Clinical Doctorate in Anesthsia - page 7

I've read and heard that eventually, 2011 - 2013, the entry level degree into Nurse Anesthsia will be a Doctorate (comparable to PharmD). Can anyone at this time offer any specifics on how this is... Read More

  1. by   mwbeah
    [font=times][font=times]
    [font=times]executive summary of national forum on the practice doctorate, co-hosted by nonpf and aacn,

    [font=times]december 8, 2003, washington, dc.



    [font=times]for the nursing discipline, the practice doctorate enhances the status and privilege of the

    [font=times]profession. a practice doctorate degree would reflect the extent of graduate work

    [font=times]accomplished and competencies acquired and would raise the bar for all levels of nursing

    [font=times]education. by providing parity in educational preparation with other health care

    [font=times]disciplines, the degree would provide graduates the skills and credentials for increased

    [font=times]leadership opportunities across health care systems and may provide the potential for

    [font=times]higher levels of reimbursement for services provided. practice doctorate students may

    [font=times]have increased opportunities for interdisciplinary education experiences, leading to

    [font=times]enhanced interdisciplinary team practice. for nursing education, the practice doctorate

    [font=times]may help alleviate the dire shortage of nursing faculty by growing the next generation of

    [font=times]expert clinicians who will also teach. (i don't see the focus on the clinical arena, it seems that this dnp program is for educational purposes, i.e. preceptors so to speak, i don't feel this approach will improve our status or cause and will alienate already master's prepared nurses).

    [font=times]challenges

    [font=times]for widespread implementation of practice doctorate programs, forum participants

    [font=times]identified a number of potential obstacles. first, program development will require

    [font=times]diversion of limited funding and other resources. second, the current shortage of faculty

    [font=times]and program administrators limits the capacity for program development. third, some

    [font=times]nursing schools may face political hurdles and logistical impediments at the institutional

    [font=times]level in establishing a doctoral level program due to institutional mission and limited

    [font=times]clinical and faculty resources. fourth, programs may face difficulty marketing the

    [font=times]program, which could decrease graduate nursing education enrollments if students find it

    [font=times]takes longer and more money to be ready to enter practice.

    [font=times]for widespread acceptance and employment of practice doctorate graduates within the

    [font=times]health care system, nursing will need to put significant effort into educating the public,

    [font=times]other nurses, and other disciplines on the purpose and benefits of the practice doctorate.

    [font=times]public and regulatory perceptions of the "doctor" designation may hinder recognition of

    [font=times]the term in nursing. dialogue with potential employers will be imperative to ensure the

    [font=times]acceptance of the graduate and address reimbursement and other practice issues. as the

    [font=times]number of practice doctorate graduates increases and if apn education evolves to the

    [font=times]practice doctorate[font=times], a significant challenge will be to accommodate the role(s) of existing

    [font=times]master's prepared nurses within an evolving education and health care system. the

    [font=times]nursing profession will need to determine how the different roles and types of preparation

    [font=times]will fit into the education and practice paradigms to avoid confusion and prevent the

    [font=times]possibility of losing current nursing functions and roles to other disciplines.

    [font=times]for anesthesia purposes, i think we cannot follow the aacn curriculum and have credibility.

    [font=times]just my thought on this.
    [font=times]mike


    Last edit by mwbeah on May 27, '05 : Reason: length
  2. by   NeuroNP
    Quote from mwbeah
    [font=times][font=times]
    [font=times]for anesthesia purposes, i think we cannot follow the aacn curriculum and have credibility.

