• Featured News

  • NBCRNA Releases New Info on Recertification


    NBCRNA CPC Program Frequently Asked Questions

    Introduction

    At the 2011 AANA Annual Meeting, NBCRNA introduced the Continued Professional Certification (CPC) Program, a new program to replace the current recertification requirements for certified registered nurse anesthetists. The CPC Program addresses evolving expectations among patients and employers as well as changes in the science and practice of anesthesia. Underlying the program is a fundamental emphasis on continuous growth and professional development throughout a nurse anesthetist’s career via lifelong learning and periodic credentialing.

    The proposed CPC Program requirements would take effect on January 1, 2015. NBCRNA developed these Frequently Asked Questions (FAQs) to provide information for changing the credentialing program, understanding the new program’s requirements and preparing for the transition to the CPC Program. The FAQs have been compiled based on feedback and inquiries from certified registered nurse anesthetists.

    What You Really Want To Know

    CPC Program Development: The Who, What and Why
    CPC Program Components
    CPC Program Benefits
    Moving Forward: The Transition Process
    Other Questions
    NBCRNA CPC Program Frequently Asked Questions

    What You Really Want To Know

    1. Why are my professional certification requirements changing?

    Like most healthcare professions today, nurse anesthesia practice faces a continuous process of new findings in clinical research, pharmacology, technology and evidence-based practice. The knowledge you acquire for your initial licensure provides only a baseline. It takes continuous learning throughout your career to develop mastery and achieve high standards for performance. This demands an ongoing and evolving certification program to ensure that your practice keeps pace with the changing standards for the profession. And that’s why the new CPC Program has been developed—to validate that your knowledge and practice adhere to professional standards throughout your career.

    2. Don’t I achieve this goal with continuing education credits?

    No. The simple accrual of continuing education credits does not necessarily demonstrate an ability to apply information. With continuing education, you may have learned new knowledge, but the real question is whether or not you can apply it effectively in each individual patient situation. This broader level of mastery is called continuing competence.

    3. Why now?

    There are three primary reasons for making a change in certification for nurse anesthetists now:

    1) The current program does not reflect recent changes in environmental trends, social mores, consumer (patient) values and evidence-based best practices – all key components in the development of professional standards.

    2) Consumers and employers expect these changes to be addressed. In fact, attitudinal research from the Citizen Advocacy Center (CAC) shows that consumers believe healthcare professionals should be required to show up-to-date knowledge and have their qualifications evaluated periodically as a condition of re-licensure. Consumers also believe that professionals should be required to pass a written test of medical knowledge at least every five years.

    3) Credentialing of healthcare professionals has changed dramatically in recent years. Work done by the Institute of Medicine and research from a wide array of nursing and healthcare credentialing organizations, such as the Institute for Credentialing Excellence, support the shift from continuing education to continuing competence and lifelong learning and assessment.

    4. Will the National Certification Examination (NCE) be used for recertification examination?
    No. The NCE is a separate examination whose purpose is to certify entry-level nurse anesthetists. The CPC Program will use a specially-developed recertification examination to test ongoing competence throughout a nurse anesthetist’s career.

    NBCRNA CPC Program Frequently Asked Questions

    5. When do I need to take the test?

    There are 12 years between now and the when the first deadline to pass the recertification examination must be met.

    6. What is this going to cost me?

    A fee structure for the CPC Program has not yet been determined by the NBCRNA Board of Directors. However, it is important to understand that NBCRNA is a not-for-profit organization that does not produce credentialing programs for the purpose of raising revenues. While there will be some cost for continuing education and the examination, these fees are expected be competitive with other advanced nursing credentialing programs. NBCRNA will work carefully to keep costs at a minimum.

    7. What are the CPC Program’s requirements and parameters?

     You must hold current and valid licensure by a state board of nursing.
     You must have completed initial certification as a Certified Registered Nurse Anesthetist.
     Beginning in 2015, the certification period is every four years.
     There are four self-study modules which address four core competencies, which you must complete during each recertification cycle. These four core competencies are: airway management techniques, applied clinical pharmacology, human physiology and pathophysiology and anesthesia technology.
     You are required to complete 35 continuing education credits per year. At least 15 of these credits each year must be earned with educational activities that include end-of-activity assessments of learning. Opportunities to earn credits for professional activities other than traditional lectures will also be expanded.
     You must provide documentation that you have completed at least 425 hours per year in nurse anesthesia work practice, including clinical, administrative, educational and research related efforts.
     You must pass a recertification examination once every other certification cycle (once every 8 years). The first recertification examination will be administered in January 2019.

