Decision-Making Dynamics of Nurse Anesthetists in Surgical Settings: A Qualitative Study

This study explores the clinical decision-making processes of certified registered nurse anesthetists (CRNAs) in the operating room, focusing on how their practice is shaped by clinical experience, education, interprofessional relationships, technology, psychological states, and ethical considerations. Using a qualitative, descriptive, and exploratory design, semistructured interviews were conducted with 10 CRNAs from public and private hospitals in France. Data were analyzed inductively through thematic analysis, following Braun and Clarke's framework. Six major themes emerged: clinical responsibility and patient safety, experience and intuition, collaboration with anesthesiologists, psychological and emotional influences, technology use, and ethical values. Participants emphasized that decisions are grounded in patient safety and shaped by trust-based collaboration with anesthesiologists. Experience was identified as a key factor enabling intuitive and rapid decision-making. Stress, tiredness, and emotional load were reported as affecting cognitive performance, while technology was viewed as a supportive but secondary tool. Ethical dilemmas, such as end-of-life care or treatment refusal, further influenced decision-making in complex contexts. The study concludes that CRNA decision-making is a multidimensional and context-sensitive process that relies on both individual expertise and relational dynamics. These findings support the need for continued simulation-based education, interprofessional training, and structured ethical reflection in anesthesia practice.