Implementa*on of a Con*nued Professional Cer*fica*on Program (CPC) for Nurse Anesthe*sts January 29, 2014 Ed Waters DNP, CRNA Karen Plaus PhD, CRNA FAAN
Overview Evolu*on of creden*aling of Nurse Anesthe*sts The need for change in recer*fica*on Con*nued Professional Cer*fica*on (CPC) Program background CPC Program requirements and current developmental status Lesson Learned NSPM Specialty Creden*aling
NBCRNA Our Mission To promote pa*ent safety through creden*aling programs that support lifelong learning Our Vision To be recognized as the leader in advanced prac*ce nurse creden*aling
Where we have been
The Road to Creden*aling of Nurse Anesthe*sts AANA President Gertrude Fife 1933 address on The Future of the Nurse Anesthe*st Ini*ated na*onal qualifying cer*fica*on exam in 1945 Cer*ficates of professional excellence were awarded to AANA members at 5- year intervals in 1969 The Council for Cer*fica*on was established in 1975 Con*nuing Educa*on became a requirement for recer*fica*on in 1976 The Council for Recer*fica*on was established in 1978
Why change the recer*fica*on process now?
Even if you re on the right track, you ll get run over if you just sit there. Will Rogers
Opportuni*es to Improve the Recer*fica*on Process Accredita*on requirements Stakeholders Not best use of available learning modali*es Parity with other professions
How have similar professions advanced to incorporate con*nued competence?
Comparison with Anesthesia Providers Component Nurse Anesthetist Anesthesiology Anesthesiologist Assistant Frequency 2 years 2 years 10 years Licensure RN and/or APRN No Medical Doctor CE 20 hours/year 20 hours/year 35 hours/year Examination None Recertification examination every 6 years Recertification examination (year 7-10) Practice 850 hours No Yes with case evaluation and simulation
Comparison with APN Component Nurse Anesthetist Certified Nurse Midwife Nurse Practitioner (AANP) Nurse Practitioner (ANCC) Frequency 2 years 5 years 5 years 5 years CE 40 hours 20 hours and 3 self- learning modules 75 hours 75-150 hours (depending on other professional development activities) Examination No Proposed in 5 years: Performance in Practice and Standard Cognitive Assessment Optional: Computer based exam or CE + practice Recertification exam may be taken in lieu of clinical practice requirement Practice 850 hours No 1000 hours 1000 hours
Changes in Healthcare Creden*aling IOM Report The Future of Nursing: Leading Change, Advancing Health Increased demand for healthcare Expanded role for advanced prac*ce nurses AARP and RWJF Ini*a*ve The Future of Nursing: Campaign for Ac*on Nurses cri*cal to the effort to remake health care system Pursuing greater opportuni*es for nurses Urging nurses receive more educa*on and be held to high standards to ensure pa*ent safety AARP urging states to expand beyond CE to include periodic assessment of condnuing competency as a condidon of license renewal
Consumer Expecta*ons 90% believe it is important for healthcare professionals to be periodically re- evaluated 84% believe healthcare professionals should be evaluated on their qualifica*ons 78% believe healthcare professionals should be required to pass a wriden test of medical knowledge at least every five years Source: Ci+zen Advocacy Center, 2007
NBCRNA Sponsored Harris Poll Collaborated with Ci*zen Advocacy Center (CAC) May 2013 Understand the public s perspec*ve about creden*aling standards required of their healthcare providers Results iden*fied the public s perspec*ve is aligned with many of the best prac*ces in cer*fica*on and recer*fica*on Supports the key elements of the CPC program
Findings 91% think it s important for clinicians to pass periodic examina*ons 74% think healthcare providers should not be excused from lifelong learning regardless of years of prac*ce 89% think health care providers should adend educa*onal programs throughout their career The majority of respondents disagree with the concept of grandfathering
Changes in Healthcare Creden*aling Ini*al cer*fica*on is only a start Knowledge at one point in *me is no longer enough (robust con*nuing educa*on is essen*al) Mastering competency through evidence- based learning Professional growth and development must be lifelong and integrated into prac*ce
Shig to a Con*nuing Competency Model An ongoing, dynamic process Focused on evolving knowledge, skills and technologies Con*nuous educa*on, mastery and assessment throughout your career Allows for quick response to changing trends in the healthcare landscape
Evidence Suppor*ng Change Physician cer*fica*on processes that include tes*ng are significantly correlated with superior pa*ent outcomes Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty Board cer@fica@on and clinical outcomes: the missing link. Academic Medicine 2002: 77(6) 534-542. Self- assessment of performance correlates poorly with a provider s actual competence Kruger J, Dunning D. Unskilled and unaware of it: how difficul@es in recognizing one s own incompetence lead to inflated self- assessment. Journal of Personality and Social Psychology. 1999; 77(6) 1121-1134.
