Important Dates for Odd Year Recertification

• Important dates if you currently recertify in odd years
  • 2015 and 2017: you will recertify with 40 CE credits over two years, practice requirement, etc., as you always have.
  • Beginning in 2017, you will participate in the CPC program (annual assessed and non-assessed activities, and self-study modules).
  • Between 2021 and 2025, you will take a recertification examination as a diagnostic/developmental tool.
  • Between 2029 and 2033, you will take a recertification examination with a requirement for passing as a criterion for recertification.

Important Dates for Even Year Recertification

• Important dates if you currently recertify in even years
  • 2014 and 2016: you will recertify with 40 CE credits over two years, practice requirement, etc., as you always have.
  • Beginning in 2016, you will participate in the CPC program (annual assessed and non-assessed activities, and self-study modules).
  • Between 2020 and 2024, you will take a recertification examination as a diagnostic/developmental tool.
  • Between 2028 and 2032, you will take a recertification examination with a requirement for passing as a criterion for recertification.  

What are the specific differences in recertification with the CPC and the current recertification process?
The specific changes enacted by the CPC program are as follows:
• Four-year recertification cycle
• Recertification examination every 8 years.

• Online competency modules (1 in each of the four core competency areas) to be completed every 4 years. Assessed continuing education credit will be awarded when these modules are completed. 
• 15 assessed continuing education credits required every year 
• Ten (10) professional activity units (developmental activities which do not require an assessment) required per year.  
• Eliminated practice hour requirements to maintain certification

How were changes to the CPC decided?
Following the introduction of the draft CPC program at the AANA Annual Meeting, NBCRNA established a CPC committee comprised of practicing CRNAs and outside consultants to collect and review CRNAs’ comments, questions and recommendations during the two-month open comment period.  The committee evaluated the feedback as well as over 60 medical and scientific resources, and considered  the expectations of NBCRNA’s accrediting bodies,  the increasing demands of the healthcare industry, and patient safety to come up with a series of recommendations.

The CPC committee assembled a panel composed of individuals identified within the profession as leaders in certification, education and practice development, to refine the committee’s list of recommendations and ideas, using a consensus-building process known as the Delphi Process. The Delphi process proved useful in further refining recommendations. In January 2012, the CPC committee presented the wealth of information collected and refined during the comment period to the NBCRNA board, along with a list of recommendations for their consideration.

Does the CPC Program grandfather any current practitioners?

The following information was sent to all nurse anesthetists and students via e-blast and letter on February 22, 2012. 

—

In this letter additional details about the Continued Professional Certification (CPC) Program are explained. The NBCRNA has been working on updating the recertification program for over four years. The existing recertification program, largely unchanged over the past forty years, served the profession well when it was conceived, but now fails to address current standards and practices for professional certification and does not reflect the maintenance of competence and lifelong learning that are the basis for other health care professionals’ recertification programs. There is an increasing expectation among key stakeholders-regulatory bodies, state boards of nursing, employers, and consumers-that members of the health care professions demonstrate their commitment to a program of continual learning and assessment throughout their professional careers.

We are fully aware of the significance of adopting new recertification requirements. The Board worked hard to address concerns expressed by long-practicing nurse anesthetists, establishing requirements that respect both their years of practice and career expectations, and considered the potential cost and demands on time. In doing so we were careful to balance those concerns with the compelling need to meet the demands of the stakeholders. Responding to the input of nurse anesthetists, we reduced the CE credit requirement, included CE credit for the competency modules, removed the challenges imposed by the practice requirement for those who need to be away from the profession for some time, extended the initiation date and delayed the implementation of a pass/fail examination. Please refer to our website www.nbcrnacpc.com for more details.

This letter outlines the requirements adopted by NBCRNA following consideration of feedback received from stakeholders. Over the next several months and years, the NBCRNA will be working to define the details of the program. We will identify opportunities to involve practicing nurse anesthetists in this process as we move forward, for it is important that we be equally vested in its lasting value. We want to thank the AANA Board of Directors and all certificants who took the time to offer thoughts and suggestions during the development of this program.

We are committed to keeping you informed as we move ahead, and look forward to sharing more information with you. Please see below for details. 

Mary Anne Krogh, PhD, CRNA

NBCRNA President

CPC Program Requirements  

Implementation:
The starting date of the Continued Professional Certification Program will be January 1, 2016.

Certification Period:
The certification period will be 4 years.

