Date of Paper/Work


Type of Paper/Work

Systems Change Project

Degree Name

Doctor of Nursing Practice



First Advisor

Margaret Dexheimer Pharris


Doctor of Nursing Practice


The overall aim of this systems change project is to identify the specific barriers to optimal care faced by Certified Registered Nurse Anesthetists (CRNAs) who are managing the pain of opioid tolerant patients, so as to eliminate those barriers.

The postoperative pain of opioid tolerant patients is substantially undertreated, implicitly requiring changes in their treatment for both ethical and economic reasons. These changes will require growth in CRNA skills and thinking. Benner’s conceptual framework has been used to describe this growth in opioid tolerant pain management from novice to expert.

A literature review informed the formulation of a descriptive survey instrument to gather data on the self-perceived barriers to optimal practice. The questionnaire was distributed via the American Association of Nurse Anesthetists (AANA) to 2500 practicing CRNAs, achieving a question response rate of 25.6% (640) to 28.9% (717), yielding a very large sample size for each question. The survey data were summarized and analyzed to distinguish the several actual from the numerous possible barriers.

The analyses of the survey results revealed three barriers above all others: (a) a lack of specific guidelines for opioid tolerant patients, (b) a general failure to use an opioid calculator to ensure proper dosing, and (c) the very broadly-perceived need for CEUs specifically for managing the pain of the opioid tolerant patient. To initiate the change process, this study was presented to members of the Minnesota Association of Nurse Anesthetists. The data and analysis will serve as a font from which future researchers will draw.