Section 6.3 Number of Directors, Election, Term of Office, and Submission of Nominations. (a) The First Board of Directors of the NBCRNA shall be composed of six (6) directors (the “First Directors”). (b) Except for the First Board of Directors, the number of directors of the NBCRNA shall be eleven (11). The number of directors may be increased to any number or decreased to not fewer than three (3) from time to time by amendment of these Bylaws. Eight (8) directors shall be certified registered nurse anesthetists who are currently recertified; one (1) director shall be a board-certified anesthesiologist; one (1) director shall be a board-certified surgeon; and one (1) director shall represent the interests of the public.

Reading the above it appears that the 11 members of the NBCRNA Board of Directors, or potentially as few as 3, have complete authority over the NBCRNA certification and recertification of all practicing nurse anesthetists in the United States. There are no shareholders, no voting members, no appointed or elected AANA representatives, meaning that the NBCRNA board of directors answers only to themselves.

Question 5) Concentrated authority, insistence on confidentiality, estranged relationship with the only national organization representing nurse anesthetists – How will NBCRNA address these concerns ?

President Vacchiano’s Response : As the certification agency for nurse anesthetists, the primary function of the NBCRNA is to serve the public safety by establishing certification and recertification programs which are in accordance with the standards of practice set by the AANA and the standards of education set by the COA. Unlike a membership service organization like AANA, the NBCRNA does not have members who elect officials and subscribe to services provided by the organization. As a non-profit organization, it also does not have shareholders who invest for financial gain.

The NBCRNA directors do not answer to themselves, but rather to the organization’s bylaws and to two accreditation agencies which evaluate NBCRNA’s policies, operations, due process for constituents, and collaboration with related agencies (such as the AANA). The NBCRNA does, in addition, answer to both public and professional stakeholders. One accreditation requirement is that NBCRNA seek feedback from the constituencies of interest before making substantive changes to programs.As an example of this, the CPC program underwent substantial change in response to feedback from CRNAs and the AANA after the initial proposal.

While the NBCRNA members must be guided by the mission of public protection, the board is comprised primarily of CRNAs who are all members of the AANA. Keep in mind that as practicing nurse anesthetists NBCRNA members are all personally subject to the decisions they make.Unlike having a certification board comprised of anesthesiologists or other types of nurses, the nurse anesthesia certification process is guided primarily by those who live it, abide by it, and care very deeply about it.

The NBCRNA has been an autonomous body for many years. Even before becoming incorporated, the certification and recertification councils were recognized as autonomous by AANA bylaws, in order to satisfy accreditation requirements that the certification board not be subject to undue influence by other organizations. NBCRNA’s standing bolsters the legitimacy of the CRNA credential which we all know regularly comes under attack when states advocate for practice rights for CRNAs. Currently, the board is comprised of 11 members, eight of which are practicing nurse anesthetists as mandated by our bylaws.

The NBCRNA strives to maintain an effective relationship with the AANA. As our professional association and certification board have evolved, we have had some growing pains, but we are committed to working together in mutual support of the profession that we all care about. While taking care to maintain the required “arms length” relationship with AANA, we are far from being “estranged”. Our executive boards meet on a regular basis, and the full boards also meet to discuss issues of importance. The NBCRNA changed the composition of the CPC committees in order to accommodate a request of the AANA board to appoint representation to each committee. We have recently signed joint letters of support on issues impacting CRNA practice.The NBCRNA is committed to maintaining the strength of our profession by administering a justifiable certification program while also supporting the strength of our professional association.

Regarding confidentiality, the NBCRNA works hard to keep members of the profession informed about issues concerning certification and recertification. There seems to be a misunderstanding as to where confidentiality concerns do arise. To maintain the legitimacy and integrity of our certification examination, as well as to protect the privacy rights of those experiencing certification or recertification issues, we ask volunteer members to agree to a confidentiality policy. Such a policy is routine in business and volunteer work.

