Answer

• • 1. Article Summary: CRNAs Working Conditions and Outcomes

       Article: Boyd, D., & Poghosyan, L. (2017). Certified registered nurse anesthetist working conditions and outcomes: A review of the literature. AANA journal, 85(4), 261-269.

       This research article, by Boyd and Poghosyan (2017), sought to examine the “working conditions and workforce outcomes” of Certified Registered Nurse Anesthetists (CRNAs) (p. 261). The authors maintain that the demand for services of CRNAs – anesthesia services – is on the rise in the U.S. as patients increasingly experience chronic and acute conditions, and other conditions that require procedural and surgical interventions. The Affordable Care Act, which enables more patients to seek anesthesia care, further stains the ability of the health care system to provide such care. Although plans are underway to increase the CRNA workforce by 25% by 2022 in order to meet the growing demand for anesthesia care, there are concerns that the CRNAs may still be insufficient, particularly in the ambulatory surgical centers. In addition to increasing the CRNA workforce, another strategy established by the authors is creating conducive productive working conditions (organizational climate) aimed at promoting CRNAs’ practices. To investigate the organizational climate of CRNAs, Boyd and Poghosyan employed systematic review and meta-analysis as the research method. The researchers then analyzed the resulting data from the reviewed studies through thematic analysis. This involved categorizing the data into four themes; namely, communication and collaboration, work relations of CRNAs, professional identity and autonomy, and CRNA outcomes (Boyd & Poghosyan 2017, p. 262).

       Findings of the study suggest that effective communication between CRNAs and anesthesiologists improves collaboration and professional exchange of ideas, which in turn promotes patient safety. It was further found that conflicts in the CRNAs’ work environment is spurred by the overlap in health care responsibilities (role conflicts) between the CRNAs and anesthesiologists due to compromised autonomy of the CRNAs ((Boyd & Poghosyan 2017). Further analysis by the researchers revealed that CRNAs often experience incivility from multiple sources, ranging from physicians to nurses, anesthesiologists, other hospital employees, and even patients. This incivility in the CRNAs’ workplace has been linked to negative outcomes, including burnout. Other CRNA outcomes, stemming from workplace incivility and lack of autonomy are job dissatisfaction, workplace aggression, burnout, occupational stress, and inclination to quit. The authors go ahead to propose interventions that hospitals and policy makers can adopt to overcome these negative outcomes: encourage effective communication and collaboration between CRNAs and anesthesiologists, and increasing CRNAs’ autonomy in decision making. The article concludes by highlighting some of the studies limitations; namely, small number of reviewed articles due to strict selection criteria used, limited external validity of findings, and potential bias in some of the included research studies (Boyd & Poghosyan 2017)