Identified as a subspecialty need, the NBCRNA established a certification program in nonsurgical pain management (NSPM) in 2014. The first NSPM examination took place in early 2015. Since then, numerous individuals have taken the exam and have been certified (NSPM-C).
The Need for the NSPM Subspecialty Certification
In 2012, the Centers for Medicare & Medicaid Services (CMS) abruptly stopped reimbursement for CRNAs who submitted requests for payment using CPT codes related to nonsurgical pain management. The AANA, COA, and NBCRNA successfully appealed this decision and the CMS reinstated that reimbursement. At that time, the NBCRNA made a commitment to developing a certification process associated with pain management to help support the profession in this subspecialty area. The NBCRNA recognizes the importance of this program to the profession of nurse anesthesia, to patients and patient safety, and to those who practice in the subspecialty of nonsurgical pain management.
The NBCRNA’s subspecialty certification in NSPM is available for CRNAs whose professional practice integrates the many components of NSPM care. The NSPM subspecialty certification is a voluntary program for nurse anesthetists who have demonstrated distinctive knowledge and a specific skillset in the subspecialty practice of NSPM. CRNAs that include NSPM as part or all of their practice have independent responsibility for direct patient care and may function as a member of an interprofessional team. They may administer various types of injections; integrate physiological, pharmacological, and psychological techniques; and other modalities for the management of acute and chronic pain outside the obstetrical and operating room areas. The services they provide typically include the assessment, planning, implementation, and evaluation of multimodal approaches in patient care.
Goals of the NSPM Program
As is the case with subspecialty certifications in other medical specialties, the decision by the NBCRNA to develop a subspecialty certification for CRNAs specializing in nonsurgical pain management (NSPM) is a means to establish a standard for which providers’ knowledge base and practice experience in the specialty area can be validated. As the delivery of healthcare becomes increasingly complex and specialized, it is important to ensure, on behalf of the public, that those performing specialized procedures possess a level of knowledge and experience which support safe practice. Certification is in effect an assurance to the public and other health professionals that certified individuals have met objective, predetermined qualifications for providing health care services.
Subspecialty Certification in Medicine
Subspecialty certification processes have been created for nursing professionals, physicians, and allied health professionals. Since 1976, for example, the Certified Critical Care Registered Nurse (CCRN) designation has been used by Registered Nurses who provide care for the acute and/or critically ill patients in intensive care units. Patients have become more informed consumers of medical services, increasingly recognizing the significance and importance of specialty certification for nurses. The CCRN certification, developed by the American Association of Critical Care Nurses (AACN), was created to assure patients, their families, and other members of the team of healthcare professionals that the critical care nurses who provide that care have met a set of certification criteria.
Subspecialty certifications have been created in some of the 24 medical specialty member boards of the American Board of Medical Specialties (ABMS). Like the NBCRNA, which oversees certification and recertification for nurse anesthetists, the ABMS oversees the certification of physician specialists in the United States. The ABMS is responsible for ensuring the standards for certification and for recertification, known as Maintenance of Certification (MOC), bringing focus and rigor to issues involving specialization and certification in medicine, and help protect patient safety.
NSPM Development Process
Work on the NSPM certification began in early 2013 when NBCRNA President Vacchiano appointed a committee made up of three Board directors to study the concept of a subspecialty certification in NSPM. Subsequently, the committee identified a voluntary task force of CRNA experts who provided input on the proposed eligibility criteria, test development process, and implementation timeline.
As part of their duties, the NSPM committee and NBCRNA Board members solicited input on the draft requirements and eligibility criteria from the CRNA community, the COA and AANA, through formalized surveys, webinars, and during an open session of the 2013 AANA Annual meeting. Additionally, another professional practice analysis was performed in the summer of 2014, which gathered the most current information specific to CRNAs practicing in this arena.
The committee and task force then integrated the feedback obtained from stakeholders into the initial recommendations for certification, recertification, and NSPM certification examination content outline. After their recommendations were reviewed and approved by the NBCRNA Board of Directors in September 2013 and January 2014, the task force worked on finalizing the criteria for the NSPM certification. The process of developing the NSPM certification was finalized in December 2014 and three test dates for the NSPM examination were set for January, March, and October 2015.