CRNA Doctorate?? - page 3

After reading the new AANA educational program policies and hearing about the renewed interest in increasing doctorate prepared nurse anesthetists (both clinical and PhD), I am curious what doctorate... Read More

  1. by   MmacFN
    debbie

    While I think that DnP is a great step and certainly the next logical move to solidify knowledge specific to a profession (the definition of profession), we have to be realistic as well.

    Nursing, NP, CRNA etc; they are all in a state of shortage because all of them come from experienced RNs which are already in crisis. The numerous other professions you mention with masters and doctorates are in no such shortage and are not in danger of it happening anytime soon. The nursing shortage is only expected to get worse.

    While I am all for education, this is not the time to push. The reality is that if there is more time added to the CRNA program (or any advanced RN program) there will be fewer applicants and fewer graduates yearly along with longer education expense and time. This isnt going to help, it is going to cause the opposite effect.

    Ask yourself; why is it that AAs (regardless of training) are slowly gaining acceptance? Its easy, the same reason CRNAs did. CRNAs started out of nessicity based on the need for a surgeon to have someone do anesthesia. In the begging this was done by interns who had no interest in anesthesia but only surgery. There was also no economic reason for MDs to take on anesthesia. A niche was created that was being filled at Mayo hospital by RNs. Why is that? The answer is easy, because there was a shortage (or an abscence) of interest by other parties to do the job. When physicians decided they wanted a piece of the pie; this signifigantly changed.

    Now here we are, many years later at an equal footing (clinically) as physicians within the anesthesia field. While the role of "leaders" in the anesthesia field has since been usurped by physicians, there is a clear place for CRNAs and more than enough jobs to support both factions. Now the tables are turning.

    Currently, there is a signifigant shortage of CRNAs across the country. There is a niche for other groups to exploit. While i dont think the profession is in jeaprody, I think we are walking a dangerous path. If you have noticed, AAs are becoming more common and lobbying for practice in many states. It will be hard for states not to open to them as the shortage gets worse, the same thing has been happening with paramedics and LPNs in ERs where there are shortages. Essentially, allowing other providers to do the jobs we have fought to carve out for nurses.

    Consider adding even one more year of education (and cost) to any RN job (advanced or otherwise) and how that would affect the volume of applicants. This would exponentially increase the "niche" already in existance. Why is this an issue? Many would agree that CRNAs are very established and the "standard" only second to MDA for anesthesia. However, if you read your CRNA history, the largest detractors (and sometimes supporters) vs CRNAs have been physicians. AAs represent exactly how CRNAs were seen at the begging of the profession, the handmaidens of physicians. Enter a program which pops out AAs in 1/2 the total time (or less in 70% of cases) and are absolutely subservient to the physician as well and you have a serious competitior in a market sorely needing anesthesia. Think now of the large hospital systems who make a fortune from surgeries. All the sudden, your shutting down ORs because of an acute lack of anesthesia.... AAs all the sudden dont look so bad.

    In anycase, based on the history of CRNAs, the continuous friction between the MDA and the CRNA (at least politically) and lastly, the hospitals need for anesthesia and it should be clear why adding years(s) to the education is a bad idea in the currently times.
  2. by   DebbieSue
    I don't see any reason why any time should be added to the current educational programs in order to convert them from MSwhatever to DNP. I think that the DNP acknowledges that the level of practice is very high, certainly equivalent at least to chiropractors, optomitrists, podiatrists, etc., etc. And even if the DNP were not rewarded until after one year of practice--that wouldn't be adding any actual time to the process. You could still take the CRNA boards and start to practice. I think it should be: same educational requirements as now + one year of actual practice = DNS. You would be a CRNA after passing boards and before the year of practice, getting paid, etc. And the DNP would be awarded to you after a year of practice. It's like being a Ph.D. even before you have completed your dissertation--people do get to call themselves "Ph.D.s (pending)" before they are totally done. It could be the same with the DNP--you would call yourself a DNP, but to keep that credential, you would have to complete a year of practice. And there would be a deadline by which time one would have to complete the practice year.

