Date of Award

Spring 2026

Project Type

Clinical Doctorate

College or School

CHHS

Department

School of Nursing

Program or Major

Doctor of Nursing Practice

Degree Name

Other

First Advisor

Cathleen Colleran

Second Advisor

Matthew Guy

Abstract

Abstract

Title: Improving Confidence in Certified Registered Nurse Anesthetists in Providing Care for Patients Undergoing Transcatheter Aortic Valve Replacements (TAVR)

Background: Anesthesia staffing for complex, high-risk procedures like Transcatheter Aortic Valve Replacements (TAVR) is challenging due to a national shortage of anesthesia providers and the company's heavy reliance on non-permanent (locum tenens and 1099) Certified Registered Nurse Anesthetists (CRNAs). At this TAVR procedure location, 70% of the team is comprised of non-permanent staff. A lack of specialized training and experience in TAVR procedures led to a decrease in provider confidence and staffing shortages for these critical cases.

Purpose: The primary aim of this quality improvement project was to enhance CRNA confidence in providing anesthesia for TAVR patients and to increase the daily pool of qualified, willing providers at a Level 2 trauma center by at least 40% (two additional providers).

Methods: Utilizing the Plan-Do-Study-Act (PDSA) framework, an educational intervention was implemented for a cohort of eight CRNAs. The intervention consisted of a 45-minute self-paced educational PowerPoint followed by a clinical practice day with an assigned support CRNA. On-going TAVR practice days were provided with support as needed. Confidence was measured using a modified version of the Crisis Resource Management Self-Efficacy Scale (CRM-SES) across four domains: situational awareness, team management, environmental management, and decision-making. Data was analyzed using a retrospective pre-post design, followed by a final confidence assessment with Hedges’ g for effect size, and paired-samples t-tests for statistical significance.

Results: Participants experienced a statistically significant increase in confidence (p < 0.05) across all domains, with an average overall improvement of 19% on a five-point Likert scale. The project yielded a large effect size (Hedges’ g > 1.0). The intervention successfully added five new members to the TAVR team, increasing daily provider availability by an average of three CRNAs per TAVR operating day Correlation data suggested a potential ceiling effect for more experienced providers, while less experienced CRNAs showed the greatest gains in confidence

Conclusion: The combination of targeted educational programming and clinical mentorship is an effective, low-cost strategy for increasing CRNA self-efficacy in high-risk procedural areas. This model is sustainable and scalable, providing a framework to address quality of care disparities and staffing barriers in other complex anesthetic specialties.

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