The Scope, Clinical Preparedness, and Contributing Factors to Rural Anesthesia Practice

摘要

In a given year, an estimated 33 million anesthetics are administered in the United States by Certified Registered Nurse Anesthetists (CRNAs). A gap exists in the literature concerning the scope and dimensions of rural anesthesia practice by CRNAs who are the predominant if not the sole providers of anesthesia care in rural hospital settings. Von Bertalanffy, and Fishbein's theory of planned behavior and Benner's novice-to-expert continuum provided the theoretical foundations for this study. This quantitative, cross-sectional survey examined the types of anesthesia services provided by CRNAs in rural critical access hospitals (CAHs), their clinical preparedness, and the factors contributing to their decision to practice rural anesthesia. The population was drawn from a representative sample of CRNAs who are active members of the American Association of Nurse Anesthetists and practicing in rural CAHs located in 8 Midwestern states. Although many of the CAH credentialing requirements predicted the CRNAs' clinical preparedness, the multiple linear regression model indicated that graduate education of the CRNAs is positively and significantly associated with clinical preparedness (p < .05). Using Pearson correlation, the factors contributing to the CRNAs' decision to practice rural anesthesia were analyzed, and the results indicated that autonomy, pay, professional status, interaction, and financial aid obligations or loan forgiveness were positively correlated with their decision to practice in rural areas (p<.05). The positive social change impact of this study is that rural health care institutions, especially CAHs, are better positioned to understand the motivations and expertise of CRNAs in making recruitment decisions, thus improving health care access to the medically underserved.