Date of Award

Spring 5-2017

Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing and Allied Health Professions

First Advisor

Elizabeth A. Palmer, Ph.D.

Second Advisor

Theresa M. Gropelli, Ph.D.

Third Advisor

Lora K. Ott, Ph.D.

Fourth Advisor

John M. O'Donnell, DrPH, MSN, CRNA


Preparation of the Student Registered Nurse Anesthetist (SRNA) to start clinical education varies greatly between nurse anesthesia programs. Variations include length of time from first day of class to the first clinical rotation, and in the content, amount, and type of instruction provided. There are no national association or accrediting body-driven curricular guidelines regarding clinical preparation, as well as little literature addressing transition to clinical education. As such, discerning what is most beneficial to prepare SRNAs for clinical education was deemed imperative. The purpose of this study was to explore and interpret the experience of entering a first clinical rotation through the memories of Certified Registered Nurse Anesthetists (CRNAs) to construct a substantive theory addressing SRNA transition to clinical education.

Charmaz’s Constructivist Grounded Theory methodology was used to interview eight CRNAs with less than ten years of professional experience. By analysis of the rich data the Theory of Competent Assimilation was constructed. This theory describes the importance of a pre-clinical foundation comprised of a preparational triad composed of orientation, didactics, and simulation of skills. It is not enough for this triad to stand alone, but rather the foundational components must be synthesized through real-like simulation (RLS), which is the key for optimal performance and application of knowledge to clinical practice. RLS provides experiential context for SRNAs to apply to clinical performance. A new application of Benner’s Novice to Expert Theory to nurse anesthesia education was discovered, in that critical care nurses start their advanced practice education as advanced beginners rather than novices, and coupled with a strong preparational triad and RLS, can begin clinical education as competent practitioners with positive assimilation to clinical practice.

This theory stresses the importance of pre-clinical preparation and positive assimilation to clinical practice. The use of this theory can help drive curriculum development and set benchmarks for clinical entry. SRNA anxieties would decrease, and as they would become less distracted and more confident, patient safety would be greatly enhanced. Positive assimilation to clinical practice will enhance clinical learning to allow for more advanced assimilation at an earlier stage, promoting stronger graduates.

Included in

Nursing Commons