Continuing Education:  

• The continuing education requirement will be 15 assessed CE units per year.
• In addition, ten (10) professional activity units (developmental activities which do not require an assessment) will be required per year.

The assessed credits will require prior-approval, while the professional activities will be self monitored by the certificant, but subject to audit by the NBCRNA.

Competency Modules:
The CPC program will require 4 self-study modules every 4 years on subjects addressing core competencies in anesthesia (airway management techniques, applied clinical pharmacology, applied physiology and pathophysiology, and anesthesia technology). Continuing education credit will be awarded when these modules are completed.

Examination: 

• A competency examination will be phased into the program over the next 20 years. Required at 8-year intervals, the first examination will be available beginning in 2020. During an anesthetist’s first 8-year interval, the examination will be used for diagnostic and developmental purposes (a nurse anesthetist failing to meet the performance standard in any major content area will complete additional continuing education credits in that category).
• By the year 2032, all nurse anesthetists will be required to meet a passing standard on the recertification examination at 8-year intervals. Four attempts to pass the test within a 4 year recertification cycle will be allowed.

Work Requirement:
In recognition of the role of local credentialing bodies, the NBCRNA will no longer monitor practice hours as a part of the CPC program.

Re-Entry:
Criteria for re-entry to practice following lapsed certification will be established at a later date.

Dear Certified Registered Nurse Anesthetists:

As we near the end of December, we are excited to offer you a status report on the proposed Continued Professional Certification program (CPC). Since the public comment period ended we have been reviewing the feedback and suggestions we have received, analyzing the data from the NBCRNA and AANA surveys, and evaluating ideas for strengthening and improving the CPC program. As we noted in our last communication, one tool we are using to evaluate recommendations is the Delphi Process. We are completing the third round of the Delphi Process. As we expected, the Delphi tool is helping consensus form around a number of recommendations. The CPC committee spent considerable time analyzing the strengths and weaknesses of potential modifications to the original CPC proposal and incorporated a number of possible modifications in the Delphi Process as a starting point for further analysis. Participants in the Delphi Process were encouraged to draw upon the comments they had reviewed to identify recommendations they felt were most worthy and add any new suggestion they deemed appropriate. The thoughtful comments and opinions offered during the Delphi Process have contributed to a more informed perspective about the CPC program.

The CPC program is intended to establish a best practice standard to advance our patient safety mission, a responsibility all CRNAs take very seriously. We understand that it is important to consider the economic, practice, psychological, and other realities which ultimately will influence overall success. Our goal is to establish and maintain an effective recertification program while avoiding undue burden on the certificate holders. The many contributions we received from CRNAs who participated in surveys, communicated through phone calls and email, or offered thoughts during state presentations gave us valuable feedback that is informing the process as we go forward.

A number of general themes have emerged. Among others, CRNAs have weighed in on grandfathering, increasing the CE requirement, and many have opposed a high-stakes exam. The issues presented in those themes help illustrate the balance the CPC committee is seeking to apply. For example, the first round Delphi analysis provided a clear consensus that if high stakes components (such as a pass/fail exam) exist in the final CPC program, then there should be a form of “grandfathering” surrounding eligible certificants. The participants in the Delphi Process will send forward recommendations on this issue that will balance the goal of creating best practices in recertification with the concerns that have been expressed by CRNAs about testing.

Once the Delphi study has concluded, the CPC committee will write a report of the entire CPC proceeding and present the report together with its recommendations to the NBCRNA Board of Directors at the Board’s meeting in January of 2012. The recommendations will be reviewed and discussed at the meeting, and refined in accordance with the responsibilities of the Board. Please note that the AANA board has been advocating on behalf of the membership and we expect to be in close communication with them during this time to apprise them of progress on revisions to the CPC program. We do have a scheduled meeting with the AANA Board on February 22, 2012. We will continue to communicate with the CRNA community regularly as we move forward.

In closing, we thank all of you who have contributed to the proposed CPC program, and hope that everyone enjoys a warm and rewarding holiday season.

Regards,

Dear Certified Registered Nurse Anesthetists:

We’d like to bring you up to date on the current status and continuing development of the proposed Continued Professional Certification Program (CPC). The public comment period ended on November 14. We received over two thousand comments through communication by email, phone, blog and facebook, and had over 4,200 responses to our survey. In addition, we made speakers available to discuss the CPC at state association meetings, and through that process interacted with and heard the thoughts and concerns of over four thousand members of the CRNA community. We also met with the AANA Board of Directors, who shared their advice and suggestions as well as the comments they had received from AANA members both in person and through the AANA survey. The feedback we received was enormously useful, and will be instrumental in shaping the final form of the CPC program. We thank everyone who contributed to the process.

