Continuing Competency in Health Care
Health care credentialing exists to ensure compliance with high standards for delivery of care in a profession. Credentialing demonstrates that providers remain up-to-date with industry best practices. One of the big shifts in credentialing is a move toward continuing competency. This is not new. In fact, most physician specialties, including anesthesia, have made the shift to competency-based credentialing systems, as have many nursing organizations.
The research shows that initial certification is just a start. Certification establishes a baseline competency at an entry level of performance. Knowledge at one point in time, however, is not enough to ensure currency with evolving knowledge, skills, and technologies or to allow the profession to respond quickly to changing trends. Professional knowledge and skills, especially in anesthesia, require continuous updating and enhancement with the most current evidence that informs practice. Continuing competency is a lifelong learning process of acquiring skills and knowledge and the ability to apply those skills and knowledge to practice.
Limitations of the Former 2-Year Recertification System
Until the CPC Program launched in 2016, credentialing for for certified registered nurse anesthetists was a two-stage process: initial certification upon entering the profession and a recertification process that included continuing education on a two-year cycle. Again, before the CPC Program launched, the NBCRNA recertification process that had been established in 1978 saw little to no change. Therefore, the CPC Program was developed to keep pace with current credentialing best practices and to support lifelong learning.
The History of Changes to the Continuing Professional Certification (CPC) Program
Designed to evolve with new information, data and technologies, the CPC Program has undergone several revisions since its first (concept) introduction in August 2011. The purpose of the revision process was to ensure that the final criteria reflected a flexible and relevant program for CRNAs, regardless of their practice situation. The changes include:
CPC Criteria Proposed (August 2011); Revision Process Begins
The first proposed criteria for the CPC Program were presented to the CRNA community and the AANA in August 2011. Shortly after this, the proposed CPC Program was opened for full comprehensive public review and comment. The NBCRNA reviewed and considered over 13,000 comments received from CRNAs and from the AANA. Complementing the CPC public comment period process, NBCRNA representatives attended state meetings to engage with members, CRNAs, and other stakeholders to talk about the proposed CPC Program, as well as answer questions and solicit input.
Following the introduction of the initial draft of the CPC Program at the August 2011 AANA Annual Meeting and the ensuing 3-month open comment period, the NBCRNA established a CPC Committee comprising practicing CRNAs and consultants to collect and review CRNAs' comments, questions, and recommendation.
The CPC Committee, informed by many factors, revised the initial criteria of the CPC Program, including:
- Feedback from CRNAs and the AANA during the open comment period and subsequently during key stages in the process;
- Information and research from medical and scientific resources;
- New standards from the certification community;
- Benchmarking other anesthesia and nursing recertification programs;
- Review of a nurse anesthetist professional practice analysis; and
The increasing demands of the healthcare industry and patient safety on educational medical education and continuing competency. The revised criteria for the CPC Program were then shared with a panel of individuals identified within the nurse anesthetist profession as leaders in certification, education, and practice development. This panel worked to refine the committee's list of recommendations, using a consensus-building process known as the Delphi Process.
Changes since concept presentation include:
1. First Major Revision of CPC Criteria, January 2012
In January 2012, the CPC Committee presented the information collected and refined recommendations for changes to the CPC Program, based on results from the public comment period. Revisions included:
- The professional work requirement for a specified number of hours of practice was removed.
- The continuing education requirement was reduced to 15 assessed CE units per year.
- Professional development education credits were first introduced to the CPC program.
- Credit earned from the Core Modules could be applied to meet assessed CE credits.
- The CPC Examination would be phased into the CPC Program, with the requirement date for meeting the passing standard moved to 2032.
- The CPC Program start date was moved back 1 year, to January 1, 2016.
2. Second Major Revisions of CPC Criteria, January 2014 through August 2014
In the fall of 2013, a second CPC survey was conducted of the CRNA community. As a result of direct discussions with the AANA and with members of the CRNA community and a review of survey feedback, additional revisions to the CPC criteria were made.
- Life support courses will be able to be reported as Class A credits or Class B credits, at the nurse anesthetist’s discretion.
- For each domain area in which a nurse anesthetist does not meet a performance standard on the CPC Examination administered during the second 4 year cycle (beginning January 2020), the nurse anesthetist will take an additional Core Module.
- The NBCRNA and the AANA agreed that the AANA Continuing Education Committee will develop the criteria for assessed CE.
- Core Module delivery mode was expanded beyond web-only and the cap on CE credits was removed. Further, vendors will determine which module performance objectives will be covered in a module based on the latest evidence.
3. Third Major Revision of CPC Criteria, August 2014 through December 2014
In the fall of 2014, the NBCRNA Board of Directors approved additional revisions to the CPC program components:
- At the request of the AANA, on behalf of the membership, NBCRNA Board of Directors approved changes to the terminology of CPC Program components:
- The term assessed continuing education requirement was changed to Class A credits.
- The term Professional Activity Unit (PAU) was changed to Class B credits.
- The term Diagnostic was removed from the CPC Examination description. Both the performance standard and passing standard CPC Examinations will be called CPC Examination.
- The CPC Program start date was moved back to August 1, 2016.
- CPC Core Modules will be voluntary for the first 4-year cycle.
- Additional options will be explored beyond retaking a CPC module for CRNAs who do not meet the performance standards of the "low stakes" CPC Examination during the 2020-2024 recertification cycle.
4. CPC Program Criteria, December 2014
Since the initial proposed criteria for the CPC Program, the CPC Committee and NBCRNA Board have continued to refine the components, based on input from the AANA, certificants, and other stakeholders. Every component of the CPC Program has been analyzed and revised to ensure that the CPC Program will have practice-related validity and that the requirements of the CPC Program are essential, regardless of practice setting, patients, and conditions.
5. Core Modules Become a Required Component, September 2017
The Core Modules were included as an optional component in the first 4-year CPC cycle as feedback and data were gathered by Core Module providers and reported to the NBCRNA. After extensive analysis by the NBCRNA, it was determined that the Core Modules provide not only a successful means to bring evidence-based information to the CRNA, but that it supported the goal of lifelong learning and provided a form of longitudinal assessment. Including the Core Module requirement was also recommended by the AANA Continuing Education Committee to the NBCRNA as a valuable educational component. In September 2017, the Board of Directors voted to include the Core Modules as a required component of the CPC Program beginning in 2020.