Anesthesia Care Delivery in Rural America: The Impact of Organizational Climate on Burnout, Job Satisfaction, and Intention to Leave among Certified Registered Nurse Anesthetists

Burnout among Certified Registered Nurse Anesthetists (CRNAs) is a growing public health crisis with recent estimates as high as 72%. As CRNAs are the predominant anesthesia providers in 80% of rural counties across the United States (US), and with rural residents notably an Agency for Healthcare Research and Quality (AHRQ) priority population, mitigating CRNA burnout and preventing its adverse sequalae (i.e., job dissatisfaction, intention to leave one’s primary position) is critical to ensure an ample supply of CRNAs to meet the demand for surgical and anesthesia care. A paucity of literature exists exploring organizational factors contributing to CRNA burnout. Organizational climate (i.e., interprofessional relations, workload, autonomy, and administrative support) conceptualizes the structural and process factors within an organization and has been shown to impact burnout, job satisfaction, and intention to leave. However, no study to date has explored these associations in the CRNA population. CRNAs provide high-quality, equitable, and cost-effective anesthesia care for rural populations, which makes clear the need to identify organizational factors that support their wellbeing and retention. The proposed study will investigate, for the first time, the impact of organizational climate on burnout, job satisfaction, and intention to leave among CRNAs employed in rural settings using a mixed-methods approach. The project’s specific aims are: Aim 1. To examine whether CRNA organizational climate (CRNA-Organizational Climate Questionnaire) is associated with burnout (Maslach Burnout Inventory), job satisfaction (single validated item), and intention to leave (single validated item) among CRNAs in rural settings. We hypothesize that poor organizational climate will be associated with increased CRNA burnout, decreased job satisfaction, and increased intention to leave primary position. We will collect cross-sectional survey data from an estimated sample of 219 CRNAs employed in rural settings in California, New York, and Texas (to study varying state scope of practice regulations) and build multi-level regression models to determine associations. Exploratory Aim. Explore whether CRNA organizational climate moderates the associations between state scope of practice regulations and burnout, job satisfaction, and intention to leave for CRNAs in rural settings. Aim 2. Understand the CRNA perspectives of organizational climate factors related to burnout, job satisfaction, and intention to leave in rural settings. We will bolster survey findings using 1:1 qualitative interviews with 10-16 CRNAs until data saturation is reached. The robust research infrastructure at Columbia University, coupled with the guidance of an exceptional mentorship team, experts in rural workforce policy, organizational climate, and multilevel modelling, will provide the support to achieve these aims. The evidence generated in this proposal, aligned with AHRQ’s mission, may optimize workforce policy and identify interventions aimed at reducing CRNA burnout and turnover to ensure access to high-quality, safe, affordable surgical and anesthesia care for rural residents.