Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Michael Carter, DNSc


Michael Herr, PhD; Todd Monroe, PhD; James Moore, PhD; Nina Sublette, PhD


Anesthesia; Anesthesia Care Team; Certified Registered Nurse Anesthesiologist


This research focused on Certified Registered Nurse Anesthesiologists’ (CRNAs’) perspectives on the value placed on their decision-making skills within the Anesthesia Care Team (ACT). The emphasis of the study was to examine CRNA’s perspectives on the strengths, challenges, conflict resolutions, and any other information they were willing to divulge when working with physician anesthesiologists in the ACT model. An electronic survey questionnaire was sent to practicing CRNAs, primarily in the southeast region of the United States, with 171 informants completing the questionnaire. Data analysis included demographic information of the convenience sample that included age, gender, initial educational preparation as a CRNA, and practice settings and arrangements. Four free-test questions were asked regarding their perspectives on decision-making strengths, challenges, conflict resolutions, and any additional information about their practice. The researcher and research advisor jointly analyzed the qualitative data and developed themes and subthemes of the informant’s responses. Data analysis revealed CRNAs enjoyed and supported collaboration within the ACT and found the team approach led to efficient patient care while having extra hands to help and minds to problem-solve complicated patient scenarios. They did not believe supervision by physicians over their practice was necessary. They found that supervision generated a lack of respect and a restricted scope of practice for CRNAs. They also reported physician microaggressions that lead to tense workenvironments and role confusion for hospital staff and patients. CRNAs often relied on collaboration, accommodation, or compromise to resolve decision-making conflicts within the ACT. However, many avoid or leave the ACT care model for independent practice when these approaches do not. Many CRNAs who left ACTs stated they were much happier with their profession and would never return to the ACT model. The recommendations from this study include a political call to action, a change in payment structure for anesthesia services, and reformed hospital credentialing. These recommendations would allow CRNAs to have a full scope of practice and work independently to deliver the high-quality anesthesia care for which they trained.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.