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Frequently Asked Questions Where did the vision for the Doctor of Nursing Practice (DNP) originate? The American Association of Colleges of Nursing (AACN), an association composed of deans of colleges of nursing, developed a vision statement that proposed that all advanced practice nurses, including nurse anesthetists, be educated at the practice degree level and earn a Doctor of Nursing Practice (DNP) by 2015. As part of its initiative, the AACN developed a document containing “essential” elements of a DNP curriculum and influenced programs offering Nursing Doctor (ND) degrees to change the degrees to DNP. Why did AANA appoint the Task Force on Doctoral Preparation of Nurse Anesthetists? The AANA Board believed it was important to further study the possible impact of requiring doctoral education for nurse anesthetists. The Task Force was formed to review the potential impact and make recommendations to the AANA Board for consideration in development of a position and strategies. How many nurse anesthesia programs will or will not develop doctoral programs? We currently do not know how many nurse anesthesia programs will or will not develop doctoral programs. About half of the nurse anesthesia educational programs are in colleges of nursing, most of which are also members of the AACN. Other programs are in colleges within disciplines other than nursing, for example colleges of allied health. Could nurse anesthesia programs that are not sponsored by colleges of nursing offer the DNP? We do not know if this is possible at this time but we are investigating the possibility. The Doctor of Nursing Practice (DNP) is proposed by the AACN as the degree for all advanced nurse practice. It has been adopted by some colleges of nursing already and is being considered by some nurse anesthesia programs that are housed in colleges of nursing. Currently, the degree title for nurse anesthesia programs (MS, MSN, MSA, etc.) is determined by the degree granting university. Institutional authority to grant types of degrees is not expected to change and the actual degree granted will need to be determined at the local level. What other doctoral degree titles are being considered by nurse anesthesia programs not housed in colleges of nursing? The Doctor of Nurse Anesthesia Practice (DNAP) is an example of a non-nursing degree that is being proposed by a nurse anesthesia program that is not affiliated with a college of nursing. Both the DNP and the proposed DNAP degrees are considered professional doctorates or practice-focused doctorates. Are any nurse anesthesia programs accredited by the Council on Accreditation of Nurse Anesthesia Programs (COA) to offer doctoral degrees? The COA accredits both master’s degree and doctoral degree programs. The types of doctoral degree programs that are eligible for accreditation are practice-oriented or research oriented doctoral degrees. Currently, there are two programs that are accredited to offer students the option of earning doctoral degrees. Rush University College of Nursing Nurse Anesthesia Program has been offering a doctoral degree since the mid-1980s and the Navy Nurse Corps Anesthesia Program began more recently. Although the majority of students in both programs have earned master’s degrees, some students have sought doctorates. Definitions published by the COA in the Standards for Accreditation of Nurse Anesthesia Educational Programs for the two types of degrees are: Practice-oriented doctoral degree – The primary purpose of the practice-oriented doctoral degree is to prepare registered nurses for professional practice as nurse anesthetists who have additional knowledge in an area of academic focus. The curriculum for a practice oriented doctoral degree is a minimum of 36 calendar months in length of full-time study or longer if there are periods of part-time study. The Doctor of Nurse Anesthesia Practice (DNAP) and Doctor of Nursing Practice (DNP) are examples. Research-oriented doctoral degree – The primary purposes of the research-oriented doctoral degree are to prepare registered nurses for professional practice as nurse anesthetists and as researchers capable of generating new knowledge and demonstrating scholarly skills. The curriculum for a research-oriented doctoral degree is a minimum of 5-7 years in length past the baccalaureate degree or 4-5 years in length past the master’s degree of full-time study, or longer if there are periods of part-time study. The Doctor of Philosophy (PhD) and Doctor of Nursing Science (DNSc) are examples. How do professional doctorates such as the DNP or DNAP degree differ from a PhD? Doctoral programs generally fall into two categories: practice-focused / professional degrees and research-focused degrees. Practice-focused degrees prepare experts for specialized roles within disciplines. Coursework focuses on practice roles with application of scientific findings that are innovative and supported by available evidence. The practice doctorate usually culminates in a clinically oriented “capstone project” that pertains to the individual’s area of specialization. Research-focused degrees prepare scientists and scholars who