








































Anesthesia eJournal
Volume 3 Issue 1 2015

AEJ

Educated Hand Publishing LLC 
“The Science Behind the Art”  

 Anesthesia eJournal - Online
ISSN 2333-2611

Abstract

A Pilot Study on Student Nurse Anesthetists’ Views on CRNA Role Transition

Purpose: 
Understanding student nurse anesthetists’ views on nurse anesthetist role transition.
Design and Methods: 
Three focus groups were conducted with a total of 17 nurse anesthesia students. Nurse anesthesia programs in the 
Chicago area were contacted to elicit volunteers.  Discussions were audiotaped and transcribed verbatim. Thematic 
analysis using constant comparison was completed within and across focus groups.
Findings: 
Nurse anesthesia students defined successful role transition from RN to CRNA as the ability to function independently 
with minimal backup or assistance while ensuring patient safety through a successful anesthetic. The following themes 
were identified as factors affecting SRNAs’ successful role transition: preceptor, mentoring, reflection, training variety, 
and CRNA role modeling.
Conclusions: 
Perceptions on which factors affect the role transition from RN to CRNA vary depending on the level of training 
SRNAs have had in their anesthesia program. SRNAs nearing the end of their training have a firmer grasp on which 
factors affect their transition. This pilot study has allowed this researcher to examine the perceptions of SRNAs at 
different levels in their training and allowed for future changes in planning for a full study.

KEYWORDS: anesthesia training, nurse anesthesia, role transition

CRNA Role Transition
The transition from registered nurse (RN) to Certified 

Registered Nurse Anesthetist (CRNA) can be challenging and 
stressful. It is unclear which factors are associated with successful 
transition into the CRNA role because of the lack of research. 
Previous research has argued that content on role transition needs 
to be developed and addressed throughout a CRNA program 
in order to be successful. 1,2 Because role transition of the RN to 
CRNA has not been well studied, the initial plan will involve 
qualitative focus groups of RNs who are currently going through 
the role transition to CRNAs to identify factors influencing 
transition. Following the methodology of similar research, a study 
using focus groups was implemented to explore how student 
registered nurse anesthetists (SRNAs) think about their role 
transition and its influencing factors.3  

METHODOLOGY
Focus group methodology is considered a naturalistic 

approach.4,5 Focus groups are viewed as a type of group interview 
to gain perspectives on specific issues. A strength of using focus 
groups as a technique is its ability to produce concentrated 
amounts of data on a specific topic.6 Interaction between group 
participants adds to this combined perspective and creates a 
unique perspective different from individual interviews. This 
approach was selected to stimulate exchanges among study 

participants to elicit a broad range of contextualized responses to 
identify influencing factors. 3,7 A strength of using focus groups 
is that group dynamics can help participants analyze and clarify 
their views, which further enhances authenticity and credibility of 
the data.3,8  

Design
Traditionally, focus groups have consisted of 6 to 10 participants 

to allow input from all participants while gathering a breadth of 
opinions.3,4,6 This group size allows participants to hear opinions 
from other participants and have time for reflection on their own 
experiences.3 For this pilot study, 3 focus groups were selected. 
Questions were designed to stimulate conversation through a 
design that gathers participants’ ideas, perceptions, and opinions. 

Sampling
Qualitative research typically uses purposive sampling to select 

participants and is appropriate for focus groups.3,9 Focus group 
participants were selected from the surrounding schools of nurse 
anesthesia, and a purposeful sampling method for gathering 
participants together based on their level of completion in their 
anesthesia training was planned. There are 3 schools of nurse 
anesthesia in the Chicago area, which were contacted for study 
participants. 

Andy Tracy, MSN, CRNA



Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 3 Issue 1 2015 

Recruitment
After Institutional Review Board approval through the 

University of Wisconsin- Milwaukee the anesthesia programs 
were contacted for recruitment. Approval was obtained from 
program directors to contact their students for study recruitment 
purposes. Participants volunteered from two different schools, for 
a total of 17 nurse anesthesia students recruited. Twelve SRNAs 
were in their second year of didactic coursework, with minimal 
clinical exposure, and the remaining 7 had completed about 5 
months of full-time residency training. Informed consent was 
obtained from all participants.

Collection
Data collection during focus group sessions were done via audio 

recordings. Focus group sessions lasted about 2 hours each. All 
identifiable information was removed during transcription, and 
only the researcher had access to the recordings. No participant 
received any compensation to participate in this research.

