Clinical Doctorate in Anesthsia

[Lambert5883]

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 to be implemented?

I was pretty excited about reading this. I hope that it is more than just a measure to appease egos and status and more of a venture into an advanced knowledge base (research and clinical).

Do you think that it is even needed?

[Lambert5883]

"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."

I am reading this post and am amazed at the lack of understanding that people have with the definitions of the "doctorate" degrees. The problem I see is this, if we as healthcare professionals cannot differentiate these differences between a practice doctorate and a research based doctorate then how will this affect out relations within the healthcare community and the public.

After reviewing what is being added to these practice doctorates, it seems that these programs are not adding more clinical hours. It appears that the increase is based on theoretical types of classes. We must understand that if this is going to work, we have to increase the focus on clinical hours and cases. What I mean by that is that the average MD who goes through an anesthesia residency obtains roughly 2000 cases (at least in the military) prior to graduation. We are requiring (what is it now) I believe 550 cases for board attendance. In my opinion, I think that at least another 1.5 years of curriculum should be added yeilding a total of 4 years to garner the practice doctorate.

I am attending a research based PhD program in neuroscience and the requirements for my program involved intensive study in advanced biochemistry, neurophysiology, neuropharmacology, anatomy and physiology, etc. It also requires that I have oral and written board exams to advance in my candidacy for laboratory work. This program can take anywhere from 4-7 years to complete depending on the individual.

I understand the intent to advance the practice but we must not rush into this foolhardy. Our credibility could (and it appears already is) suspect.

Mike

Mike,

You have imparted a very sensible approach in addressing the issue of clincal doctorates in nurse anesthesia. And from some of the other posts, which seem to agree with you, it seems that, perhaps, the answer lies in extending curricula and defining an appropriate number of clinical hours in order to justify a practice doctorate in anesthesia.

If the concensus amongst those of you currently practicing as CRNAs is that the aforementioned should be the rule, why would anesthesia programs not follow suit and implement programs based on greatly increasing the number of clinical hours? Also, Lizz makes a great point in that if the educational requirements are increased, it could dissuade some from entering the profession and, perhaps, entice them to go the route of AAs. Also, could the CRNA profession as a whole find itself requiring more in salary or compensation as a means of addressing the new edcational requirements and costs? Again, would hospitals, and the like, turn to AAs as a means of offseting this type of occurrence?

I know you don't hold all the answers and I am not trying to put it all on you, but your perspective is greatly appreciated.

[Lambert5883]

Purely from a practical standpoint ... but couldn't a doctorate requirement hurt CRNA's with the battle over AA's?

From what I've read on this board, I thought the CRNA schools were trying to increase enrollments since the major justification for AA's is the anesthesia provider shortage. If a doctorate becomes the norm, couldn't that worsen the shortage and, potentially drive the ASA's efforts to get AA's accepted by more states?

Afterall, more educational requirements usually means more barriers of entry into the labor pool. Just curious if anybody has any thoughts on this possibility ...

Lizz,

I think this is a good point. Makes you focus on a myriad of scenarios concerning the divergence, or convergence, of MDAs, CRNAs, and AAs and how the practice of anesthesia will evolve, shortly.

[loisane]

I am reading this post and am amazed at the lack of understanding that people have with the definitions of the "doctorate" degrees. The problem I see is this, if we as healthcare professionals cannot differentiate these differences between a practice doctorate and a research based doctorate then how will this affect out relations within the healthcare community and the public.

Mike

Mike, I appreciate your sharing about RESEARCH doctorates, based very solidly on your personal experience. I applaud your efforts to earn a PhD, you will be a great asset to our profession. But I have to ask you, do you also have personal knowledge about PRACTICE doctorates? If you do not, then your opinions are a little on the speculative side, don't you think?

I would like to ask everyone, respectfully, to take the rhetoric down a notch, and get some good solid information on these programs. They are not new. They are well founded, and have established criteria. There are graduates on these programs in our work force right now. As we speak, there are students enrolled, and many preparing to graduate.

I think there is a need for many of us to get some first hand, "official" info about the DNP. Here is one good place to start:

The case for the clinical doctorate in nursing; Joyce Fitzpatrick, RN, MBA, PhD, FAAN; Reflections on Nursing LEADERSHIP; 2003 - http://www.nursing.upenn.edu/Practice_Doctorate/casex.pdf

And

AACN Position Statement on the Practice Doctorate in Nursing, October 2004

http://www.aacn.nche.edu/DNP/pdf/DNP.pdf

Yes, part of practice doctorate education is an extended clinical component. But it is VERY important to realize that these degrees do not exist in a vacumn. Nursing did not invent these degrees. They exist in many other fields. It is my understanding that education experts have looked at "the numbers", and have concluded that nurse anesthesia education ALREADY requires clinical education requirements congruent with other fields' practice doctorates. Part of the push for this degree, IMHO, is that SRNAs are not getting a degree comparable to the work they are doing.

And again, Mike, I KNOW basic nurse anesthesia education is nowhere near what you are doing for a RESEARCH doctorate. I completely agree with you on that. A practice doctorate is another type of doctorate. It is not meant to be on the level of what you are doing. But it is a doctorate.