    8. I haven’t taken an exam like this for years. Will it be hard for me to pass the examination?

    The recertification examination is designed to test real-world knowledge of nurse anesthesia practice particularly related to the four core competency modules (airway management techniques, applied clinical pharmacology, human physiology and pathophysiology and anesthesia technology). It is not intended to be burdensome, but simply to reflect the kind of knowledge and skills that certified registered nurse anesthetists use in day-to-day practice and in every practice setting. Additionally, NBCRNA will publish a detailed outline of the test to help certified registered nurse anesthetists with test preparation.

    NBCRNA CPC Program Frequently Asked Questions

    9. Will NBCRNA grandfather current Certified Registered Nurse Anesthetists into the program?

    No. All nurse anesthetists must comply with the CPC Program requirements. This decision was made in order to protect the public, avoid establishing two tiers of providers and comply with external accreditation standards. The NBCRNA does not support credentialing requirements that are different based on initial certification date or years of experience. Fairness and equity for all constituents is required to ensure compliance with external accreditation standards.

    How might grandfathering pose a problem? Here’s an example: two nurse anesthetists are applying for the same job. One has met the CPC Program requirements and the other has not. How will an employer determine which individual is more competent and prepared? What standard can the employer use to distinguish between the two candidates? Would employers give preference to the CRNA who has satisfied the CPC Program requirements? To avoid this type of confusion in the marketplace, there will be no grandfathering into the new CPC Program.

    10. Do I get an opportunity to express my viewpoint about the new CPC Program?

    Yes, you do. NBCRNA will hold a Public Comment Period from September 6, 2011 through November 14, 2011. During this period, you are encouraged to complete a survey accessible at www.nbcrnacpc.com to give us your feedback as well as send us your comments about the program. You can also direct any questions you may have about the program to us any time at recertification@nbcrna.com. Your feedback will be used to refine program parameters prior to final approval by the NBCRNA Board of Directors.

    CPC Program Development: The Who, What and Why

    1. Who is the NBCRNA?

    The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is a not-for-profit organization whose mission is ―to promote patient health and safety through credentialing programs that support lifelong learning.‖ The NBCRNA is responsible for the credentialing (certification and recertification) of nurse anesthetists. As an independent body, the NBCRNA must be responsive to the needs of a wide variety of interested parties (stakeholders), including certificants, regulatory bodies, state boards of nursing, employers and consumers.

    2. What is the relationship between the NBCRNA and the AANA?

    NBCRNA is an independent and autonomous organization responsible solely for credentialing nurse anesthetists. AANA is a completely separate membership association for nurse anesthetists. AANA recognizes NBCRNA as the profession’s credentialing agency. It also supplies educational programming and resources authorized by NBCRNA that nurse anesthetists can use to for continuing education credits.

    NBCRNA CPC Program Frequently Asked Questions

    3. What are current trends in healthcare credentialing?

    Several significant concepts related to health care credentialing have emerged in recent years:

     Initial certification is only ―the first step‖ for entry into a profession.
     Demonstrating an acceptable level of knowledge at only one point in time is no longer enough; instead, there must be ongoing learning and assessment throughout your professional career.
     Competence implies a level of knowledge that includes good clinical judgment and is derived from evidence-based learning.
     Professional growth and development must be lifelong and integrated into practice.

    4. What is continuing competency?

    Continuing Competency focuses on the evolving knowledge, skills and technologies related to one’s profession. It includes continuous education, mastery and assessment throughout your career and allows for quick responses to changing trends in the healthcare landscape.