can develop programs of research that lead to advancing the knowledge and science of a discipline. PhD programs require extensive coursework in theory, research methodology, and statistics. The PhD culminates in an original research project with completion and defense of a dissertation. Would a doctoral degree for nurses generate confusion about who is a “Doctor”? Historically, the title “Doctor” refers to both academic (PhD) and professional (MD, DDS, DPM) degrees and acknowledges a higher degree of educational attainment in an area. Traditionally, only medical doctors practicing in the hospital setting were called “Doctor.” It has been suggested that patients may become confused if other healthcare workers are addressed as “doctors,” and trust in the doctor-patient relationship will be eroded. However, while we understand the concern about creating confusion among patients, no evidence has been provided that supports these concerns. In addition, professional ethics would require CRNAs identify themselves appropriately as “certified registered nurse anesthetists” in the clinical setting, no matter what their level of education. Would requiring a doctoral degree for entry into nurse anesthesia practice mean that CRNAs would no longer be permitted to practice without a doctorate? Since doctoral degrees are not required, it is difficult to determine how they could impact practice requirements. We do know that as states began to explicitly incorporate a requirement for a master’s or graduate degree for CRNAs into state law or rule, the AANA and state nurse anesthetist associations sought, and continue to seek, appropriate degree language that is acceptable for CRNAs. Issues of importance to CRNAs include (1) a graduate degree requirement that is not limited solely to a degree “in nursing”; and (2) grandfathering of currently practicing CRNAs without graduate degrees, whether in-state or out-of-state, with no application deadline. While the AANA and state nurse anesthetist associations have been successful in achieving these elements in the great majority of the 28 states that currently have a master’s degree requirement for CRNAs, there are currently four states that have an application deadline for grandfathering; these states are (application deadline in parentheses): Colorado (7-1-2008), Georgia (6-30- 2006), Illinois (12-31-2006), and Tennessee (7-1-2005). CRNAs without master’s degrees who do not obtain recognition in these four states by the application deadline are not eligible for future recognition in these states; CRNAs without master’s degrees who obtain recognition by the deadline will continue to be grandfathered. What opportunity has there been for CRNAs and students to have input into the deliberations of the Doctoral Task Force? The Doctoral Task Force held its first meeting in December 2005. Since that time the Task Force co-chairs have presented information on the issue at every Assembly of School Faculty, AANA Mid-Year Assembly, AANA Fall Assembly and the AANA Annual Meeting. Feedback from meeting attendees was obtained through question and answer sessions as well as from questionnaires. Two focus groups have been conducted for nurse anesthesia students and CRNA practitioners. In addition, surveys have been conducted to obtain input from program directors, CRNA practitioners and students. Anyone can send their comments to the Doctoral Task Force or directly to any member of the AANA Board of Directors. Questions and comments to the Doctoral Task Force are welcome at firstname.lastname@example.org. Have CRNAs and students communicating with the Doctoral Task Force voiced any advantages or disadvantages of doctoral preparation for nurse anesthetists? Feedback has been obtained from both CRNAs and nurse anesthesia students. The advantages and disadvantages identified from both groups were quite similar. The opportunity to increase knowledge and parity with others were the top two advantages noted. In contrast, the cost and time factors were overwhelmingly cited by both groups as the main disadvantages of doctoral preparation for nurse anesthetists. The results of electronic surveys have not been fully analyzed by a statistician or the Doctoral Task Force. All of this information will be evaluated prior to making final recommendations. Have the Councils had any input into the deliberations of the Doctoral Task Force? Yes, each of the Councils has appointed a representative who can attend meetings and participate in deliberations. Members of the Doctoral Task Force represent CRNA practitioners and CRNA educators. Some educators work within colleges of nursing and others work in colleges from other disciplines. Both civilian and military anesthetists are represented. When does the Doctoral Task Force expect to have recommendations for the AANA Board of Directors to consider? It is estimated that the work of the Doctoral Task Force will be completed by Spring 2007 when final recommendations are made to the AANA Board of Directors. The recommendations will include options for the AANA Board to consider along with issue papers on topics investigated during task force deliberations.
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