The literature suggests that most nurse anesthetists never receive formal preceptor training. Thus, many CRNA preceptors may not be informed of ideas or information concerning the education of adult learners or how to educate them effectively. As a result, certified registered nurse anesthetist (CRNA) clinical preceptors may lack the skills necessary to assess an adult learner’s needs, not possess effective communication strategies, and have difficulty managing conflict or providing constructive criticism to the student. The lack of a formal preceptor education may also lead to frustration, stress and anxiety for SRNAs during their clinical residency. This deficiency can therefore lead to decreased learning by the SRNA because of this breakdown in communication.
At the same time, medical errors are currently the third leading cause of death in the United States. In anesthesia, more than 70% of critical errors that directly contribute to brain damage and death stem from underdeveloped non-technical skills, more specifically from the lack of situation awareness. Anesthesia non-technical skills (ANTS), such as teamwork and situation awareness, are a key aspect of crisis management in anesthesia. While anesthesia technical skills are taught through clinical rotations, non-technical skills are often left unaddressed. As a result, student anesthesia providers may have insufficient crisis management experience prior to beginning independent practice.
The combination of the lack of formal CRNA preceptor training and prevalence of the non-technical skills failures led the co-PIs to develop an online workshop for CRNAs (https://ubwp.buffalo.edu/ub-crna-preceptor-guide/). The workshop included the following educational material: the purpose of the preceptor tutorial, the importance of continuing education of clinical preceptors, information for preceptors regarding the role of the student, the role of the clinical preceptor, implementation of the preceptor role, promoting student success, enhancing skill transfer, evaluation of the student, and promoting effective communication with the student. The online workshop also included information about the clinical importance of nontechnical skills, how to implement nontechnical skills, and implications of improved nontechnical skills in the clinical setting. A website was developed by the co-PIs to host the workshop, consent, study information and surveys.
The specific aims of this scholarly project included:
1. The development of an online evidence-based preceptor-training workshop for CRNA preceptors in New York.
2. Improve CRNA perception of the consistency of student registered nurse clinical education. The online preceptor educational workshop established baseline precepting behaviors to ensure CRNA clinical preceptors are providing SRNAs with consistent feedback and education while attending varied clinical sites, and while working with different clinical preceptors.
3. Increase the knowledge and usage of anesthesia non-technical skills by CRNAs in the New York area through the provision of an online educational module focusing on the clinical implications of non-technical skills. Provide CRNAs with the tools to teach non-technical skills to SRNAs, with an emphasis on applying these skills to difficult, high stress situations.
The study design was nonexperimental and longitudinal, with an educational workshop. The participants were New York CRNAs that serve as clinical preceptors for SRNAs (within the last 6 months). A convenience, snowball sample was used. Study participants completed a 20 question pre-workshop; a one hour educational workshop; a post-workshop 19 question survey, completed immediately after workshop; and a one month post-workshop, 24 question survey.
1Thank you to the New York State Nurse Anesthetist
Association (NYSANA), as well as their members for taking the time to
participate in this DNP project. A special thank you to Dr. Cheryl Spulecki for
her support, encouragement, and commitment to this project’s success.
The number of valid responses was 37
CRNAs participated in the pre-workshop survey, 28 CRNAs completed the workshop
and post-workshop survey, and 20 CRNAs completed the one-month follow up
survey. Based on the findings of this study, the following conclusions can be
made. An online CRNA clinical preceptor workshop did not dramatically change
preceptor perceptions of the consistency of clinical education that they
provide to SRNAs. A majority of the results were statistically insignificant
and did not demonstrate that perceptions of CRNAs were positively changed
following participation in the online educational workshop from the
pre-workshop survey to the one-month follow up survey. However, a majority of
the participants in this project stated that there would be value in having a
CRNA clinical preceptor workshop. Of note, there was a statistically
significant improvement in CRNA preceptor perception of managing and resolving
conflict with SRNAs as well as for the survey question, “When reflecting upon
your previous precepting experiences, please indicate how much you agree with
the following interactions with SRNAs: I feel I Provide a formal debriefing of
SRNAs performance at the end of every clinical day.” These results indicate
that there was improved perception amongst CRNAs on these topics and thus
future studies could focus on communication techniques, evaluation strategies,
and managing and resolving conflict with SRNAs.