    5. Why make the shift to continuing competency for Certified Registered Nurse Anesthetists?

    The NBCRNA is establishing the CPC Program to support the lifelong professional growth and development of nurse anesthetists. Many credentialing organizations and other advanced practice nursing professions have made similar changes. In fact, 73% of American Board of Nursing Specialties organizations now require testing for recertification. Additionally, our physician peers in anesthesiology have implemented a Maintenance of Certification (MOC) program and anesthesia assistants require recertification that includes testing every six years.

    6. What do consumers expect regarding professional credentialing?

    In 2007, the Citizen Advocacy Center (CAC), a nonprofit organization that serves the public interest by enhancing the effectiveness and accountability of health professional oversight bodies, released survey data that highlighted a number of relevant consumer insights:

     Consumers expect that healthcare providers are competent throughout their professional careers.
     Consumers believe that professional regulatory bodies ensure licensees’ competence.
     52% believe being licensed means periodic evaluation and assessment.
     95% believe healthcare professionals should be required to show up-to-date knowledge as a condition of re-licensure.
     90% believe it is important for healthcare professionals to be periodically re-evaluated.
     84% believe healthcare professionals should be evaluated on their qualifications.
     78% believe healthcare professionals should be required to pass a written test of medical knowledge at least every five years.

    NBCRNA CPC Program Frequently Asked Questions

    7. What are the goals of the CPC Program?

    The goals of the CPC Program are for nurse anesthetists to maintain core competence and enhance competence beyond the expectations of initially-certified registered nurse anesthetists.

    8. How did NBCRNA devise the CPC Program?

    NBCRNA conducted a three-year study into continuing competence, particularly as it applies to nurse anesthesia practice and to other healthcare specialties and professions. In conducting the analysis, NBCRNA evaluated ways to align its recertification program to current concepts of continuing competence and best practices in recertification. The analysis highlighted a paradigm shift towards progressive recertification processes based on a comprehensive view of how to enhance and measure continuing competence. Other advanced practice nursing certifications have already implemented changes similar to those proposed for the CPC Program.
    CPC Program Components

    1. What are the competencies that form the foundation to the CPC Program?

    The program focuses on four core competencies and an additional six competencies that enhance professional performance. These core competencies apply to all nurse anesthetists, regardless of the nature of their professional practice.

    The four core competencies address topics and skills that are essential hallmarks for nurse anesthesia:

     A nurse anesthetist has advanced knowledge and skill in basic, currently available and commonly used alternative airway management techniques.
     As practitioners of applied clinical pharmacology, nurse anesthetists are knowledgeable about the actions, interactions and adverse effects of anesthetics and adjuvants.
     Nurse anesthetists are knowledgeable about human physiology and pathophysiology and their application to anesthesia practice.
     Anesthesia technology is continually changing and new devices are introduced into practice regularly. Nurse anesthetists have knowledge of the principles of operation and the ability to interpret and respond to data acquired from anesthesia equipment and instrumentation.
    The six additional competencies enhance a nurse anesthetist’s ability to provide patient care:
     A fundamental expectation of the nurse anesthetist is the ability to access, evaluate for currency and reliability and apply sources of information as required on a day-to-day basis.
     Nurse anesthetists have knowledge of evidence-based practices and use them to improve the quality of patient care and outcomes.
     Nurse anesthetists have knowledge of and adhere to current standards of practice, including ethics, privacy and cultural diversity.
     Nurse anesthetists have knowledge of and comply with current regulatory and facility accreditation requirements.
     Nurse anesthetists are leaders in interprofessional teams working to improve patient outcomes and the quality and safety of anesthesia care within the healthcare system.
     Nurse anesthetists develop expanding specialized knowledge and skill pertaining to specific patients, procedures, conditions and settings gained through personal study and experience.