Evidence Suppor*ng Change Health care agencies should not rely solely on con*nuing educa*on to maintain competency Swankin D, LeBuhn RA, Morrison R. Implemen@ng con@nuing competency requirements for health care prac@@oners. AARP Public Policy Ins@tute, 2006, Washington DC. Periodic demonstra*on of knowledge, skills and judgment are cri*cal to public safety Ins@tute of Medicine Crossing the Quality Chasm: A New Health Care System for the 21 st Century. Washington DC: Na@onal Academy Press. 2001.
Evidence Suppor*ng Change Increased formal educa*on and training leads to improved test scores Brennan TA, et al. The role of physician specialty board cer@fica@on status in the quality movement. JAMA, 2004; 292(9):1038-1043. All health care provider organiza*ons should have periodic provider recer*fica*on with measurable demonstra*on of con*nuing competency. Tes*ng is one method of a measurable assessment of knowledge. Kan N, Burkhalter B, Cooper M. Measuring the competence of health care providers. Opera@ons research issue paper, Vol 2 Bethesda MD. US Agency for Interna@onal Development (USAID) by the Quality Assurance Project (QA), 2001.
The Con*nued Professional Cer*fica*on (CPC) Program Developing a new standard for ongoing cer@fica@on of nurse anesthe@sts
Background of the CPC Program 3 year study of con*nuing competency models Included benchmarking study of 331 con*nuing competency programs Focus groups at na*onal mee*ngs Students, prac**oners, educators, na*onal and state leaders Recer*fica*on Prac*ce Analysis Recer*fica*on Task Force Included nurse anesthesia prac**oners and educators Evidenced based review of creden*aling literature
Informa*on Sharing Over a 2 year period prior to the announcement of the CPC Program in 2011, the NBCRNA BOD members have provided informa*on at a variety of mee*ngs about upcoming changes to the recer*fica*on program Na*onal mee*ngs State mee*ngs 30 state mee*ngs Over 2,000 nurse anesthe*sts in adendance
Informa*on Sharing 51 state presenta*ons since August 2011 E- blasts Regular communica*ons with AANA Voices were heard: 920 emails 4,200 survey results 280 blog site ques*ons 6,631 AANA survey results 1,249 emails forwarded from AANA
CPC Program Requirements
CPC Program Overview Con*nuing Educa*on Credits Assessed (post- test) Credits per year Professional Ac*vity Units Professional Ac*vity Units (non- assessed professional developmental ac*vi*es that offer a wider range of flexibility) Self- Study Modules Self- study modules on the four core competencies CPC Examina*on Assess progress in life long learning
CPC Program Requirements Begins January 1, 2016 Recer*fica*on cycle is every 4 years Progress audit every two years with a reminder leeer sent to individuals not comple@ng at least half of the required components Con*nuing Educa*on Credits 15 Assessed (post- test) Credits per year Professional Ac*vity Units 10 Professional Ac@vity Units (non- assessed professional developmental ac@vi@es that offer a wider range of flexibility) per year Non- assessed units are self monitored by the cer@ficant, but audited by the NBCRNA as necessary
CPC Program Requirements Self- Study Modules Self- study modules on the four core competencies to be completed every 4 years Work Requirement In recogni@on of the role of local creden@aling bodies, the NBCRNA will no longer monitor prac@ce hours as a part of the CPC program.
Recer*fica*on Examina*on Exam every 8 years (every other recer*fica*on cycle) For individuals cer*fied before January 1, 2024 the first exam would be for diagnos*c purposes only The diagnos*c exam will require extra CE (above the normal CE requirement) for failure to meet pre- established standards in any content area By 2032 a pass/fail examina*on will be a mandatory part of the program An individual will have four opportuni*es to pass the examina*on within a recer*fica*on cycle CPC
Recer@fica@on Examina@on Content Areas Airway management Applied clinical pharmacology Human physiology and pathophysiology Anesthesia technology Test Specifica@ons 150 items MC and alterna@ve items Clinical Scenarios
What About Grandfathering? Our accreditors oppose grandfathering If cer*fica*on standards are established to indicate competence, then all nurse anesthe*sts should be included We heard the interest in grandfathering and sought other ways to approach the concerns Extend phase- in period and allow natural adri*on to exempt experienced prac**oners
More about Grandfathering The Tale of the Nurse Midwives Grandfathered all Nurse Midwives who graduated prior to 1996 In 2008, Boards of Nursing in some states stopped recognizing the cer*fica*on of the grandfathered midwives In response, the American Midwifery Cer*fica*on Board (AMCB) began incorpora*ng the grandfathered midwives into their con*nuing competency program in 2009 Barger, M., Camune, B., Graves, B., & Lamberto, J. (2009). The past, present, and future of assessing con@nuing competency for midwives. Journal of Midwifery and Women s Health, 54(5), 338-340.
