Coping as a CRNA
CRNA Exposure to Emotional Events
At some point in their careers, most nurse anesthetists will experience a critical incident or adverse event, such as a perioperative death or catastrophe. After such an event, physical and emotional responses — including feelings of isolation, negative self-image, massive emotional impact, anger syndromes, and fatigue syndromes — are not uncommon. The stress response is a healthy part of coping, however, and it is important to be able to identify these symptoms in oneself and in others. Indeed, recognizing the manifestations of a “normal” stress response to a critical event and being familiar with appropriate interventions could help lessen its effects.
CRNAs may be exposed to various emotional events that could lead to critical incidence stress. This condition is defined as “any event that produces psychological and/or physiological reactions such as shock, anger, confusion, excessive fatigue, sleep disturbances, anxiety, depression and difficulty concentrating.” Critical incidence stress can also significantly affect one’s ability to provide safe patient care.
Responses to Critical Events
Expected responses include guilt, even if the incident was not preventable, and reliving the incident. Other responses take the form of concern about the patient and his or her family; concern about one’s own professional reputation, fearing the loss of respect and trust; and concern about loss of licensure or legal action. Delayed reactions may also occur in some people, presenting as having greater difficulty performing previously common duties and even changes to personal relationships.
Also following a critical event, a number of symptoms may appear. Physical symptoms include tiredness, muscle tension, sleep disturbances, gastrointestinal disturbances, decreased libido, palpitations, and impaired immune response. On the psychological side, symptoms include feelings of isolation, fear, loss of comfort in the work environment, sadness, anger, a decline in job satisfaction, and decreased intimacy.
Stages of Recovery
The path to recovery will be different for everyone. However, the overall trajectory can be summed up in six stages. During the first stage, the individual recognizes the event that occurred and experiences chaos and confusion, and may need help with patient care. In the second stage, the individual may relive the event, including a careful review of decision-making and management of patient care. During stage three, the individual may seek support from family, friends, or colleagues, and they may have to manage any associated gossip. In the fourth stage, the individual understands the severity of the event and may have to repeat the story to several parties, including risk management. During stage five, healing begins, with support coming from a trusted colleague and/or a professional mental health providers. In the last stage, there are three potential outcomes: dropping out, surviving, or thriving. If there is proper intervention and support, the individual will hopefully adapt to the event and thrive.
Emotional support in the form of peer support, self-help groups, and counseling can be helpful. The power of peer support is significant, and many providers have stressed the value of another professional simply asking, “Are you okay?” and then talking with the individual about how they felt. Key steps include acknowledging the situation and the individual’s emotional response to it and allowing the individual to share their experience and feelings without interruption.
Help is Available via the AANA
If these symptoms continue or begin to affect how you function, professional counseling is recommended. If an Employee Assistance Program is available through your workplace, counseling options may be offered through it, or you can ask for recommendations from your healthcare provider.
AANA offers a number of resources for members in need of assistance, including:
The AANA Peer Assistance Helpline: (800) 654-5167
AANA Resources for Adverse Medical Events/Critical Incidents: https://www.aana.com/practice/health-and-wellness-peer-assistance/about-health-wellness/emotional-and-mental-well-being/adverse-medical-events-critical-incidents—how-to-cope
COVID-19 Well-Being: https://www.aana.com/aana-covid-19-resources/covid-19-well-being