    2. What are the CPC Program components?

     Licensure: Applicants must have current and valid registered nursing and/or advanced nursing practice license issued by the certificant’s state board(s) of nursing.
     Initial Certification by NBCRNA: Recertification is contingent on having achieved initial certification as a Certified Registered Nurse Anesthetist by NBCRNA or its predecessor(s).
     Length of Certification: The certification period is four years and compliance with CPC Program requirements during the four-year period is monitored annually.
     Competency Modules: Four core competency modules, developed and administered by NBCRNA, are required in every recertification cycle: airway management techniques, applied clinical pharmacology, human physiology and pathophysiology and anesthesia technology.
     Continuing Education: NBCRNA requires 35 continuing education credits per year (140 over four years). Each year up to 20 credits per year can be earned in educational activities that do not have an end-of-activity assessment of learning and the other 15 credits (or more) per year must be earned in educational activities that do have end-of-activity assessments of learning.
     Recertification Examination: Successful completion of a standardized recertification examination based on a published content outline consistent with the core competencies of the CPC Program is required every eight years.
     Professional Work Practice Requirements: Because NBCRNA certification is a credential to practice, accurate documentation is required to verify that the applicant has at least 425 hours per year in nurse anesthesia work practice. Work practice includes the clinical practice of anesthesia or anesthesia-related administrative, educational or research services.

    3. What are continuing education credit options?

    The NBCRNA will work with the AANA to develop a variety of options for continuing education (CE) credit. Proposed CE options include, but are not limited to, the following (subject to approval by the AANA Continuing Education Department):

     AANA workshops.
     Academic credits.
     Administrative contributions to the profession (e.g., service on professional, state, and national boards and committees).
     Authorship of book chapters and peer-reviewed journal articles.
     e-Learning.
     Facility in-service (practice relevant) programs.
     Independent study programs on topics related to nurse anesthesia.
     Lecture presentations.
     Meetings attendance.
     Preceptorship of graduate nurse anesthesia students.
     Participation in simulation-based education.
     Scholarly poster presentations.

    4. Why do some continuing education options require an end-of-activity assessment?

    This requirement has been added in response to the Institute of Medicine’s “Redesigning Continuing Education in the Health Professions” 2010 report on the value of CE. One of their leading recommendations is that some type of assessment be required after continuing education presentations to reinforce knowledge and demonstrate proficiency.

    5. What will the recertification examination cover?

    NBCRNA is currently in the process of developing the recertification examination for the CPC Program. This will be accomplished by executing a rigorous process for examination development that complies with credentialing and psychometric standards.

    The first activity is to conduct a comprehensive Recertification Practice Analysis, an in-depth study to ascertain the current knowledge, skills and abilities required for the profession. The information obtained through this analysis is used to help NBCRNA determine what the content and validity measures are needed for the exam. NBCRNA will then develop a content outline, determine the type of questions and rating standards for the exam, assemble a diverse group of nurse anesthetists to write the exam questions, pilot test the examination and complete any refinements.

    6. How will you make up an exam that accounts for the various specialty areas of anesthesia practice?

    Patients and employers have expectations of anyone known as a certified registered nurse anesthetist regardless of your area of practice or expertise. The recertification exam will be designed to assess the core common competencies – skills, knowledge and practices which are as important to an obstetric CRNA as they are to a cardiac CRNA or a CRNA who performs only sedation for outpatient procedures.

    7. What happens if I don’t pass the examination?

    Individuals who fail the recertification examination on their first attempt are permitted a total of three additional attempts before the expiration date of their NBCRNA certification. An individual who does not pass the recertification examination after
    four attempts will lose their NBCRNA certification and must re-apply for initial certification and retake the National Certification Examination.

    8. What can I do if I do not meet the work practice requirements each year?

    If an individual does not document compliance with the CPC Program’s professional work practice requirement (at least 425 hours per year) for any one continuous twelve-month period during the four-year recertification cycle, NBCRNA will require completion of up to 20 additional hours of continuing education with end-of-activity assessments. Any individual that has been out of practice for more than 12 months is not eligible for recertification. The refresher program will no longer exist.

    9. What happens if I decide not to comply with the CPC Program?

    Failure to meet all CPC Program requirements will result in the expiration of certification.
    CPC Program Benefits

    1. What are the benefits of the CPC Program for certified registered nurse anesthetists?

     Objective validation of your individual competence.
     A predictable system for lifelong learning.
     Contribution to your ongoing career advancement.
     Built-in flexibility for you to choose from a variety of training techniques and resources that best match your individual learning style.
     Confidence in your ability to deliver the highest quality and safest patient care.
     Assurance of the highest standards for your performance – now and in the future.
     Knowledge that you are up-to-date with leading practices, technologies and pharmacology.
     Sense of achievement you experience from maintaining your relevance and professionalism.

