Personality characteristics of Dutch nurse anesthetists and surgical nurses when compared to the normative Dutch population, a quantitative survey study.

BACKGROUND: Working in the perioperative context is complex and challenging. The continual evaluation in this environment underscores the need for adaptability to technological advancements, and requires substantial allocation of resources for training and education. This study aimed to explore personality characteristics of nurse anesthetists and surgical nurses that are instrumental for sustainable employability in technologically advanced environment. METHODS: Exploratory, cross-sectional survey study including nurse anesthetists and surgical nurses, both certified and in training, and a sample of the normative Dutch population. Personality characteristics were identified with the Big Five Inventory, which consisted of 60 items answered on a five-point Likert scale (strongly disagree to strongly agree). RESULTS: Specific personality traits were found for nurse anesthetists and surgical nurses when compared to the normative Dutch population. Traits of both nurse anesthetists and surgical nurses differed significantly on all domains of the Big Five Inventory, with the largest differences found within the dimension negative emotionally. CONCLUSIONS: This study highlights the role of specific personality traits in maintaining employability within the rapidly evolving and technologically advanced landscape of healthcare. It emphasizes the relationship between individual traits and professional excellence, being crucial educational strategies for overall improvement in healthcare.

Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care.

BACKGROUND: In the perioperative care of individuals with obesity, it is imperative to consider the presence of risk factors that may predispose them to complications. Providing optimal care in such cases proves to be a multifaceted challenge, significantly distinct from the care required for non-obese patients. However, patients with morbidities regarded as self-inflicted, such as obesity, described feelings of being judged and discriminated in healthcare. At the same time, healthcare personnel express difficulties in acting in an appropriate and non-insulting way. In this study, the aim was to analyse how registered nurse anaesthetists positioned themselves regarding obese patients in perioperative care. METHODS: We used discursive psychology to analyse how registered nurse anaesthetists positioned themselves toward obese patients in perioperative care, while striving to provide equitable care. The empirical material was drawn from interviews with 15 registered nurse anaesthetists working in a hospital in northern Sweden. RESULTS: Obese patients were described as "untypical", and more "resource-demanding" than for the "normal" patient in perioperative care. This created conflicting feelings, and generated frustration directed toward the patients when the care demanded extra work that had not been accounted for in the schedules created by the organization and managers. CONCLUSIONS: Although the intention of these registered nurse anaesthetists was to offer all patients equitable care, the organization did not always provide the necessary resources. This contributed to the registered nurse anaesthetists either consciously or unconsciously blaming patients who deviated from the "norm".

Assessing CRNA Knowledge of Local Anesthetic Systemic Toxicity Treatment.

Local anesthetic systemic toxicity (LAST) is a rare life-threatening adverse event. Due to the potential for devastating patient outcomes, it is crucial for anesthesia providers to understand appropriate LAST management. The primary aim of this study was to assess certified registered nurse anesthetist (CRNA) knowledge of the 2020 American Society of Regional Anesthesia and Pain Medicine (ASRA) LAST treatment guidelines. The secondary aim was to determine whether there was a relationship between the frequency of CRNAs' exposure to perioperative local anesthetic use and their knowledge level. A quantitative descriptive study and national American Association of Nurse Anesthetists electronic survey solicited practicing CRNAs. Survey findings revealed knowledge scores averaging 47.3% among 184 respondents. Almost all (97.8%) recognized the importance of early lipid emulsion administration. Over half (54.3%) were unaware of the recommended epinephrine dosing during LAST. No relationship was found between knowledge level and CRNAs' exposure to local anesthetics. Those who reported having immediate access to written or electronic guidelines in the event of LAST had significantly higher knowledge scores than those without access (P = .049). Implementing cognitive aids may help bridge knowledge gaps identified in this study and ensure critical steps are not missed. Further studies examining the use of cognitive aids to improve CRNA knowledge of LAST management may be beneficial in the future.

Narrative review of mathematical and psychological studies of staff scheduling for holidays as applicable to anesthesiologists and nurse anesthetists.

