Nurse Anesthetists: Current Perceptions and Practices Related to Substance Use

Background: Certified registered nurse anesthetists (CRNAs) are a known high-risk group for substance use disorders (SUDs). However, few investigations have been conducted since 2006 that have specifically examined the phenomenon of substance use in this group. Purpose: The aim of this mixed methods study was to merge the qualitative exploration of CRNA vulnerabilities that lead to initiation, recurrence, and continued use of substances with the quantitative findings of current organizational practices designed to discourage diversion. Methods: Using an online survey approach, content analysis was conducted on four open-ended items (n = 86-125) and merged with descriptive statistics from the American Association of Nurse Anesthesiology (AANA) recommended strategies to minimize drug diversion (n = 198). Eleven strategies were posed to the CRNAs in two ways: which strategies were being implemented in their organization and which strategies they believed were effective. Qualitative and quantitative data were merged in the convergent design. Results: Various themes were derived from data with CRNAs' descriptions of the regulatory barriers to self-reporting substance use. The unique context of the CRNA, which exacerbates existing vulnerabilities, and the "penalties for seeking help" were reported. Significant differences were noted between the strategies implemented and the perceived effectiveness of the same strategies. Conclusion: Merged qualitative and quantitative data reflect that CRNAs believe significant barriers exist that prohibit reporting of substance use. Employer emphasis on alternative-to-discipline programs to promote a safe environment for reporting substance use and an examination of a reduction in penalties for reporting impairment are called for.