    And if the Masters-prepared advanced practice nurses get grandfathered in when the DNP starts (at which time the Masters programs will disappear) why then all anesthesia faculty would become grandfathered-DNPs and would/could continue as faculty.

    It is my understanding that the DNP education is going to replace the Masters education. Not be in addition to it. And since one big sticking point is going to be NOT creating a system that totally screws all the Masters-prepared APNs currently in practice, I really think that there WILL be a stipulation to somehow grandfather the current MSN APNs to being DNPs.
    I think the TRUE stumbling block most likely to occur is not a longer program, or lack of faculty, but the bugaboo of how non-nursing Masters programs, like MS in Anesthesia, or MS in Health Science, or any of the other non-nursing Masters degrees that CRNAs come out with, how they are going to transition to DNP? I mean, will only MSNs be able to grandfather to DNP?? Anesthesia is the only advanced practice nursing specialty that allows non-nursing Masters. I'm pretty sure that midwifery Masters are all nursing Masters, and I'm sure that the nurse practitioner and nurse specialist Masters are all nursing Masters. Anesthesia has a number of non-nursing Masters degrees. I don't understand why this is, since it is a NURSING specialty.

    Anyway, this is all just pipe-dreaming. Unitl I start to actually see the BSN to DNP happening, this is moot. And also, regardless of what credentials one has, to others in the healthcare systems, a nurse is a nurse is a nurse, etc. I doubt if most docs even know what the term 'advanced practice nursing' means........And no way within the hospital will we ever be allowed to be called 'Doctor' anything. (Although I know of PhD psychologists who have priveleges and are called Dr. within the hospital and while in the company of psychiatrists.) Having CRNAs given the title Doctor would make the ASA and AMA go ballistic--but it would be great for APNs to actually get the recognition for what they have been doing all these years.

    God, I have forgotten what my reason for 'reply'ing actually was......
  3. by   MmacFN
    hey debbie

    That is an excellent point. I agree with you. If there is no added time then there isnt a reason to hold back on DnP.

    Sadly, i also agree that even if there is a Doctorate involved, there would be absolutely no recognition of that within the hospital. However, i also believe that it would look good for the profession to have this "step up" as it were.
  4. by   Jengirl18
    Hey guys, I'm still learning about the scope of practice of a DrNP. Pardon me if I disagree with one of the above posts, but I dont think you can compare the level of a DrNP to a Podiatrist. Podiatrists are licensed to perform surgery autonomously and go to school full time for 4 years and also do a residency. From what I have been reading, DrNP is only a few more credit hours than an NP, so I dont think they are on the "same level" as Podiatrist. Both are well respected professions.
  5. by   VickyRN
    Quote from DebbieSue
    And if the Masters-prepared advanced practice nurses get grandfathered in when the DNP starts (at which time the Masters programs will disappear) why then all anesthesia faculty would become grandfathered-DNPs and would/could continue as faculty....

    I really think that there WILL be a stipulation to somehow grandfather the current MSN APNs to being DNPs.
    I think the TRUE stumbling block most likely to occur is not a longer program, or lack of faculty, but the bugaboo of how non-nursing Masters programs, like MS in Anesthesia, or MS in Health Science, or any of the other non-nursing Masters degrees that CRNAs come out with, how they are going to transition to DNP?
    No, that is not the way it works. CRNA's with Masters degrees would be allowed to continue to practice as CRNA's by the act of grandfathering (much like the diploma nurses in Canada were grandfathered in prior to the mandatory BSN enacted in many provinces - These nurses are still diploma, allowed to continue to practice as RN's, but are not BSN's). In this hypothetical scenario, these Masters CRNA's would not be awarded a DNP by virtue of grandfathering. They would simply be allowed to continue to practice as CRNA's - period. If they want the DNP title, then they would have to "pay the price" by furthering their education. The same holds true for nursing faculty - They all would have to further their education to earn the doctorate title behind their name. And, you cannot conduct a doctorate program with Masters-prepared faculty. Unfortunately, most of the faculty in CRNA programs only possess a Masters degree.
  6. by   MmacFN
    vicky

    Are you currently a CRNA? Im just wondering where you have read this?
  7. by   Nitecap
    Quote from MmacFN
    vicky

    Are you currently a CRNA? Im just wondering where you have read this?