Going forward, we will allow as much time as is needed to complete the review of the feedback and suggestions, analyze the data from the NBCRNA and AANA surveys, and evaluate ideas for strengthening and improving the CPC program. As part of this review period, NBCRNA will use the Delphi Process to identify those recommendations that deserve particular consideration by NBCRNA. The Delphi Process is a structured method that groups use to eliminate bias and build consensus when evaluating new ideas. The process is conducted in a way that ensures that none of the participants is able to identify who made any particular contribution. As a result, each person’s input is considered with equal weight. Ideas are either endorsed or discarded over a series of evaluation rounds according to pre-determined percentages of participant support. The panel of participants in NBCRNA’s process will be comprised of nurse anesthetist representatives from NBCRNA, AANA board, the AANA CE Committee Chair, and members at large. The names of all participants are posted on the NBCRNA and AANA websites.

Once the Delphi study has concluded, the CPC committee will write a report of the entire CPC proceeding and present the report together with its recommendations to the NBCRNA Board of Directors at the Board’s meeting in January of 2012. The recommendations will be reviewed and discussed at the meeting, and undergo further careful consideration for successful implementation by the NBCRNA. We then will discuss our progress on the CPC program with the AANA Board of Directors during its meeting on February 22, 2012. When a final decision is made about the full details of the program, we will work diligently to prepare communication materials and methods to promote full understanding of the new program among certificate holders. The NBCRNA understands that this is a significant change, and we are committed to achieving confidence that careful consideration has been given to the program before we settle on it and roll out its details. We will be communicating with the CRNA community regularly as we move forward. The entire CPC report, which will include information about the research that was reviewed, the feedback received, and the results of the Delphi study, will be posted and available to all CRNAs and other interested parties.

We know the road all of us have traveled to get to this point has been bumpy. The AANA Board of Directors has been actively asserting the views of its members, and has discussed all of the issues involved with us in a forthright manner. Even where we do not entirely agree, we can say that the AANA BOD has effectively made its case. We appreciate the effort they have put into representing the members, and the work they do in so many areas to advocate for and advance the CRNA profession.

In closing we’d like to once again extend thanks to all of you who have contributed to the proposed CPC program. Together, we will ensure the CRNA credential continues to be recognized as the standard of excellence.

Regards,

The public comment period for the proposed Continued Professional Certification (CPC) program is now closed. Thank you to the more than 6,000 individuals who submitted feedback via the survey, CPC blog, email or phone! The NBCRNA Board and the CPC Committee are reviewing all of these suggestions and recommending program modifications based on stakeholder input. 

If an individually unsuccessfully takes the recertification exam, would that information be discoverable by an employer or state board of nursing?

No.  The NBCRNA treats all information contained in an anesthetist’s certification files, including test scores, as privileged and confidential and we do not disclose such information in response to requests and we vigorously oppose requests via subpoenas. To date, the NBCRNA has never been required to turn over such information.

Would nurse anesthetists be required to notify their employer or state board of nursing if they did not pass the exam?

It would be up to the individual anesthetist, and his or her employer, to determine whether disclosure is required.  It will depend on state laws, but an anesthetist would only have to report unsuccessful exam completion at such time as he or she actually loses certification.

Who will write the questions for the exam? If CRNAs are writing the exam questions how will they be allowed to take an exam they prepared?

If the proposed exam component is implemented, the NBCRNA will assemble a committee of nurse anesthetists representing all practice settings to write the exam questions.  The results of the recertification practice analysis (to be conducted if the exam is implemented) will create a content outline to guide writers in their item authoring and will be published for all nurse anesthetist to use in exam preparation.   There are methods organizations like ours use to deal with concerns of test preparation advantage. We will select the method most appropriate for our situation when the time comes.

Are the competency modules another exam that will take place in a standardized testing facility?

No. The proposed competency modules have not been developed but the NBCRNA does not intend them to be an exam and they will not take place in a testing facility.  Nurse anesthetists will be able to complete the modules online, from home or work. The preliminary discussion regarding the modules indicates that there will be four modules, one for each of the four core competencies.  Nurse anesthetists will need to read approximately 3 articles related to the competency and answer a few questions in response to those articles.  The modules are intended to keep nurse anesthetists abreast of current literature related to practice.

