Setting Sail for Credentialing

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Setting Sail for Credentialing

• Karen Zaglaniczny PhD, CRNA, FAAN

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Objectives

• Review the results of the Council on
  Recertification of Nurse Anesthetists Needs
  Assessment on credentialing.
• Discuss the implications of the Council on
  Recertification of Nurse Anesthetists Needs
  Assessment .
• Describe the COR recommendations in response to
  the survey.

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Overview

• Planning the trip
• Needs Assessment
• Setting Sail

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Historical Background

• 1967 and 1968
• BOD continued professional excellence
• AANA Annual Meeting in 1969
• Bylaw adopted to provide certificates
• Mandatory CE program adopted at the 1976 Annual
  Meeting,
• full implementation effective August 1, 1978
• April 1978
• Ad Hoc Committee on Recertification

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Recent Events

• 2001 - 2004
• COR respond to recommendations
• AANA BOD Ad Hoc Committee on Continuing Education
  and Recertification
• AANA BOD Continuing Education/Recertification
  Task Force
• Recommended consideration and implementation of
  short and long-term changes to the CE program and
  to the recertification process.

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Current Events

• Restructuring the CE program, including a change
  in the number of required credits and the
  creation of categories of credit
• Requiring testing every 6-10 years as a condition
  of recertification
• Establish a program of continuous professional
  development (CPD)

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Current Events

• Possibly perceived by state BON, third party
  providers, and others as lowering the quality of
  the nurse anesthetist recertification credential.
• Support
• Keep CE content tied to the AANA Scope and
  Standards of Nurse Anesthesia Practice.
• Maintaining the minimum number of Core Content CE
  credits at no less than 40
• Survey
• Obtain input from CRNAs about their need/desire
  for a continuous professional development plan
• Opinion regarding the Task Force recommendations
  for changes in the continuing education
  requirements and retesting for recertification.

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Trends in Credentialing and Literature Review

• Debate and controversy exists as to the best
  method to measure continued competence
• Assess continued competence
• provider has kept up with new advances,
  knowledge, and procedures in the area of
  specialty practice
• how to document that the individual is a safe
  practitioner

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Trends in Credentialing and Literature Review

• Current methods
• testing, continuing education, job evaluations,
  completion of case reviews and portfolios
• Each method has advantages and disadvantages
• CE is the most widely used method for competency
  assessment in the nursing profession.

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Trends CE

• Requirements for contact hours for nursing
  licensure vary from state to state
• Currently, 32 states require CE credit
• Advantages of mandatory CE credit
• Job Evaluations
• Determine whether a provider is meeting the
  standard of performance for their specialty and
  institution.
• Used for documentation of skills, abilities and
  knowledge required for the specific job category

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Trends

• Case Review
• Determine how a provider responds to an actual or
  scripted case scenario.
• Formats involve written, simulated or discussion
  groups.
• Advantages Challenges
• Portfolios
• Collection of documents for the specialty
  practice area, career developments and a record
  of accomplishments.
• CE sessions, reading materials, case records and
  performance evaluations.

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Retesting

• Requires a significant investment of time and
  resources to assure fairness, validity,
  reliability and psychometric precision
• The exam must take into consideration
• a variety of practice settings,
• discriminate competent providers,
• legally defensible
• Disadvantages
• cost and time required for development study
• potential for loss of employment.

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Methods

• Purpose Seek input from CRNAs
• number of required CE credits, possibility of
  retesting, demonstration of clinical competency
• demographic information
• 10 questions about the current and potential
  changes in the recertification process
• 8 questions related to the demographic
  information.

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Methods

• Validity and reliability of the survey
• Pilot assessment by the members of the Council
  and Continuing Education committee
• Distribution 29,000 CRNAs
• Response
• 15,791 for a 54.5 return rate
• Continued submission
• 8,145 comments

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Results Age

•    

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Results Gender
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Results Years in Practice

•    

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Results Level of Education

•    

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Results Area of Work Responsibility

•     Clinical practice 89.8 96.5

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Results Employment Setting

•    Hospital 83.7 82.7

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Results Type of Practice

•    

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Number of credits summary of comments

