Assessing stress patterns of first year graduate nurse anesthesia students through salivary cortisol

Certified registered nurse anesthetists (CRNA) are instrumental in ensuring safe anesthesia in all surgical settings. Nurse anesthetists have been administering anesthesia in all types of surgical cases for more than 100 years in every setting where anesthesia is administered. Roughly 32 million anesthetics are administered in the United States yearly by nurse anesthetists as part of a team model with anesthesiologists or independently using all agents and techniques. Vigilance and attention to detail by nurse anesthetists are two examples of excellence which increase patient safety and surgeon satisfaction. The inherent responsibilities of a CRNA can result in high stress. Stressful situations encountered by CRNAs include staffing difficult surgical cases, performing difficult intubations, experiencing various patient complications, and even death. Combined feelings of stress and exhaustion can be magnified in the CRNA student. Didactic requirements and excessive financial demands contribute to this stress. Constant desire for approval from preceptors, doctors, peers, and program faculty can lead to feelings of inadequacy and stress. As individuals experience stress, the body reacts in a variety of ways in an effort to cope. Cortisol release is a physiological response that stimulates the sympathetic nervous system during heightened periods of stress. Increased release of cortisol plays an integral role in the body's physiologic mechanism to cope with the increased physiologic demands as a result of stress. Prolonged secretion of this steroid hormone can have deleterious effects and can become harmful to the individual experiencing chronic stress. The purpose of this study was to assess stress patterns of first year nurse anesthesia residents from Webster University.;A convenience sample of 13 first year nurse anesthesia residents meeting inclusion criteria were recruited for the study. Salivary cortisol samples were collected using Salimetrics Oral Swabs, and enzyme immunoassays were performed to obtain cortisol levels. Corresponding questionnaires (reported stress) and the Mind Body Perceived Stress Scale (perceived stress), designed to assess external variables, were provided at the time of data collection to aid in identifying correlative stress causes.;Student t-test were performed to compare mean cortisol values between terms. Pearson's r correlation was performed to determine if a relationship existed among salivary cortisol levels, perceived stress, and reported stress scales.;Average cortisol levels obtained from first year nurse anesthesia residents attending Webster University peaked during the first, third, and fifth term of studies. A significant increase in cortisol during term 1 was noted with a (p=.013), when compared to baseline salivary cortisol levels. A significant decrease was noted during term 2 with a (p= 0.015), when compared to term 1. A significant increase was noted during term 3 with a (p= 0.000), when compared to term 2. A significant decrease was noted during term 4 with a (p= 0.000), when compared to term 3. Cortisol levels increased in term 5 from term 4 but the increase was not a significant (p=0.088). Cortisol levels did not have any significant correlations to perceived stress. Correlational analysis of reported stress and perceived stress failed to produce significant results. Reported stress scales did not have any significant correlations to perceived stress scales.;Unresolved stress is linked to fatigue and burnout. Identifying stressors, developing coping mechanisms and wellness programs may help anesthetists and residents better manage stressful situations. This study will be used as a pilot study for future research on cortisol and stress levels in student nurse anesthetists at Webster University.