Transcript Transitioning Into a Doctoral Program in Nurse Anesthesia

Transitioning Into a Doctoral
Program in Nurse Anesthesia
Presented by:
Daniel Stairs, CRNA, MSN, MBA
Assistant Director
Excela Health School of Anesthesia
April 4, 2008
Nurse Anesthesia Education
“If you don’t know where you are going,
you will probably end up somewhere
else”
Dr. Lawrence Peter, 1919
Nurse Anesthesia Education
Where have we come from?
 Where are we now?
 Where do we want to be?

Where Have We Come From?
1877 – Sister Mary Bernard, Erie PA
 1915 – Lakeside Hospital School of Anesthesia
 1931 – National Association of Nurse
Anesthetists (NANA) founded by Agatha
Hodgins
 1933 – First NANA Annual Meeting
 1939 – NANA changes name to AANA
 1945 – AANA administers first certification
examination

Memories From the First Certification
Examination in 1945 . . .

"I Remember..."
"We had been well prepared by our instructors
at Charity Hospital, so I did not find the
questions overly difficult. I did not take
anesthesia work lightly. I worked and studied
very hard…the examination was a definite step
forward.“
Jessie Hood
Charity Hospital
New Orleans
Memories from the First certification
Examination in 1945 . . .

"I thought the examination was a good
idea…Nurse anesthesia was a very hard job. I
started at $250 a month and was on call
every day and every other weekend….The
examination was hard, too, considering the 9
month course I had taken in anesthesia. It
took me all day to write it."
Elizabeth Coolidge
Grace Hospital
Detroit
Memories from the First Certification
Examination in 1945 . . .

"I did not prepare ahead of time. Each school
taught what it wanted, because there were
not any regulations at that time. I felt the
first examination was a feeler to learn how
the schools measured up."
Gail Getway
Grace Hospital
Detroit
Other Important Dates in History
1944 – AANA membership extended to
African-American nurse anesthetists
 1947 – AANA membership extended to male
nurse anesthetists
 1952 – AANA implements program for
accrediting schools of nurse anesthesia
 1955 – U.S. Department of Health education
and Welfare recognize AANA as accrediting
agency for schools of nurse anesthesia
 1956 – AANA members adopt the credential of
CRNA

Where Have We Come From?
1987 – Bachelor’s degree required
 1989 – 1998, Programs start to transition
into Master’s Degree
 June 2007 – AANA Board of Directors
develop and unanimously adopt a
consensus Position Statement on
doctoral preparation of nurse
anesthetists

Reasons for Move Towards Doctorate
Change in scope and complexity of practice
 Increase in required number of college credits
 Increase the credibility of the nurse
anesthesia practitioner
 Completion of career ladder
 Increase the number of doctorally-prepared
faculty
 Movement of other healthcare professions to
doctorate
 Doctorate may be required by some states for
licensure

AANA Position Statement
Where Are We Going?
“The American Association of
Nurse Anesthetists supports
doctoral education for entry
into nurse anesthesia practice
by 2025.”
AANA Position Statement Rationale
Advances in technology, pharmacology, and
clinical practice mandate for evidence-based
practice
 Healthcare is changing at a dramatic rate
 Informatics
 Systems approach to quality improvement
 Increase in credit hours already required
 Increase reliance on APNs to provide
healthcare
 Some programs already moving to doctorate

Where are we at TODAY?
108 NA programs in U.S. (as of 3-25-09)
 Vast majority offer various master’s degrees
such as MS, MSN, MS in nurse anesthesia,
MHS, master’s in biology
 2 doctoral entry level programs now in
place:
1. Charleston Area Medical Center School of
Nurse Anesthesia/Marshall University (WV);
-Doctor of Management Practice in NA
2. University of Minnesota NA Program
-Doctor of Nursing Practice

Where are we TODAY?

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2.
3.
4.
Several schools offer doctoral completion
programs for masters prepared CRNA:
Virginia Commonwealth University
-Doctor of Nurse Anesthesia Practice (DNAP)
Texas Wesleyan University
-Doctor of Nurse Anesthesia Practice (DNAP)
Robert Morris University (for all APNs)
-Doctor of Nursing Practice (DNP)
University of Pittsburgh
-Doctor of Nursing Practice (DNP)
What’s the Difference in the Initials?
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1.
2.
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PhD is a research oriented degree; requires
a dissertation
DNP and DNAP are clinical (practiceoriented) doctorates:
Prepares graduates to function at the highest
clinical level
Requires capstone project completion
DNP program housed within a graduate
school of nursing
DNAP program housed within graduate
school of health sciences (outside nursing)
Competencies for the CRNA
Practitioner at Clinical Doctorate Level

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1.
2.
3.
4.
5.
6.
7.
8.
For doctoral curriculum development
Are 8 competencies:
Ethics
Health Systems Management
Public and Social Policy
Technology and Informatics
Practice Inquiry
Healthcare Improvement
Professional Role
Biological Systems,Homeostasis,
Pathogenesis
Ethics
Apply ethically sound decision making
 Informs public of role and practice
 Upholds “Code of Ethics for CRNAs”

Health Systems Management
Ability to analyze structure, function and
outcomes
 Negotiates, implements, assesses
 Develops and implements integrated risk
management plan

Public and Social Policy
Advocates for health policy changes
 Influences regulatory aspects of health
policy
 Evaluates impact of local and global
political change

Technology and Informatics
Uses information systems and technology to
support systems improvement
 Uses systems/technology to evaluate
programs of care
 Critically evaluates clinical and research
databases

Practice Inquiry
Able to assess and evaluate health
outcome in diverse populations, clinical
settings, and systems
 Ability to disseminate research evidence

Healthcare Improvement
Uses EBP in clinical decision making
 Evaluates healthcare financing
 Strategic planning

Professional Role
Ability to undertake complex leadership roles
 Demonstrates leadership to facilitate
collaboration
 Critical and reflective thinking
 Utilizes a variety of leadership principles in
management of situations

Biological Systems, Homeostasis, and
Pathogenesis
Develops best practice models for nurse
anesthesia patient care management
 Uses systematic outcomes analysis approach

Our Plans for Excela Health
Fall 2011 – DNAP Completion
 Need to increase CRNAs with doctorate for
capstone advisors
 Fulfillment of AANA doctoral competencies
 Time frame for completion
 Eventual program transition from MS to
DNAP

The Future of Nurse Anesthesia
So
what do you think???
Are you ready for doctoral
level education???
Nurse Anesthesia Educators
needed as we prepare for the
future of nurse anesthesia