We performed a narrative review of articles applicable to anesthesiologists' and nurse anesthetists' choices of who works each statutory holiday for operating room and non-operating room anesthesia. We include search protocols and detailed supplementary annotated comments. Studies showed that holiday staff scheduling is emotional. Working on holidays often is more stressful and undesirable than comparable workdays. Intrinsic motivation may overall, among practitioners, be greater by preferentially scheduling practitioners who choose to work on holidays, for compensation, before mandating that practitioners who would prefer to be off must work on holidays. Granting each practitioner (who so desires) at least one major holiday off can depend on identifying and scheduling other clinicians who want to work holidays for monetary compensation or extra compensatory time off. Scheduling holidays by random priority (i.e., a lottery choosing who gets to pick their holiday[s] first, second, etc.) is inefficient, resulting in fewer practitioners having their preferences satisfied, especially for small departments or divisions (e.g., cardiac anesthesia). No article that we reviewed implemented a random priority mechanism for staff scheduling. The selection of practitioners to take turns in choosing their holidays is perceived to have less fairness than a selection process that collects each participants' preferences. Although holidays often are scheduled separately from regular workdays and weekends, doing so will not increase efficiency or fairness. Holidays can, in practice, be scheduled simultaneously with non-holidays. Models can explicitly include fairness as an objective. For example, fairness can be based on the difference between the maximum and minimum number of holidays for which practitioners of the same division are scheduled. Holidays can be given greater weights than other shifts when estimating fairness. Staff scheduling for holidays, when done simultaneously with regular workdays, nights, and weekends, can also use personalized weights, specifying practitioners' preferences to be satisfied if possible.

Called to Lead: A Qualitative Examination of the Experiences and Contributions of Certified Registered Nurse Anesthetists During the COVID-19 Pandemic Response in the United States.

The COVID-19 pandemic strained healthcare providers, particularly certified registered nurse anesthetists (CRNAs). To date, little research has focused on the effects of the COVID-19 pandemic on CRNAs, whose unique skillset conferred on them expanded roles and responsibilities, increasing their stress load. Therefore, the purpose of this study was to utilize qualitative descriptive methodology to examine the experiences of CRNAs during the COVID-19 pandemic. Twelve CRNAs providing patient care in the US during the COVID-19 pandemic completed the interview protocol. Five key themes were identified including 1) roles of CRNAs, 2) collaboration, 3) challenges, 4) mental health implications for CRNAs, and 5) pride in profession. This study's descriptions of CRNA experiences during this unprecedented time in contemporary history identifies critical areas for further investigation and provides insights into anesthetic, mental health, and policy priorities to better support CRNAs now and through future infectious disease outbreaks.

Implementation of a Certified Registered Nurse Anesthetist Second Victim Peer Support Program.

PURPOSE: Second victimhood, a phenomenon experienced by about half of health care providers, occurs when an individual experiences negative physical, psychological, or emotional effects after an adverse event, such as patient-related near miss, harm, or death. The stress of anesthesia practice increases the incidence of this phenomenon among anesthesia providers. Second victimhood increases turnover, absenteeism, and risk of medical error. This project aimed to decrease second victim distress among certified registered nurse anesthetists (CRNAs) by implementing a peer support program - second victims are more likely to use peer support over commonly offered support services. DESIGN: A quality improvement project. METHODS: Eight volunteer CRNAs were trained to provide peer support 24-hours a day. CRNAs needing peer support could self-identify or be identified by a colleague, peer supporter, or lead CRNA, and could locate the peer supporter on call in the electronic anesthesia dashboard. Pre- and post-implementation second victim distress were assessed using the Second Victim Experience and Support Tool, a validated survey that measures distress symptoms and perceived institutional support. FINDINGS: Although differences in pre- and post-implementation survey scores were statistically insignificant, the program was welcomed by leadership and staff. CONCLUSIONS: The program experienced higher utilization compared to similar launch studies, with eight encounters in the first month. Impact on staff morale is expected to increase; long-term peer support can improve provider well-being and patient outcomes.

Development, Validation, and Results of a Survey of Personal Electronic Device Use Among 299 Anesthesia Providers From a Single Institution.

