The FAQs below are also available for download as a PDF.
The starting date of the Continued Professional Certification Program will be January 1, 2016.
Following the introduction of the draft CPC Program a the AANA Annual Meeting, the 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 the 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 assembles 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.
There are a number of ways to introduce grandfathering into a recertification program. The CPC Program will utilize a long introduction period for the recertification examination. No currently practicing CRNA will need to pass a recertification examination until 2032, almost 20 years from now. This, in essence, will grandfather many currently practicing CRNAs from this component.
The NBCRNA conducted an extensive review of 60 medical and scientific resources from the past 30 years to evaluate the current CRNA recertification program and to develop the initial proposed Continued Professional Certification (CPC) Program.
Certification is part of a larger process which includes licensure and credentialing, which help protect the public. Behaviors pertinent to clinical practice are documented - that's why we ask about drug addiction, allegations of incompetent practice, et. on the recertification application. The CPC Program will ensure CRNAs take advantage of opportunities to keep their skill-sets sharp, stay current with changes in science and technology, and demonstrate their continued competence through evaluations of knowledge. Knowledge does not guarantee that a person will make the right decisions, but a lack of knowledge certainly raises the chances of error. We recognize no single form of continuing education or evaluation will ensure competency. The multi-modal approach that underpins the new CPC Program is regarded as the standard of excellence for protecting patient safety.
None of the literature presented by the NBCRNA to the nurse anesthesia community has implied that the NBCRNA believes nurse anesthetists are incompetent anesthesia providers in any way. We have read the research articles regarding safe and effective nurse anesthesia care and, as practitioners, have delivered decades’ worth of anesthetics ourselves. The CPC Program is not intended to question the competency of nurse anesthetists, but rather, to enhance it. Patient safety is our primary responsibility, and we believe we can always do more to ensure the best possible patient care. The move to a continued competency model will also demonstrate to regulators, state boards, hospitals, and patients that nurse anesthetists have met the increasing standards expected of all healthcare providers. It will incorporate a lifelong learning component into the exceptional education and training that all nurse anesthetists receive. And finally, it will place the CRNA credential in a positive light in an effort to ensure that nurse anesthetists continue to be a preferred anesthesia provider.
For current nurse anesthetists, the first examination, which will be a diagnostic tool (not pass-fail), will be taken after the year 2020, depending on the individual’s recertification cycle. Those currently on an even-year cycle will be required to complete the first examination by 2024, and those on an odd-year cycle must complete the exam by 2025. You can take the exam at any time of your choosing within a four-year window. There will always be a requirement to take the examination every eight years.
Anesthetists certified after January 1, 2024, will be required to pass an examination during their first 8-year recertification cycle.
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.
How will I be able to study for such a test?
The NBCRNA will conduct a recertification practice analysis to describe nurse anesthetist practices. This analysis will be used to identify clinically relevant content areas that should be included on the examination. A detailed content outline will be published in advance of the first test administrations. Questions will come exclusively from content included on the outline and will have references from the most widely regarded anesthesia-related textbooks.
Will recent graduates have an advantage on the recertification examination?
The recertification examination will be clinically based. The intent of the examination is to test general knowledge that spans all areas of practice and not sub-specialties. Therefore, the NBCRNA anticipates that veteran practitioners with years of experience, not only will not be disadvantaged, but should be better served taking an examination based on clinical skills and decision-making which they have developed over time.
Is this examination a way of forcing CRNA's into early retirement so they don't have to take the examination? How do you expect someone who has been out of school for decades to undertake such a stressful undertaking as studying for the examination while working?
In deference to the career expectations of current CRNAs, we intentionally created a long phase-in period for the examination. CRNAs who certify before January 1, 2024 will take their first examination for diagnostic purposes and will only be required to take additional assessed CEUs in any areas for which they do not receive a passing score. The intent of this requirement is to encourage self-assessment and support a commitment to learning. Subsequent 8-year examination cycles will require a passing score on the recertification exam to maintain certification.