Asking for volunteers or employees to maintain confidentiality is not a means of being secretive; it is a way to prevent miscommunication and misunderstanding that may occur when a number of people speak separately on behalf of an organization. To ensure stakeholders are informed the NBCRNA has greatly expanded avenues of open communication, from a new web site, to quarterly e-newsletters, to social media sites, to increased mailings and regular presence at professional meetings. We are committed to maintaining open communication and dialogue with all stakeholders.

The most recent NBCRNA IRS Form 990 for 2010 indicates revenues during this period of 5.3M, mostly from fees paid by SRNAs and CRNAs for certification and re-certification, and assets of over 11M derived over time from the same sources. Does NBCRNA plan to raise the fees charged to AANA members for these services?

President Vacchiano responds: To continue to promote the value of nurse anesthetists, the NBCRNA is committed to maintaining a strong financial footing, while at the same time controlling cost to the certificants. Over the years, the NBCRNA has maintained low certification and recertification fees by making wise financial decisions, developing effective investment strategies, and keeping a tight budget.

While maintaining a low fee structure we have been able to introduce new technology, improve services, and increase efficiencies that have translated into enhanced certification and recertification programs. For example, in 2009, we were able to implement electronic recertification without needing to raise customer fees beyond a modest inflationary adjustment.

Looking forward, we are projecting a substantial investment in additional technology, systems, and programs that will support the strengthening of the CRNA credential through the development of the Continued Professional Certification (CPC) program. As the cost of development and operationalization of the CPC program become more apparent, we will re-evaluate the fee structure.However, because of our current financial position and effective planning, we do not anticipate any significant fee increases in the near future.

It should be kept in mind that all CRNA members of the NBCRNA Board are volunteers who also pay recertification fees, and have a firsthand awareness of the value of providing a certification program at a reasonable cost. We recognize our responsibility to keep the fees as low as possible, while maintaining a strong professional certificate and certifying organization as a means of protecting the value of the credential.

Next and final question – NBCRNA’s concentrated authority, insistence on confidentiality, estranged relationship with the AANA – How will these concerns be addressed ?

Recently there was a comment online regarding a conversation with the current President of the NBCRNA Board stating the last time NBCRNA sent out a general call to the AANA membership for new board members, they had very few replies and fewer that had the qualifications they were looking for. Which prompted a reply from a former AANA President, which included :

“… I had been told by other CRNA leaders and past president’s not to apply for the NBCRNA board because their board would never select an AANA Past President because we were considered to be too strong of a leader. I chose to give it a try because I truly felt I could be of benefit to the development of the CPC program, work well with the NBCRNA board and committees and help with the NBCRNA-AANA relationship. I was not given the opportunity to be of service AND I find it very hard to believe the NBCRNA’s claim that they have not had qualified applicants for board members, especially since the surgeon on the NBCRNA board, who led my interview, told me I was very qualified for the position…”

What qualifications is NBCRNA looking for in new board members and is there a reluctance to bring on strong leaders ?

President Vacchiano responds: The general qualifications for an NBCRNA board member are delineated in our application form and include leadership experience; employment status with respect to clinical practice, education, administration, research or some combination of these; career achievements; elected or appointed positions on working groups, committees, or boards at the state or national level; examples of public presentations; and a statement regarding commitment to serving on the Board.

The CRNA members of the NBCRNA board of directors include expert clinicians, educators, program directors, and former elected members of the AANA Board of Directors. We are an all volunteer board composed of members who donate hundreds of hours per year to the governance of the certification function for nurse anesthetists. All are “strong” leaders as defined by their level of experience, knowledge, expertise, objectivity and individuality. The strength of their leadership qualities is apparent in their commitment to assuring a future recertification process that continues to enhance the value of the credential in a rapidly changing health care environment.

