2026 Theses Doctoral

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

Congdon, Christina R.

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 a vulnerable 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 studies to date have 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 dissertation investigates, for the first time, the impact of organizational climate on burnout, job satisfaction, and intention to leave among CRNAs employed in rural settings. Specific aims include: 1) identifying and synthesizing the prevalence, contributing factors, and associated outcomes of burnout among CRNAs in the US; 2) examine the relationship between organizational climate, burnout, job satisfaction, and intention to leave among CRNAs employed in rural settings; and 3) understand the impact of organizational climate on CRNA burnout, job satisfaction, and intention to leave using the firsthand CRNA perspective.

The first chapter provides a brief introduction to the practice of CRNAs in the US, the growing
rates of burnout among this population, and the novel concept of CRNA organizational climate, which will be investigated in this dissertation. Further, the guiding theoretical framework and innovative nature of the dissertation are discussed.

The second chapter provides an integrative review identifying and synthesizing the prevalence, contributing factors, and associated outcomes of burnout among CRNAs in the US. Current burnout estimates range from 12.5% to 72%, with an average of 39%. Lack of autonomy, lack of leadership support, poor relations between CRNAs and physicians, decreased professional recognition, increased number of hours worked, and moral distress were identified as significant contributors to burnout, highlighting the need to explore these associations further.

The third chapter is a cross-sectional analysis of survey data from 73 rural CRNAs examining the relationship between organizational climate and workforce outcomes (i.e., burnout, job satisfaction, intention to leave). Most CRNAs were satisfied with their job and had no intention of leaving their primary position. However, 53.6% of participants met criteria for burnout. Poor CRNA organizational climate, specifically negative relationships between CRNAs and administration which is one dimension of organizational climate, contributed to adverse workforce outcomes for our participants.

The fourth chapter uses a mixed methods approach to determine the impact of organizational climate on CRNA workforce outcomes and hear the CRNA perspective on organizational climate in rural settings. The CRNA-Administration relationship was determined to have a significant association with CRNA burnout among our participants. In-depth analysis of this subscale identified “Administration shares information equally with CRNAs and physicians,” “There are enough ancillary staff to help with patient care,” “Administration makes efforts to improve working conditions for CRNAs,” and “Administration treats CRNAs and physicians equally,” to be the lowest scoring items. Using qualitative data from semi-structured interviews with eleven CRNAs, the CRNA-Administration Relations domain was further assessed to understand key aspects of this relationship impacting overall organizational climate. Six themes emerged: 1) Physician-oriented communities, 2) Respect and value of CRNAs, 3) CRNA communication with administration, 4) Balancing surgeon demands, financial pressures, and doing what’s best for the patients, 5) Impact of hospital ownership on organizational climate, and 6) Administrative factors contributing to poor organizational climate.

The fifth chapter summarizes and discusses the results of the included studies, the strengths and limitations of the research, and the overall implications for practice, policy, and future research.