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In March of 2020, the World Health Organization declared COVID-19 a pandemic. The pandemic had unprecedented impacts on nurse anesthesia education delivery. The aim of this mixed methods study was to describe and quantify the personal and educational impacts of the COVID-19 pandemic on student registered nurse anesthetists (SRNAs). Three themes emerged from the qualitative arm of the study: 1) COVID-19 caused feelings of isolation, anxiety, and stress; 2) COVID-19 was a financial silver lining; and 3) COVID-19 changed nurse anesthesia education delivery and learning for SRNAs. The quantitative arm of the study revealed that SRNAs experienced anxiety, social isolation, and a sense of being overwhelmed. Almost half of the participants received federal stimulus money. Most participants reported an increase in distance education delivery and virtual simulation. This study summarizes the impact of the COVID-19 pandemic on SRNAs and how nurse anesthesia education was altered.

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STUDY OBJECTIVE: In 2018, the American Society of Anesthesiologists stated that student registered nurse anesthetists (SRNAs) "are not yet fully qualified anesthesia personnel." It remains unclear, however, whether postprocedural outcomes are affected by SRNAs providing anesthesia care under the medical direction of anesthesiologists, as compared with medically directed anesthesiology fellows or residents, or certified registered nurse anesthetists (CRNAs). We therefore aimed to examine whether medically directed SRNAs serving as in-room anesthesia providers impact surgical outcomes. DESIGN: Retrospective, matched-cohort analysis. SETTING: Adult patients (≥18 years old) undergoing inpatient surgery between 2000 and 2017 at a tertiary academic medical center. PATIENTS: 15,365 patients exclusively cared for by medically directed SRNAs were matched to 15,365 cared for by medically directed CRNAs, anesthesiology residents, and/or fellows. INTERVENTIONS: None. MEASUREMENTS: The primary composite outcome was postoperative occurrence of in-hospital mortality and six categories of major morbidities (infectious, bleeding, serious cardiac, gastrointestinal, respiratory, and urinary complications). In-hospital mortality was analyzed as the secondary outcome. MAIN RESULTS: In all, 30,730 cases were matched using propensity score matching to control for potential confounding. The primary outcome was identified in 2295 (7.5%) cases (7.5% with exclusive medically directed SRNAs vs 7.4% with medically directed CRNAs, residents and/or fellows; relative risk, 1.02; 95% CI, 0.94-1.11). Thus, our effort to determine noninferiority (10% difference in relative risk) with other providers was inconclusive (P = .07). However, the medically directed SRNA group (0.8% [118]) was found to be noninferior (P < .001) to the matched group (1.0% [156]) on in-hospital mortality (relative risk, 0.75; 95% CI, 0.59-0.96). CONCLUSIONS: Among 30,730 patients undergoing inpatient surgery at a single hospital, findings were inconclusive regarding whether exclusive medically directed SRNAs as in-room providers were noninferior to other providers. The use of medically directed SRNAs under this staffing model should be subject to further review. Clinical Trial and Registry URL: Not applicable.

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There is limited research regarding student registered nurse anesthetist (SRNA) burnout. To our knowledge there is no recently published work that has explored the associations between characteristics of SRNAs and burnout. Addressing this gap could establish the SRNA experience of burnout, identify demographic characteristics and situational factors that may correlate with burnout, and lay the foundation for future research. The purpose of this exploratory descriptive study was to assess the SRNA experience of burnout and any relationship between burnout to demographic or situational factors via the Oldenburg Burnout Inventory-S and demographic questions.The research questions were: 1) Do SRNAs experience different levels of burnout during the didactic curricula and/or clinical training element of nurse anesthesia school? 2) Is there an association between SRNA burnout and demographic or situational factors? Power analysis set the minimum n at 421. Five hundred thirty SRNAs responded to the randomized survey through the American Association of Nurse Anesthesiology. Data analysis was conducted using one-way ANOVA, Spearman's rho, 2-tailed t-test, and Chi square analysis. More hours in class per week correlated with lower exhaustion scores. Higher disengagement scores were reported by SRNAs further in their training, while more hours per week in clinical correlated with both higher disengagement scores and increased total burnout scores.

