Beyond Borders: DNP students provide anesthesia care in the Dominican Republic
At the College of Nursing, three Doctor of Nursing Practice (DNP) residents, Quang Lu, Lindsey Warne, and Morgan Wondrak, recently stepped far beyond the familiar walls of U.S. clinical care, expanding their skills and perspectives during a surgical mission in the Dominican Republic. Specializing in Nurse Anesthesiology, they delivered anesthesia in a resource-limited setting, where adaptability, teamwork, and patient-centered care were not just ideals but daily necessities.
“Opportunities like this immerse our students in real-world challenges that demand critical thinking, compassion, and innovation,” said Brian Ahn, PhD, dean of the College of Nursing. “They return not only as stronger clinicians but also as more thoughtful, globally minded health care leaders.”
The residents joined assistant clinical professor Christopher Herring, DNP, CRNA, on the trip, part of a long-running interprofessional effort to provide surgical care to underserved communities. Herring has been involved with the program since 2006 and brought the initiative to the University of Arizona in 2018, expanding access to global health experiences for nursing anesthesia residents. This marked the third year that College of Nursing residents have participated, joining a team of 35 to 60 volunteers who travel annually.
“For many of our residents, this is their first time stepping into a health care environment with limited resources,” Herring said. “That is where much of their growth happens. They must adjust from a resource-rich setting to one where they make do with less and learn to deliver high-quality care with confidence despite those challenges. We are here to train providers that can work equally well within a team or independently.”
Quang Lu, DNP student
Inside the operating rooms, the contrast was immediate. The team performed a wide range of procedures, including hernia repairs, hysterectomies, and mass excisions, using general, spinal, and regional anesthesia. With limited equipment and only one anesthesia machine, they maintained three full service operating rooms. The team relied heavily on clinical judgment, creativity, and collaboration to ensure safe care.
“In the United States, we rely heavily on advanced monitors and technology,” Lu said. “In the Dominican Republic, many of those were limited or unavailable, so constant vigilance was essential.”
Those constraints often required quick thinking. During one case, Lu improvised a method to monitor a patient’s breathing using available materials, ensuring accurate readings while conserving oxygen. “It was a good example of having to think quickly and adapt to what was available to maintain safe patient care,” he said. Lu also described a complex seven-hour surgery that stayed with him long after it ended. “When I checked on the patient the next morning, she was comfortable and already preparing to walk,” he said. “That outcome meant a lot, not only clinically but also personally.”
Lindsey Warne, DNP student
For Warne, the experience strengthened her confidence as a future provider. “We had to find creative ways to deliver anesthesia without a full machine,” she said. “It showed me that safe, high-quality care is still possible with fewer resources. It just requires more preparation and problem-solving.”
She also reflected on the trust patients placed in the team despite language and cultural barriers. “I cannot imagine how intimidating it must be to undergo surgery with providers who may not speak your language,” Warne said. “Yet every patient was incredibly kind, grateful, and brave. That experience reinforced our responsibility as providers.”
For Wondrak, the environment's unpredictability stood out most. “We did not fully know what we had to work with until we arrived,” she said. “Our first day was spent taking inventory and developing a plan to safely care for patients with what was available.”
Morgan Wondrak, DNP student
One patient interaction left a lasting impression on her. During a procedure under spinal anesthesia, she cared for a patient who had spent months learning English to communicate with the visiting medical team. “Even in a vulnerable moment, he prioritized connection,” she said. “It was deeply humbling.”
Experiences like these are central to the design of the DNP Nurse Anesthesiology program, which emphasizes technical excellence and adaptability in diverse care settings.
“Our goal is to prepare students to deliver safe, high-quality anesthesia care in any setting,” said Lindsay Bouchard, DNP, PMHNP-BC, interim chair and DNP program director. “Experiences like this push them to rely on their foundational knowledge, communicate effectively as a team, and think critically in ways that cannot be replicated in a traditional setting.”
As they prepare to graduate, all three students say the experience will continue to shape their practice.
“It made me more grateful for the care we provide in the U.S., not just the care itself but also the resources that support it,” Lu said. “It gave me a deeper appreciation for the small things often taken for granted, such as air conditioning in the operating room or even something as simple as an adjustable operating table.”
Wondrak shared a similar perspective. “This experience broadened my understanding of global health by reinforcing how variable and limited access to surgical and anesthesia care can be,” she said. “It highlighted that many of the systems we rely on in the U.S. are not universally available and that routine care is not taken for granted elsewhere.”
“The patients we treated received definitive surgical care for serious health problems, and they would not have had access to it without us,” Warne added. “Our week of work enabled these patients to lead significantly healthier, more comfortable lives.”
After graduation, Warne and Wondrak will remain in Tucson to serve their local community, but they now also aspire to serve global populations in need. Lu, who has accepted a position in Phoenix, plans to carry forward the lessons from this experience while seeking opportunities to return to mission-based care. Together, they leave the program not only prepared for clinical practice but also committed to expanding access to safe anesthesia care wherever it is needed most.