Recent Doctor of Anesthesia Practice (DrAP) graduate, Dr. Ray Elmblad, has been named the 2013 Practice Doctoral Fellow of the American Association of Nurse Anesthetists (AANA) Foundation. This prestigious title comes with a cash award of $10,000. Elmblad earned the title through his study on the association between workplace incivility and professional burnout in Michigan Certified Registered Nurse Anesthetists (CRNAs). The project was part of Elmblad’s capstone requirement for the DrAP program. Gergana Kodjebacheva, assistant professor of health care administration, and Lynn Lebeck, clinical assistant professor of anesthesia and former anesthesia program director were Elmblad’s capstone advisors. He expressed gratitude for their support, “without those two, this would not have happened,” he said.
The idea for the project came out of Elmblad’s 23 years of experience working as a CRNA and his interest in workplace dynamics and communication. In the DrAP program, Elmblad’s coursework included healthcare management and organizational behavior. Working in hospital operating rooms around the country, Elmblad observed that the stressful nature of these environments can increase incivility. Finding a measurable research question on the topic was challenging, and Elmblad went through many ideas before deciding to examine the connection between incivility and burnout. Incivility can be defined as rude and discourteous behaviors such as inappropriate jokes, insulting comments, denigration of the target’s work, and spreading of false rumors. Burnout can be defined as the physical or mental breakdown resulting from over-working or stressful situations.
Elmblad sent a survey to over 1,700 Michigan CRNAs with the help of the Michigan Association of Nurse Anesthetists, a state association of the AANA. The survey consisted of approximately 40 questions, combining the Nursing Incivility Scale and the Copenhagen Burnout Inventory with demographic and open-ended questions. A total of 385 CRNAs responded to the survey—a 22.6% response rate—and the results showed that incivility was associated with burnout.
Responses to the open-ended questions, which asked CRNAs to provide recommendations for preventing, detecting, and coping with incivility, told a qualitative story that complemented quantitative findings. CRNAs used these questions to express their frustration about experiences with incivility in the workplace. “People are really affected by this,” Elmblad said. CRNAs demonstrated creative ways of coping with incivility. The most notable recommendation related to curbing incivility suggested implementing a zero tolerance policy, regardless of professional title or role. Other recommendations suggested using team building workshops and example setting to prevent incivility; behavior change to cope with incivility; and increased management presence and visibility in the clinical area to improve detection of incivility.
The AANA’s recognition of Elmblad’s work is a major accomplishment. The AANA represents more than 45,000 CRNAs and student registered nurse anesthetists in the U.S. The selection process for this AANA fellowship is highly competitive, with a large number of applications, all of them high-caliber. Elmblad is proud, but modest; he says he “had no idea how competitive the award was” and that it “really took (him) by surprise” to learn that he had been selected.
After graduating, Elmblad became the clinical education coordinator at the University of Michigan Health System for the UM-Flint/Hurley Medical Center MS in Anesthesia program. He hopes to publish his research in the AANA Journal. He will be attending the AANA’s annual meeting this August, where he will present his research and receive his award.