    [font=times]just my thought on this.
    [font=times]mike
    one of my biggest complaints with nursing in general is the lack of consistancy when it comes to education. for this to be effective and for us to be taken seriously, there needs to be uniformity and it needs to emphasize clinical work. otherwise, it'll look like we're "wannabe doctors" who have come up with a way to get dr. in front of names so we can say, "we're just a good as they are."

    as a side note, srnas are required to do 550 cases to sit for boards. i've been told that most do a lot more than this. if that's the case, why not raise the minimum standards?

    personally, i'd like to see a clinical doctorate program in place that is 3-4 years in length, with at least an additional year of nothing but clinical work. it'll be probably another 5 years or so until i'm ready to begin crna school, and i'd like to see that system in place by then.
  3. by   loisane
    Mike, I think you and I have come to the point where we have to agree that we disagree. And our personal discussion mirrors the profession, we do not have a clear consensus at this time. Let's see what comes of the summit next month that has been called by AANA president Frank Maziraski on this subject.

    On the point of curiculum and minimum numbers, that is set by our accrediting body the Council on Accreditation of Nurse Anesthesia Programs. It is a separate (although related) discussion. It is not in our best interest for those decisions to be made by another body, I think there is widespread support on that.

    Any AANA member who is interested in these things can attend one of the Assembly of School faculty meetings held twice a year. These issues are discussed at each meeting. There you can hear the pros and cons involved with decisions regarding required curicula and minimum case number requirements.

    loisane crna
  4. by   Sheri257
    I'll go out on a limb here and say CRNA's would probably only shoot themselves in the foot with this proposal.

    It seems pretty obvious that CRNA's gained 65 percent of the market share by being cheaper yet still qualified providers. MDA's may make more money, but they only have 35 percent market share.

    Implement a doctorate requirement and you could be looking at the same thing, reduced market share. It would inevitably limit the labor pool and increase the cost of CRNA's. While CRNA's could make more money short term, the greater expense could also open the door to more competition from AA's who are already gaining some momentum with the recent Florida victory.

    With aging baby boomers you're already looking at a severe anesthesia provider shortage that's only going to get much worse in the next 20 years. If you create a crisis by worsening that shortage even further with a doctorate requirement, you inevitably drive the ASA's political agenda or some other alternative that could erode your current advantage.

    IMHO, CRNA's should focus on getting more of their people into the labor pool to meet the growing demand and increase their current advantage with sheer numbers. Salaries will probably increase anyway even with a larger labor pool, because of the huge predicted demand, and more CRNA's should be there to take advantage.

    Otherwise, in twenty years you could be where the ASA is now, trying to eliminate the competition after the fact, which is much harder to do ... Especially when there's a severe shortage and you don't have enough of your own people to fill it.

    Last edit by Sheri257 on May 28, '05
  5. by   Brenna's Dad
    As a staunch supporter of the clinical doctorate, im surprised by the lack of support the idea receives.

    I think the argument that the Nurse Anesthesia profession would somehow lose out with the clinical doctorate is false. I'm sure similiar arguments were made with the change to a Master's degree for entry into practice. As others have said, we already do (or become very close to doing) the required hours and credits in our Master's programs already. Why not get credit for it?

    Having clinical doctorates can only serve to increase our professional credibility with the public. It is a necessary step and I believe the profession needs to embrace it.
  6. by   VickyRN
    Quote from Brenna's Dad
    As a staunch supporter of the clinical doctorate, im surprised by the lack of support the idea receives.

    I think the argument that the Nurse Anesthesia profession would somehow lose out with the clinical doctorate is false. I'm sure similiar arguments were made with the change to a Master's degree for entry into practice. As others have said, we already do (or become very close to doing) the required hours and credits in our Master's programs already. Why not get credit for it?

