Hello all! My name is Don Beissel. I am a CRNA practicing in Southwest Missouri. I own a practice where I provide image guided pain management injections, deliver office plastics anesthesia, and work in a day surgery center. I am also part of the faculty at the Missouri State University School of Anesthesia. I am President of the Missouri Association of Nurse Anesthetists and working on my Doctor of Nursing Practice at Brandman University in Irvine, California.
I was fortunate enough to be able to attend the information session on the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) Continuous Professional Certification (CPC) program. I attended the program in person in Las Vegas on August 12th and via webinar on August 19th. Dennis Gundersen, the owner and editor of this forum, has asked me to write up the highlights from these experiences.
I was surprised at the limited attendance at both sessions. I counted 21 people in the room in Las Vegas, with most of them being members of the leadership from the AANA, NBCRNA, or state associations. Drs. Wanda Wilson and Karen Plaus were in attendance, as were Dennis Bless and Dr. Charles Vacchiano. The webinar had 30 attendees, but I could not see who they were. With nearly 47,000 CRNAs in the AANA and the fervor over the CPC, I thought attendance would be higher at each event.
Dr. Steve Wooden, Secretary/Treasurer of the NBCRNA, conducted both programs. The program began with a review of the history of the CPC. Our current recertification standard was set in 1978. CRNAs have a good safety record, but it was stated that we couldn’t expect the 1978 standards to be best practice forever. Those standard were set 35 years ago.
We also have to look at what our competition is doing. MDAs take 15 more CEUs a year than we do and test every 7-10 years to stay board certified and AAs take the same CEUs, but test every 6 years. Our friends at the ASA like to compare us to AAs when talking to legislator and they are pointing out that “anesthesia nurses” are the only providers who do not test to recertify. We need to keep pace or surpass these providers to remain competitive.
Steve also discussed how what we learn in school is not adequate to carry us through an entire career. One thing I would like to note here is that sugamadex and precedex were not even on the horizon when I graduated in 2001 and we were mixing pentothal and propofol together in the pharmacy to “save money”. We also used vecuronium and cis-articurium because rocuronium was still on patent. All AAA repairs were open at that time. Things change very quickly in anesthesia.
This phenomenon means that we need to focus on life-long learning that allows CRNA skills to grow to meet the demands of an evolving health care system. This learning needs to be assessed. Here is where people became aware of the CPC; when someone said TEST. Steve presented and discussed 6 citations for the efficacy of assessment for recertification of health care professionals. This movement has been happening in other specialties as well as nurse anesthesia.
Then Consumer (patient) expectations were discussed. The Citizen Advocacy Center found that 90% of patients believe it is important for their care providers to be re-evaluated, 84% believe health care professionals should be evaluated on their qualifications, and 78% believe providers should pass a written test of their knowledge at least every 5 years.
Steve pointed out that it is a common misconception that the CPC was initially presented at the 2011 AANA Annual Meeting. The NBCRNA made it’s first complete program presentation at this meeting, but focus groups, informational meetings, surveys, and a benchmarking study took place for 3 years before the announcement of the complete program. This fits with my memory because I know that a representative from the NBCRNA came to a Missouri Association meeting well before Boston and discussed changes in recertification. I remember this was before Boston because he said there would be grandfathering and we all know that is not the case. Most of this went unnoticed until the announcement was made in Boston that CRNAs would test every 8 years to recertify.
Steve then outlined the efforts made over the past 2 years since the Boston meeting to educate AANA members about the CPC. They have given 51 presentations, sent blast emails, and communicated with the AANA. NBCRNA read over 2,000 emails, over 250 blog site questions and over 10,000 survey results. He then went on to say that the NBCRNA has learned a great deal about communication and admitted that work remained to be done in this area.
Then the talk turned to the requirements of the program. They are on the NBCRNA website (http://www.nbcrna.com/cpc/Pages/default.aspx), so I hesitate to list them all. I do want to relay what was said about a few topics of major concerns to CRNAs.
Many CRNAs want to be able to “grandfather” their credential. Here is NBCRNAs rational for not grandfathering. Those that accredit the NBCRNA oppose grandfathering. It is not considered to be a best practice. The analogy was made that you probably would not want your airline pilot to be grandfathered. It is also difficult to choose where to draw the line. If every CRNA credentialed before 2015 was grandfathered, we could have CRNAs practicing under the 1978 standard in 2050. Also, Nurse Midwives tried to grandfather everyone certified before 1996 when they created new standards. This created two standards and some states refused to recognize the credentials of those who were grandfathered until the grandfathering was phased out. It was emphasized that the NBCRNA never wants to put any CRNA in the position of not having their credential recognized.
There has also been a lot of concern about the requirements for increased numbers of CEUs, professional activities units and cost for rural and military CRNAs. There is also concern about new re-entry requirements. Steve stated that the NBCRNA is working on ways for re-certification to be cost neutral to the provider. They are also working on professional activity and assessment plans that are reasonable for rural and military practitioners. He then explained how the current re-entry system is breaking down because clinical sites will not accept non-certified providers. Therefore, a system for educating and helping the out of practice CRNAs catch up with the CPC is being developed.
Steve then explained that 13,000 CRNA comments were considered when developing the final program. The AANA also provided input. The subcommittees developing the programs came from over 80 applications and include appointments from the AANA Board. 75% of the subcommittee members are practitioners for diverse backgrounds and geographic areas. These committees are who are developing the program. All details will be worked out between now and implementation in 2016. The NBCRNA realizes 2016 is sooner than most think, but they believe it to be a reasonable deadline.
Dates of interest: the education programs start in 2016, the first CPC cycle ends in 2020, the first diagnostic test must be taken by 2024 and the pass/fail exam will start in 2032. I am an odd year certifier and will take the exam in 2033. I will be 64 years old. I will certainly be at the tail end of my career.
Questions were then entertained. Someone asked when and where the next NBCRNA meeting was and if there would be an open session. I forget when and where, but there is no open session. It was then asked why there was no open session and Dr. Vacchiano stated that the CPC is a relatively small part of NBCRNA Board meeting business and most of the meeting needs to be closed because certification and recertification testing is being discussed and that information needs to be confidential to maintain the integrity of the exams. There were several questions about grandfathering, cost and re-entry. The answers are covered in my summary of the presentation. The last question asked whether the webinar would be available for replay. It was noted that it was being recorded and that 4 more webinars would be held to further inform the members about the progress on the CPC program. The dates and times for these webinars will be posted on the NBCRNA website.
Thank you for this opportunity to share my impressions of the NBCRNA CPC informational sessions.