Self-Efficacy, Stress, and Social Support in Relation of SRNAs

AANA Journal  April 2015  Vol. 83, No. 2 133 E ducators and program administrators have long considered how to select the best applicants for admission to their program by identifying admission criteria that are most associated with student academic and clinical success. Applicants to nurse anesthesia educational programs (NAEPs) compete for a finite number of openings, and admission criteria can vary from program to program. The basic admission criteria used by most programs across the United States include grade point average (GPA), science GPA, Graduate Record Examination (GRE) scores, and critical care nursing experience. Additional requirements may include letters of recommendation and applicant interviews. The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the enrollment of baccalaureate-prepared registered nurses with at least 1 year of acute or critical care experience. Not only is student selection important, but so are the retention and successful progression of competent students in NAEPs. Attrition rates in anesthesia programs are of interest to educators and to the profession as an important educational process outcome. When there is student attrition, there is a loss in terms of time and financial resources to the student, to the NAEP, and to the anesthesia and nursing professions. If a student does not complete the program, his or her position cannot be filled. This is a loss to another student who may have been capable of successful program completion. Program loss results in decreased tuition dollars and loss to the withdrawing student in terms of nonrefundable school-related investments and tuition costs. A report from 2014 of only tuition and university fees for US anesthesia programs (both master’s and doctoral programs) showed a median of $50,077 with a range of $15,000 to $118,056, and these figures do not include living expenses, net income forgone, and loan costs. Generally students are required to end their employment arrangements for full-time study, and the critical care nursing unit loses a trained specialty nurse. Nursing turnover costs have been reported to cost $64,000 for turnover of a specialty nurse. Attrition is a waste of time, money, and effort by all parties. The nurse anesthesia profession is affected by not only student attrition but also stress. Stress in nurse anesthesia education is inevitable and can be a positive motivator for students, but at higher levels it can result in negative consequences. Chipas et al reported that 47% of anesthesia students reported depression and 21% reported suicidal ideations. If stress exceeds a manageable level, negative consequences can arise, affect the health of the student registered nurse anesthetist (SRNA), and possibly impair patient safety. Self-efficacy is related to one’s beliefs in one’s ability to accomplish an objective. High levels of self-efficacy have been shown to be predictive of increased academic performance and improved student retention. Selfefficacy can be increased in numerous ways, including task mastery as with high-fidelity simulation; social persuasion/support; vicarious experiences; and emotional or somatic states (Table 1). Social support, which increases self-efficacy, has been shown to be helpful for those facing stressful situations. Several studies suggest the need for more social support and stress management for SRNAs. Increasing social support and other methods of increasing self-efficacy could be helpful for the SRNA by promoting academic success, retention, and Many studies document the presence of stress and the need for social support in anesthesia students. By addressing these, one can increase students’ selfefficacy, which is related to beliefs in one’s ability to accomplish an objective. By measuring and instituting measures to increase self-efficacy, we could improve student selection in nurse anesthesia programs, and increase academic success and likelihood of retention. This article reviews the literature on this topic and makes recommendations for increasing student self-efficacy.