We are aware of a recent online discussion which suggested that we have a paucity of applicants and that the board shuns “strong leaders”. The online comment regarding the response to calls for applicants for the NBCRNA Board of Directors was reported out of context.

It is a fact that the Board historically has not had a lot of applicants for open positions. We have been fortunate in getting well credentialed applicants, but given the potential pool of applicant’s numbers in the thousands we would like to have a higher response rate. The statement regarding qualifications of board members was not in reference to past applicants, but was intended to explain the desire of the board to further diversify the nurse anesthetists who are motivated to engage in the certification and recertification processes.

The board strives to represent the constituency of interest with a balance of educator vs. practitioners, and a geographic diversity of board members. However, because our application requirements favor those who have experience in governance, finance, and leadership not typical of more junior CRNAs, we decided our board could be more reflective of the CRNA population by including a greater spread of years of experience.

The “Emerging Leader Fellowship” is a service to offer leadership development experience to professionals who may step up to future leadership roles in our profession, particularly those interested in the certification aspect. Similar to the way AANA and the COA include associate members on various committees, the NBCRNA would also like to show our support for and inclusion of younger leaders of our profession.

Next question – The most recent NBCRNA IRS Form 990, indicates the revenue during this period of 5.3M, mostly from fees paid by SRNAs and CRNAs for certification or re-certification and assets of over 11M derived over time from the same sources. Does NBCRNA plan to raise the fees charged to AANA members for these services ?

“The vision of the NBCRNA is to be recognized as the leaders in advanced practice nurse credentialing.” Does that mean that NBCRNA plans to expand beyond credentialing of nurse anesthetists ? Please clarify the NBCRNA vision statement.

To some CRNAs it appears NBCRNA is attempting to compete or even replace AANA as the national authority for CRNA practice. Are you concerned with this perception, if so how do you plan to remedy it ?

Dr. Charles Vacchiano, PhD, CRNA, President of NBCRNA Board of Directors responds: The practice of Nurse Anesthesia can be likened to a three-legged stool whose stability is dependent on the strength of its legs, represented by the AANA, NBCRNA, and COA. All three are necessary to assure CRNAs are well informed, well educated practitioners who are held accountable to protecting patient safety through vigorous certification and recertification processes. These three entities have distinct and separate missions and while the NBCRNA has always viewed them as autonomous organizations, it recognizes the need for cooperation and communication.

The NBCRNA is primarily composed of dues paying members of the AANA who recognize the AANA as the professional organization that represents CRNA practice. The NBCRNA has a well-defined certification function, that by definition, cannot replace the function of AANA as the professional association for nurse anesthetists. The NBCRNA has worked with and will continue to work with the AANA as exemplified in the seating of AANA chosen members on the CPC committees, the joint statement issued on pain management, mediated joint communication sessions, increased joint executive committee meetings, just to name a few. The NBCRNA’s dedication to protecting patient safety through vigorous certification and recertification processes provides AANA the evidentiary basis it needs to advocate on behalf of our profession.

Chuck Vacchiano earned a BSN at Wright State University (OH) in 1979, a Bachelor of Science in Anesthesia from George Washington University in 1984, and a PhD in Physiology from the Medical University of South Carolina in 1995. He spent 26 years in the U.S. Navy as a practicing nurse anesthetist, educator, and researcher. During this time, he provided anesthesia care at stateside and overseas hospitals and aboard naval combat vessels. He also taught and performed clinical research in the Navy Nurse Corps Anesthesia Program, and was the Director of Biomedical Sciences Division at the Naval Aerospace Medical Research Laboratory.

Following his retirement from the U.S. Navy, Dr. Vacchiano became Director of the Gooding Institute, Bay Medical Center Nurse Anesthesia Program. He has published in multiple journals (including American Journal of Physiology, Cardiovascular Research, Shock, and the American Association of Nurse Anesthetists Journal), and serves as a reviewer for several agencies and journals. He was named the American Association of Nurse Anesthetists Researcher of the Year in 2007. He is currently a member of the Duke University School of Nursing, Nurse Anesthesia Program faculty.

