• Competition – The Good, the Bad, and the Ugly: How Competition Affects Certified Registered Nurse Anesthetists in the School and Work Environment

    It can be competitive to get into nursing school, again to obtain a coveted spot in a rigorous nurse anesthesia educational program, and then again in the workplace. It comes as no surprise that many Certified Registered Nurse Anesthetists (CRNAs) describe themselves or their work environments as “competitive.” Classmates and colleagues may even define themselves as competitive or “Type A.”

    Competition among student registered nurse anesthetists (SRNAs) or practicing CRNAs is
    often unavoidable in school and the workplace. Competition can stimulate resourcefulness and creativity and drive individuals to reach for goals
    and improve performance. Alternatively, competition can lead to unethical behavior if it spurs rivalry or dishonesty to disparage a coworker or colleague. The differentiation in routes between ethical and unethical behavior may stem from how the particular competition makes the individual feel.1 Table 1 summarizes the various characteristics of positive and negative competition.

    Positive Competition and Motivation

    Competition commonly occurs in a social or work dynamic in which SRNAs or CRNAs contend
    for personal recognition, perks, bonuses, and/or promotions.1 Among colleagues, it may motivate SRNAs and/or CRNAs, causing them to work harder and thereby achieving greater results. Among peers, it can actually increase physiological and psychological activation due to changes such as the “anticipatory” rise in cortisol.2 This activation prepares the mind and body for increased effort, which in turn, can enable higher performance.1

    The idea of “winning” something, such as a financial bonus or public recognition, can generate positive feelings overall and increase enthusiasm. This type of competition can benefit the individual, the group, and organizations with multifactorial long- term growth benefits such as decreasing divisiveness and increasing the team mentality. Colleagues may surpass their counterparts through spearheading new ideas and innovations that can provide long- and short-term benefits to individuals, groups, or organizations.

    Negative Competition Causes and Consequences

    On the flip side, competition can lead some individuals to achieve their outcomes through negative or offbeat means. Unethical, unfair, or corrupt pathways may appear to show results initially but ultimately may result in high long-term penalties and price tags in the aftermath. Some forms of competition, real or perceived, can evoke fear and/or anxiety that may lead to unethical behavior such as lying, cheating, bullying, backstabbing, or malicious gossip.

    These feelings of angst or concern may be due to what the individual or group perceives as threats (generally not physical).2 Specific concerns include being publicly humiliated, appearing weak or incompetent, losing one’s job, or having a substantial decrease or loss of income.1-3 The scenario of anxiety and fear leading to unethical behavior is more likely if previous education focusing on healthy competition, integrity, and self-awareness is lacking.1

    Negative behavior and conflict within an institution may result and can be sustained due to mismanagement which can in turn result in substandard communication. This could cause delays or the absence of critical patient information involving necessary medical care or handoff report. The presence of poor employee performance, decreased productivity, increased absenteeism, and turnover may rise.4 These employee changes have been associated with increased organizational liability, decreased patient safety, and increased medical costs overall.4

    The AANA’s practice considerations titled Promoting a Culture of Safety and Healthy Work Environment states that a highly stressful or competitive facility environment can contribute to an unhealthy work environment and workplace violence.4 Negative behavioral patterns caused by unhealthy competition in the hospital setting can increase the incidence of medical errors and threaten the safety of patients and providers. Patient satisfaction can also become significantly impacted in a negative manner. This issue can affect the CRNA profession holistically.

    Promoting Constructive Competition

    Organizational leaders and hospital and university administrators can address this issue by employing strategies to positively motivate SRNAs and CRNAs. Leaders can promote excitement and enthusiasm by focusing on the constructive possibilities of competition, such as recognizing or rewarding high performers, instead of generating widespread anxiety and fear by identifying and emphasizing “below par” performers.1 Promoting and reinforcing unique individual or group strengths can benefit the whole organizations as well as the individual or group. When establishing competition, leadership should encourage SRNAs and CRNAs to use their unique skill sets, with the ultimate goal of eliciting positive behavior and achieving organizational and professional improvement.


    Excitement/enthusiasm and anxiety/fear are opposite emotional reactions to real or perceived competition. These very different emotions commonly elicit behaviors that can in turn influence ethical or unethical behavior in individuals and among groups. Individuals or groups reacting to competition with anxiety and fear may be less inclined to choose innovative or productive actions to solve problems, which may lead to unethical behavior.

    Conversely, individuals or groups that are motivated by competition with excitement or enthusiasm may choose more ethical, innovative, or productive behaviors.1 Competition among individuals and groups in school and the workplace is unavoidable for CRNAs and SRNAs. With structure and thought, constructive competition may improve performance. To ensure that competition promotes positive and creative behavior, organizational leaders must make a point to lead positively and avoid leading through fear.1

    Resources (includes depression and suicide resources) (Includes the AANA Peer Assistance, Suicide, and Sexual Assault/Sexual Harassment Hotlines)

    1. Steinhage A, Cable D, Wardley D. The pros and cons of competition among employees. Harvard Business News. https:// employees. Published 2017. Accessed April 15, 2019.

    2. Alix-Sy D, Scanff CL, Filaire E. Psychophysiological responses in the pre-competition period in elite soccer players. J Sports Sci Med. 2008;7(4):446-454.

    3. Bullying impact. Workplace Bullying Institute. https://www. Accessed April 15, 2019.

    4. Promoting a culture of safety and healthy work environment. In. Park Ridge, IL: American Association of Nurse Anesthetists; 2018.

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