How many attempts do I have to pass the test? Is loss of licensure immediate?

The NBCRNA is proposing to allow all nurse anesthetists FOUR attempts to pass the proposed recertification exam over a four year period.  Individuals who fail the exam receive a score report designed to specifically target areas of need.  Failure of the exam does not result in immediate loss of certification. The “Continuing Competence for Nurse Anesthetists” document identifies that “passing the recertification examination on any attempt results in recertification, and failure after the fourth attempt results in the loss of certification at its expiration date.”  Therefore certification is not revoked immediately upon the fourth failure, but rather is lost on the expiration date of the current recertification cycle.

How can we be assured that the test is relevant to all types of practice?  If I am an office based anesthetist am I going to be subjected to questions that are not part of my practice and are not relevant to my practice?

The NBCRNA has identified that a recertification exam would be clinically based on the four core competencies that all nurse anesthetists share.  In the development of the proposed program, the Recertification Task Force identified, based on a survey of practice, that all nurse anesthetists, despite any specialty or practice setting shared the same four skills: airway management, anesthesia technology, pharmacology, and pathophysiology. The recertification exam will consist of clinical applications of these competencies. In this sense, questions will be relevant to all nurse anesthetists. It would be contrary to the intent of a recertification examination to include specialty practice content which is not germane to every practitioner.

Interested in learning more about the proposed Continued Professional Certification (CPC) Program and the shift to continuing competency?

Introducing the NBCRNA YouTube Channel! The NBCRNA has posted videos on YouTube so that nurse anesthetists who are unable to attend state association meetings or who wish to learn more about the CPC may watch the presentation at any time. In addition to the CPC presentation, three NBCRNA Board Directors answer the most frequently asked questions in the CPC Common Questions video. Click the link below to visit the NBCRNA YouTube Channel. 

http://www.youtube.com/user/TheNBCRNA?feature=mhee

The Role of the Anesthesiologist on the NBCRNA Board of Directors - From the Anesthesiologist’s Perspective

By Michael O’Connor, DO, MPH - NBCRNA Board Director

Assuming the anesthesiologist meets the NBCRNA criteria of an “ideal board member” (commitment, integrity, professionalism, accountability, positive attitude, moral courage…), anesthesiologists should add value by virtue of our experience working with CRNAs either in an academic or private practice setting. We should also provide a vision of anesthesiology in the larger world of medicine, and, in particular, in the unsettled arena of health care reform and how it impacts the CRNA practice. Finally, because of our own professional commitment to life-long learning and professional development, we should provide a valuable voice that furthers the mission of the NBCRNA in certification and recertification and brings an awareness of other professional certifying organizations, like the ABA. 

These are the professional values that an anesthesiologist should provide to the NBCRNA at a minimum. There are personal and practical characteristics as well that define the ideal anesthesiologist board member that mostly center around engagement, teamwork, communication, and leadership skills. On a great day, I would hope that experiences like serving as a CRNA champion, working with CRNAs first in the military and now at the Cleveland Clinic, and as a department chair leading change and adapting our team model of practice to the exigencies of health care reform and changing reimbursement models would also add value to the NBCRNA. 

One question/concern often expressed about the CPC exam is the suggestion that we will give the first exam and inadvertently “fail out” half of the profession.  This concern is answered in part by looking at how passing standards are established for credentialing examinations.  The NBCRNA will be following industry-standard, best practices for establishing the passing standard (pass/fail point) on the CPC examination, just as it does for the initial National Certification Examination.  The passing standard on the CPC exam will not be a simple percentage of questions answered correctly, nor will it be set to pre-determine a specific pass rate (as in the case of setting the passing standard so that 70% of the people pass).   Rather, the passing standard  will reflect a meaningful level of proficiency that all competent individuals should be able to attain.  Please see the tumblr thread on Standard Setting for Examinations, for a more in depth discussion of this topic. 

Also, another “best practice” which will be followed for the CPC exam is the use of Item Response Theory (IRT), a probabilistic framework for the design, analysis, and scoring of tests.  When applied to testing data, IRT scales examinees (proficiency) and test questions (difficulty) in such a way that allows us to understand of how these will function in the future.  IRT allows the test developer to create a test which is appropriately targeted to the abilities of the examinee population.  IRT analysis of pilot (or “beta”) administrations of a potential CPC examination would render useful performance data and statistical information, enabling the NBCRNA to make informed, reasonable decisions about the appropriateness of test questions, test specifications, and the passing standard for the examination.