    Having clinical doctorates can only serve to increase our professional credibility with the public. It is a necessary step and I believe the profession needs to embrace it.
    I think almost everyone is missing the most important point in the discussion here. There simply are not enough doctorally-prepared nurse educators to make this thing work!!! The shortage of nursing faculty is becoming critical in many areas of the country. (My local university school of nursing is losing 5 nurse educators alone this year. They are desperate to replace these, as many are full professors with doctorates.) I believe one poster pointed out that faculty for nurse anesthetist programs are about as rare as hen's teeth! Where are you going to find the faculty to produce the doctorate students? The majority of nurse faculty in most nurse anesthetist programs only possess a Masters. Obviously, to teach doctorate students, a faculty member must have a doctorate. Unless a way can be found to overcome this most insurmountable hurdle, the practice doctorate for middle-level nurse providers will never become the standard.
  7. by   loisane
    Quote from lizz
    It seems pretty obvious that CRNA's gained 65 percent of the market share by being cheaper yet still qualified providers. MDA's may make more money, but they only have 35 percent market share.
    Lizz, you are missing something here. Most anesthetics are given within the team model, with both CRNAs and 'ologists participating. So you can't just subtract one number from the other, it is more complicated than that.

    Brenna's Dad, thanks for chiming in. I think there is more support for this that would seem evident from this board. I hope we will win over some of the doubters, as this moves forward and they see evidence of how this will increase the number of doctorate faculty without any appreciable negative effect on workforce numbers. I think it is difficult for people to really visualize what a practice doctorate is all about, unless they have had the opportunity to personally observe such a program or one of its students/graduates.

    loisane crna
  8. by   mwbeah
    Quote from vickyrn
    i think almost everyone is missing the most important point in the discussion here. there simply are not enough doctorally-prepared nurse educators to make this thing work!!! the shortage of nursing faculty is becoming critical in many areas of the country. (my local university school of nursing is losing 5 nurse educators alone this year. they are desperate to replace these, as many are full professors with doctorates.) i believe one poster pointed out that faculty for nurse anesthetist programs are about as rare as hen's teeth! where are you going to find the faculty to produce the doctorate students? the majority of nurse faculty in most nurse anesthetist programs only possess a masters. obviously, to teach doctorate students, a faculty member must have a doctorate. unless a way can be found to overcome this most insurmountable hurdle, the practice doctorate for middle-level nurse providers will never become the standard.
    without the proper faculty and the appropriate clinical focus, this will not work. i am an advocate for a clinical doctorate, i just don't want to "hand out" these degrees after receiving training from non-doctoral prepared instructors.

    mike
  9. by   mwbeah
    Quote from loisane
    yes, we need more faculty. we need more schools. there is a huge provider shortage. they used to make predictions about when it would turn around, but they don't even do that anymore. many say this is the most profound shortage ever. our profession is working feverishly to get more programs up and running. do not believe that programs are deliberately not opened in order to keep the shortage in place. that would be too short sighted. if we don't produce crnas, there may be non-nurses more than willing to sit at the head of the table.

    loisane crna

    in your very first posting you wrote this (as well as other things), you are right we already have a faculty shortage....... so how is the current concept of the clinical doctorate supposed to be implemented without the proper faculty? if a nursing (generic setting) school does not have the proper faculty in place, that school does not receive or in fact loses its accreditation.

    again, i am an advocate for a clinical doctorate, but i feel people should have to work for it and it not be given to them. in my previous postings i think i have relayed what should be involved.

    mike
    Last edit by mwbeah on May 28, '05 : Reason: spelling
  10. by   loisane
    Quote from mwbeah
    ...so how is the current concept of the clinical doctorate supposed to be implemented without the proper faculty? Mike
    I must not be explaining this very well, because I see no contradiction in what I said earlier and what I am saying now. Changes like this are taken over time. We will not implement this overnight. Present faculty who are at the masters level will have time to earn the next degree, if that is their choice.

    Practice doctorate programs are already in place, and increasing in number. Present and future faculty can (and are) taking advantage of these programs. Those who wish to pursue PhDs, are of course still able to do so. But if a PhD isn't your cup of tea, you can earn a practice doctorate in less time, incurring less expense than a research doctorate. Those in the know have made the point that MORE people will pursue doctorates, because people who for whatever reason just didn't make the committment for a research doctorate, will get on board for a practice doctorate.

