AANA DNP Task Force

					AANA Task Force on the
 Doctoral Preparation
 of Nurse Anesthetists


     Sandra Ouellette, CRNA, MEd, FAAN
     Denise Martin-Sheridan, CRNA, PhD
        AANA Annual Meeting 2007
  Objectives




1. Background review
2. Activities of the AANA DTF
3. Options, Recommendations and Competencies
Task Force Members
Issue Papers

Final Report

Options

Competencies
          options




options   options   options
Doctoral Preparation of                    Mandate
Nurse Anesthetists                       The Practice
                                          Doctorate
Option Ranked #1                           for Entry
                                         Into Practice
                                               By
                                             2025




               Promote      Promote
             Development    Doctoral
                                           Maintain
                 Of        Degrees for
 Develop                                 Oversight of      Promote           Monitor
              Practice-     CRNAs                                                            Implement
  AANA                                    Education,     Recognition of   Regulatory and
              Oriented        And                                                             Phase II
 Position                                Accreditation     Doctoral         Legislative
               Degrees      Students                                                       Communication
Statement                                    And         Competencies        Activity
                                                                                               Plan
                                         Certification
Option 1
Mandate the Practice Doctorate for Entry Into Practice
                         2025

Recommendations:
1. Develop a position statement.
2. Promote development of practice-oriented doctoral
degrees.
3. Promote doctoral degrees for CRNAs and students.
4. Maintain oversight of education, accreditation and
certification.
5. Promote recognition of doctoral competencies.
6. Monitor regulatory and legislative activity.
7. Implement Phase II communication plan.
       Doctoral Preparation of                                  Do Not
                                                               Mandate
       Nurse Anesthetists                                     The Doctoral
                                                               Degree for
                                                               Entry Into
                                                                Practice
       Option Ranked #2




                                                                                        Monitor
                                                                                        professional,
                                   Continue                             Do not be the   state, federal
                  Continue       Ongoing Data                           First Nursing   organizations for
                                                    Continue to
                 Support of      Collection to                            Group to      impact on           Educate about      Implement
Develop AANA                                       Advocate for
               Masters Level        Validate                             Mandate a      licensing and       the Safety and      Phase II
   Position                                         Funding of
                   NAPs         Appropriateness                           “Target”      credentialing        Capability of   Communication
  Statement                                        Masters Level
               For Entry Into     of Master’s                             Date for      of graduates           CRNAs             Plan
                                                      NAPs
                  Practice      Degree for Entry                       Doctoral Entry   from
                                Level Providers                          Education      Master’s
                                                                                        Degree
                                                                                        Programs
Option 2
Do Not Mandate the Practice Doctorate

Recommendations:
1.Develop a position statement.
2.Continue support of MS level NAPs for entry into practice.
3.Continue ongoing data collection to validate appropriateness of MS
degree for entry-level providers.
4.Continue to advocate for funding of MS-level programs.
5.Do not be the first nursing group to mandate a “target” date for
doctoral entry education.
6.Monitor professional, state, and federal organizations for impact of
credentialing graduates from MS programs.
7.Educate about the safety and capability of CRNAs.
8.Implement Phase II communication plan.
Doctoral Preparation of
                                           Support
Nurse Anesthetists
                                          NAPs that
                                           Select to
Option Ranked #3                         Transition to
                                         the Doctoral
                                            Degree




               Promote      Promote
             Development    Doctoral
                                            Maintain
                 Of        Degrees for
 Develop                                  Oversight of      Promote           Monitor
              Practice-     CRNAs                                                             Implement
  AANA                                     Education,     Recognition of   Regulatory and
              Oriented        And                                                              Phase II
 Position                                 Accreditation     Doctoral         Legislative
               Degrees      Students                                                        Communication
Statement                                     And         Competencies        Activity
                                                                                                Plan
                                          Certification
Option 3
Support NAPs that Select to Transition to the Practice
Doctorate


Recommendations:
1. Develop a position statement.
2. Promote development of practice-oriented doctoral
degrees.
3. Promote doctoral degrees for CRNAs and students.
4. Maintain oversight of education, accreditation and
certification.
5. Promote recognition of doctoral competencies.
6. Monitor regulatory and legislative activity.
7. Implement Phase II communication plan.
Doctoral Preparation of
                                          Mandate
Nurse Anesthetists
                                         The DNP for
                                          Entry into
Option Ranked #4                           Practice
                                             By
                                            2015




                            Promote
               Promote
                           The DNP for     Maintain
             Development
 Develop                     CRNAs       Oversight of      Promote           Monitor
                 Of                                                                          Implement
  AANA                         And        Education,     Recognition of   Regulatory and
            DNP Programs                                                                      Phase II
 Position                   Students     Accreditation      AACN            Legislative
                                                                                           Communication
Statement                                    And           Essentials        Activity
                                                                                               Plan
                                         Certification
Option 4
Mandate the DNP for Entry Into Practice by 2015