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Student registered nurse anesthetists (SRNAs) are required by the Council on Accreditation to provide anesthetics to a minimum of 30 patients ages 2-12 years and 10 patients younger than 2 years. Pediatric anesthesia can prove to be stressful because children are at higher risk for morbidity and mortality during the perioperative period compared with adults. Simulation allows SRNAs the opportunity to review and develop skills in a safe and supportive environment. The purpose of this project was to provide a high-fidelity pediatric simulation for SRNAs prior to their pediatric rotation to improve skills, knowledge, and self-confidence in the recognition and management/treatment of common pediatric anesthesia complications (airway obstruction, laryngospasm, bronchospasm, and bradycardia). Twenty SRNAs enrolled in a nurse anesthesia program participated in the pediatric anesthesia simulation prior to the start of their pediatric anesthesia rotation. Participants completed surveys at three intervals; presimulation, postsimulation, and at the end of their pediatric rotation that addressed the trainee's perceived self-confidence level and ability to identify and manage/treat common pediatric anesthesia complications. Statistical significance (P < .05) was achieved in the participants overall self-confidence levels in their ability to recognize, treat, and manage common pediatric complications (P = .00) after completion of simulation experience.

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This study examined the level of perceived cultural competence of student registered nurse anesthetists (SRNAs) in Illinois and made educational recommendations. A descriptive, cross-sectional study was completed using the Clinical Cultural Competency Questionnaire (CCCQ) to evaluate the perceived level of cultural competence among SRNAs in Illinois. Four domains of clinical cultural competency--knowledge, skills, attitudes (awareness), and encounters--were evaluated and reported. The survey response rate was 16.7% (N=57). A significant positive correlation was observed between cultural knowledge and age (P=.03). There was a significant difference in cultural knowledge between students attending a nurse anesthesia program in suburban Northeastern Illinois and students attending a large, urban university in the city of Chicago, with CCCQ knowledge mean rank scores of 38.44 and 13.77, respectively. The overall level of perceived clinical cultural competence of SRNAs was low: mean (SD)=3.13 (0.54); range=2.17 to 4.89. The authors concluded that SRNAs need additional cultural education and training in their program of study to enhance their perceived level of cultural competence and to deliver culturally competent anesthesia care. The desire to become culturally competent coupled with deficient levels of cultural knowledge among SRNAs merits further work.

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An emerging degree program of student registered nurse anesthetists (SRNAs) enrolled in a doctoral program of study exemplifies a highly challenging educational path with intense clinical and academic requirements. The focus of this study was to address the lack of research about SRNAs' stress, anxiety, and well-being by exploring responses from the newest doctoral cohorts. Students who were enrolled in a doctoral nurse anesthesia program of study from a small urban university completed valid and reliable questionnaires measuring self-perceived stress, anxiety, and distress. Other questions revealed students' perceptions of performance, experiences, and suggestions for improvement. Results were analyzed using statistical software (SPSS version 24.0, IBM Corp) and open-coded thematic analysis. Significant results revealed that as numbers of SRNAs with low well-being increased, so did levels of anxiety (P=.02), perceived stress (P=.001), and perceived impacts on academic performance (P=.003). Open-ended questions described students' perceptions of stress, new-onset anxiety, poor well-being, and a lack of support and provided suitable suggestions for improving well-being in students. The prevalence of stress, anxiety, and low well-being among SRNAs enrolled in a doctoral program suggests the need for developing interventions and educational changes to improve the well-being of students in the anesthesia community.

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Nurse anesthesiology education is inherently stressful, and student registered nurse anesthetists (SRNAs) must demonstrate a high level of resilience for successful completion. Because of the coronavirus disease 2019 (COVID-19) pandemic, social unrest from racial protests, and uncertain economic conditions, SRNAs are facing unprecedented levels of stress. Additionally, traditional clinical and didactic training has been drastically interrupted, leading to feelings of anxiety and uneasiness. Much research has demonstrated that high levels of stress and anxiety can lead to burnout and mental health concerns, including fatigue, depression, substance abuse, and suicidal ideation. To prevent burnout, promote resilience, and decrease the risk of severe mental health conditions, nurse anesthesiology educational programs must explore ways to promote students' well-being, through offered wellness interventions and resources.

