Term Paper: Nurse Anesthetist Are One of the Oldest

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Nurse anesthetist are one of the oldest forms of specialized advanced practice nursing and are frequently faced with role changes, especially with regard to autonomy (a new trend) and technology. Nurse anesthetists are seeking an increased level of autonomy, as many other specialized advanced practice nurses are. To be successful at this task they must improve communication, work within an environment of safety and be flexible enough to develop team building systems that support new technology and a simultaneous trend of autonomy for advanced practice nurse anesthetists. This paper will analyze three journal articles that discuss the role of nurse anesthetists in a highly technology driven field with greater autonomy.

The role of the Nurse anesthetist, as with many other areas of advanced practice nursing is once again expanding to allow the practitioner a greater amount of autonomy. Legislation to create such changes has developed in most states as a result of the success of other autonomous advanced practice nursing situations, especially with regard to the cost effective nature of the transition. In this new state of autonomy nurse anesthetists still must continue to be rigorous in training and adaptation to new technology in an environment of safety, teamwork and open communication. Anesthesiology is a highly skilled profession that requires extreme attention to detail. The inherent conflicts in this highly skilled care are those associated with a zero margin for error in application of anesthesia as well as a need for simultaneous autonomy and connectivity to the physician anesthesiologists and all other members of the surgical team. "Health care institutions strive to be HROs, [highly-reliable organizations] providing technically challenging and intrinsically hazardous modalities of medical care to patients efficiently and safely (Gaba, 2001)." (Gaba, Singer, Sinaiko, Bowen & Ciavarelli, 2003, p. 173) Anesthesiology is an area of medical care that is in and of itself dangerous, as the role of the application of anesthesia is to intentionally place the patient in one of the closest states to death there is in life and to successfully bring patients back from this brink, over and over again, on a daily basis. Nurse anesthetists therefore work within one of the most dangerous areas of care and frequently need to make rapid decisions about changing modalities in the moment and in theory, which they are expected to be as current in as humanly possible. The traditional support team of the anesthesiologist and the nurse anesthetist, in cooperation with surgeons and other team members, has supported an effective system of support for both, though the current movement for nurse anesthetist autonomy is challenging this traditional hierarchical model and requiring all involved to seek out new ways to work together and independently to get the job done as safely as possible.

Jameson's article articulates the problem of communication and autonomy between CRNAs and anesthesiologists, seeking to understand through in depth interviews the conflict that arises in daily interactions. The work stresses the importance of achieving the desires of both parties to have a more seamless and collaborative working environment.

Communication between certified registered nurse anesthetists (CRNAs) and anesthesiologists reveals each group's desire for autonomous decision-making and their simultaneous needs for connection. in-depth interviews with CRNAs and anesthesiologists illustrate that these professionals feel pressured to both demonstrate their individual contributions to the anesthesia process and earn each other's respect. This difficult balance of autonomy and connection creates an environment of on-going conflict between members of these groups. Yet members of both groups express desires to improve their communication and create a collaborative relationship. (Jameson, 2004, p. 257)

The work then goes on to discuss the need of individuals in this environment to use politeness strategies to manage conflict and to build interpersonal relationships that allow each to place trust in the efficacy of the other as an autonomous decision maker. Within the context of the work there is a clear sense that realistic strategies can be employed that will alleviate the stress that is created when two parties are in a struggle to determine new roles based upon new standards of autonomy. I chose this work, specifically because it analyses the chosen role of autonomy in a changing environment.

Edmondson, Bohmer & Pisano, stress the importance of creating a collective learning process that does not leave some members alienated from change. Learning new technology and protocol is one of the most difficult aspects of any type of dangerous work, and this article discusses some of the frequent causes of breakdown in the transmittal of new information in to groups who are expected to work together and have done so in a certain way for a very long time. The work discusses in a case study format the need to demonstrate collaborative approaches to learning so each member of the team is aware of the reasons and theory behind a change and is therefore not resistant to the change when it is implemented. The article describes the way in which new technology or procedures can alter the roles of team members and therefore create an interdependent situation, where some members are resistant to change, as the change shifts their duties, roles and previous recognized authority.

The new technology not only changes individual team members' tasks, it blurs role boundaries and increases team interdependence. Successfully enacting this change affects deeply engrained status relationships in the or team, as the surgeon's role shifts from that of an order giver to a team member in the more interdependent process.

(Edmondson, Bohmer & Pisano, 2001, p. 685)

Specifically, the article discusses a technology shift in cardiac surgery, but the nature of the change alters all relationships in the team, including the nurse anesthetists and the anesthesiologist. The article then goes on to describe ways in which surgical teams have fostered team building successfully to combat this new source of interdependence and the stress it can cause. I chose this article because it also specifically deals with the context of change of autonomous roles within the context of changing technology.

The final article by Gaba, Singer, Sinaiko, Bowen & Ciavarelli develops the context of a high-hazard hospital environment and compares it to an equally challenging safety environment, that of aviation. The article analyses the concept of a security culture, and how embedded this culture is in the hospital setting, specific to nurse anesthetists. The article compares responses of CRNAs responses to those of pilots and other safety personnel in aviation to determine how ingrained the safety culture was, and how hospitals could better respond to the situation, while CRNAs are in a transition to greater autonomy.

Problematic response to individual questions from those in high-hazard hospital domains ranged from 2.6% to 59.4%, with an average of 20.9%. This was significantly more problematic than for hospital workers as a whole (p <.001). Problematic response among high-hazard hospital workers was up to 16 times greater than that among aviators (Table 2)....Respondents to the PSCHO survey, on average, were three times more likely than naval aviators taking the CSAS to give a problematic response to similar questions. These findings were true both for the aggregate of all health care respondents and, even more strikingly, for respondents from particularly hazardous health care arenas.

A chose this work, because it reflects the foundation of goal of autonomy for nurse anesthetists in a seamless situation that does not put patients at any greater risk in this highly skilled and technical environment. The goal of the greater environment to create a culture of safety is indispensable tot the creation of a seamless trusting position of autonomy in the nurse anesthetist role as a primary decision maker in a rapidly changing technological situation.

Jameson's findings indicate that there is a significant impact in situations where roles are changing when communication skills and especially politeness tactics are utilized by both parties to resolve conflicts and alleviate potential conflicts. The nurse anesthetist and the anesthesiologist must work together in a trusting manner and in a collaboration, while transitioning to greater autonomy on the part of the CRNA. According to Jameson:

findings are consistent with previous research revealing that any communication strategy that attends to only one pole -- autonomy or connection -- leaves parties dissatisfied (Baxter, 1988; Lewis, 2000). Thus while specific groups or individuals within groups may have a general preference for managing the tension, they all find themselves needing to balance autonomy and connection when facing disagreement. The use of politeness strategies provides a way to address both connection and autonomy needs simultaneously -- needs that are salient to organizational members individually as well as organizations as a whole. It is both theoretically and empirically important, therefore, to recognize politeness as a direct communication strategy for the inevitable balancing that individuals must engage in when communicating in organizational contexts. (Jameson, 2004, p. 257)

The Edmondson, Bohmer & Pisano article further explains the definitions and innate conflicts that can arise in a situation where roles are changing due to technological advancement as well as autonomous rulings. It finds that the importance of… [END OF PREVIEW]

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