Transitioning Into a Doctoral Program in

Nurse Anesthesia

Presented by:Daniel Stairs, CRNA, MSN, MBA

Assistant DirectorExcela 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 StatementWhere 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 NA2. University of Minnesota NA Program -Doctor of Nursing Practice

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)

What’s the Difference in the Initials?

PhD is a research oriented degree; requires a dissertation

DNP and DNAP are clinical (practice-oriented) doctorates:

1. Prepares graduates to function at the highest clinical level

2. 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

For doctoral curriculum development Are 8 competencies:1. Ethics2. Health Systems Management3. Public and Social Policy4. Technology and Informatics5. Practice Inquiry6. Healthcare Improvement7. Professional Role8. 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