As we get closer to the AACN (2015) and AANA (2025) deadlines of implementing a doctoral program of nurse anesthesia, many issues still remain. Kathleen A. Fagerlund, CRNA, PhD; and Michael D. Fallacaro, CRNA, DNS, offered their take on the “Movement to Doctoral Education – Challenges and Opportunities.”
Fagerlund and Fallacaro’s presentation kicked off the Assembly of School Faculty, held on Saturday. Fagerlund reviewed the process of incorporating the doctorate into current nurse anesthesia programs. By 2015, no new nurse anesthesia programs will be approved unless they offer a doctorate. By January 1, 2022, all programs must offer a doctorate. And by 2025, all nurse anesthesia graduates entering practice must have a doctorate.
Fagerlund continued her presentation with the challenges and the opportunities involved in moving to a doctoral program – from the student, nurse anesthesia administrative faculty, didactic faculty, clinical faculty and the university points of view. Among the student concerns are paying more tuition, spending more time in a program, having to spend more time away from the work force (in this case three years), and weighing cost benefit analyses. Challenges for nurse anesthesia faculty include having to share their students with other specialties; faculty of the nurse anesthesia programs would no longer control their students’ time. Opportunities, on the other hand, include being able to have their students interact with other specialties, having the faculty act as role models, and the fact that doctoral projects can help anesthesia departments.
Michael Fallacaro, CRNA, DNS, spoke about justifying a doctoral program at Virginia Commonwealth University. Virginia Commonwealth was facing an increase in student demand for a doctoral program. Fallacaro says students are using lack of a doctoral program as a method to filter out prospective programs.
Fallacaro emphasized that a Doctorate of Nurse Anesthesia Practice (DNAP) is nurse anesthesia specific. It is not a nursing degree, but specifically for nurse anesthetists. He also advocated for calling nurse anesthesia a specialty of nursing rather than the “nurse anesthesia profession.”
Clinical Site Sharing
Bette M. Wildgust, CRNA, MS, MSN, spoke about the challenges of sharing clinical sites. In a heavily populated area, there can be many nurse anesthesia and medical programs. Wildgust spoke about the Philadelphia area, where there are seven nurse anesthesia educational programs and four anesthesia residencies in a 20-mile radius. Some of the area clinical sites host as many as six programs with 17 to 20 students assigned to a clinical site per day. Some sites (particularly pediatric hospitals) have both nurse anesthesia students and anesthesia residents.
Advantages to sharing clinical sites include student socialization, a strengthened learning environment, and a good mix of students. Wildgust said that some of the major issues the Philadelphia program administrators face in sharing clinical sites include clinical and class schedules that vary, separate and distinct academic calendars, challenges in scheduling specialty rotations, the inevitable comparison of one program’s students with another’s, competition for cases, the use of multiple evaluation tools, and clinical CRNA faculty burnout. Coordination among the seven program administrators is imperative.
New Centralized Application Process Put into Place
Rebecca L. Gombkoto, CRNA, DNP, spoke about the new NursingCAS, which the American Association of Colleges of Nursing (AACN) launched earlier this year. The new service is the first national, centralized application service for students applying to registered nursing programs.
Using NursingCAS, prospective nursing students complete one electronic application and prepare one set of corresponding materials, which then is disseminated online to designated schools of nursing for their consideration. In Phase I of NursingCAS, students can use the service to apply to undergraduate RN programs.
Phase II is planned for release in Fall 2010. In Phase II, students can use the NursingCAS to apply to master’s and doctoral degree nursing programs. One potential concern of the NursingCAS is that it encourages applicants interested in nurse anesthesia to apply to programs housed in schools of nursing versus programs outside of nursing.
Teaching Rules and Reimbursement
AANA President James Walker, CRNA, DNP, and Ann Walker-Jenkins from the AANA Washington, D.C. office, spoke about the importance for student/resident nurse anesthetists to understand how anesthesia services are reimbursed.
In 2010, the Centers for Medicare & Medicaid Services (CMS) implemented changes in the Medicare reimbursement for teaching anesthesiologists and teaching CRNAs, which will potentially affect nurse anesthesia educational programs. Walker and Walker-Jenkins developed a resource list and an assignment to illustrate one way of accomplishing the goal of teaching students about reimbursement.
The assignment requires students to identify the correct Code for Procedural Terminology (CPT), number of base units, and calculate the number of time units for each procedure. The student then applies the correct conversion factor to determine the total amount that will be billed for each case.
The resource list includes links to several Codes of Federal Regulations, a revised CMS-1500 form, a Medicare Claims Processing Manual, and the Anesthesiologists Center on the CMS website.