Future of CRNA education....

Britt.MSN2b.Drexel'11 · Nov 27, 2005

i am enrolled to begin a B.S.N program next year, so really have no insight as to CRNA programs. My question is, why do they let so few applicants into school if we are hurting so badly for nurse anesthetists? I understand that programs want only the best, but there are many qualified applicants unable to be accepted into programs. You would think that there would be a push to expand the programs, and to accept more applicants.

Nitecap · Nov 27, 2005

I promise you they wont at all change the requirments. There are more than enough applicants presently that meet all the requirments. I know NP is a great field and all dont get me wrong, but its way different that anesthesia. Look PA's have no experience either.

The education will only get harder, I promise you. Programs will be longer in fact eventually when all will be awarding doctorate degrees.

Pay your dues and do your time and get prepared as much as you can, your time will come.

BigDave · Nov 27, 2005

One of my best NP classmates was a pipelined BSN-NP student. Another was a biology undergrad and did a RN/MSN NP track. They did well in school and in practice. I really do not think it mattered that much, but there were some in the program that were unthrilled by the alternate routes.

For anesthesia school, I had 8 years ICU time, but was only working in the unit on weekends at a moonlighting job. That wasn't good enough for the program director at the school I wanted to attend, so I had to quit my CNS/NP job and go to the unit full-time again.

The one year required ICU time serves several valuable functions. Foremost, it ingrains the correct personality (calm and functional under stress). It also teaches critical thinking and decision-making skills that CRNA school does not have time to develop. I think that the drip management/swan/vent management aspect is just a minor player.

I do not see this ICU requirement ever dumbing down. Heck, the talk is making the CRNA a doctorate requirement. The profession is the midst of a turf war, lowering standards, for whatever reason, would not be beneficial for the profession.

Britt.MSN2b.Drexel'11 · Nov 27, 2005

it would not be benefitial. I wasnt talking about lowering standards, just possibly expanding programs a little to allow some more QUALIFIED applicants admission. Thanks for your input.

BigDave · Nov 27, 2005

Sorry, I misread what you were saying.

There has been a large increase in total programs, from 83 ten years ago to I think 105 now. There are three things limiting expansion: 1) lack of clinical site availability. There are many schools that ship students out of town or out of state to get clinical hours. 2) lack of faculty. Face it, teaching lowers a person's income. You have to really have the desire to make this comittment. And 3) The political landscape between the CRNAs and MDAs. There is a heated debate concerning teaching rules and payment through Medicare that threatens to actually reduce availability of CRNA clinical sites by paying MD residents 100% of services rather than the current 50%. It would be more advantageous for hospitals to expand MDA programs and cutting us out. There was a "thoughtbridge" program between our professions to exchange information and practice parameters. After the November meeting, it looks like this program has serious troubles and friendly dialog may be at an end.

Oh, there is a fourth reason: resistance from the profession. Nursing has always be cyclical in employment. When I graduated in 1995, the hospital that I was an extern at did not even have a job for me. We used to go through this every few years. Shortages led to expansion in schools, then a glut and no jobs/stunted wage growth. CRNAs worked hard to be where they are. If there were an excess of providers, wages and other incentives would decrease (the old supply and demand story). The only thing different is that the baby boomer wave threatens to strip available resources no matter what we put out...and bankrupt our country's budget.

Britt.MSN2b.Drexel'11 · Nov 27, 2005

Thanx for your explanation

"it would be more advantageous for hospitals to cut us out"-- i guess i was mistaken. I always thought that hospitals would prefer nurse anesthetists, because of the fact that they are more cost effective than hiring anesthesiologists.

BigDave · Nov 27, 2005

luckily the teaching rule change did not go through:

cms declines to change anesthesia teaching rules

in addition, the 2006 part b update final rule includes language indicating the agency is not changing its payment rules for teaching anesthesiologists at this time. according to cms' final rule preamble, "in terms of anesthesia manpower, we did not receive any information from surgical groups indicating difficulty in getting anesthesiologists or crnas to provide anesthesia services. additionally, we did not receive any comments identifying areas of offsetting savings that might be used to fund any change in the teaching anesthesia payment policy. we will continue to review the information and relevant data presented by the commenters and consult with the stakeholders before we move forward with any proposal."

the agency acknowledged the importance and growth of crna educational programs. "(t) here has been an increase in the number of nurse anesthesia programs from 83 programs in 2000 to 105 programs projected for 2006," the cms language states. "the number of nurse anesthesia graduates has surged from 1075 nurse anesthetists in 2000 to 2035 projected for 2006. despite these increases, nurse anesthesia programs had reported similar financial problems, such as levels of teachers' salaries, in recruiting faculty to teaching nurse anesthetists."

"there are problems with the anesthesia teaching rules," said purcell. "in the interest of the medicare beneficiaries for whom crnas provide care, problems with the teaching rules should be addressed through a process that treats anesthesia professionals equitably."

crnas are indeed cheaper for the patient, but the hospital would be able to bill medicare 100% for the mda supervising two residents instead of 50% for each resident at the present. that would potentially double the billable amount for anesthesia services (at an estimated $35 million annual cost to medicare). so for now, the bears are off our backs...but they are always hungry!

Kiwi, BSN, RN · Nov 27, 2005

My question is, why do they let so few applicants into school if we are hurting so badly for nurse anesthetists?

Since you are a BSN student, you know how competitive BSN program slots are due to the lack of nursing instructors/clinical sites. Same thing with NA schools.

Britt.MSN2b.Drexel'11 · Nov 27, 2005

yes, i sent my applications in and i have to wait 10-12 weeks before i even get to hear anything!!!!! Every school is different with the admissions. Some are much more difficult than others. Old Dominion's BSN program is if you start there as a freshman, your guarenteed. Minnesota gets like 450 applicants, 130 are accepted. so im already beginning to find out how frustrating it is to get accepted into a slot. Even worse though, is the waiting.

Kiwi, BSN, RN · Nov 27, 2005

I'm a May '05 grad and have been working ever since. I can tell you that even when you are getting your ICU experience -- I could have scratched like 75% of my undergrad nursing education. It is that different and challenging. It's been about 6 mos months for me, and I feel like I am finally getting a hang of helping the critically ill. There are so many times where there is something that requires you to critically think - fast. I am so glad that the requirement is there. I sure wouldn't want to be stuck at the head of the table without knowing about gtts/cardioversion/lines, etc. Remember as it stated so frequently here, NA requires the best and brightest nurses.