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 . 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.

Development of an Online CRNA Preceptor Workshop for the University at Buffalo DNP Nurse Anesthesia Program Recruitment and Retention

Alexis Stachowski

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.

Improving Anesthesia Non-Technical Skills in Nurse Anesthetists Through an Online Workshop

Melanie Schutt

The number of valid pre-workshop survey (n = 38), post-workshop survey (n=29) and one- month follow up surveys (n=22) was competed by CRNAs that precepted mostly UB students. CRNAs reported a consistent, high level of ANTS knowledge, with no statistically significant change.  The literature points to the prevalence the failure ANTS, however CRNAs reported a high level of ANTS understanding. This study points to knowledge not being the driving factor for deficits in the application of ANTS. Experienced CRNAs’ ANTS knowledge and self-perceived ability to train ANTS in SRNAs shows that clinical experience may be the best predictor of non-technical skills. Additionally, CRNAs gained more knowledge about ANTS, the less confident they seemed to be in their ability to effectively train ANTS in SRNAs. Perhaps ANTS are more dynamic than educators and practicing anesthesia providers currently think. CRNAs highlight barriers faced when attempting to implement ANTS, all of which pointed toward the culture in the perioperative period. As this topic continues to be discussed, perhaps one focus should be to address the perioperative culture. Creating a no blame environment allows all care team members to actively participate without fear of repercussion.