Transitioning Into a Doctoral Program in Nurse Anesthesia

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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

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Nurse Anesthesia Education

• If you dont know where you are going, you will
  probably end up somewhere else
• Dr. Lawrence Peter, 1919

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Nurse Anesthesia Education

• Where have we come from?
• Where are we now?
• Where do we want to be?

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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

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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 hardthe examination was a definite step
  forward.
• Jessie Hood
• Charity Hospital
• New Orleans

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Memories from the First certification Examination
in 1945 . . .

• "I thought the examination was a good ideaNurse
  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

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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

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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

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Where Have We Come From?

• 1987 Bachelors degree required
• 1989 1998, Programs start to transition into
  Masters Degree
• June 2007 AANA Board of Directors develop and
  unanimously adopt a consensus Position Statement
  on doctoral preparation of nurse anesthetists

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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

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AANA Position StatementWhere Are We Going?

• The American Association of Nurse Anesthetists
  supports doctoral education for entry into nurse
  anesthesia practice by 2025.

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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

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Where are we at TODAY?

• 108 NA programs in U.S. (as of 3-25-09)
• Vast majority offer various masters degrees such
  as MS, MSN, MS in nurse anesthesia, MHS, masters
  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

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Where are we TODAY?

• Several schools offer doctoral completion
  programs for masters prepared CRNA
• 1. Virginia Commonwealth University
• -Doctor of Nurse Anesthesia Practice (DNAP)
• 2. Texas Wesleyan University
• -Doctor of Nurse Anesthesia Practice (DNAP)
• 3. Robert Morris University (for all APNs)
• -Doctor of Nursing Practice (DNP)
• 4. University of Pittsburgh
• -Doctor of Nursing Practice (DNP)

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Whats the Difference in the Initials?

• PhD is a research oriented degree requires a
  dissertation
• DNP and DNAP are clinical (practice-oriented)
  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)

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Competencies for the CRNA Practitioner at
Clinical Doctorate Level

• 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

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Ethics

• Apply ethically sound decision making
• Informs public of role and practice
• Upholds Code of Ethics for CRNAs

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Health Systems Management

• Ability to analyze structure, function and
  outcomes
• Negotiates, implements, assesses
• Develops and implements integrated risk
  management plan

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Public and Social Policy

• Advocates for health policy changes
• Influences regulatory aspects of health policy
• Evaluates impact of local and global political
  change

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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

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Practice Inquiry

• Able to assess and evaluate health outcome in
  diverse populations, clinical settings, and
  systems
• Ability to disseminate research evidence

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Healthcare Improvement

• Uses EBP in clinical decision making
• Evaluates healthcare financing
• Strategic planning

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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

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Biological Systems, Homeostasis, and Pathogenesis

• Develops best practice models for nurse
  anesthesia patient care management
• Uses systematic outcomes analysis approach

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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

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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