An Exploration of the Strategies Certified Registered Nurse Anesthetists Employ to Maintain Monitoring Vigilance and Alertness During Surgical Procedures

Abstract

Varying surgical stimulation requires appropriate levels of anesthesia while preserving the patient’s hemodynamic stability and safety throughout the surgery. Certified Registered Nurse Anesthetists (CRNAs) must be able to maintain monitoring vigilance and alertness to anticipate both the patient and surgical needs. In order to identify the factors that maintain monitoring vigilance and alertness, an electronic survey was disseminated to the members of the American Association of Nurse Anesthetists (AANA). Two hundred fifty currently practicing CRNAs, both certified and re-certified participated. Results showed that focusing on patient care, having more than 6 hours of sleep, and providing Monitored Anesthesia Care (MAC) were helpful in maintaining alertness while providing anesthesia. Only 2 factors were identified as beneficial in maintaining monitoring vigilance: room temperature and patient medical history. In addition, a statistically significant relationship was found between experience and breaks  CRNAs with more than 20 years of experience tend to agree that breaks impacted their ability to maintain monitoring vigilance (2 = 11.5, p= 0.02); however, those with more than 20 years of experience were less likely to take a break when their vigilance was waning (2 =8.18, p= 0.017). This conflicting result was possibly due to the presentation of the survey question. Participants were not asked how breaks impacted their monitoring vigilance, rather if breaks had an impact on their vigilance. This merits investigation in future studies to determine the relationship between experience and breaks in maintaining vigilance among CRNAs.