Analysis
Thematic analysis was used to analyze the data and went beyond 

reading through the transcript to reading across the transcript 
with comparison between groups’ transcripts.11,12 Throughout 
the process of coding, the investigator used the process of 
“constantly comparing” until categories emerged. Data from each 
focus group were examined individually, and field notes of the 
primary researcher were examined during the analysis. Data were 
also compared between focus groups, comparing themes and 
examining data for new themes.  

FINDINGS
The following themes emerged (Table 1). The findings were 

consistent across groups. The factors which SRNAs perceived 
as having the greatest influence on their role transition were 
preceptors and mentors, especially when they were experienced 
CRNAs, to which the SRNAs could look up to as role models. 
Preceptors actively engaged and invested in the SRNAs’ 
education appeared to be of greatest influence. While preceptors 
who were not CRNAs were also noted as positive influences, 
SRNAs felt that working with CRNAs with whom they could 
identify and look up to fostered a smoother transition to their 
new role. 

Theme Meaning
Preceptor Preceptors who were invested in the SRNA’s education and success. Having the same preceptor 

during a rotation allowed faster progression.
• Supportive
• Respectful
• Fosters a progressive sense of autonomy and independence
• Allows time for critical thinking and problem solving
• Explains changes to anesthetics 
• Stresses the importance of basic skills
• Allows comparison between anesthetic techniques and approaches

Mentoring
• Faculty mentoring
• Peer mentoring

Formal mentoring programs 
• Supported throughout all levels of the program

Faculty mentoring 
• Implemented at the start of the program rather than at the start of immersion residency

Peer mentoring
• Individual student mentoring by an advanced SRNA
• Groups allotted time for peer meetings to share ideas and experiences
• Meeting with students from other programs and sharing experiences

Reflection
• Self-reflection
• Group reflection

Self-reflection
• Performed while driving home

Group reflection
• Discussion with preceptor at the end of the day: “What did you learn today?”
• Sharing of experiences with trainees from other programs

Training variety Exposure to a variety of training experiences which allows to SRNA to develop flexibility and critical 
thinking skills.

• Large academic centers: exposure to trainees in other professions (medicine, pharmacy, nursing)
• Smaller urban hospital: limited and often older equipment
• Small rural hospitals, especially hospitals with CRNA-only anesthesia groups
• Office practice settings: limited backup and forced autonomy

Experiencing CRNAs Working with CRNAs in various practice settings.  Seeing CRNAs who practice independently, 
formulate their own anesthetics, and make autonomous clinical decisions.

TABLE 1: PERCEIVED FACTORS POSITIVELY INFLUENCING SRNAs’ ROLE TRANSITION



Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 3 Issue 1 2015 

Mentoring was perceived to be a positive influence on SRNAs 
during their training. Formal mentoring, faculty mentoring, peer 
mentoring, and group mentoring programs supported throughout 
the program were listed. These allotted meetings for mentoring 
programs were times in which students could share ideas and 
experiences and seek advice from senior SRNAs, faculty, and 
formal mentors. Also, participants felt peer mentoring with 
students from other programs helped foster successful transition 
through the sharing of experiences. Peer mentoring and group 
mentoring appear to be tools that assist SRNAs during their 
training.

Reflection was found to be another common theme but not one 
openly discussed until it was mentioned in the focus group, and 
students learned that others were also using reflection. Reflection 
has been used in other nurse specialties to promote role transition 
success, and SRNAs perceive it to be a positive influence during 
their transition.12 The types of reflection perceived to be beneficial 
included self and group reflections.

Exposure to a variety of training experiences were perceived 
by SRNAs as an asset in developing the flexibility and critical 
thinking skills needed to provide safe anesthesia care. SRNAs 
perceived large academic centers as a place for exposure to 
trainees from other professions. Larger hospitals were perceived 
as places to learn flexibility. Urban and rural hospitals were 
perceived as places in which SRNAs learned greater autonomy 
from viewing CRNAs, who functioned with autonomy and 
independence. While SRNAs viewed larger hospitals as providing 
exposure to a greater variety of technologies, smaller hospitals 
were perceived as places where they learned to function with 
limited supplies, older equipment, and limited support. Office 
anesthesia practice settings were viewed by the SRNAs as settings 
of forced autonomy and limited backup and equipment.