    2. What are the benefits of the CPC Program for the profession?

     Assurance that certification meets all regulatory, credentialing, licensure and quality requirements.
     Ability to quickly communicate new findings in research and practice.
     Confidence that nurse anesthetists are individually competent to deliver high-quality, safe patient care.
     Positive recognition for nurse anesthetists among patients, other healthcare providers, administrators and clinicians.
     Reinforcement for the credibility and reputation of the credential.

    3. What are the benefits of the CPC Program for patients?

     Security, comfort and confidence in the care delivered by nurse anesthetists.
     Assurance of patient safety and effective anesthesia services.
     Unbiased validation of nurse anesthetists’ competence.
     Confidence that nurse anesthetists are up-to-date with the latest in practices, technologies and pharmacology.

    4. What are the benefits of the CPC Program for legal, regulatory and compliance agencies?

     Assurance that certification meets all regulatory, credentialing, licensure and quality requirements.
     Security of knowing that credentialing is independently, objectively developed and managed.
     Ability to quickly update program based on evidence-based practice.
     Confidence that nurse anesthetists are individually competent to deliver high-quality, safe patient care.
     Recognition that nurse anesthetists are up-to-date with leading practices, technologies and pharmacology.
     Better risk management.

    Moving Forward: The Transition Process

    1. What will the transition process look like?

    The steps and schedule for implementing the CPC Program are:
    • Public Comment Period: Survey available online from September 6 through November 14, 2011.
    • Program Refinement: Changes made to the program based on public comments from November 2011 – January 2012.
    • Board Approval: The NBCRNA Board of Directors approves and adopts the final CPC Program at its January 2012 Board Meeting.
    • Transition Planning: Development of the detailed process that will be used to prepare nurse anesthetists for making an effective transition to the CPC Program by August 1, 2013.
    • Recertification Examination Development: Completion of the development, testing and refinement for the recertification examination by September 1, 2018.
    • Program Implementation: The CPC Program goes into effect on January 1, 2015.
    • Recertification Examination: The first recertification examination under the CPC Program will be held in January 2019.

    2. How will the NBCRNA communicate the final CPC requirements after the January 2012 Board Meeting?

    The NBCRNA will use a variety of communications methods to make sure all certified registered nurse anesthetists are informed about the program requirements, rules, timelines and implementation process. This includes:

     Posting all information on the NBCRNA website (www.nbcrna.com).
     Posting all information on a special website dedicated to the CPC Program (www.nbcrnacpc.com).
     Mailing information directly to all certified registered nurse anesthetists and other constituents.
     Developing and disseminated a CPC Program State Tool Kit for each state association.
     Conducting explanatory presentations at NBCRNA meetings.

    3. Who is being asked to provide input during the Public Comment Period?

    Everyone! The NBCRNA will engage a wide array of constituents, external stakeholders and customers in the strategic dialogue to reach consensus on a meaningful CPC Program for nurse anesthetists. The term stakeholders refers to the different groups that have an interest in the recertification of nurse anesthetists. Stakeholder groups include the public, patients and their families, anesthesiologists, other physicians, hospitals, other employers, regulatory bodies (such as the National Council of State Boards of Nursing), continuing education program providers, NBCRNA certificants and the American Association of Nurse Anesthetists.

    4. Will I have the opportunity to comment on the CPC Program before it is adopted?

    Yes, you will. NBCRNA will hold a Public Comment Period from September 6, 2011 through November 14, 2011. During this period, you are encouraged to complete a survey accessible at www.nbcrnacpc.com to give us your feedback as well as send us your comments about the program. You can also direct any questions you may have about the program to us any time at recertification@nbcrna.com. Your feedback will be used to refine program parameters prior to final approval by the NBCRNA Board of Directors.

    Other Questions
    1. Where can I go to get more information?

