The impact of geography, training, and experience on scope of practice among Certified Registered Nurse Anesthetists

Abstract

IMPACT OF GEOGRAPHY, TRAINING, AND EXPERIENCE ON SCOPE OF PRACTICE AMONG CERTIFIED REGISTERED NURSE ANESTHETISTS By: Jennifer Elyse Greenwood, PhD A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2014 Major Director: Chuck Biddle, PhD. Director of Research, Department of Nurse Anesthesia The role of Certified Registered Nurse Anesthetists (CRNAs) in the delivery of anesthesia care is evolving given the recent recommendations for Institute of Medicine and provisions in the Affordable Care Act. Despite rigorous clinical training and consistent outcomes studies to support quality care given by CRNAs, the scope of practice of nurse anesthetists is frequently limited, and they do not practice to the full extent of their education and training. As health care spending becomes more constrained and demand for anesthesia services rises, the role of nurse anesthetists as more autonomous providers of anesthesia may be required to maintain access to quality care in a cost-conscious environment. Understanding the factors that influence one’s decision to engage in a broad scope of practice may guide training and recruiting practices. Using Bandura’s Self-Efficacy Theory as a framework to conceptualize scope of practice, an internet based survey of a cross-section of practicing CRNAs was conducted. Subjects responded to questions to describe the geography of their practice, experience as a civilian or military CRNA, and detailed clinical training variables. A composite score was created to gauge overall quality of clinical training. Each CRNA then rated their global scope of practice using a novel SOP-VAS, from 0-100. 1409 subjects participated in this study, yielding 1202 usable data sets. CRNAs practicing in rural locations exhibited higher mean SOP scores than those practicing in urban and suburban locations (p<0.001). CRNAs practicing in states that had opted-out of physician supervision had higher mean SOP scores (p<0.001). Years in Practice was positively correlated with SOP (p<0.01), however months on active duty in the military as a CRNA did not show a statistically significant correlation with SOP. Gender and the composite quality score also demonstrated a statistically significant affect on SOP. Regression modeling using significant predictors from prior analyses resulted in predictive model to describe SOP (p<0.001). Use of the novel SOP-VAS was found to be a reliable and valid tool to measure SOP among nurse anesthetists. Further study is warranted to identify additional factors that may contribute to scope of practice among nurse anesthetists.