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					                      Doctoral Preparation for Nurse Anesthetists
                             Frequently Asked Questions

What is the AANA’s official position statement on doctoral education and where can
I view it?

The AANA Board of Directors’ position statement on doctoral education is: ―The AANA
supports doctoral education for entry into nurse anesthesia practice by 2025.‖ The statement can
be accessed on the AANA website at http://www.aana.com/dpcrna_presentations.aspx.

Where did the vision for the Doctor of Nursing Practice (DNP) originate?

The American Association of Colleges of Nursing (AACN) has adopted a position that all
advanced practice nurses, including nurse anesthetists, be educated at the practice doctorate
degree level and earn a Doctor of Nursing Practice (DNP). As part of its initiative, the AACN
developed a document containing ―essential‖ elements of a DNP curriculum and influenced
programs offering a Nursing Doctor (ND) degree to change the degree to the DNP.

Why does the AANA support the vision of doctoral education for future nurse anesthetists?

Since its founding in 1931, the AANA has advanced quality education as the means to ensure
that Certified Registered Nurse Anesthetists (CRNAs) are the best-prepared, safest anesthesia
providers possible. Over the years, the educational standards for nurse anesthesia programs have
grown to meet the required knowledge and skills for entry into practice. During the 1980s nurse
anesthesia educational programs moved from hospital-based certificate programs to university-
based graduate programs, and in 1998 the Council on Accreditation of Nurse Anesthesia
Educational Programs (COA) finalized the requirement that all programs award a master’s or
higher level degree. To best position CRNAs to meet the extraordinary changes in today’s
healthcare environment, the AANA believes it is essential to support doctoral education for
future nurse anesthetists.

As a result of the AACN’s activity, the AANA Board of Directors felt it was important to study
the possible impact of requiring doctoral education for nurse anesthetists based on increased
interest in the nursing community. The Task Force on the Doctoral Preparation of Nurse
Anesthetists was appointed in 2005 to research the advisability of doctoral degrees for nurse
anesthetists. Although it is difficult to know how many of the current nurse anesthesia
educational programs will eventually develop doctoral programs, many of these nurse anesthesia
programs are in colleges of nursing that are members of the AACN. Other programs are in
colleges of nursing that are not members of the AACN, or are in colleges within disciplines other
than nursing.
Could nurse anesthesia programs that are not sponsored by colleges of nursing offer the
DNP?

The DNP is proposed by the AACN as the degree for all advanced nursing practice. Some nurse
anesthesia programs affiliated with colleges of nursing already award or are considering
awarding the DNP. The Doctor of Nurse Anesthesia Practice (DNAP) is an example of a non-
nursing degree that has been approved by the COA for a nurse anesthesia program that is not
affiliated with a college of nursing. Both degrees, DNP and DNAP, are considered professional
doctorates or practice-focused doctorates. Currently, the graduate degree title for nurse
anesthesia programs—MS, MSN, MSA, DNP, DNAP, etc.—is determined by the degree-
granting university. Institutional authority to grant types of degrees is not expected to change.
The AANA does not support a requirement of the DNP as a degree title.

Are any nurse anesthesia programs accredited by the Council on Accreditation of Nurse
Anesthesia Educational Programs (COA) to offer doctoral degrees?

The COA accredits both master’s degree and doctoral degree programs. The two types of
doctoral degree programs that are eligible for accreditation are practice-oriented and research-
oriented. Currently there are three 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. Very recently, the University of Pittsburgh
School of Nursing Nurse Anesthesia Program was approved to offer an optional DNP and
Virginia Commonwealth University Department of Nurse Anesthesia was approved to offer an
optional DNAP.

Definitions for the two types of degrees published by the COA in the Standards for
Accreditation of Nurse Anesthesia Educational Programs are as follows:

       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 typically a minimum of 36 calendar months of
       full-time study or longer if there are periods of part-time study. The DNAP and DNP are
       examples of this type of degree.

       Research-oriented doctoral degree – The primary purpose of the research-oriented
       doctoral degree is 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 typically a
       minimum of 5-7 years of full-time study beyond the master’s degree, or longer if there
       are periods of part-time study. The Doctor of Philosophy (PhD) and Doctor of Nursing
       Science (DNSc) are examples of this type of degree.
How do practice-oriented doctorates such as the DNP or DNAP differ from the PhD?

Doctoral programs generally fall into two categories: practice-oriented (professional) degrees
and research-oriented degrees. Practice-oriented 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-oriented 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. The two types of doctoral
degrees are alternative approaches to the terminal level of educational preparation in a field.

Do doctoral degrees 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
―doctor,‖ and trust in the doctor-patient relationship will be eroded. No evidence exists that
patients are confused about who is an MD (medical doctor) or DO (doctor of osteopathy) and
who is not. Nurses are proud to be nurses and routinely identify the nature of their profession and
practice, regardless of the particular degree they possess. There is no credible evidence that
nurses who currently hold doctorates use their credential and title in a way that misleads patients.
In addition, ethical concerns require that 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?

While the AANA Board's position statement supports nurse anesthesia programs moving to a
practice-oriented doctoral degree by 2025, this is not a mandate. At this time it is difficult to
determine how moving to a doctoral degree might impact practice requirements. However, we do
know that as states began to explicitly require a master’s or graduate degree for CRNAs in state
laws or rules, the AANA and state nurse anesthetist associations sought, and continue to seek,
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 who do not have 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 states that currently have master’s degree requirements, a
few states have an application deadline for grandfathering. A 50-state chart of state degree
requirements, updated on an ongoing basis, is available at www.aana.com under Resources >
State Legislative & Regulatory Requirements > Advanced Education Requirements. States with
an application deadline for grandfathering eligibility are noted on the last page of the chart.
CRNAs without master’s degrees who do not obtain recognition in those few 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 did CRNAs and students have for input into the AANA Board’s decision
to support doctoral degrees?

Between December 2005 and February 2007 the co-chairs presented information on the issue at
every Assembly of School Faculty, AANA Mid-Year Assembly, AANA Fall Assembly and
AANA Annual Meeting that took place. Feedback from meeting attendees was obtained through
question and answer sessions as well as from questionnaires. Two focus groups were conducted
for nurse anesthesia students and CRNA practitioners. In addition, surveys were conducted to
obtain input from program administrators, CRNA practitioners and students. Results were
analyzed by a statistician. An email address offered anyone the opportunity to communicate
directly with members of the Doctoral Task Force. Questions and comments about doctoral
education are still welcome at doctorate@aana.com.

Have CRNAs and students voiced any advantages or disadvantages regarding doctoral
preparation for nurse anesthetists?

Feedback was obtained from both CRNAs and nurse anesthesia students. The advantages and
disadvantages identified by both groups were quite similar. Opportunities to increase knowledge
and achieve parity with others were the top two advantages noted. In contrast, cost and time
factors were overwhelmingly cited by both groups as the main disadvantages of doctoral
preparation for nurse anesthetists. All feedback from communities of interest was evaluated by
the Doctoral Task Force prior to presenting various options for the AANA Board to consider in
reaching its final decision.

Did the councils have any input into the deliberations of the Doctoral Task Force?

Yes, each of the councils appointed a representative who attended meetings and participated in
deliberations. Members of the Doctoral Task Force represented CRNA practitioners and
educators. Some educators worked within colleges of nursing and others worked in colleges from
other disciplines. Both civilian and military anesthetists were represented.