Recommendations:
1. Develop a position statement.
2. Promote development of DNP programs.
3. Promote the DNP for CRNAs and students.
4. Maintain oversight of education, accreditation and
certification.
5. Promote recognition of the AACN Essentials.
6. Monitor regulatory and legislative activity.
7. Implement Phase II communication plan.
Competencies for the Doctorally Prepared CRNA

                                   Professional
                                       Role
                    Biological
                     Systems                        Healthcare
                   Homeostasis                     Improvement
                   Pathogenesis



                                    Doctorally
                                                           Practice
                Ethics              Prepared
                                                           Inquiry
                                     CRNA




                                                   Technology
                  Health Systems
                                                       And
                   Management
                                                   Informatics
                                    Public and
                                   Social Policy




Maintain/Enhance Required Hours of Clinical Practice
The Competencies for the CRNA Practitioner at the
Clinical Doctorate Level may serve as the framework
upon which the curricula of practice-focused doctoral
education programs in nurse anesthesia will be based.

The Competencies for the CRNA Practitioner at the
Clinical Doctorate Level complement the Practice
Doctorate Nurse Practitioner Entry-Level Competencies
2006(4) developed by the National Organization of Nurse
Practitioner Faculties.
                 Code of Ethics
 For the Certified Registered Nurse Anesthetist


             Competency Area: Ethics

Applies ethically sound decision-making for
complex issues

Informs the public of the role and practice of the
doctoral-prepared CRNA and represents themselves
in accordance with the Code of Ethics for CRNAs

Fulfills the obligation as a doctoral-educated
professional to uphold the Code of Ethics for CRNAs
    Competency Area: Health Systems Management

Demonstrates the ability to analyze the structure, function
and outcomes of integrated delivery systems and complex
organizations

Negotiates, implements and assesses business plans in a
collaborative organization

Develops and implements an integrated risk management
plan based on information systems and technology, to
promote outcome improvement for the patient,
organization and global populations
       Competency Area: Public and Social Policy

Advocates for health policy change based on an intent to
achieve excellence, to do so within an ethical context,
upholding cultural mores and values

Influences the statutory and regulatory aspects of health
policy in relation to nurse anesthesia care

Evaluates the impact of local and global political change
on the globalization of health care policy development
     Competency Area: Technology and Informatics

Uses information systems/technology to support and
improve patient care and healthcare systems

Designs, selects and uses information
systems/technology to evaluate programs of care and
care systems

Critically evaluates clinical and research databases used
as clinical decision support resources
           Competency Area: Practice Inquiry

Demonstrates the ability to assess and evaluate health
outcomes in a variety of populations, clinical settings,
and systems

Demonstrates ability to disseminate research evidence to
diverse audiences through a variety of methods
    Competency Area: Healthcare Improvement

Uses evidence based practice to inform clinical
decision making in nurse anesthesia

Evaluates how complex organizations, public policy
processes and world markets impact the financing,
delivery and quality of anesthesia and healthcare

Develops, implements and assesses strategies to
improve patient outcomes and quality of care
           Competency Area: Professional Role

Demonstrates increased ability to undertake complex
leadership roles in nurse anesthesia

Demonstrates ability to provide leadership that facilitates
intraprofessional and interprofessional collaboration

Integrates critical and reflective thinking in leadership
style

Demonstrates ability to utilize a variety of leadership
principles in the management of situations
Competency Area: Biological Systems, Homeostasis and
                   Pathogenesis

Develops best practice models for nurse anesthesia
patient care management through integration of
knowledge acquired from arts and sciences within the
context of nurse anesthesia philosophical and scientific
framework

Uses a systematic outcomes analysis approach in the
translation of research evidence and data in the arts and
sciences to demonstrate they will have the expected
effects on nurse anesthesia practice
Study of Practice-Oriented
        Doctorates


      Conducted by: Marianne Phelps, PhD
    Presented by: Francis Gerbasi, CRNA, PhD
              Background
• Trend toward practice-oriented doctoral
  degrees in the health care professions

• Interest in similarities and differences in
  degree requirements
                 Purpose

To compile and analyze the requirements for
practice-oriented doctoral education in health
care professions
 Professions Included in the Study
• Fourteen professions

• Six have required the doctoral degree for many
  years – in some cases as long as 100 years

• Eight have adopted the practice-oriented doctoral
  degree sometime within the last few years but not
  all plan to require it for entry into the profession
                Methods

• Identified 14 healthcare professions for
  study
• Reviewed websites and interviewed
  accrediting agency staff
• Examined accreditation standards
• Requested agency staff to confirm accuracy
  of information compiled
• Prepared descriptive study
    Assumptions / Limitations
• Information on website and provided by
  interview was accurate
• Variability in way requirements are written
  and in educational programs
• Some professions provide considerable
  leeway for programs to determine structure
  and/or content
                   Example
• The optometric curriculum must fulfill the intent
  of the mission statement of the program to prepare
  graduates for entry-level practice as defined by the
  program.

