How do Certified Registered Nurse Anesthetists (CRNAs) contribute to professional, ethical nursing practice and healthcare outcomes?

How CRNAs Contribute to Professional, Ethical Nursing Practice and Healthcare Outcomes

CRNAs contribute to professional and ethical nursing practice by serving as patient advocates throughout the perioperative continuum, integrating technical expertise with compassionate care while maintaining professional autonomy, and driving value-based healthcare improvements through evidence-based practices that optimize patient outcomes.

Professional Practice Contributions

Patient Advocacy and Representation

• CRNAs serve as the patient's primary representative during anesthesia, particularly when patients are unconscious and unable to advocate for themselves 1
• CRNAs maintain patient dignity by ensuring advance care plans and resuscitation wishes are respected and communicated to the entire surgical team 2
• They protect patient confidentiality by sharing sensitive personal information only with consent and when necessary for safe care 2

Integration of Technical and Caring Roles

• CRNAs view anesthesia nursing as an integration of technical tasks and caring, where the relationship with the patient is central to their professional identity 1
• They attend to patients' basic needs while patients are anesthetized, demonstrating professionalism through their representation of unconscious patients 1
• CRNAs deliver anesthesia to more than 34 million patients annually in both inpatient and outpatient settings across the United States 3

Value-Based Care Leadership

• Anesthesia providers, including CRNAs, are uniquely positioned to impact perioperative healthcare through proactive engagement in preoperative optimization of patients' health 4
• They implement best practices that are data-driven and evidence-based, providing structure that allows patients to return to their optimal state of functional, cognitive, and psychological health 4
• Through collaborative relationships with perioperative stakeholders, CRNAs consolidate their role as clinical leaders driving value-based care and healthcare transformation 4

Ethical Practice Contributions

Respect for Patient Dignity and Autonomy

• CRNAs confirm and use patients' preferred names and pronouns at all times to show respect and decrease risk of distress 2
• They create processes for patients to safely disclose personal information relevant to their care during preoperative assessment 2
• CRNAs advocate for appropriate care and prevent disregard for patient dignity, which has been identified as a common issue in hospital care 2

Ethical Decision-Making Across Perioperative Phases

• During the preoperative phase, CRNAs communicate all specific perioperative considerations during surgical briefs to ensure the team is aware of important patient factors 2
• Intraoperatively, they consider patients' preoperative priorities and goals of care when making clinical decisions, especially when conditions change unexpectedly 2
• Postoperatively, CRNAs facilitate early oral feeding and mobilization to promote recovery while respecting patient comfort and independence 2

Managing Ethical Challenges

• The most frequently occurring ethical issue CRNAs encounter is conflict in nurse-physician relationships, while the most disturbing issue is working with incompetent or impaired colleagues 5
• CRNAs consult with hospital legal representatives when uncertain about professional and legal obligations, particularly regarding end-of-life care 2
• They participate in quality improvement initiatives and audits to ensure compliance with best practices 2

Healthcare Outcome Contributions

Patient Safety and Quality Care

• CRNAs demonstrate awareness of patient safety through thorough patient assessment, passing critical information to the team, and being aware of potential risks 6
• They implement appropriate care measures including age-appropriate anesthesia, proper fluid therapy, thermoregulation, and analgesia 2
• Anesthesia providers have made enormous gains in reducing intraoperative risk through continued engagement with patients and stakeholders across the continuum of surgical care 4

Communication and Collaboration

• CRNAs communicate and listen with compassion, being considerate and knowledgeable in their standard operations 6
• They forward necessary patient information to the team to ensure awareness of abnormalities and maintain safety in every phase of performance 6
• Communication and collaboration are central themes in CRNA working conditions that directly impact patient outcomes 3

Cost-Effectiveness and Access to Care

• Patients and insurance payors benefit from improved outcomes with associated cost avoidance secondary to reduced complications and discharge disposition 4
• Hospital administrators appreciate improved efficiency and coordination of care provided by anesthesia teams including CRNAs 4
• Positive CRNA workforce outcomes have financial, access-to-care, and quality-of-care implications for organizations where CRNAs practice 3

Common Pitfalls and Prevention

Workforce Challenges

• Job dissatisfaction, occupational stress, incivility, burnout, workplace aggression, and intent to leave are prevalent CRNA outcomes that can negatively impact patient care 3
• Unresolved ethical conflicts can negatively influence nurses' morale, leading to avoidance of issues and contributing to burnout 5
• CRNAs find it difficult to define nursing in anesthesia care because of overlapping tasks and skills between CRNAs and anesthesiologists, which can create professional identity challenges 1

Maintaining Professional Standards

• CRNAs must maintain consciousness to work on the basis of ethics and professional standards, particularly when working under physician supervision 6
• They need experience in appropriate communication, professional knowledge, and skills to thoroughly assess patients and be aware of potential risks 6
• Identifying ethical issues and disturbance levels experienced by CRNAs contributes to the development of ethics education programs that address issues encountered in practice 5