1. CPC Program Update
I am happy to be able to be here to talk about the CPC program.
In spite of all these communications to date, we recognize that there is still a need for more education about the CPC Program.

2. Objectives Why change? What is CPC? What are the components of CPC?
What is the timeline?
This presentation will talk about
the events leading up to planning the CPC Program,
the components of the CPC program, and
what will be happening leading up to the launch of the CPC Program on August 1, 2016.

3. CPC Program Start Animation
I’ll start with this animation because it gives a 3-minute overview of my talk. You can find this on the NBCRNA website.
Start Animation

4. Why Change? Changing certification requirements/healthcare trends
Consumer demands/expectations
Evolving knowledge and skills and Lifelong learning
Technology
Recognition of activities nurse anesthetists already do
The first question on people’s minds is, Why do we have to change? CRNAs are very safe practitioners. We know that safety ratings are very, very good.
Changing certification requirements/Evolving knowledge and approaches/Lifelong Learning The CPC program is responding to changes in certification and regulator requirements.
  When you look at practice of nurse anesthetists today versus 30 years ago, it is drastically different. Changes in the skills and core knowledge required of nurse anesthetists should be reflected in the planning and delivery of education and in the requirements for recertification.
Consumer demands/expectation
Patients and the public are an important stakeholder in the recertification process. At the start of the CPC planning process, in 2007, for example, 2 groups advocating for consumers--AARP and the Citizen Advocacy Center—had just published the results of surveys that showed that patients had an expectation that a healthcare professional go through periodic re-evaluation through which they demonstrate the up-to-date knowledge and skills needed to provide quality of care as a condition of retaining their license. A 2013 study by the NBCRNA and the Citizen Advocacy Center showed that the public’s perspective of the importance of periodic assessments and lifelong learning had not changed.
Technology provides new opportunities Technology has changed how we deliver care; how we pursue our education (online, simulation, webinars, for example); and how we manage knowledge and access information. These changes should be reflected in the recertification process. Technology can also support new processes for recertification.
Recognition for activities we already do There are many developmental opportunities that nurse anesthetists are currently doing that are not counting toward the current recertification process. We participate in teaching, research, professional service, administration, and clinical and professional activities beyond continuing education. These further demonstrate our commitment to patient safety and our contribution to healthcare delivery.

5. Shift to Continuing Competency
Initial certification is only a start
Competency demonstrated through evidence-based learning and assessment
Professional growth and development must be lifelong and integrated into practice
Credentialing organizations and other advanced practice nursing professions have made the change
The shift to continuing competency is a shift to an emphasis on lifelong learning beyond initial certification.
Knowledge and skills within a profession change over time. Evidence-based learning and assessments are tools for demonstrating continuing competency.
The concept of continuing competency is supported in the changing recertification requirements in many healthcare professions, including those who accredit the certification organizations for nurses and advanced practice nurses.

6. Comparisons Recertification Components Nurse Anesthetists (Current)
Anesthesiologist Assistants
Anesthesiologists
Certified Nurse Midwives
Nurse Practitioners (AANP)
Nurse Practitioners (NCC)
Frequency
Every 2 years
Every 10 years
Every 5 years
Every 3 years
Current Licensure
Yes NA
Continuing Education
40 hours
350 hours
20 hours
3 Self Learning Modules
75 hours
hours
Examination
Every 6 years
7 to of each Cycle
Proposed
Optional
Practice
850 hours
Not required
1,000 hours
In benchmarking the recertification requirements from other professions, we compared the current NBCRNA 2-year recertification program with the recertification programs from other professions. We found that other anesthesia groups and advanced nursing professions have started to change their recertification requirements, moving toward assessed education and recertification exams.  

7. Your Voice Matters 2010 to 2014 >22,000 Interactions Public Review
2 Surveys
Focus Sessions at the AANA Meeting
State Association Meetings
Webinars
, Blogs
>22,000 Interactions
Between 2010 and now, we sought the input of the AANA and nurse anesthetists on changes to the recertification program.
The first proposed criteria for the CPC Program were opened up to a period of public review and comment.
We conducted 2 major surveys and participated in focus sessions at the AANA Annual Meeting and in state association meetings.
NBCRNA presented live webinars that talked about the changing recertification program.
These interactions directly led to modifications to the program.