Next question : The vision of the NBCRNA is to be recognized as the leaders in advance practice nurse credentialing. Does that mean that NBCRNA plans to expand beyond credentialing of nurse anesthetists ? Please clarify the NBCRNA Vision Statement.

AANA and the Councils on Certification and Recertification of Nurse anesthetists developed a collaborative, yet autonomous relationship. Since incorporation by the National Board of Certification and Recertification of Nurse Anesthetists (NBCRNA), this relationship has changed significantly. NBCRNA assuming a more prominent role, distancing itself from any perceived influence by AANA. This alarms many AANA members who question NBCRNA’s motives.

I recently sent the following email to Karen Plaus, CEO of NBCRNA:

Karen,

There is growing concern regarding the apparent disconnect between NBCRNA and AANA.  Considerable online discussion and an AANA bylaw proposing to replace "NBCRNA" with "entity" in regards to recognized nurse anesthesia credentialing bodies, indicate that direct communication rather than public relations is indicated.  

I would like to pose 5 questions to you or an NBCRNA spokesperson to address concerns expressed by CRNAs regarding the strained relationship between AANA and NBCRNA to be published on CRNAbiz.com.  

I consider it imperative for NBCRNA to reassure the CRNA community of its desire to work with the CRNA community and AANA in regards to certification and re-certification standards. 

CRNAbiz.com allows both NBCRNA and CRNAs an opportunity to interact and discuss concerns and perhaps better understand each others perspective.  Please contact me at your earliest convenience if there is interest by NBCRNA in cooperating with this interview request.

Respectfully,

Dennis Gundersen, CRNA
www.CRNAbiz.com Dennis

Dennis 

Good afternoon – I have reviewed your request with our board leadership and yes we will cooperate with responding to the interview questions. Please email the questions at your convenience and I will coordinate the response.     

Best Regards, 

Karen 

Karen Plaus PhD, CRNA, FAAN 
Chief Executive Officer

National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)

8725 W. Higgins RD| Suite 525 |Chicago, IL 60631
Office: 708-667-0101|Fax: 708-669-7636| Email: kplaus@nbcrna.com Website: www.NBCRNA.com

Tennessee unexpectedly lost a great Leader, Educator, CRNA, and friend today. Dr. Don Bell passed away last night. As program director at UT-Knoxville he was dedicated to SRNAs, as the current Chairman of the Tennessee Board of Nursing he was an advocate for CRNAs and CRNA practice, as a former president of the Tennessee Association of Nurse Anesthetists he always led by example. He also had served on multiple AANA Committees. He dedicated much in order to see the field of nurse anesthesia advanced.

Please remember his wife Beverly, a CRNA. Remember those at the UT-Knoxville nurse anesthesia program, in this great loss.

Mark J Haffey MSN, CRNA, APN

Now that AANA elections are in the rear view mirror, let’s share perspectives. I’m interested in both candidates, voters and non-voters perspectives. Below are some questions for each group.

To the Candidates – What worked or didn’t work for your campaign ? What surprised you or perplexed you about the results ? What advice would you care to share with future candidates ?

To the Voters – When you didn’t know candidates, how did you decide whom to vote for ? Does having more than two candidates in a race improve the chances of getting the best qualified person for the position ?  Does having a candidate from your state as an officer or BOD member significantly influence your vote ?

To the non-voters – What suggestions do you have that might encourage you to vote next time ?

Please add your comments below.

In March 2013, Anesthesia Essentials announced the following under Hot Topics

All candidates running for AANA elected positions who have been placed on the official ballot or are write-in candidates who have notified the Nominating Committee chair shall have the opportunity to purchase a mass email (“Eblast”) from the AANA. This email will be sent only to AANA members who became eligible to vote since the previous election and/or those members who have voted in the past two elections. Continue reading →