    We agree that nobody should be given a degree without earning it. If you talk to practice doctorate program students, you will assured that is not happening.

    loisane crna
  11. by   DrEdwina
    Quote from Tony35NYC
    This statement is inaccurate. DrNPs in New York are permitted to use the title "dr" in the clinical area and it is not at all misleading because, strange as it may sound, they are clinical doctors---just of a different sort.
    Finally, someone has addressed this issue of being called doctor. Why not? as stated before, you are a Clinical Doctor in Primary Care. Nurses keep downing their abilities as healthcare providers. It is time for the clinical doctorate. Optometrists are doctors (Doctor of Optometry) in their field vs Ophthalmologists who are MD's. Podiatrists are Doctors in their filed (DPM) Doctor of Podiatry Medicine.

    I am a FNP, it is disheartening when your patient brings you a form to fill out for a disabled sticker and NP's are eliminated from the list. Guess who is listed, which don't make since? Doctor of Chriopracters, Optometrists, Audiologists, MD is the qualified one. Why? Because they carry the title Doctor, even though DC's can't prescribe, Audiologists can't prescribe, Optometrists are very limited in prescribing. The APN can prescribed in all areas in many states schedule 2 thru to 5.

    Nurses became to academic and not clinical in our own profession. By the way, I am a preceptor for a 3-year MD program at UC Berkeley in California. After three years the student graduates with his/her MD degree and a masters of science degree, then the students go on to UCSF for 2 years for their clinical rotations. So now MD's are reaching for some academia, where as in the past, it was a straight MD four year program with internship and residency.

    Every since I became a nurse from 1976, nurses have been bickering over status of Diploma vs ADN, BSN, MSN and Doctorate then, was well out of reach for most nurses. It is really time to standardized the profession once and for all, then by choice, you decide what level you want in nursing.
  12. by   mwbeah
    Quote from dredwina
    , it is really time to standardized the profession once and for all, then by choice, you decide what level you want in nursing.
    the problem is that nursing leardership has to decide what is or is not "the standard"

    certification and the practice doctorate in nursing

    on october 25, 2004, member institutions of the american association of colleges of nursing (aacn) voted to move the current level of preparation necessary for advanced nursing practice roles from the master's degree to the doctorate level by the year 2015; click here to read the position statement and press release. there is some misunderstanding that the american nurses credentialing center has also made a decision to require the practice doctorate in nursing by 2015 as the educational requirement to sit its advanced practice exams. please be assured that this is not the case; ancc has not had any discussions nor made any decision at this time to require the practice doctorate in nursing for eligibility to sit its nurse practitioner or clinical nurse specialist exams. ancc will work with other certifying bodies, regulators, licensing bodies, and specialty organizations, along with aacn, as the practice doctorate is implemented in the future to determine its impact and the need for any changes in requirements.


    looks like "the standard" will not be defined for quite some time and that means confusion and presumption ultimately leading to infighting with nurses against nurses against physicians against (you get the point).

    mike
  13. by   Vance
    Quote from loisane
    This is an incorrect assumption. DNP is a terminal degree, a full fledged academic doctorate. It is not a research doctorate. Neither is a MD, by the way! True, a PhD is the top of the totem pole, and qualifies a person for higher academic positions. But do not count out practice doctorates. I know several tenure track faculty in this category.
    loisane crna
    What's the point of credentials? Wouldn't it be better if we judged 'novice to expert' by metrics such as time in service, clinical record, skill and testable expertise. For instance, compare and contrast the hypothetical: a brilliant, highly skilled articulate, CRNA exuding leadership having published research advancing the practice vs. a dottering DSc/PhD who's somehow obtained CRNA credentials (or vice versa) but wouldn't be your choice of anesthetists in any case. I propose we choose to evaluate the individual and ascribe their level of competence according to a 'clinical ladder' whereby expertise, knowledge, competence is graded by levels and must be renewed on a periodic basis. Aircraft pilots work within this sort of framework. They must demonstrate and renew their proficiencies before piloting an aircraft with souls on-board. Degrees and tattoos are just ink. Wink wink

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