer to family. Not long into his new position, Tuttle and his wife decided to return to Iowa. “We all loved Iowa,” he says. “Waverly was a rotation spot and it checked every box I could have ever wanted. The town is fantastic, the schools are great…I guess we’re Iowa for life now.”