Early Career
  • Moving Beyond Socialization: Student Registered Nurse Anesthetist Professional Role Formation

    By:  Patrick Haltom, BSN, Samford University

    Student registered nurse anesthetists (SRNAs) come from a variety of personal and professional backgrounds. Each SRNA enters a nurse anesthesia educational program with individual motives, attitudes, and perceptions of what it means to be a certified registered nurse anesthetist (CRNA). Given these diverse backgrounds and experiences, students commonly encounter role ambiguity as a significant stressor when functioning in the clinical arena.1,2 The transition from being an expert critical care nurse to a novice SRNA can be disheartening and disenfranchising for students, and SRNAs frequently describe CRNA role transition as a common challenge to graduate education and practice entry.1,2 Students may sense that others in the operating room (OR) disregard their valuable experience as a bedside nurse, and as a result, SRNAs may lack confidence in their clinical abilities. Traditionally, role socialization has been a prominent framework for assisting SRNAs in identifying with the CRNA role.3 While role socialization is an important process as students establish themselves as professional CRNAs, this framework has several limitations, necessitating further methods for students to navigate the enigmatic process of CRNA role attainment. The development of individual professional identities is a pathway that incorporates traditional role socialization and can be completed using pragmatic tools available to students and educators to assist SRNAs in identifying with the CRNA role.

    Traditional role socialization includes skills acquisition, knowledge attainment, behavior adaptation, and career commitment formation to establish students as CRNAs.3,4 As students prepare to enter the OR, skills and behavior acquisition are essential components to begin the socialization process and assist SRNAs in role identification. However, skills acquisition can be slow and tedious; it is primarily based on external factors that are outside of the students’ control: the clinical facility, case type and volume, and preceptor preferences. Additionally, while clinical skills are crucial to the CRNA role, they are not specific to it. For example, other professionals also intubate, place central lines, and use the anesthesia machine. A simple focus on skills acquisition alone minimizes vital components of the CRNA’s role and the SRNA’s critical care experience — critical thinking and clinical reasoning. The socialization framework, including the emphasis on occupational skills and behavior, is further limited in that much of the socialization process relies on external exposure that professional members rather than the student discern to be important to the role.4 In other words, role socialization involves students exhibiting skills and behaviors that align with becoming a CRNA but does not necessarily involve student awareness or the formation of a professional identity. Role socialization may assist students in functioning like a CRNA and provide a necessary scaffolding for performance in the OR, but this process falls short of encouraging students to analyze and formulate their professional identities as future CRNAs. In contrast, the development of individual professional identities cultivates students’ preparedness to investigate, explore, and apply their diverse talents to the variety of roles nurse anesthetists occupy inside and outside of the OR, including political, research, academic, military, and entrepreneurial roles.

    Several practical methods exist that may assist SRNAs with professional identity formation. Strengths-based education is one framework that educators can use to promote strengths development in students and increase student self-discovery.5 Additionally, strengths-based assessments, such as CliftonStrengths, have been utilized by educators to assist students with strengths development.6,7 These assessments may assist SRNAs in creating an internal identity that is not solely dependent on the external factors of the OR and allow students to form a professional identity that is resilient in the face of a challenging clinical environment or difficult skills acquisition. For example, if SRNAs place a heavy emphasis on skills acquisition for successful role identification, their performance of direct laryngoscopy during a single clinical day may leave them feeling discouraged and doubting their ability to perform in the role of a CRNA. In contrast, students who are involved in internal professional identity formation through strengths-assessments may find that not achieving direct laryngoscopy is not a failure of their ability to become a CRNA. Rather, they may see poor skills performance as an opportunity to apply their individual, identified strengths to a clinical and performance problem.

    Similar to strengths assessments, emotional intelligence (EI) is an ability-based tool that may assist students in crafting their professional identities for CRNA role attainment.8 In particular, EI assessments may assist students in processing their feelings, understanding the feelings of others, and using their feelings to influence decision-making and behavior.8 This type of assessment may assist SRNAs in moving beyond skills acquisition by teaching them how their emotions inform aspects of their critical thinking, decision-making, and teamwork in the OR.9 As students gain perspective on their EI profiles, they may be able to better discern their individualistic professional role as a CRNA and the interplay their role has with other perioperative professionals.