BACKGROUND: The pattern of perioperative use of personal electronic devices (PEDs) among anesthesia providers in the United States is unknown. METHODS: We developed a 31-question anonymous survey of perioperative PED use that was sent to 813 anesthesiologists, anesthesiology residents, and certified registered nurse anesthetists at 3 sites within one health system. The electronic survey assessed patterns of PED use inside the operating room (OR), outside the OR, and observed in others. Questions were designed to explore the various purposes for PED use, the potential impact of specific hospital policies or awareness of medicolegal risk on PED use, and whether PED was a source of perioperative distraction. RESULTS: The overall survey response rate was 36.8% (n = 299). With regard to often/frequent PED activity inside the OR, 24% reported texting, 5% reported talking on the phone, and 11% reported browsing on the Internet. With regard to often/frequent PED activity outside the OR, 88% reported texting, 26% reported talking on the phone, and 63% reported browsing the Internet. With regard to often/frequent PED activity observed in others, 52% reported others texting, 14% reported others talking on the phone, and 34% reported others browsing the Internet. Two percent of respondents self-reported a distraction compared to 15% who had observed a distraction in others. Eighty percent of respondents recognized PED as a potential distraction for patient safety. CONCLUSIONS: Our data reinforce that PED use is prevalent among anesthesia providers.

Stress Reduction Through Mindfulness Meditation in Student Registered Nurse Anesthetists.

Student registered nurse anesthetists (SRNAs) experience high levels of stress related to the level of difficulty and time commitment associated with an integrated Doctor of Nursing Practice anesthesia program. Although some degree of stress is necessary for motivation, unmanaged stress can contribute to illness, dissatisfaction, and substance use. A search of the literature showed that mindfulness meditation training reduces stress and improves academic performance in graduate student populations. An evidence-based practice project was developed and implemented to provide SRNAs with a novel stress management mechanism. A guided mindfulness meditation application for smart phones (Headspace, Headspace) was chosen as the intervention modality. Research shows that this application is an effective and convenient delivery system for mindfulness meditation training, decreasing stress during a 10-day trial. SRNAs attended a mindfulness presentation and completed an introductory guided mindfulness meditation module using the Headspace application on their personal smart phone. Preintervention and postintervention surveys (N=33) using the Depression Anxiety Stress Scales 21-item questionnaire were analyzed using the Wilcoxon signed rank test. Results showed significant reductions (P<.01) in depression (Z=-3.36), anxiety (Z=-3.07), and stress (Z=-3.46) scores, representing reductions of 32%, 32%, and 47%.

Relationship Between Population Density and Scope of Practice for Certified Registered Nurse Anesthetists in Arizona.

Certified Registered Nurse Anesthetists (CRNAs) work in practice models ranging from full scope (independent) to limited scope (dependent). Little is known about the influence of population density on CRNAs' scope of practice (SOP) and job satisfaction in Arizona, an independent practice state. The objectives were to examine relationships between (1) SOP and population density and (2) job satisfaction and SOP. In this descriptive study, an 11-question survey was sent to CRNAs practicing in Arizona. A total of 515 surveys were distributed; 261 responses (50%) were received, and 230 respondents (46%) met inclusion criteria. Spearman rank-order correlation was used to analyze the relationship between SOP and population density and between SOP and job satisfaction. Rank biserial correlation was used to examine association between CRNAs' SOP and geographic location. More than half the participants were male (54%), and 46% were female (age range, 27-75 years; years' experience, 1-50 years). Population density had no association with SOP (P=.074). However, SOP and job satisfaction showed a positive correlation (P<.001). These findings suggest that removal of regulatory barriers to CRNAs' SOP could decrease costs and increase access to care. Autonomy plays a clear role in job satisfaction, which may have implications for recruitment and retention.

"The Worst Is the Worry": Importance of Preoperative Preparation of Preschool Children.

Children often experience a high level of anxiety before anesthesia, which may lead to poor cooperation during anesthesia induction and negative consequences for the postoperative period. The aim of this study was to obtain knowledge that may improve practice in preparing preschoolers for anesthesia and surgery by analyzing nurse anesthetists' preoperative experiences with children. A focus group interview with nurse anesthetists was conducted. The interview was recorded and transcribed verbatim, and results were analyzed using qualitative text analysis. Three main themes were identified to relieve preschoolers' anxiety: "Making the unknown and scary harmless," "Using oneself," and "Having a lap to sit on." Findings indicate that explanation and preparation through play, as well as experiences of participation and coping, can safeguard children who are feeling anxious. The professional and personal qualities of a Certified Registered Nurse Anesthetist (CRNA) are important when managing pediatric patients' anxiety. It is essential that CRNAs have the ability to adapt the induction of anesthesia to suit the child individually (and parents). The parents constitute an important collaborator for CRNAs. Young children need explanations and knowledge about what is happening and what to expect. CRNAs should focus on codetermination and participation for preschool children undergoing anesthesia.

