An Examination of Collaborative Practice in Anesthesia Care Team Settings and Occupational Sress in Nurse Anesthetists

Abstract

The purpose of this study was to provide a comprehensive understanding of the nature of certified registered nurse anesthetist (CRNA) scope of practice (SOP), collaboration with anesthesiologists in anesthesia care team (ACT) settings, and occupational stress. A critical philosophy viewpoint serves as a broad perspective in understanding the depiction of domination and conflict between CRNAs and anesthesiologists in ACT environments. The theoretical basis for this study was derived from the quality of nursing practice framework, with an elaboration of the process component to examine CRNA' s scope of practice, collaboration between CRNAs and anesthesiologists, and rolerelated occupational stress. A mailed survey questionnaire was mailed to all CRNAs from the six (6) New England states, with a return rate of 31 % (n=347). Data analyses were conducted in terms of sample practice characteristics and demographics. Reliability testing were performed using Cronbach's alpha for the three measures (SOP, collaborative practice scale [CPS], and occupational stress inventory [OSI-R]). The research questions were examined applying correlational analysis, t-test, and ANOVA addressing relationships among SOP, CPS, and OSI-R. Restrictions to scope of practice were especially evident with CRNAs employed by anesthesiology groups, compared to hospital employed. There were relationships between SOP and CPS; higher scores on SOP were associated with higher scores on CPS, while lower SOP scores were associated with lower scores on CPS. Most respondents indicated utilizing "compromise" as a conflict resolution mode, instead of "collaboration." This suggested that CRNAs tended to avoid the escalation of conflict by neutralizing interpersonal differences, which may result in reducing the ability of the CRNA to satisfy their own concerns regarding the patient's care. Finally, respondents with higher levels of SOP reported higher stress in role overload and responsibility. However, respondents with lower SOP reported higher stress in role insufficiency and role ambiguity. These findings suggested that a broader SOP was related to increased responsibilities, independence, and active engagement in complex patient care. CRNAs in this context may be viewed as emotionally and professionally more self-assured, allowing more intrinsic power to practice autonomously. Implications for further research include exploring "best practice" ACT models, understanding productivity and anesthesia provider mix structures, and improving overall anesthesia care team services.