I'm retiring before 2032, do I still need to pass the examination before then?
Nurse anesthetists who plan to retire by 2032 will not be required to take and pass the recertification examination to maintain certification. However, they will be required to take the examination as a diagnostic tool if their second four year recertification cycle ends prior to 2032.
How many attempts do I have to pass the test? Is loss of certification immediate?
As the requirement for passing an examination is phased in, all nurse anesthetists will have FOUR attempts to pass the recertification examination over a four year period. Individuals who fail the examination will receive a score report designed to specifically target areas of need. Failing the examination will not result in immediate loss of certification as the certification period is valid for a full four years. The examination only influences the ability to recertify into the subsequent cycle.
If an individual does not initially pass the recertification examination, 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. 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 examination?
As the examination does not impact the status of current certification, an anesthetist would only have to report unsuccessful examination completion at such time as he or she actually loses certification. As with the current system, an anesthetist who does not comply with or does not complete recertification requirements is only mandated to disclose when he or she actually fails to become recertified.
How will the passing standard be established?
Standard setting refers to the process of establishing the pass/fail point on an examination. In certification and licensure, a single passing score is established in order to determine to award or withhold a credential. In the academic experience of most people through high school and college, the passing score is usually defined as simple percentage of test questions answered correctly (e.g., passing score is 70%). In the context of examinations for credentialing, however, standard setting follows a much more complex and rigorous process, usually taking the form of (a) defining and describing a performance standard, defined as the minimally adequate level of performance for some profession or occupation, and (b) translating this level of performance to a single point on the examination score scale.
There are a number of methods that may be used for standard setting. In most cases a panel of participants, consisting primarily of subject matter experts, is assembled to provide to the certifying body guidance on the appropriate level of knowledge that must be demonstrated in order to be considered competent to practice in a profession safely. Since the recertification examination will be clinically focused, this panel of subject matter experts will consist of practitioners. The panel is typically convened for a 1-day meeting to conduct an in-depth discussion about the knowledge, skills, and abilities required of a credential-holding practitioner, and to set about making the judgments that will be used in determining the passing score for the examination. The standard setting panel, using one of a number of methods for setting performance standards, arrives at a single, consensus score reflecting the minimum level of proficiency required of all certificants, and makes a recommendation to the certifying body for the pass/fail point on the test. The panel’s passing score is subject to review, adjustment, and ratification by the governing certification body.
Periodic standard setting studies for examinations are required by Standard 12 of the National Commission for Certifying Agencies and Standard 4 of the American Educational Research Association and the National Council on Measurement in Education. The NBCRNA will continue to follow industry-standard best practices for establishing the passing standard (pass/fail point) on the examination, just as it does for the initial National Certification Examination. The passing standard on the CPC examination 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.
Will the NBCRNA provide CRNA's with all the testable material that will be covered on the test?
Since the first examinations will not be administered until 2020, the NBCRNA will develop the examination, practice examinations and questions, and preparatory materials over the next several years. In addition, as a part of examination development, the NBCRNA will be conducting a recertification practice analysis to identify the content areas for the examination. These content areas will be published in an outline that will be available to all nurse anesthetists for examination preparation.
When and how is the examination to be given?
The NBCRNA will establish a subcommittee to explore options for how the recertification examination will be developed and administered. This subcommittee will be charged with developing recommendations for: practice analysis and testing specifications, requirements for examination, development of a testing committee, testing options, pilot testing, scoring, and creation of review materials. The recertification examination is likely to be computer-based and administered at one of several hundred proctored testing centers around the country. While the CPC Committee and NBCRNA are investigating technologies that would allow for this type of examination to be administered at home and online, initial research seems to indicate that current testing technology is not sufficiently advanced to accommodate this type of examination at home.
How will CRNAs who have been working in a specialty type setting for long periods of time be able to pass a broad spectrum examination?
For all nurse anesthetists including those practicing in a specialty setting, there are four core competencies they must possess: airway management, pharmacology, pathophysiology, and anesthesia technology. These four core competencies are relevant in all areas of practice. The examination will focus on clinical applications of these general competencies. The examination will cover knowledge relevant for all nurse anesthetists, but will not cover specific knowledge that would only be possessed by specialists.
Who will write the questions for the examination?
The NBCRNA will assemble a committee of nurse anesthetists representing all practice settings to write the examination questions. The results of the recertification practice analysis will create a content outline to guide writers in their item authoring and will be published for all nurse anesthetists to use in examination preparation.
Why do we have to take an exam when the anesthesiologists do not?
The American Board of Anesthesiology requires a written examination and a simulation-based performance examination for maintenance of certification. The NBCRNA did not deem that simulation based testing has reached a level of standardization and objectivity sufficient to use it as a high stakes examination. Furthermore, one of the issues strongly contested by nurse anesthetists about the CPC Program was their concern about an increase in cost of recertification. Our research showed that simulation-based testing significantly increases cost to the practitioner, on the order of thousands of dollars more than a computer-based examination.
What are the continuing education requirements for the CPC Program?
The continuing education requirement will be 15 assessed CE units per year. In addition, ten (10) professional activity units (this is a new category which encompasses developmental activities that 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. The NBCRNA will establish a subcommittee to explore guidelines for non-assessed professional activities, and the unit values for each activity. This subcommittee will be charged with exploring: what activities qualify, what credit is given for each activity, how activities will be monitored, how activities are audited, and what happens if a certificant fails an audit.
What do you mean by "professional activity units"?
Typically CE credits consist of on-site conferences or home-study courses. We recognize that many developmental activities contribute to building clinical knowledge, but there is no way to receive recognition for those activities under the current recertification system. We are using the term “professional activity units” to describe such activities as precepting students, publishing articles, and delivering inservice education. As we operationalize the CPC Program we will work with the community of nurse anesthetists to identify professional activities that contribute to the goals of the program, and assign a value (unit) to each activity.
If our current CE program is not considered a valid means to maintain competency, why not eliminate mandatory CEs?
The current CE system is not invalid, but it is based on an objective of attendance, not learning. That is to say that credit is granted for attending, but our profession would find it challenging to quantify the quality of the education or to demonstrate that meaningful learning takes place under the current system. We seek to enhance the quality of education by providing a more relevant outcome- that practitioners demonstrate that learning occurred as a result of the activity. The current system also allows a loophole in that there is no mechanism to link the subject of CE to an individual’s learning needs or practice area. The CPC Program will increase opportunities for self-selection of relevant activities by way of the non-assessed credit requirement, while it also standardizes education with the four competencies which are relevant to all practitioners.
Would post tests on current CE programs count towards the 15 "end of activity assessment" CE requirement?
Yes. The end of activity assessment can take any form of demonstrated learning. This may include post tests with multiple choice questions, simulation, or other forms of evaluation, pending review by the CE Committee. The NBCRNA is working in conjunction with the AANA CE Committee in regard to the changing requirements.
What are "assessed" continuing education credits?
Assessed education simply means that the educational provider gives each participant an assessment to complete following an educational activity. The assessment could take the form of a pencil and paper quiz, online test or a variety of other means. Many home-study and internet-based approved CE programs already use an assessment in the form of a post-test completed by the participant. The assessed education credits will help achieve two important goals of the CPC Program -- to provide greater depth of learning from CE activities and to provide objective evidence that certificants achieve new knowledge on an ongoing basis. While continuing education credits will have an assessment mechanism, professional activity units will not.
What does "end of activity assessment" for continuing education (CE) credit mean?
The exact context of an “end of activity assessment” for the 15 annual continuing education credits will take a number of forms. Assessments will likely include any graded evaluation of content learned in the credit session. The NBCRNA is evaluating various forms of demonstrated learning which may be included under the “assessment” umbrella. This may include multiple choice questions, simulation based evaluations, or other suggestions.
Will the four core modules count for CE credit?