From the Operating Room to the Front Lines: Shared Experiences of Nurse Anesthetists During the Coronavirus Pandemic.

Coronavirus disease 2019 (COVID-19) has resulted in severe health, economic, social, political, and cultural consequences while thrusting Certified Registered Nurse Anesthetists (CRNAs) at the forefront of battling an often invisible enemy. A mixed-methods study was conducted to assess the impact of the COVID-19 pandemic on CRNA practice. The purpose of the qualitative component of the study, a focused ethnography, was to use personal and group interviews to determine the shared experiences of CRNAs who worked during the COVID-19 pandemic. Six themes were identified: (1) CRNAs are part of the solution, (2) doing whatever it takes, (3) CRNAs are valued contributors, (4) removal of barriers promotes positive change, (5) trying times, and (6) expertise revealed. The quantitative component of the study will be discussed in a separate article.

Redeployment of Certified Registered Nurse Anesthetists During the Coronavirus Disease 2019 Pandemic.

Certified Registered Nurse Anesthetists (CRNAs) are uniquely skilled anesthesia providers with substantial experience managing critically ill patients. During the coronavirus disease 2019 (COVID) pandemic, CRNAs at a large academic medical center in the Mid-Atlantic United States experienced a shift in their daily responsibilities. As the hospital transitioned to the management of patients who tested positive for the virus that causes COVID, the severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2), CRNAs were redeployed into the roles of respiratory therapists and intensive care unit registered nurses. Although facing the stress of the global pandemic, this facility's CRNAs proved to be flexible, capable, and necessary members of the care team for patients with COVID-19.

Work patterns, socio-demographic characteristics and job satisfaction of the CRNA workforce - Findings from the 2019 AANA survey of CRNAs.

BACKGROUND: An ongoing shortage of anesthesia providers lends importance to the study of job satisfaction and retention among this critical workforce. Certified registered nurse anesthetists (CRNA) make up an increasing share of this workforce and the impact of factors affecting their satisfaction is not fully understood. PURPOSE: Understanding the job satisfaction of Certified Registered Nurse Anesthetists (CRNA) and its determinants. Methods We conduct a comprehensive survey in which we collect information on the job satisfaction of a nationally representative sample of CRNAs, along with information on factors related to their job satisfaction. We measure the impact of these characteristics on the CRNA's level of job satisfaction using a multivariate regression analysis. FINDINGS: Many CRNAs would prefer to pursue training opportunities on peripheral nerve blocks, epidural anesthesia and advanced airway management. Refreshing training on these procedures are factors that may enhance their job satisfaction, and potentially reduce unmet needs for anesthesia services. DISCUSSION: We find that most CRNAs are either very satisfied or somewhat satisfied with their job. Factors that significantly increase the probability of being very satisfied include greater autonomy in the delivery of anesthesia, and higher compensation.

The Psychometric Analysis of an Instrument to Measure the Perceived Workload for Certified Registered Nurse Anesthetists.

BACKGROUND AND PURPOSE: In a previous study, the CRNA Workload Perception Scale (CWPS) was developed. The purpose of this study was to investigate the psychometrics of the CWPS. METHODS: The CWPS was tested in a population of CRNAs. This study was conducted in two phases. Phase I consisted of classical psychometrics; the 12-item instrument was piloted in a sample of 265 CRNAs. Phase II consisted of qualitative analysis to provide feedback on items that did not perform well. RESULTS: Phase I: Instrument demonstrated good reliability (r = .77). Parametric and nonparametric analysis indicated 6 of 12 items were good fit to measure perception of workload. PHASE II: Qualitative analysis resulted in refinement of four items, addition of one item, and elimination of two items. CONCLUSIONS: A revised 11-item CWPS was developed.

Relationship Between Emotional Intelligence and Occupational Stress Levels Among Certified Registered Nurse Anesthetists.