8. CPC Program Class A Class B First 4-Year Cycle
8 years, comprising two 4-year CPC Cycles
CPC
Class A
Core Modules
CPC Exam
Class B
First 4-Year Cycle
Class A Requirements: Assessed CE
Class B Requirements: Professional Activities
RN Licensure and Active Practice
Core Modules -- Voluntary
Second 4-Year Cycle
CPC Exam, Core Modules
Class A, Class B
RN Licensure and Active Practice
The CPC Program is an 8-year period, comprising two 4-year cycles. This slide represents the first 8-year period.
Each 4-year cycle has a set of components:
Class A Requirements, or assessed CE
Class B Requirements, or Professional Activities
Core Modules
Class A should be relevant to practice; Class B are non-assessed professional activities.
The overall total is 100 requirements or about 25/year. (On average, this is 5 more per year than in the current 2-year recertification program).
Currently our 2-year recertification cycle requires 40 CEs or 80 every 4 years. 
The new CPC requirements will require at least 60 Class A (assessed) CE every 4 years and permit flexibility of an additional 40 per 4 years of either Class A (assessed) or Class B.
There is an examination component, but only in the second 4-year cycle for each 8-year period.
There is a requirement to provide licensure information and a requirement to attest to active practice.
___________________________________________________________
NOTE for speaker
What is the practice requirement for the CPC Program?
The requirement is that the nurse anesthetist attest that he/she is in an active practice, but there is no requirement for a specific number of hours. This is intentional. The NBCRNA defers to the state for practice requirements. If no state practice requirements exist, the NBCRNA will ask the nurse anesthetist to attest that he/she has been engaged in active practice during the 4-year CPC cycle. It is up to the nurse anesthetist to determine how to define active practice. An important concept for the CPC Program is that it is both flexible and relies on individual accountability.
A nurse anesthetist who can attest to being actively engaged in any of four areas--education, research, clinical, or administration--is considered to be in active practice.

9. Class A Requirement: Assessed CE
AANA Learn
AANA Journal course
Any Assessed CE
Current Reviews
Audio Digest
60 Class A per 4-year CPC Cycle
Has some form of assessment
Prior approved
Related to anesthesia care
Assessment = any type of measure of performance against objectives
The Class A requirement, or assessed CE, is not a new concept for the nurse anesthesia profession, but it is new as it relates to face-to-face meetings and other types of CE activities that have not had to provide evidence that learning has occurred.
CPC requires 15 CEs per year, or 60 CEs per CPC cycle.
Class A is prior approved by an accredited organization (like AANA) and must be directly related to the delivery, or the improvement, of anesthesia care for patients.
Testing is only one kind of assessment—self-assessment, demonstrations, polling, case studies, and simulations are valid forms of evaluation, depending on the type of educational activity. The AANA CE Committee will develop the standards and criteria for assessed CE.

10. Class B Requirements: Professional Activities
40 Class B per 4-year CPC Cycle
Enhances the anesthetist’s foundational knowledge
Supports patient safety, or
Fosters understanding of the broader healthcare environment.
No assessment
No prior approval
Class B recognizes alternatives for learning. Class B requirements are not assessed.
CPC requires 40 Class B per CPC cycle.
Class B
Enhances the anesthetist’s foundational knowledge of nurse anesthesia practice,
Supports patient safety, or
Fosters the nurse anesthetist’s understanding of the broader healthcare environment.
If an activity meets one or more of these three definitions, it is Class B.
If you take more than the 60 Class A assessed CE required for that 4-year cycle, the excess can be reported as Class B.
Class B often are also RN licensing requirements (such as pharmacology or ethic) or employer requirements.