    Yeah I have not heard this. The degree would be meaningless if we could just grandfather everyone in. And programs will be lengthened no doubt. More emphasis will be placed on didactics and research theory classes. If a CRNA wants the extra title they will have to go back to school and take the extra coures. When implemented all new grad CRNA's will have the clinical doctorate.
  8. by   VickyRN
    Quote from Nitecap
    Yeah I have not heard this. The degree would be meaningless if we could just grandfather everyone in. And programs will be lengthened no doubt. More emphasis will be placed on didactics and research theory classes. If a CRNA wants the extra title they will have to go back to school and take the extra coures.
    Exactly... Which again brings up my point - Where are you going to find adequate qualified doctorally-prepared CRNA faculty to make this DNP requirement possible?
  9. by   rn29306
    Quote from Nitecap
    More emphasis will be placed on didactics and research theory classes. If a CRNA wants the extra title they will have to go back to school and take the extra coures.

    I would be willing to bet the majority of practicing clinicians would tell the AANA to stuff it.

    And I would volunteer be the first.
  10. by   MmacFN
    Vicky

    Again, where did you read this or are you simply making an assumption?
  11. by   DebbieSue
    Well, if the DNP does not take off nationally, it will be because the current Masters-prepared APNs will put up a fight. In every article I have read about the DNP, the one question everyone asks is, "What about the current APNs?"

    I have a friend who is currently setting up one of those replace-the-MSN DNP programs, and there will be few, if any, additional courses. I very highly doubt if the AACN (the credentialling org) is going to make it hard to convert. The whole point that everyone acknowledges started this all is that APNs AT THEIR CURRENT PRACTICE LEVEL are comparable to other allied health practice doctorates. I wouldn't be surprised if the trend becomes BSN-to-Ph.D when the BSN-to-DNP becomes common. This whole thing is about getting rid of the Masters level. As long as other professions have ed programs that are Bachelors to Doctorate, then the push is going to be to do that in nursing, too.

    I don't think that a regulation mandating a switch to DNP will work in anesthesia because so many of the programs are not MSN and the instructors have non-nursing Masters degrees. There will be no official or unofficial 'grandfathering' of those Masters up to the DNP. I'm sure that the AANA will eventually get around this somehow. As far as faculty goes, I know that the program my friend is starting is going to be taught by 'grandfathered' DNPs. She will be one of them. And I am talking a very prestigious School of Nursing--one of the top 10 in the nation. An interesting point, however: the head of the anesthesia program is not talking about the DNP yet, probably because the AANA is not completely on board yet. The only anesthesia programs that could make the change quickly are MSN ones. My friend is working on the NP and CNS switch.

    This bandwagon is already rolling.....and programs are jumping on all over the place. And doing what they have to do to make it happen.

    As far as podiatry goes.....like nurse anesthesia, nurse midwifery, nurse practitioning, and the CNS, it is a deep but narrow knowledge-base. I don't think that doing foot surgery as it is done by them is any more advanced than what a CRNA or NP or CNM or CNS does....it is just different.

    All the allied health advanced practice (including nursing) is deep but narrow. MDs/DOs knowledge base is deep and broad. That's what MDs get out of all the additional years of school and residency. That's what they should get credit for. That's what they get paid for-- and why they are paid more.

    This is an interesting discussion....

    Debbie, RN, MSN, CNS
  12. by   Jengirl18
    I'm with you Vicky. There is no reason for a Doctorate if it isnt more academic. There's no reason to dumb down degrees. Let it be something that NPs can be proud of that they earned, not one that ppl will think that was given away. It's also misleading to the patients.
  13. by   UCDSICURN
    Quote from MmacFN
    Vicky

    Again, where did you read this or are you simply making an assumption?
    That's how the grand-fathering worked before. CRNA's didn't always need a master's degree and when they transitioned to having the master's as the entry-level degree requirement for CRNA's, they grandfathered all practicing CRNA's so they could keep practicing with their BSN's with CRNA certificates.

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