More about Grandfathering It is possible that grandfathering could be a decep*ve prac*ce. It creates an appearance of greater homogeneity within cer*fied ranks than in fact exists, and possibly induces the consumer to underes*mate the differences between those who have completed the cer*fica*on requirements and those who were merely grandfathered. Havighurst, Clark C. (1986). The Changing Locus of Decision Making in the Health Care Sector. Journal of Health Poli@cs, Policy and Law, 1986 Volume 11, Number 4: 697-735.
Cons*tuent Feedback Public Comment Period was held to further develop the CPC Program The NBCRNA reviewed and considered over 13,000 comments received from engaged nurse anesthe*sts in the development of the final program We solicited volunteers to assist in the development of the program details
What is the current status of the Con*nued Professional Cer*fica*on Program?
What is the Current Status of CPC Program? Subcommidees formed and developing policies and procedures Informa*on updates posted on NBCRNA website Hosted Webinars October November 2013 Mailing of CPC brochure to candidates when they pass the NCE and recer*fy
CPC Program Review CPC Subcommidees formed in October of 2012 Four subcommidees with 5 CRNAs on each commidee Members selected from over 80 applica*ons Charged with evalua*ng all aspects of the CPC Program Ways to minimize cost of the program to cer*ficants Iden*fy and suggest integra*on methods for common issues between components
CPC Repor*ng Structure Subcommidee structure was designed to maximize open discussion among CRNAs on the subcommidees Conference calls were held by each subcommidee about every two weeks The CPC Commidee composed of the subcommidee chairs meet once per month to coordinate ac*vi*es The CPC Commidee reports periodically to the NBCRNA and AANA BOD, as well as the AANA membership and other stakeholders through NBCRNA.com and e- blasts
Timetable CPC program details finalized by the end of 2014 PAU, CE, and Module programs start in 2016 The first CPC Program cycle will end in 2020 The first CPC Test for diagnos*c purposes must be taken by 2024 The first pass/fail exam will start in 2032
Reentry and Audit Subcommidee Iden*fied reasons for loss of cer*fica*on Reviewing op*ons for regaining cer*fica*on Program should be reasonable, straighlorward, and balanced Considering a mul*step program CPC Program catch- up Simula*on evalua*on Clinical component
Timelines
NSPM Specialty Creden*aling
NSPM Creden*aling Overview Voluntary Specialty Cer*fica*on Eligibility Requirements CE Prac*ce Timeline for Implementa*on NSPM Examina*on PPA and Test Blueprint
NSPM Content Outline Content Areas Physiology and Pathophysiology of Pain Imaging Safety Assessment / diagnosis / integra@on / referral Pharmacological treatment Interven@onal pain strategies Professional Aspects Test Specifica@ons 150 items MC and alterna@ve items Clinical Scenarios
Test Delivery Inves@ga@ng opportuni@es Test Center Online Proctored Considera@ons Test security Exposure of test items Cost for organiza@on and cer@ficants Meet accredita@on standards
OUTCOMES AND MEASUREMENT OF COMPETENCY
Considera@ons What does the literature tell us Models in other countries (Canada & Europe) Physician outcomes based on protocols What can be measured and how Challenges Numbers of CRNAs involved Variety of prac@ces Reimbursement and billing prac@ce
NSPM Creden@aling Documenta@on of care Types and number of procedures Return to Ac@vi@es of Daily Living Complica@ons Put in examples
Approach Network and collabora@on Specialty nursing creden@aling organiza@ons NCSBN regulatory agencies Value of cer@fica@on
Avenues for Communica@on Avenues for Communica*on
Lessons Learned Communica*ons Pa*ent Safety Focus Creden*aling Mission and Vision
Where to Find More Informa*on NBCRNA Communica*ons Newsleder, Website, Facebook, Twider Keep current with news and announcements Website www.nbcrna.com Links to further informa*on about the developing CPC Program
Ques*ons / Comments