11. Examples of Class B Education and Teaching Research
Clinical and Professional
Professional service
Administration
Excess Class A
Class B can include
Education and Teaching, such as precepting, teaching a lecture or class, or providing oversight to medical students or life flight nurse in the OR
Research, such as performing data collection, developing a scholarly article, or participating in quality improvement or research projects.
Clinical and Professional, such as grand rounds, morbidity and mortality conferences, or infection prevention training
Professional service, such as public education, journal reviewing, or serving on committees, such a hospital QI committee or an item writing committee
Administration, such as acting as a chief nurse anesthetist or clinical coordinator for a nurse anesthesia education program or subspecialty practice
Excess Class As, If you have more than the 60 Class A required for any 4-year CPC cycle, you can apply those to the Class B requirement.
There is not a one to one relationship between hours spent and Class B values. A full chart is on the website.
The only exception is Class A assessed CE, because those values are determined by the accredited CE provider.
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Notes for Speaker
Class B Value
Assessed CE 1 CE = 1 Class B Requirement
Academic coursework 3 credit semester course = 9 Class B Requirements
Presentations hour presentation = 3 Class B Requirements
Teaching activities 1 day = 1 Class B Requirement
Administrative activities 1 year = 5 Class B Requirements
Research or practice inquiry 1 – 10 Class B Requirements
Professional service 1 – 5 Class B Requirements
Publishing 5 – 10 Class B Requirements

12. Life Support Courses
Life support courses* may be reported as Class A or Class B
Class A if it meets assessed CE criteria
Class B if it does not
Up to 20 total as Class A and/or Class B per 4-year cycle.
May report both initial and renewal life support courses in the same CPC cycle.
*e.g., BLS, ACLS, PALS, NALS, NRP, ATLS
Life support courses may be reported as Class A if it is prior approved and has an assessment, or it can be reported as Class B if it does not meet Class A criteria.
Up to 20 total can be reported as Class A and/or Class B during any one 4-year cycle.
Both initial and renewal life support courses can be reported during the same CPC cycle, provided the combined course total does not exceed 20.

13. Evidence from Literature
CPC Core Modules
Voluntary for first 4-year cycle
Are Class A assessed CE
Four identified core areas in anesthesia:
Airway management techniques
Applied clinical pharmacology
Human physiology and pathophysiology
Anesthesia technology and equipment
Evidence from Literature
Clinical Experience
Patient Centered Care
CPC core modules will be voluntary for the first 4-year cycle.
Core modules will based on a common set of objectives and focused on the most recent literature. They will address the critical areas of anesthesia practice that apply to all CRNAs.
They are prior approved, assessed CE and so are Class A.
The core modules and the exam share a common content outline and cover the same core domains of nurse anesthesia practice:
airway management
anesthesia equipment and technology
applied clinical pharmacology
physiology and pathophysiology
Any modifications to the core module requirement during the second cycle will be based on data gathered and evaluated during the first cycle.

14. First CPC Examination: Performance Standard
Not meeting standard will not affect certification – complete an additional requirement
Testing
Identify areas for learning
Create study plans
The CPC Exam will focus on the knowledge that all nurse anesthetists in practice should know, regardless of their practice focus.
The exam will be taken every 8 years, during the second CPC cycle of each 8-year program.
For those who recertify in 2016, the first exam will be between 2020 and 2024.
For those who recertify in 2017, the first exam will be between 2021 and 2025, or about 9 years from today.
You will take the first performance standard CPC Examination only once.
The first exam will be based on the same areas as the core modules: airway management, technology, pharmacology, and pathophysiology.

15. What If the Performance Standard Is Not Met?
Failing to meet the performance standard on the first CPC examination will not affect certification
Will indicate additional areas of study
NBCRNA, in consultation with AANA, will explore additional options beyond taking a CPC module
There was a strong call for a practice run and an opportunity to become familiar with the CPC examination and identify areas for additional study.
The first exam is, essentially, an evaluative process. Your certification will not be affected.
If you do not achieve a performance standard in one or more of the four core areas, you would be expected to gain knowledge in that area by taking an education program.
Right now, this would be taking a core module, but the NBCRNA is considering other options as well.

16. CPC Examination: Passing Standard
Every 8 years or
Achieve passing standard to maintain certification
Four attempts available to pass the examination
Results will help inform planning of future exams
Achieving a passing standard on the CPC Exam will be required in 17 years, or by 2032 for those recertified in even years and 2033 for those recertified in odd years.
For this exam, you will have 4 attempts over 4 years to pass the second CPC Exam.
There will always be a pathway to keep the credential. This process will be very clearly outlined on the NBCRNA website.
It is reasonable to expect that because we are developing a recertification process that is based on evidence, the CPC Program will continue to evolve. The exam will evolve as we review trends and evidence in the literature; study outcomes; and evaluate changes in testing systems.

