Nurse anesthetist reaction to the unexpected or untimely death of patients in the operating room.

Certified registered nurse anesthetists (CRNAs) experience the unexpected death of the their patients much differently than other nurses. Unlike all other nurses, they are held directly responsible for maintaining their patients' physiologic parameters in the face of surgical and pharmacologic insults and not only for selecting the types of anesthetic and adjuvant drugs but also for manipulating their doses on a minute-to-minute basis. Four factors significantly enhance their stress: the presence of an unrescinded advance medical directive and/or do not resuscitate order; the harvesting of vital organs; psychologic factors, including distractions, errors in clinical judgment, fatigue, boredom, or lack of vigilance; and legal threats. Unless CRNAs have significant coping skills firmly in place, any of these stresses may cause them to deteriorate physically, emotionally, or professionally.