www.aana.com/aanajournalonline AANA Journal June 2012 Vol. 80, No. 3
The purpose of this focused ethnography was to
describe the shared experiences of Certified Regis-
tered Nurse Anesthetists (CRNAs) who were on duty
in New Orleans, Louisiana, during Hurricane Katrina as
well as to elucidate the psychosocial impact the storm
had on them. Ten CRNAs participated in 1 of 3 focus
groups that were audio recorded. The audio record-
ings were transcribed and analyzed using qualitative
data analysis computer software (NVivo 8, QSR Inter-
national, Melbourne, Australia).
Six major themes emerged from the study: caught
off guard; sense of duty; uncertainty/powerlessness/
frustration; group identity and cohesiveness; anger;
and life-changing event. The themes represented how
unprecedented mandatory evacuation of all nonessen-
tial personnel on August 28, 2005. Certified Registered
Nurse Anesthetists (CRNAs) were considered essential
personnel in the hospitals and were required to report for
duty during disasters.
In the event of tropical storms and hurricanes, New
Orleans hospitals had staffing policies in place. Most hos-
pitals used activation/duty teams, which were expected
to report for duty just before a storm with provisions and
clothing for approximately 3 days. Provisions included
nonperishable food and water. The hospitals also uti-
lized recovery teams, which were expected to relieve the
activation team within 3 days after a storm. In the past,
CRNAs who were on duty during storms were typically
relieved the day after a storm. However, the widespread
flooding and closure of roads in the city in the aftermath
of Hurricane Katrina made relief of the activation team
impossible. When the patients and staff in the New
Orleans hospitals were finally rescued, the devastation
of the healthcare infrastructure was incomprehensible.1
Conditions in the hospitals deteriorated when the
infrastructure declined and electricity and potable water
were lost. Backup generators failed once the flood-
the CRNAs appraised and coped with the stressful
events surrounding Hurricane Katrina. The psycho-
social impact of Hurricane Katrina on the CRNAs
resulted mainly in short-term sleep disturbances and
increased drinking. Only 2 CRNAs expressed long-
term psychosocial effects from the storm. The results
of this study should be used to guide policies regard-
ing disaster activation of CRNAs, to educate CRNAs on
preparing for disaster duty, and to provide a frame-
work for future disaster studies regarding CRNAs.
Keywords: CRNAs, focused ethnography, Hurricane
Katrina, natural disaster.
Shared Experiences of CRNAs Who Were on
Duty in New Orleans During Hurricane Katrina
Marjorie A. Geisz-Everson, CRNA, PhD
Dianne Dodd-McCue, DBA
Marsha Bennett, RN, DNS, APRN, ACRN
urricane Katrina, which hit New Orleans,
Louisiana, as a category 3 storm, was one
of the most devastating natural disasters in
US history. The storm damaged all hospitals
in New Orleans and closed several of them
permanently. The mayor of New Orleans called for an
waters seeped into the basements and first floors of the
hospitals, which left the patients and hospital staff in a
vulnerable situation. Basic necessities such as food and
water were rationed.2 Rescue and evacuation efforts were
hindered by random acts of violence as well as by street
flooding. The 2 indigent hospitals in New Orleans were
the last to be evacuated. Several employees of the indi-
gent hospitals recalled that they were glad to be rescued
but were frightened for their lives because of the chaos
that was occurring in the city (eg, looting and gunfire).
Although disaster literature exists pertaining to
victims and rescue workers, an extensive review of the
literature failed to reveal research regarding CRNAs and
disasters. This study describes the shared experiences
of CRNAs who were on duty in New Orleans during
Materials and Methods
This study was a focused ethnography using group inter-
views to determine (1) the shared experience of CRNAs
who were on duty in New Orleans during Hurricane
Katrina and (2) the psychosocial impact that Hurricane
Katrina had on CRNAs who were on duty in New Orleans
during the storm. The protocol was approved by the in-
stitutional review boards of Virginia Commonwealth
University, Richmond, and Louisiana State University
Health Sciences Center, New Orleans, and appropriate
consents were obtained from all participants.
Focused ethnography describes a specific aspect of a
212 AANA Journal June 2012 Vol. 80, No. 3 www.aana.com/aanajournalonline
similar studies regarding healthcare workers and stress.
Psychosocial sequelae of healthcare workers following
disasters may include stress, anxiety, depression, sleep
disturbance, post-traumatic stress disorder, somatic com-
plaints, stress-related physical symptoms, fear, shock,
and excessive alcohol use.13-16 Most symptoms disap-
pear with time and without professional intervention of
mental health personnel.17 Many of the participants in
this study experienced anxiety and/or sleep disorders that
resolved over time without professional intervention.
Several limitations existed in this research. First,
the study took place 4 years after the storm. Another
limitation is that convenience sampling was used, and the
results of the study may not be transferable except to other
CRNAs who experience hurricanes. A third limitation was
that CRNA experiences may not have been similar based
on the type of institution in which they worked. Ten of a
potential 17 CRNAs participated in this study and, while
the participation rate was 58%, the study may have been
biased toward those who wished to tell their stories.