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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%.

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Nurse anesthesia programs are stressful, with routine information overload, immersion into new environments, and financial stressors. One strategy to combat this stress is to practice clinical skills in the less intimidating and safe environment of simulation. Evidence strongly suggests that simulation is an important component of a well-rounded nurse anesthesia program. However, no simulation literature was found to assist the transition of student registered nurse anesthetists (SRNAs) into their cardiac anesthesia rotations. The purpose of this evidence-based practice improvement project was to create an open-heart surgery simulation that supplemented the cardiac curriculum of second-year SRNAs, in order to improve self-efficacy prior to their cardiac clinical rotation. Twenty-three SRNAs, enrolled in a nurse anesthesia doctorate of nursing practice program, participated in the anesthesia simulation in cardiac surgery. After the students' anesthesia simulation experience, they shared in a debriefing session and completed a survey-based evaluation. When SRNAs were asked their level of agreement to the statement "I am confident that I am developing the skills and obtaining the required knowledge from this simulation to perform necessary tasks in a clinical setting," the mean score was 4.61, with 5 indicating strongly agree. Overall, SRNAs agreed that skills they learned in the simulation would transfer to their cardiac rotation.

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BACKGROUND: Hand hygiene compliance is low among anesthesia providers in the operating room, which places patients at risk of preventable infections. The goal of this project was to improve hand hygiene compliance by educating anesthesia providers on the World Health Organization's 5 indications for hand hygiene, and increasing access to hand hygiene products in the operating room. METHODS: Observations of hand hygiene in the operating room took place in 3 phases: preimplementation, postimplementation, and 60 days postimplementation. RESULTS: The results showed significant improvements in compliance for each of the 5 indications for hand hygiene as well as overall compliance. Each of the 3 phases of anesthesia demonstrated significant improvement as well. The results also showed a significant decrease in both glove use and use of the portable hand sanitizer device. DISCUSSION: Education and monitoring of hand hygiene among anesthesia providers in the operating room can improve hand hygiene compliance. CONCLUSIONS: Although the use of the portable device declined, further studies could focus on observing single anesthesia providers instead of a preceptor/student combination, and also examine proximity to hand hygiene products in relation to compliance.

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With the creation of its Wellness Program, the American Association of Nurse Anesthetists (AANA) has advocated for renewed emphasis in education, research, and practice on anesthesia provider wellness. This research was designed to explore the relationship between student registered nurse anesthetists' perceived wellness and students' thriving throughout their academic program. Because of the multifactorial nature of wellness and its alignment with the AANA's wellness model, a salutogenic wellness framework provided the theoretical basis for this study. Four variables related to thriving in a nurse anesthesia program were studied in relationship to students' perceived wellness, measured using the Salutogenic Wellness Promotion Scale (SWPS): self-efficacy, academic achievement, technical clinical competence, and patients' perceptions of students' relational skills. Measurements were taken at 5 points during the academic program. There was a significant correlation, using multiple regression analysis, between SWPS and self-efficacy at times 1, 2, and 3, but not at times 4 and 5. The Emotional Score subscale of the SWPS significantly correlated with self-efficacy at the same intervals. Within the variable of student academic achievement, overall wellness negatively correlated with the National Board of Certification & Recertification for Nurse Anesthetists' Self-Evaluation Examination scores. These results have potential implications on nurse anesthesia education.

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The role transition from student registered nurse anesthetist (SRNA) to Certified Registered Nurse Anesthetist (CRNA) can be challenging and stressful. In the United States, CRNAs practice in every healthcare and administer anesthesia to more than 32 million patients a year. A qualitative phenomenographic research approach was used to identify the factors affecting CRNAs' role transition. Online recruitment and interviewing techniques were used to sample recently graduated CRNAs to identify these factors. Five factors were perceived as promoting the CRNA role transition: mastery of self-efficacy and confidence, expert mentoring and guidance, supportive work envi-ronment, peer support, and previous experience as a SRNA. Four factors were also perceived as impeding CRNAs' role transition: practice limitations, lack of orientation and preceptor, hostile work environment, and decreased workload or caseload. This study has implications for employers of newly graduated CRNAs in implementing interventions that promote successful role transition and guide future research.