• Emotional Intelligence as a Predictor of SRNA Success

    Emotional intelligence (EI) incorporates a range of noncognitive skills not related to intelligence quotient (IQ) that affect how an individual manages situational stressors and makes decisions, especially when working as part of a team.

    Historically, nurse anesthesia educational program (NAEP) admissions committees have relied heavily on science course grade point average, GRE scores, candidate interviews, letters of recommendation, and years of critical care nursing experience as preadmission criteria and predictors of success in their rigorous didactic and clinical programs.

    What conventional criteria miss

    However, such traditional admissions criteria are not standardized and lack intangible factors such as student persistence and its contribution to successful program completion.  Clinical performance deficits are known to be a primary component of student registered nurse anesthetist (SRNA) attrition, and NAEP programs continue to select applicants who fail to meet clinical performance standards.

    This recent exploratory study, recently published in Nursing Education Perspectives, was conducted at a midwestern university by Krista L. Christianson, PhD, CRNA, an active duty US Air Force nurse anesthetist currently serving at the US Air Force Academy in Colorado Springs, Colorado; Louis Fogg, PhD, an associate professor, Rush University College of Nursing, Chicago, Illinois; and Michael J. Kremer, PhD, CRNA, FAAN, a professor at Rush University College of Nursing and co-director of Rush Center for Clinical Skills & Simulation.

    The researchers used a cross-sectional, quantitative, correlational design to investigate the relationship between SRNA clinical evaluations and SRNA EI scores at a single point in time.

    The 5 domains

    All participants were enrolled in clinical practicums as full-time SRNAs in their second or third year in the NA program. Seven participants (63.6 percent) were female, and four (36.4 percent) were male and ranged in age from 25 to 37 years.  All participants reported their ethnicity as Caucasian.

    The researchers used Mayer-Salovey-Caruso Emotional Intelligence Test Version 2.0 (MSCEIT) scores to group SRNAs into EI types, introducing the idea of creating student EI pro-files.  EI as a potential predictor of performance in clinical training has never been studied in SRNAs, state the authors.

    Participants completed the 141-item MSCEIT questionnaire online during November/December 2017.  Multi-Health Systems generated reports of raw scores, and the researchers obtained participants’ daily clinical evaluations from January through November of 2017.  Summary results and mean scores for all clinical evaluations were compiled for each participant.  Daily clinical evaluations included five behavioral domains:

    1. Patient safety
    • Operating room preparation, equipment safety check, demonstrated situational awareness.
    1. Psychomotor skills
    • Universal precautions, airway management, venous/arterial line placement, regional anesthesia, record keeping/charting.
    1. Knowledge base
    • Anatomy and physiology, pathophysiology, pharmacology.
    1. Clinical judgment
    • Utilizing knowledge of physiology, pathophysiology, pharmacology; current anesthesia research.
    1. Professionalism/interpersonal skills.
    • Responsibility/accountability, acceptance of feedback, communication, stress management, working as part of a team.

    Each behavioral domain included detailed criteria. Evaluations of clinical performance were based on clinical preceptors’ scores using a 0-to-5 Likert-type scale.  Relationships between EI and clinical performance were examined.

    Deficits among the diamonds

    Participants consistently met clinical performance objectives but were unable to use emotion to solve problems or to recognize others’ emotions the study found, suggesting to the authors that EI abilities could impact future student registered nurse anesthetist clinical performance.

    Higher scores on the MSCEIT suggest a greater ability-based EI.  The total mean EIQ score (N = 11) was 109.27 (SD = 10.01).  Higher clinical performance scores indicated that the participant performed in that behavioral domain with more independence and less support from the clinical preceptor.

    Two of the eight MSCEIT task scores (facilitation task and blends task) were significantly negatively correlated with the five behavioral domains on the daily clinical evaluations.  The negative relationships between each of the five behavioral domains and the facilitation task were statistically significant, r(11) = .64, .67, .66, .66, .73, p =.05.

    The strongest negative relationship, r(11) = .73, was between the professionalism/interpersonal skills domain and the facilitation task.  The negative relationship between knowledge base and the blends task was also statistically significant, r(11) = .61, p =.05.

    Why it matters

    The researchers believe that results of this study contribute to the developing body of research using EI as a potential predictor of future clinical performance in SRNAs.  Further, they contend that its findings reinforce the need for NAEP programs to give additional consideration to employing EI as an additional tool in the admissions process.

    Although the use of traditional admissions criteria is generally a reliable process, there are still SRNAs who struggle during clinical training and a small number who ultimately leave their programs.  From a practical standpoint, and beyond that, the authors note, the failure to successfully complete program requirements consumes considerable resources for both educators and students and may jeopardize patient safety.

    By incorporating the science of reasoning and emotion through EI assessment, they posit that educators may be able to better predict clinical success where conventional measures of intelligence related to IQ and traditional admissions criteria have failed.

    While measuring EI in NAEP applicants or SRNAs is not done routinely, implementing EI screening may identify deficits that could affect clinical progress.  Findings did not support the hypothesis that higher ability-based EI scores were associated with better SRNA clinical performance.  SRNAs consistently met or exceeded daily clinical performance objectives, but scored low in their ability to use emotion to solve problems and to recognize the existence of others’ emotional language.

    The EI imperative

    The authors cite previous research in the literature which reported that failures in clinical training are rarely attributable solely to intelligence, but rather to deficits in noncognitive or interpersonal skills (Talarico et al., 2013).  In one study (Collins & Callahan, 2014), most of the SRNAs scored lower in facilitating emotions on the MSCEIT, which is consistent with findings from this study.

    The study authors conclude, “We believe that EI must be considered in nurses at all levels of the organization.  EI is central to the very nature of nursing practice, the delivery of holistic nursing care, and the improvement of patient outcomes.

    “It is our opinion that an individual who cannot effectively and consistently recognize and use emotions to solve problems may not be a desirable SRNA candidate or future certified registered nurse anesthetist.”

    “Nurses provide care by way of human interactions and through the development of relationships with patients, their families, and other members of the health care team.  EI has been reported as a high-level nursing skill required for the delivery of competent care, underscoring the importance of both undergraduate and graduate nursing programs to admit and graduate practitioners who possess the EI to successfully navigate the demands of a career in nursing.”

    Find more details on your CRNA colleagues’ study, analysis, and conlcusions, “Relationship Between Emotional Intelligence and Clinical Performance in Student Registered Nurse Anesthetists. Nurs Educ Perspect. 2021 Mar-Apr 01;42(2):104-106.”, at: