Advanced Practice

xxii Introductionin increased credit requirements and length of educational programs over the past decade.Therefore, after many years of investigation and dialogue within and outside the nursingprofession, the American Association of Colleges of Nursing (AACN) membership in 2004approved the position that advanced practice nursing education evolve to the DNP level by2015. 5 This position was reinforced by the National Research Council of the National Academyof Science in a subsequent report, which stated that “the need for doctorally prepared practitionersand clinical faculty would be met if nursing could develop a new non-research clinicaldoctorate, similar to the MD and PharmD in medicine and pharmacy.” 6(p 74) Other APRNorganizations, including the National Organization of Nurse Practitioner Faculties (NONPF),have endorsed the transition to the DNP for entry into advanced nursing practice. The DNPprograms will focus on practice, preparing clinicians with the expertise needed to function atthe highest level in an area of advanced or specialty nursing practice.Critical issues facing APRNs are changing constantly. Just since beginning work on thistext, changes in economic policies, health policies, funding sources, and even organizationalpolicies have significantly affected, both positively and negatively, APRN practice and education.An overall and ongoing awareness of these issues, and of others not yet evident, isimperative if each APRN is to navigate the current and future healthcare environment successfully.Four nursing leaders, each recognized for leadership and expertise in one of the APRNroles, were asked to identify and briefly discuss the critical issues facing their specific APRNrole now and in the near future. These perspectives represent the individual’s opinion and personalthoughts and are presented here as a basis for reflection and discussion.The Certified Registered Nurse Anesthetist: Key Issues Todayand TomorrowFrancis R. Gerbasi, PhD, CRNAExecutive DirectorCouncil on Accreditation of Nurse Anesthesia Educational Programs (COA)Nurses were first asked to provide anesthesia in the middle of the 18th century. The first nurseanesthetists were trained by surgeons to meet anesthesia workforce needs, which resultedfrom the discovery of ether by dentist William Morton in 1846. Agatha Hodgins, an anesthetistand teacher, was the instructor for an early anesthesia school, the Lake Side HospitalSchool of Anesthesia, in Cleveland, Ohio, begun between 1912 and 1915. She was also thedriving force for starting a national organization for nurse anesthetists. In 1931 the NationalAssociation of Nurse Anesthetists, later renamed the American Association of Nurse Anesthetists,was formed by 40 founding members. They identified the need to establish standardsfor educational programs. A formal accreditation process for nurse anesthesia educationalprograms was approved in 1950 and recognized by the U.S. Department of Education in1955. In the late 1970s separate councils for accreditation, certification, and recertification,as well as for public interest, were established as autonomous decision-making bodies. Duringthe next 30 years, the nurse anesthesia profession continued to grow, and the requirementsfor educational programs evolved.Today there are approximately 40,000 CRNAs providing anesthesia in all 50 statesand in U.S. protectorates. Nurse anesthetists provide anesthesia in a wide variety of practicesettings for patients of all ages. In fact, CRNAs provide more than 85% of the anesthesia inrural hospitals.The educational programs for CRNAs are using technology, including simulation and distanceeducation, to enhance educational offerings and are initiating the move to offer professionaldoctoral degrees for entry into practice. On July 7, 2008, the Consensus Modelfor APRN Regulation: Licensure, Accreditation, Certification & Education (LACE) wascompleted, and nursing organizations were requested to endorse the document. As of