RIGOR AND CREDIBILITY
Threats to rigor and credibility were addressed throughout the 

study using established guidelines and as follows.9 Recruiting 

participants from multiple locations helped reduce bias based 
on location and increase credibility of findings through external 
validation. Continuous communication with the supervising 
professor throughout the study was performed to ensure 
systematic and transparent collection of data.13 Follow-up 
verification of findings was performed with participants to 
ensure credibility of findings through phone conversations with 
randomly selected participants.14,15 

LIMITATIONS
Focus group methodology is not a reliable technique for 

eliciting or determining an individual’s point of view, but rather 
it is a group interview. Individuals who are supportive during a 
focus group may have individual perceptions that are different. 
Therefore, it is not possible or appropriate to assess each 
individual’s perceptions during a focus group study. This pilot 
study examined 3 focus groups. For a full study, 3 additional 
focus groups of SRNAs near the end of the residency training 
are needed to ensure data saturation. Ideally, they will come from 
programs not previously sampled. Ideally, these SRNAs would be 
recruited from 3 different training programs through the same 
process as the pilot study and from training programs in different 
regions of the American Association of Nurse Anesthetists 
outside the Midwest. 

CONCLUSION
This qualitative pilot study using focus groups examined the 

perceptions of SRNAs on their role transition from RN to 
CRNA by identifying factors that they feel are positively affecting 
their role transition. Factors identified included preceptor, 
mentoring, reflection, training variety, and CRNA role modeling. 
This pilot study was not large enough to ensure data saturation, 
and a full study may identify other factors that positively 
influence role transition. 



Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 3 Issue 1 2015 

REFERENCES

1.  Hamrick, A. B. & Hanson, C. M. (2003). Educating advanced practice nurses for practice reality. Journal of Professional 
Nursing, 19(5), 262-268.

2.  Miller, A. B. (2012, August). Attitudes and perceptions of newly graduated certified registered nurse anesthetists about their nurse 
anesthesia program’s ability to sufficiently educate graduates as full service providers. Paper presented at the annual meeting of the 
American Association of Nurse Anesthetists, San Francisco, CA.

3.  Finch, H. & Lewis, L. (2010). Focus groups. In J. Ritchie & J. Lewis (Eds.). Qualitative research practice: A guide for social science 
students and researchers. (pp. 170-198). Thousand Oaks, CA: Sage.

4.  Krueger, R. A. & Casey, M. A. (2009). Focus groups: A practical guide for applied research. (4th ed.). Thousand Oaks, CA: Sage.
5.  Morgan, D.L. (2002). Focus group interviewing. In J.F. Gubrium & J.A. Holstein
 (eds.), Handbook of interviewing research: Context & method (pp. 141–159). Thousand Oaks, CA: Sage.
6.  Morgan, D. L. (1997). Focus groups as qualitative research. (2nd ed.). Thousand Oaks, CA: Sage.
7.  Kaplan, L. & Brown, M. A. (2007). The transition of nurse practitioners to changes in prescriptive authority. Journal of Nursing 

Scholarship, 39(2), 184-190. 
8.  Grove, S. K., Burns, N., & Gray, J. R. (2013). The practice of nursing research: Appraisal, synthesis, and generation of evidence. (7th 

ed.). St Louis, MO: Elsevier Saunders.
9.  Polit, D. F., & Beck, C. T. (2010). Generalization in quantitative and qualitative research: Myths and strategies. International 

Journal of Nursing Studies, 47(11), 1451-1458. doi:10.1016/j.ijnurstu.2010.06.004
10.  Liamputtong, P. (2009). Qualitative data analysis: Conceptual and practical considerations. Health Promotion Journal of 

Australia, 20(2), 133-139.
11.  Riessman, C. K. (2008). Narrative methods for the human sciences. Los Angeles, CA: Sage.
12.  Poronsky, C. B. (2011). Online faculty mentoring and transition balance in family nurse practitioner students (Doctoral dissertation, 

University of Wisconsin-Milwaukee). Retrieved from ProQuest Dissertations & Theses database. (UMI No. 3510670).
13.  Northcote, M. T. “Selecting criteria to evaluate qualitative research” (2012). Education Papers and Journal Articles. Paper 38. 

http://research.avondale.edu.au/edu_papers/38 
14.  Lewis, J. & Ritchie, J. (2010). Generalizing from qualitative research. In J. Ritchie & J. Lewis (Eds.). Qualitative research 

practice: A guide for social science students and researchers. (pp.263-286). Thousand Oaks, CA: Sage. 
15. Giacomini, M. K. & Cook, D. J. (2000). Qualitative research in health care: Are the results of the study valid? Journal of the 

American Medical Association, 284(3), 357-362.

REVIEWER SUMMARY:  The manuscript provides the results of a completed pilot study on the view of student nurse 
anesthesia student role transition to CRNA. The strengths of the manuscript are the topic of role transition and use of focus groups.  
There are several recommendations to strengthen the manuscript, including further elaboration on the makeup of subject participants 
in regards to their standing within current nurse anesthesia programs and elaboration on future plans about recruitment of additional 
subject participants in nurse anesthesia programs.