What are the CPC competency modules?
The competency modules are 4 self-study modules that will be required 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.
Are the competency modules another examination that will take place in a standardized testing facility?
No. The NBCRNA does not intend them to be an examination and they will not take place in a testing facility. The modules are intended to be presented in a self-study format which can be completed online or in printed form. There will be four modules, one for each of the four core competencies. The modules are intended to keep nurse anesthetists abreast of current literature related to practice.
Cost and Effort
I am a solo practitioner. How do you expect me to accomplish all of these requirements? How will the CPC Program accommodate people in different practice settings?
The CPC Program will not require a significant increase in time away from work to accomplish requirements. In fact, compared to the current program, it will provide flexibility that may be an added benefit to people in different practices. For nurse anesthetists who are very involved in state association activities, teaching, or research, the professional activity unit component of the CPC Program will provide an opportunity to fulfill a portion of your education requirements with those activities, at no additional expense or time requirement. In this regard, some nurse anesthetists will find that they are spending less time away from work to complete their recertification requirements. The current CE educational activities may also be used for the professional activity units.
Is this going to increase the time or expense required to recertify?
Some components of the CPC Program will require additional effort. However, the program will give nurse anesthetists the benefits of learning through multiple means and greater flexibility in achieving their educational requirements. For instance, the NBCRNA allocated some of the educational requirements to professional activity units rather than continuing education credits. Some of the 10 professional activity units might cost nurse anesthetists nothing by giving them credit for activities they may carry out in the course of their regular work (precepting students is one example of this type of activity). The NBCRNA is committed to containing costs for all of the CPC Program requirements. The exact cost of the recertification examination will be determined as it is developed (the first diagnostic/practice examination will be available eight years from now).
Why couldn't experienced practitioners be grandfathered in, and exempted from participating in the program?
The topic of grandfathering received many comments from nurse anesthetists and underwent much discussion and consideration by the NBCRNA. To address this issue, we postponed the deadline for the first pass/fail examination. This approach provides ample time for the profession to prepare for the changes, but does not create different groups of practitioners following different guidelines simultaneously.
We are making the transition to the CPC Program because our recertification program needs to meet current standards, expectations, and accountabilities. To exempt over 40,000 current practitioners would suggest that using the best, current methods for continuous competency development is important for new, but not for experienced anesthetists. Our certification and recertification program is intended to offer a single interpretation of the nurse anesthesia credential: a practitioner who meets the highest standard for professional practice
Additionally, having a single program will avoid confusion for CE providers and practitioners regarding who needs and who does not need to submit end-of-activity assessments. Furthermore the CPC Program adds the benefit of increased flexibility in how a nurse anesthetist satisfies recertification requirements. Eliminating current nurse anesthetists from the program would deny them the benefit of this added flexibility.
Why did the anesthesiologists grandfather in current practitioners, but we could not?
The implications of
grandfathering are much different for physicians, because their board
certification is an optional process. While some physicians use their board certification
to suggest that they are superior to non-certified colleagues, the basic right
to practice comes from their medical license, not their board certification. We
also felt it prudent to protect nurse anesthetists by not grandfathering when
we analyzed how nurse midwives moved to implement a new recertification
program. Currently-practicing midwives
were grandfathered from an evolving national program, but later some states ceased
to recognize the credential of midwives who were grandfathered and therefore
did not participate in the current program of recertification. The
credentialing organization had to revamp its procedures and ultimately pull all
of those experienced practitioners into the new program, after all.
Will nurse anesthetists have input into developing program details?
Yes; we absolutely need the input of nurse anesthetists as we determine the best ways to plan and implement the program. The NBCRNA is collaborating with the AANA and in particular the education department on issues related to CE credits. Nurse anesthetists are currently serving on CPC subcommittees to develop the learning modules, determine the types of activities that will be appropriate as “non-assessed” professional activity units, develop the recertification examination, and more. A rough estimate is that the NBCRNA will recruit approximately 30 individuals to form the initial working groups.