    Resources accessible now and in the future from a special page on the NBCRNA website. Simply go to www.nbcrna.com. Key resources available from the site include:

     A document titled ―National Board of Certification and Recertification for Nurse Anesthetists: Continuing Competence for Nurse Anesthetists,‖ which provides a detailed description of the CPC Program development and its components.
     An article titled‖ Advancing Recertification for Nurse Anesthetists in an Environment of Increased Accountability‖ (scheduled for publication in the October 2011 AANA Journal) provides an overview of the history of nurse anesthesia credentialing. Note that this will be posted in October after it is published.
    Comments 5 Comments
    1. Katalina's Avatar
      Katalina -
      well this issue with mandatory reexamination every 8 years to recert is sure to cause great strife and division amongst our ranks. We have many members who have strong convictions on the new recert process ....and our organization, the AANA, should be a liason and represent and support the members. CRNA'S convictions and concerns were not even considered before this nbcrna recert plan was put in motion!!!! Well.. with 9 CRNA programs now in Florida...as well as AA's...we continue to flood the market with CRNA's who have trouble finding work and continue to underbid their rates and under cut each other to offer anesthesia services at the lowest possible rate because the competition is well known. Perhaps if some of the CRNA's that haven't retired yet ...choose not to retake their examination for recertification...then these jobs would open up for these new graduates...just wondering? Even the subgroup of physicians that retakes exams for board certification..only does that every decade--not every 8 years!! And many physicians that were trained years ago were grandfathered in... we were not even offered the option?? continuing education standards could be modified to ensure continued competency..if that is really the issue. I found an interesting parallel...check out website: theaba.org. The anesthesiologists prior to 2000 are "grandfathered" in and are not required to retake exam. Found this interesting on theaba.org site: "Maintenance of Certification in Anesthesiology (MOC) The Maintenance of Certification (MOC) concept originated with the American Board of Medical Specialties (ABMS) in 1999. As a member board of the ABMS, the American Board of Anesthesiology (ABA) has been charged with implementing MOC activities that will assure the public that its diplomates demonstrate... commitment to quality clinical outcomes and patient safety.Each MOCA cycle is a 10-year period that includes ongoing Lifelong Learning and Self-Assessment...ABA diplomates certified in 2000 or after hold a time-limited certificate and are enrolled in MOCA after initial board certification. This allows them the full 10-year period to meet all requirements. To avoid expiration of certification, all MOCA requirements must be completed within the 10-year period. Participation in MOCA by non-time-limited diplomates, those certified before 2000, is voluntary and encouraged."very interesting...I believe the decision was made by the NBCRNA without any discussion with CRNA's, nor was any evidence presented that this radical change was needed.
    1. Unregistered's Avatar
      Unregistered -
      It's ok this is a pseudo-science based re-certification program anyway. The psychometric testing used to "certify" students(GRNAs) to make them CRNAs is a fraud. The Exam does not test competency, nor does it in any way address ability or knowledge required on a daily basis by a working CRNA.
      The AANA states in their own publication " A Professional Study and Resource for the CRNA" that certain races, nationalities and no one over 40 should be a "new" CRNA because they are "less committed to nurse anesthesia ".
      Thus psychometric testing is used on a bias to eliminate 40 + year old students. This is discrimination.
    1. MmacFN's Avatar
      MmacFN -
      Pretty serious allegations, got any proof?

      Also, you should register to really bring any validity to your comments

      Quote Originally Posted by Unregistered View Post
      It's ok this is a pseudo-science based re-certification program anyway. The psychometric testing used to "certify" students(GRNAs) to make them CRNAs is a fraud. The Exam does not test competency, nor does it in any way address ability or knowledge required on a daily basis by a working CRNA.
      The AANA states in their own publication " A Professional Study and Resource for the CRNA" that certain races, nationalities and no one over 40 should be a "new" CRNA because they are "less committed to nurse anesthesia ".
      Thus psychometric testing is used on a bias to eliminate 40 + year old students. This is discrimination.
    1. Flossy's Avatar
      Flossy -
      I had no idea how to approach this before-now I'm lcoked and loaded.
    1. yoga's Avatar
      yoga -
      Quote Originally Posted by Flossy View Post
      I had no idea how to approach this before-now I'm lcoked and loaded.
      Flossy???? What is your point?