I know I am repeating myself, maybe I'll just go and bang my head on a rock for awhile for a change of pace. I may not convince anyone here of their worth, but let me at least convinve you of the existence of the DNP. It is here, some of you will work with CRNAs with this degree, regardless of the conclusion in the current debate regarding entry level requirement. And believe it or not, some of us think that is a very good thing.

loisane crna

[Lambert5883]

And believe it or not, some of us think that is a very good thing.

loisane crna

Thanks for the insight, loisane, and the links are greatly appreciated. Why is it a good thing, though, generally speaking?

[mwbeah]

Thanks for the insight, loisane, and the links are greatly appreciated. Why is it a good thing, though, generally speaking?

I agree it can be a good thing, but it should be done appropriately. More clinical hours with advanced type cases.

Mike

[loisane]

Thanks for the insight, loisane, and the links are greatly appreciated. Why is it a good thing, though, generally speaking?

Hmmm-fair enough question, but I am not sure how much I can add that isn't already in my other posts. I have never tried to summarize it, but I'll give it a try.

*Increasing the numbers of doctoral prepared individuals is important for the evolution of any professional discipline. Nursing is a young discipline, but even taking that into account, we are behind on this. Nursing needs doctors.

*We especially need nursing doctorates, to contribute specifically to the development of the profession. (Not to discount the contribution of non-nursing doctorates)

*Research doctorates (PhD) are important for the development of new theories and science. We will always need them, but there is somewhat of a natural disconnect between the ivory tower of the PhD and the working trenches of the bedside nurse.

*This has fostered a distrust and lack of appreciation for theory and research among many "rank and file" nurses.

*IMHO practice doctorates (used to be called clinical doctorates) are the missing link between research and practice. Education in a practice doctorate definitely includes research, but it is more focused on the practical application and use of knowledge in nursing practice.

*APNs are a very natural fit into the practice doctorate paradigm. We have knowledge and skills above that of the entry level nurse. But we remain directly involved with patient care. APNs should be advancing the science of that care through research and the development of theory. These are the hallmarks of doctorate level practice.

*I believe APNs are already doing a lot in the way of research and theory, but we are lacking in the formalization of that process. For instance, our contributions are usually handed down orally, instead of developed fully and put through the peer review process associated with publication.

*Less than 1% of CRNAs hold a doctorate degree, most of which are of the research type. They are involved in research and publication, but we need more. We need more PhDs. The increased availability of practice doctorates may offer those who are not interested/able to go the PhD route an alternative way to make a contribution at the doctorate level.

*Other health care professions are moving to the practice doctorate-pharmacy, psychology, physical therapy. Optomitrists and podiatrists are other examples, that have been around a while.

*To me, we are at a fork in the road. We can use practice doctorates for APNs to help distinguish nursing as its own profession, just like the others listed above. Or we don't take that path, and risk remaining a poorly defined subset of medicine (in most people's estimation). If nursing lacks leadership/research/theory then I am afraid we will always be subservient and under the complete control of physicians.

Finally, for those of you who are still having trouble conceptualizing this, I remind you of this example. This is how medicine started. Medical education is a practice doctorate. There are PhDs that do research, but it is MDs/DOs that are the link between pure research and the application of that research to patient care.

WE CAN DO THIS! WE SHOULD DO THIS!

loisane crna

[mwbeah]

executive summary of national forum on the practice doctorate, co-hosted by nonpf and aacn,

december 8, 2003, washington, dc.

for the nursing discipline, the practice doctorate enhances the status and privilege of the

profession. a practice doctorate degree would reflect the extent of graduate work

accomplished and competencies acquired and would raise the bar for all levels of nursing

education. by providing parity in educational preparation with other health care

disciplines, the degree would provide graduates the skills and credentials for increased

leadership opportunities across health care systems and may provide the potential for

higher levels of reimbursement for services provided. practice doctorate students may

have increased opportunities for interdisciplinary education experiences, leading to

enhanced interdisciplinary team practice. for nursing education, the practice doctorate

may help alleviate the dire shortage of nursing faculty by growing the next generation of

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).

challenges

for widespread implementation of practice doctorate programs, forum participants

identified a number of potential obstacles. first, program development will require

diversion of limited funding and other resources. second, the current shortage of faculty

and program administrators limits the capacity for program development. third, some

nursing schools may face political hurdles and logistical impediments at the institutional

level in establishing a doctoral level program due to institutional mission and limited

clinical and faculty resources. fourth, programs may face difficulty marketing the

program, which could decrease graduate nursing education enrollments if students find it

takes longer and more money to be ready to enter practice.

for widespread acceptance and employment of practice doctorate graduates within the

health care system, nursing will need to put significant effort into educating the public,

other nurses, and other disciplines on the purpose and benefits of the practice doctorate.

public and regulatory perceptions of the "doctor" designation may hinder recognition of

the term in nursing. dialogue with potential employers will be imperative to ensure the

acceptance of the graduate and address reimbursement and other practice issues. as the

number of practice doctorate graduates increases and if apn education evolves to the

practice doctorate, a significant challenge will be to accommodate the role(s) of existing

master's prepared nurses within an evolving education and health care system. the

nursing profession will need to determine how the different roles and types of preparation

will fit into the education and practice paradigms to avoid confusion and prevent the

possibility of losing current nursing functions and roles to other disciplines.

for anesthesia purposes, i think we cannot follow the aacn curriculum and have credibility.

just my thought on this.

mike

[NeuroNP]

for anesthesia purposes, i think we cannot follow the aacn curriculum and have credibility.

just my thought on this.

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.

[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

[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.

[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.

[VickyRN, MSN, DNP, RN]

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.