• Some professions specify outcomes or
  competencies, in some cases long lists of
  competencies, that graduates must attain and in so
  doing provide a framework for the curriculum.
 Professional Accrediting Agency
Requires Programs Offer Doctoral
      Degree as Entry-Level
•   Audiology      •   Osteopathic Medicine
•   Chiropractic   •   Pharmacy
•   Dentistry      •   Podiatry
•   Medicine       •   Psychology
•   Optometry
Professional Accrediting does not
Require Programs Offer Doctoral
     Degree as Entry-Level

•   Clinical Laboratory Sciences
•   Occupational Therapy
•   Advanced Practice Nursing
•   Nurse Anesthesia
•   Physical Therapy
    Degree Title – No Flexibility
• Chiropractic - Doctor of Chiropractic (DC)
• Medicine - Doctor of Medicine (MD)
• Nursing – Doctor of Nursing Practice (DNP)
• Optometry - Doctor of Optometry (OD)
• Pharmacy - Doctor of Pharmacy (PharmD)
• Physical Therapy - Doctor of Physical Therapy
  (DPT)
• Podiatric Medicine – Doctor of Podiatric
  Medicine (DPM)
      Degree Title – Flexibility
• AUDIOLOGY - Doctor of Audiology (AuD), Doctor of
  Science (ScD), and Clinical (PhD)

• CLINICAL LABORATORY SCIENCES – Clinical
  Doctorate in Clinical Laboratory Sciences

• DENTISTRY – Doctor of Dental Surgery (DDS), Doctor
  of Dental Medicine (DDM)

• NURSE ANESTHESIA –Doctor of Nursing Practice
  (DNP), Doctor of Philosophy (PhD) and Doctor of Nurse
  Anesthesia Practice (DNAP)
 Degree Title – Flexibility (Cont.)
• OCCUPATIONAL THERAPY – Occupational Therapy
  Doctorate (OTD) or Doctor of Occupational Therapy
  (DrOT)

• OSTEOPATHIC MEDICINE – Doctor of Osteopathy
  (DO) or Doctor of Osteopathic Medicine (DO)

• PSYCHOLOGY – Doctor of Psychology (PsyD) or Doctor
  of Philosophy (PhD)
      Reasons for Moving to the
             Doctorate
• Change in scope and complexity of practice
• Increase in required number of credits
• Increasing the credibility of the practitioner
• Completion of career ladder
• Increase the number of doctorally-prepared faculty
• Movement of other healthcare professions to the
  doctorate
• Doctorate required by some states for licensure
    Admissions Requirements
•   Bachelor’s Degree
•   Prerequisite Courses
•   Clinical Practice
      Research Requirements

• Research project required – Clinical Laboratory
  Sciences, Nurse Anesthesia, Occupational
  Therapy, Podiatry
• Research exposure – Audiology, Dentistry,
  Medicine, Nursing, Psychology
• Research requirement – not specified –
  Chiropractic, Optometry, Osteopathic
  Medicine, Pharmacy, Physical Therapy
Time to Doctorate from Entry into
    Baccalaureate Program
8 Years            7 Years            6 Years
Audiology          Dentistry          Chiropractic
Medicine           Nursing            Pharmacy
Nurse Anesthesia   Occupational       Physical Therapy
                   Therapy
Psychology         Optometry
                   Osteopathic Med.
                   Podiatry
         Summary of Findings
• 9 require doctoral degree for entry level
• 7 have no flexibility in degree title
• Wide variability in curriculum and clinical
  requirements
• Standards commonly include competencies or
  outcomes required
• Length from entry into bachelor’s degree program
  to doctoral degree ranges from 6-8 years
           Results Suggest

• Considerable differences exist in curriculum
  and clinical requirements for practice-
  oriented doctoral degrees in the fourteen
  health related professions studied.
• Most requirements related to knowledge
  and competencies required for entry into the
  practice of the profession.
  AANA Board of Directors
Position on Doctoral Education
    for Nurse Anesthetists


        Terry Wicks, CRNA, MHS
            AANA President
               Background
• Educational requirements have evolved over the
  past 75 years
• Healthcare professions have moved to doctoral
  degrees
• October 2004 the AACN adopted its Position
  Statement on the Practice Doctorate in Nursing
• June 2005 AANA convened an Invitational
  Summit
        Background (Cont’d)
• August 2005 Task Force on Doctoral Preparation
  of Nurse Anesthetists (DTF) appointed
• April 2007 – DTF report submitted to the AANA
  Board of Directors
• June 2007 – AANA Board of Directors, with input
  from staff, developed and unanimously adopted a
  consensus Position Statement
      Position Statement

     The American Association of
  Nurse Anesthetists supports doctoral
education for entry into nurse anesthesia
           practice by 2025.
                   Rationale
• Advances in technology, pharmacology and mandate for
  evidence-based practice
• Healthcare is changing at a dramatic rate
• Informatics
• Systems approach to quality improvement
• Increase in credit hours
• Increased reliance on APNs to provide healthcare
• More independent CRNA practice
• Programs already moving to the doctoral level
 “If you don’t know where you are going,
you will probably end up somewhere else.”



                        Dr. Lawrence Peter, 1919
                              Canadian educator

				
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