A Q Methodology Study of Operating Room Personnel's Perceptions of Certified Registered Nurse Anesthetists

Purpose and Background/Significance: While the Institute of Medicine has called for nurses to practice to the fullest extent of their training and education, little is known about what perceptions exist towards Certified Registered Nurse Anesthetists (CRNAs) among other operating room team members. The purpose of this study is to explore patterns of attitudes among physicians, nurses, and technicians who work with CRNAs.

Method: This study used a Q methodology design with a purposeful sample of operating room personnel recruited from four different institutions in the Midwestern United States. Participants were given a set of 34 attitude statements representing a wide range of beliefs about CRNAs. The participants completed a -4 to +4 rank ordering of their level of agreement with each statement. Data analysis was done using PQMethod software. Natural groupings were determined through factor analysis with varimax rotation. A factor array and narrative report was used to describe the discovered shared viewpoints towards CRNA practice.

Results: Analysis of 24 returned Q sorts revealed three distinct viewpoints that explained 66% of the variance. Factor one was associated with high levels of confidence in CRNA abilities. Factor two was characterized by an acceptance for CRNAs with recognition for anesthesiologist supervision. Factor three recognized CRNAs were more patient focused but ultimately preferred the anesthesiologist.

Conclusions: Discovering patterns of attitudes towards CRNAs provides new direction for research on how to best support nurses in advanced practice roles.