1. 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

2. Nurse Anesthesia Education “If you don’t know where you are going, you will probably end up somewhere else” Dr. Lawrence Peter, 1919

3. Nurse Anesthesia Education  Where have we come from?  Where are we now?  Where do we want to be?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. AANA Position Statement Where Are We Going? “The American Association of Nurse Anesthetists supports doctoral education for entry into nurse anesthesia practice by 2025.”

13. 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

14. 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

15. 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)

16. 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)

17. Competencies for the CRNA Practitioner at Clinical Doctorate Level  For doctoral curriculum development  Are 8 competencies: 1. Ethics 2. Health Systems Management 3. Public and Social Policy 4. Technology and Informatics 5. Practice Inquiry 6. Healthcare Improvement 7. Professional Role 8. Biological Systems,Homeostasis, Pathogenesis

18. Ethics  Apply ethically sound decision making  Informs public of role and practice  Upholds “Code of Ethics for CRNAs”

19. Health Systems Management  Ability to analyze structure, function and outcomes  Negotiates, implements, assesses  Develops and implements integrated risk management plan

20. Public and Social Policy  Advocates for health policy changes  Influences regulatory aspects of health policy  Evaluates impact of local and global political change

21. 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

22. Practice Inquiry  Able to assess and evaluate health outcome in diverse populations, clinical settings, and systems  Ability to disseminate research evidence

23. Healthcare Improvement  Uses EBP in clinical decision making  Evaluates healthcare financing  Strategic planning

24. 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

25. Biological Systems, Homeostasis, and Pathogenesis  Develops best practice models for nurse anesthesia patient care management  Uses systematic outcomes analysis approach

26. 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

27. 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