    While both strengths-based assessments and EI assessments help students craft their professional identities, these self-discovery tools are not readily connected to the CRNA role specifically. As students pursue self-discovery to formulate their professional identities, it is imperative that they connect these self-assessments to the larger identity of the CRNA profession. Specifically, students can utilize professional standards and specific SRNA resources outlined by the American Association of Nurse Anesthetists (AANA) to connect their individual identities to the overarching professional identity. Students might consider how their professional identities uphold CRNA professional standards provided by the AANA, such as the Code of Ethics for Certified Registered Nurse Anesthetists and the Standards for Nurse Anesthesia Practice.10,11 Additionally, the AANA provides opportunities for SRNAs to explore how the development of their professional identities may be operationalized. Students can engage in these unique opportunities, including scholarly writing, committee involvement, and student wellness, to determine how their professional identities intersect with CRNA roles outside of the traditional OR.12 By drawing connections between individual professional identities to the larger nurse anesthesia professional identity and by pursuing professional development opportunities offered by the AANA, SRNAs can further engage in a process that engenders a true role formation. This process extends beyond traditional socialization to prepare students to function in leadership roles and non-traditional environments.

    The use of professional socialization is a helpful framework to understand how SRNAs exhibit attributes associated with becoming a CRNA, yet true professional identity formation is also needed for SRNAs to achieve CRNA role formation in a diverse and rapidly evolving healthcare system.3 Self-discovery tools can be helpful, practical ways to assist students with the formation of individual professional identities that not only incorporate their past experiences, values, and perceptions from nursing but also include newly developing strengths and interests from their graduate education. Students may solidify role attainment through the process of reflecting on how the characteristics of their professional identities connect to the overarching professional characteristics and standards of being a CRNA. Further, students may envision how their professional identities are applied by utilizing student engagement opportunities offered by the AANA. As students navigate the rigor of nurse anesthesia educational programs, the stressor of role ambiguity may be mitigated not by solely teaching students how to act like a CRNA through traditional role socialization but by incorporating it into guidance and encouragement for students to form their professional selves capable of growing into the CRNA role.

    References

    1. Wildgust BM. Stress in the anesthesia student. AANA J. 1986;54(3):272-278.
    2. Tracy A. Perceptions of certified registered nurse anesthetists on factors affecting their transition from student. AANA J. 2017;85(6):438-444.
    3. Waugaman WR, Callahan MF, Hornsby L. The socialization and professional roles of certified registered nurse anesthetists. In: Foster SD, Callahan MF, eds. A Professional Study and Resource Guide for the CRNA. 2nd ed Park Ridge, IL: American Association of Nurse Anesthetists; 2011:25-40.
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    5. Lopez SJ, Louis MC. The principles of strengths-based education. J Coll Character. 2009;10(4):1-8.
    6. How educators use CliftonStrengths. Retrieved from Gallup website. https://www.gallup.com/cliftonstrengths/en/253862/cliftonstrengths-for-schools.aspx. Accessed February 25, 2020.
    7. Borden JP. Designing and implementing a strengths-based approach to student development. Business Educ Innovation J. 2018;10(2):164-168.
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    9. Collins S, Andrejco K. A longitudinal study of emotional intelligence in graduate nurse anesthesia students. Asia Pac J Oncol Nurs. 2015;2(2):56-62. doi:10.4103/2347-5625.157566
    10. American Association of Nurse Anesthetists (AANA). Code of ethics for nurse anesthesia practice. Retrieved from AANA website. https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/code-of-ethics-for-the-crna.pdf?sfvrsn=d70049b1_4. Accessed March 23, 2020.
    11. American Association of Nurse Anesthetists (AANA). Standards for nurse anesthesia practice. Retrieved from AANA website. https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/standards-for-nurse-anesthesia-practice.pdf. Accessed March 24, 2020.
    12. American Association of Nurse Anesthetists (AANA). Opportunities for students. Retrieved from AANA website. https://www.aana.com/membership/students/opportunities-for-students. Accessed March 25, 2020.