• Do you consider that 40 CEUs is an adequate
  number to achieve every two years for a CRNAs
  recertification?
• 93.8 forty credits is adequate
• 81 not support an increase in the number of CEUs
  required every two years
• Yes (n2770)
• 52 suggested 41 50
• 34 suggested 51 60
• 61 100 hours

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Number of Credits

• Comments (n1617)
• Financial and time constraints
• State nursing requirements gt 40 credits
• Each CRNA is responsible to maintain their
  educational requirements based on type of
  practice and need.
• CRNAs do not need credit for every class attended
  
• Quality of CE credits is more important than the
  quantity

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Number of Credits

• Concerns about people cheating on written CE
  credits
• Regulate type of CE credits required
• Consider credit for ACLS, PALS, NALS
• Inability to get time off for rural solo
  providers
• Consider moneymaking venture for CE companies

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Number of Credits Comments

• Many states require more than AANA COR
• Many CRNAs choose to obtain gt 40, let 40 be the
  minimum for all so you dont overburden all
• Number is not as important as the actual learning
  
• Consider working everyday CE, how many points do
  I get for going to work giving a safe
  anesthetic?
• No specific number can replace continuous self
  education

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Content Categories

• Should the COR allow content categories (Core
  and Ancillary) of credits for recertification?
• 58 replied no and 40 replied yes
• If the COR adopted two content categories for
  recertification, what should be the required
  distribution of credits for the 2-year
  recertification period?
• For the core, 39 responded 40 credits
• 0.6 3.8 responded 50 100 credits
• 47.2 did not respond

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Content Categories

• For the ancillary
• 22 responded forty credits
• 0.4 11 responded 5 25 credits
• 54.6 did not respond
• For the core plus the ancillary
• 50.4 responded forty credits
• 0.1 11.6 responded 45 100 credits
• 29.5 did not respond
• 2,486 comments
• CRNAs could obtain additional knowledge in
  ancillary areas but these were not essential to
  clinical practice

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Retesting Grandfathering

• In response to the question Should the COR
  require mandatory retesting for recertification?
  
• 94 replied that no testing should be required
• For those who responded yes (n774)
• 38 every five years and 32 every ten years
• If retesting were to be required
• 85 agreed that the COR should allow
  Grandfathering of currently recertified CRNAs
  and NOT require that group to mandatory retest
  for recertification.

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Clinical Competency Skill Assessment

• In response to the question Should the COR
  require some type of documentation of clinical
  competency from your employer for
  recertification?
• 74 replied that no documentation of clinical
  competency should be mandated
• The comments reflected consensus that CRNAs
  demonstrate clinical competency in their
  everyday. practice and oversight is not needed by
  the COR.

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Clinical Competency Skill Assessment

• In response to the questions Should the COR
  require skill assessment, e.g. airway management,
  on a patient simulator for recertification? and
  Should the COR require demonstration of clinical
  competency, i.e. completion of cases on a patient
  simulator?
• 91 and 90 replied not needed because it is
  demonstrated in daily nurse anesthesia practice.

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Comments

• n4042
• The major themes of the comments included
• Keep the recertification process as is.
• Challenge to get time off.
• Increase cost of educational activities makes
  increased number of CE credit unaffordable.
• There is a lack of access to simulators in rural
  areas
• Use the same credentialing process as the
  physicians
• Full-time clinical practice shows competency and
  good evaluations from peers/employers are more
  important and should suffice
• Want more online educational activities that can
  be performed at home.
• If it isnt broke dont fix it

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COR Recommendations

• Majority of nurse anesthetists prefer to maintain
  the current recertification requirements.
• 40 CE credits is adequate
• No mandatory retesting
• No documentation of clinical competency and
  skills assessments as modes of evaluation for
  recertification.
• Challenges exist in accurately determining how to
  measure clinical competency with the tremendous
  variation in our practices.
• The Council will continue to assess and monitor
  trends regarding credentialing methods to most
  appropriately document current recertification
  practices

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Continuing on the Pathway

• Challenges
• Competition with other providers
• AA CE retest 6 years (CDQ)
• MD MOCA
• Maintenance of Certification In Anesthesiology
• 10 year process
• Depends on initial certification
• Professional Standing license
• Practice Performance references
• Lifelong Learning Assessment 350 CME
• Cognitive Examination Year 7

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Sailing On