An implication of this study for CRNA practice in-
cludes developing storm duty policies based on the find-
ings. These policies should address exactly how many
CRNAs should be on duty and what provisions the duty
CRNAs should bring to the hospital. Another implication
of this study consists of educating CRNAs and future
CRNAs in the preparation and expectations of disaster
duty. They should be educated as to their specific role
during disaster duty. They should also be notified as to
how long they can expect to remain on duty during a di-
saster and potential evacuation and rescue plans. A final
implication of this study includes the need to conduct
future research based on different types of natural disas-
ters, such as tornadoes, earthquakes, volcanic eruptions,
and flooding, and their impact on CRNAs.
Although CRNAs were caught off guard by Hurricane
Katrina, they still shared a sense of duty when they
were activated for duty during the storm. They faced
uncertainty and powerlessness and expressed anger at
situations revolving around the storm and the institu-
tions. However, they also experienced group identity
and cohesiveness throughout their tenure on storm duty.
Hurricane Katrina was a life-changing event for those
who experienced it as these participants did. This was
the first study examining CRNAs with respect to natural
disasters, and substantial insight was gained as to the
impact of a natural disaster on a CRNA community.
1. Berggren RE, Curiel TJ. After the storm—health care infrastructure in
post-Katrina New Orleans. N Engl J Med. 2006;354(15):1549-1552.
2. Van Meter K. Katrina at Charity Hospital: much ado about something.
Am J Med Sci. 2006;332(5):251-254.
3. Knoblauch H. Focused ethnography. http://www.qualitative-research.
net/fqs-texte/3-05/05-3-44-e.htm. Forum Qual Soc Res. 2005;6(3).
Accessed April 23, 2008.
4. Lecompte MD, Schensul JJ. Designing & Conducting Ethnographic
Research. Walnut Creek, CA: AltaMira Press/Sage Publications; 1999.
5. Creswell JW, Plano Clark VL. Designing and Conducting Mixed
Methods Research. Thousand Oaks, CA: Sage Publications; 2007.
6. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York, NY:
Springer Publishing Co; 1984.
7. Mathieu MM, Ivanoff A. Using stress, appraisal, and coping theories
in clinical practice: assessments of coping strategies after disasters.
Brief Treatment Crisis Intervent. 2006:6(4):337-348.
8. Giarratano G, Orlando S, Savage J. Perinatal nursing in uncertain times:
the Katrina effect. MCN Am J Matern Child Nurs. 2008;33(4):249-257.
9. Qureshi KA, Merrill JA, Gershon RR, Calero-Breckheimer A. Emer-
gency preparedness training for public health nurses: a pilot study. J
Urban Health. 2002;79(3):413-416.
10. Chaffee MW. Making the decision to report to work in a disaster:
nurses may have conflicting obligations. Am J Nurs. 2006;106(9):54-57.
11. French ED, Sole ML, Byers JF. A comparison of nurses’ needs/con-
cerns and hospital disaster plans following Florida’s Hurricane Floyd.
J Emerg Nurs. 2002;28(2):111-117.
12. Smith E. Emergency health care workers’ willingness to work during
major emergencies and disasters. Aust J Emerg Manage. 2007;22(2):
13. Gray MJ, Maguen S, Litz BT. Acute psychological impact of disaster and
large-scale trauma: limitations of traditional interventions and future
practice recommendations. Prehosp Disaster Med. 2004;19(1):64-72.
14. Leon GR. Overview of the psychosocial impact of disasters. Prehosp
Disaster Med. 2004;19(1):4-9.
15. Mitchell AM, Sakraida TJ, Zalice KK. Disaster care: psychological
considerations. Nurs Clin North Am. 2005;40(3):535-550.
16. North CS, Tivis L, McMillen JC, et al. Psychiatric disorders in res-
cue workers after the Oklahoma City bombing. Am J Psychiatry.
17. Ursano RJ. Post-traumatic stress disorder. N Engl J Med. 2002;346(2):
Marjorie A. Geisz-Everson, CRNA, PhD, is assistant clinical professor at
the University of Southern Mississippi, Hattiesburg, Mississippi. At the
time this article was written, she was an instructor at Louisiana State Uni-
versity Health Sciences Center (LSUHSC) Nurse Anesthesia Program, New
Orleans, Louisiana. Email: email@example.com.
Dianne Dodd-McCue, DBA, is associate professor, Virginia Common-
wealth University Program in Patient Counseling. Email: ddoddmccue@
Marsha Bennett, RN, DNS, APRN, ACRN, is associate professor and
associate dean for nursing research, scholarship & science at LSUHSC
School of Nursing. Email: firstname.lastname@example.org.
We would like to thank the CRNAs who participated in this study, the
AANA Foundation for partially funding the education of lead author
Marjorie Geisz-Everson, and Diana Douglas, DNS, for her role in this study.