17. Not Certification Examination Again
CPC Examination very different from certification exam
Assess fundamental areas in nurse anesthesia practice
Test content breakdown:
Airway management techniques – 28%
Applied clinical pharmacology – 28%
Human physiology and pathophysiology – 28%
Anesthesia technology and equipment – 16%
We know that the knowledge required of an experienced practitioner is different from the knowledge that is required of a new practitioner.
The CPC examination content outline was informed by a professional practice analysis of practicing nurse anesthetists.
This content outline is available on the NBCRNA website.

18. Grandfathering?
Passing requirement for CPC Examination is 17 years away
Grandfathering can potentially create a situation in which it could take up to 40 years until a new recertification program is fully implemented across all certificants.
This can send a mixed message. Can we say that the new recertification program is in the best interest of our patients…but only some of our practitioners uphold the standard?
We heard the strongest call for grandfathering the CPC Examination. The NBCRNA responded in two ways.
We pushed back the passing requirement for the CPC Examination by 17 years, to 2032 or 2033,
We provided a performance standard examination as a means of becoming familiar with test taking and to identify areas for additional learning.
For perspective, a nurse anesthetist who has a newborn child today will send that child off to college before they have to pass an exam to maintain their certification.

19. CPC Program Implementation
CPC program start date moved from Jan. 1, 2016 to Aug. 1, 2016.
Current certificants
Transition after completion of 2-year cycle (i.e., by August 1, or August 1, 2017)
New graduates
2014 graduation/certification: August 1, 2016
2015 graduation/certification: August 1, 2017
NBCRNA has moved the CPC program start date--from Jan. 1, 2016 to Aug. 1, 2016.
Current Certificants
Those of you who currently hold the credential will be transitioned into the CPC after you complete your 2-year cycle.
certificants enter August 1, 2016
certificants enter August 1, 2017
New CRNA graduates who obtain certification between now and December 31, 2015
They will complete the current 2-year recertification process, before entering the CPC program in 2016 or 2017, depending on certification year.
Individuals who are NEWLY certified on or after 1/1/2016
They will directly enter the CPC Program on August 1, 2016 or beyond.

20. Cost
CPC Committee is beginning to work with test processors and other vendors on elements of the CPC that will affect cost
Ongoing goal is to minimize costs to individual nurse anesthetists while maximizing quality
We expect annualized cost to be similar to current recertification cost
CPC Committee is beginning to work with test processors and other vendors on elements of the CPC that will affect cost
Our ongoing goal is to minimize costs to individual nurse anesthetists while providing a very high-quality program.
We expect that the annualized cost will be similar to current recertification cost.

21. CPC Program Class A Class B First 4-Year Cycle
8 years, comprising two 4-year CPC Cycles
CPC
Class A
Core Modules
CPC Exam
Class B
First 4-Year Cycle
Class A Requirements: Assessed CE
Class B Requirements: Professional Activities
RN Licensure and Active Practice
Core Modules -- Voluntary
In summary,
8-year period comprises two 4-year CPC cycles.
Each 4-year CPC cycle has
60 Class A Requirements (assessed CE), or 15 per year.
40 Class B Requirements (professional activities), or 10 per year.
The core modules are voluntary for first 4-year CPC Cycle.
The second 4-year cycle will include the CPC Examination.
Certificants will need to maintain a state license and an active anesthesia practice in clinical, education, research, or administration.
Second 4-Year Cycle
CPC Exam, Core Modules
Class A Credits, Class B Credits
RN Licensure and Active Practice

22. Additional Information
CPC materials on website (
NBCRNA and AANA communications
Questions may be submitted to
The NBCRNA website has a lot of new information about the CPC Program and will be updated regularly.
The AANA website is another good source of information.
The AANA and the NBCRNA will be working together to make sure that over the next year and a half leading up to the Aug. 1, 2016 start, you will have the information you need.