Clinical Doctorate in Anesthsia

loisane · May 28, 2005

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

mwbeah · May 28, 2005

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

mwbeah · May 28, 2005

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

loisane · May 28, 2005

...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

DrEdwina · Sep 25, 2005

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.

mwbeah · Sep 25, 2005

, 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

Vance · Sep 30, 2005

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 :banghead:

soliant12 · Oct 4, 2005

I understood from the 75th AANA meeting that this proposal is dead. The impotant thing is do the numbers show that CRNA's need to be practicing at a doctoral level? I would say no since there are no differences in outcome when compared to MDAs

DrEdwina · Oct 5, 2005

I understood from the 75th AANA meeting that this proposal is dead. The impotant thing is do the numbers show that CRNA's need to be practicing at a doctoral level? I would say no since there are no differences in outcome when compared to MDAs

For NP's The proposal was approved. The first Practice Doctorate NP's graduated from Columbia, in New York.

mwbeah · Oct 5, 2005

For NP's The proposal was approved. The first Practice Doctorate NP's graduated from Columbia, in New York.

AANA doesn't currently support the timeline proposed by the AACN.

http://www.aana.com/members/president/pdfs/aacn_ltr061505.pdf

mwbeah · Oct 5, 2005

for np's the proposal was approved. the first practice doctorate np's graduated from columbia, in new york.

"the task force on the essentials of the dnp is comprised of individuals representing multiple constituencies in advanced nursing practice. the series of regional hearings that will be conducted from september 2005 to january 2006 is designed to involve a larger and more diverse group of stakeholders in the process, which will shape the education of nurses prepared for the highest level of nursing practice. "

its great they graduated but official recognition is a ways away.

http://www.aacn.nche.edu/dnp/pdf/essentials.pdf

mwbeah · Oct 5, 2005

1. doctorate in nursing practice (dnp): the american association of colleges of nursing (aacn) board of directors charged an 11 member task force with examining the current status of clinical or practice doctoral programs, and with comparing various models and making recommendations regarding future developments. the task force identified 13 recommendations in a draft position statement on the doctorate in nursing practice (dnp).

in october 2004, the aana and coa were informed that the aacn's draft position statement on the doctorate in nursing practice was being brought to the october 25, 2004 aacn membership meeting for action. the aacn membership voted to accept the position statement to transition all advanced practice nursing educational programs to the dnp by 2015.

to date the aacn has established two task forces: one for the implementation of the dnp and the other to develop the essentials document. i am happy to report that ed thompson, crna, phd, program director at the university of iowa college of nurse anesthesia program, was appointed to the essentials task force.

the dnp movement was discussed at the council/aana liaison luncheon during the fall assembly of states in november 2004. as a result of that conversation and the concerns expressed i recommended that a summit of the nurse anesthesia community and other interested stakeholders be convened as soon as possible. the summit is now scheduled to meet june 9-10, 2005 at the chicago o'hare marriott hotel. (i will speak to the summit later in my report).

the dnp has sparked a significant amount of controversy not only in the academic community, but also in the practitioner and other communities.

it is important that this body thoroughly discuss the issues and their impact on the profession, and provides guidance to the coa and the aana.

there will be a number of focus sessions at this meeting conducted by linda shinn to gather information that will assist us during the summit in june. i would encourage you to sign up at the meeting registration desk for one of the focus sessions.

also, if you have not read the article written by dolores clement, drph, in the aana journal, february 2005, vol. 73, no. 1, titled "impact of the clinical doctorate from an allied health perspective," you should do so, because the information she provides is very insightful.

http://www.aana.com/members/president/maziarski/maziarski032805asf.asp