Certified Registered Nurse Anesthetists (CRNAs) are exposed to multiple job-related stressors and therefore experience high levels of occupational stress and job burnout. In healthcare systems, job burnout from occupational stress may lead to poor patient care and safety outcomes. Prior research findings suggest nurses who reported higher levels of emotional intelligence (EI) had significantly lower work-related stress and less job burnout than nurses who reported lower levels of EI. To date, the relationship between EI and occupational stress among CRNAs has not been studied. The purpose of this study was to determine if a relationship exists between EI levels and workplace stress levels among CRNAs. A descriptive survey design was used to answer the research question. Findings from the study reveal a significant relationship between the levels of EI and levels of stress in the CRNA population surveyed (r = -0.20, P = .01). CRNAs who reported higher levels of EI experienced less workplace stress than CRNAs who reported lower levels of EI. Additional findings suggest that CRNAs who have higher levels of EI are better able to cope with occupational stressors. Developing and implementing strategies to increase EI among CRNAs may be key to decreasing work-related stress and burnout.

Managing complexity in the operating room: a group interview study.

BACKGROUND: Clinical work in the operating room (OR) is considered challenging as it is complex, dynamic, and often time- and resource-constrained. Important characteristics for successful management of complexity include adaptations and adaptive coordination when managing expected and unexpected events. However, there is a lack of explorative research addressing what makes things go well and how OR staff describe they do when responding to challenges and compensating for constraints. The aim of this study was therefore to explore how complexity is managed as expressed by operating room nurses, registered nurse anesthetists, and surgeons, and how these professionals adapt to create safe care in the OR. METHOD: Data for this qualitative explorative study were collected via group interviews with three professional groups of the OR-team, including operating room nurses, registered nurse anesthetists and operating and assisting surgeons in four group interview sessions, one for each profession except for ORNs for which two separate interviews were performed. The audio-taped transcripts were transcribed verbatim and analyzed by inductive qualitative content analysis. RESULTS: The findings revealed three generic categories covering ways of creating safe care in the OR: preconditions and resources, planning and preparing for the expected and unexpected, and adapting to the unexpected. In each generic category, one sub-category emerged that was common to all three professions: coordinating and reaffirming information, creating a plan for the patient and undergoing mental preparation, and prioritizing and solving upcoming problems, respectively. CONCLUSION: Creating safe care in the OR should be understood as a process of planning and preparing in order to manage challenging and complex work processes. OR staff need preconditions and resources such as having experience and coordinating and reaffirming information, to make sense of different situations. This requires a mental model, which is created through planning and preparing in different ways. Some situations are repetitive and easier to plan for but planning for the unexpected requires anticipation from experience. The main results strengthen that abilities described in the theory of resilience are used by OR staff as a strategy to manage complexity in the OR.

The operating room as a learning arena: Nurse anaesthetist and student nurse anaesthetist perceptions.

AIM: To examine which competencies mentors and student nurse anaesthetists perceive as important in a clinical anaesthesia education practice. BACKGROUND: Mentoring during clinical placement in the operating room can be challenging from the viewpoint of both a nurse anaesthetist and their students. The operating room is a work environment with many restrictions, and the nurse anaesthetist's work requires prompt decisions and actions. Simultaneously, the mentor is tasked with guiding and supporting the student. METHOD: A qualitative approach including two focus group interviews was used. The analysis was conducted using systematic text condensation. The COREQ checklist for qualitative studies was applied. RESULT: The analysis yielded two main categories, including two sub-categories for each. The first, "Mentoring in the operating room," contained sub-categories "Application of knowledge and expectations" and "Mentoring experiences," and the second, "Creating a good climate for learning," contained sub-categories "Impact on mentoring: human factors" and "Impact on mentoring: obstacle factors." The mentor's knowledge of human relationships and learning strategies emerged as an important factor with the potential to influence the students' learning and self-confidence. Another valuable consideration was the ability to give constructive feedback, from the perspective of both. However, production pressure was a negative factor for effective knowledge transition. CONCLUSIONS: The ability to give constructive feedback and having an awareness of one's own attitude-which should ideally be positive and inclusive-are crucial mentoring skills. Mutual expectations must be clearly communicated before the clinical placement period, including learning assumptions, a progression plan and learning outcomes. This will facilitate the planning and help to direct the optimal course of learning. IMPLICATIONS FOR CLINICAL PRACTICE: This study highlights that an awareness of the student's vulnerability and the mentor's pedagogical competence and learning strategy are crucial factors to take into account.

Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic-assisted surgery.

AIMS AND OBJECTIVES: To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic-assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic-assisted laparoscopic surgery (RALS). BACKGROUND: The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. DESIGN: A qualitative descriptive study. METHOD: Semi-structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April-24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. RESULTS: Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. CONCLUSIONS: The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well-trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and will ultimately impact patient outcomes.