Education News. Feasibility of a doctoral degree for nurse anesthetists

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1 Education News LORRAINE M. JORDAN, CRNA, PhD AANA Director of Research SUSAN SHOTT, PhD Chicago, Illinois Feasibility of a doctoral degree for nurse anesthetists Stimulating discussions have evolved concerning the possibility of mandating doctoral education for entry into practice because of increased educational preparation for nurse anesthesia students and the credibility a doctoral degree carries in the healthcare community. Based on members' interest, the AANA Board of Directors appointed a Task Force to investigate the feasibility of doctoral degrees for entry into practice. The Task Force was also directed to investigate educational avenues for CRNAs at the doctoral level. Results of a survey revealed that the majority (65%) of the respondents did not support a doctoral degree for entry into practice, and more than half (6%) of the nurse anesthesia education programs indicated that it was not feasible to offer doctoral degrees at their institutions. Key words: Doctoral degree, master's degree, nurse anesthesia education, nurse anesthesia practice. Introduction Over the years, the AANA has been committed to educating competent nurse anesthetists. The desire to promote and maintain cutting-edge educational standards for nurse anesthesia has been demonstrated throughout the history of the AANA. Nurse anesthesia education has progressed from a 3- to 4-month program to a minimum 24-month program with a curriculum designed to award a master's or higher level degree. 1 Over the years, the ongoing evaluation of the educational preparation of nurse anesthetists has sparked lively debates among AANA members. Debates have ranged from providing a prescribed curriculum to allowing each program to design its own curriculum, requiring all nurse anesthesia programs to be in nursing, and mandating doctoral preparation for all CRNAs. Over several decades, the revision of the Standards and Guidelines for Nurse Anesthesia Educational Programs resulted in the development of a 2- to 3-year graduate level program for advanced practice nurses with academic as well as clinical requirements in anesthesia.' History One of the first nurse anesthesia programs was started by Agatha Hodgins, CRNA, in Cleveland, Ohio, at Lakeside Hospital. The program was designed to teach nurses to administer anesthesia through both classroom and clinical teaching. However, opening the Lakeside Program was not accomplished without opposition. The ongoing struggle to keep nurse anesthesia programs viable was seen early at Lakeside. In 1917, the program closed after the first class graduated due to a controversy with the Ohio State Medical Board. However, the closure of the program was reversed 1 year later.; The initial program at Lakeside sparked the opening of nurse anesthesia programs throughout the country in the 192s and 193s. June 1998/ Vol. 66/No

2 In September 1933, at the first Annual Meeting of the National Association of Nurse Anesthetists, minimum standards for schools of nurse anesthesia were agreed upon. The minimum standards included a 4-month course, a minimum of 25 cases, and 75 hours of classroom instruction. The purpose of developing educational essentials was twofold: to establish standards for schools and to develop a process to evaluate the schools of nurse anesthesia.' An accreditation program was established, and the first on-site visit was made in 1952 at Ravenswood Hospital School of Anesthesia, Chicago, Illinois. The Health, Education and Welfare Committee (now known as the Department of Education) recognized the AANA in 1955 as the accrediting agency for schools of nurse anesthesia.; As nurse anesthesia practice and education became more organized, the need for specialized recognition in the form of accreditation became clear. The value of public recognition for educational institutions became evident, and the AANA recognized and supported the development of the Council on Accreditation in 1975 with its main purpose being to accredit schools of nurse anesthesia. As the education and practice of nurse anesthetists have evolved, so have the educational standards. In the late 197s, many nurse anesthesia students were entering programs with a baccalaureate degree and were seeking postbaccalaureate education. Many of the nurse anesthesia education programs were already teaching at a postbaccalaureate level and requiring students with or without a baccalaureate degree to possess basic knowledge of pharmacology, physiology, anatomy, and nursing. In 198, the Council on Accreditation implemented the admission requirement that stated anesthesia students entering a nurse anesthesia program must possess a baccalaureate or higher degree or a minimum of 3 semester hours or its equivalent of college credits in specific areas of study.-' Later in 1986, the Council on Accreditation adopted the accreditation requirements that any student admitted into a nurse anesthesia program on July 1, 1987 and thereafter would be required to have earned a baccalaureate degree (Council on Accreditation of Nurse Anesthesia Educational Programs' files, correspondence from Doris Stoll, CRNA, MSEd, director of Accreditation, September 23, 1986). As the educational standards for nurse anesthesia programs have changed to meet the demands of the profession, so have some thoughts regarding advanced education in nurse anesthesia. In the late 198s, many educators and the AANA Education Committee began to explore the movement of the programs to a graduate level. Re- alizing the need for graduate level education, the Council on Accreditation responded and established a new standard. The specific criterion for programs under "Standard III: Curriculum and Instruction" states: "design a curriculum that will award a master's or higher level degree to students who will enter the program on or after January 1, 1998 and who successfully complete graduation requirements."' As the discussion of graduate education began, the issue of mandating doctoral education for CRNAs arose. It was debated that the amount of educational time spent in an academic setting and the caliber of the required curriculum for nurse anesthesia warranted awarding a doctoral degree. The minimum requirements to become a nurse anesthetist are a 4-year baccalaureate degree, a registered nursing license, a minimum of 1 year of acute care experience, and a minimum of 24 months in a nurse anesthesia program (equivalent to 3 academic years). This requires a nurse to have a minimum of 7 years of educational experience and preparation before becoming a nurse anesthetist. The number of years and education to become a nurse anesthetist are comparable to that of other professionals who are awarded a doctorate. Professionals, such as chiropractors,'- optometrists (personal conversation with Lisa Wright- Solomon, director of Professional Affairs, Association of Schools and Colleges of Optometry, February 18, 1998)," podiatrists (personal conversation with Pam Coleman, DPM, director of Health Affairs, American Association of Podiatric Medicine, January 21, 1998),- and pharmacists (personal conversation with Jeffrey W. Wadelin, PhD, associate executive director, the American Council on Pharmaceutical Education, January 21, 1998)" spend a similar amount of academic time in programs and earn a doctorate while most nurse anesthetists earn a master's degree (Table I). None of the professions mentioned, with the exception of nurse anesthesia, requires a baccalaureate degree for entry into a professional program of study by accreditation standards. However, optometrists and podiatrists require the completion of specific courses prior to entry into their programs, and most students have a baccalaureate degree. While pharmacists do not require specific courses, the majority of the students have completed 2 years of preprofessional education. Examining the educational curriculum for other professionals who earn the title of doctor and comparing their education to that of nurse anesthetists presents an interesting question: "Why not investigate the doctoral degree for nurse anesthesia education?" Nurse anesthesia has elevated its educational 288 Journal of the A merican Association ol \urse Anesthetists

3 i v v Table I Professional designation requirements Profession v Chiropractors 5 Optometrists 6 Podiatrists' Pharmacists 8 Nurse anesthetists 1 Admission requirements Years of work Undergraduate* experience Specific courses Minimum 6 semester hours Specific courses Standard prerequisite courses Specific courses 2-Year preprofessional 4-Year baccalaureate degree 1 year Professional education requirements Length Degree awarded 4,2 hours (5-minute hours) 4 years minimum 4 years minimum academic 4 years minimum academic professional degree 3 years minimum academic *For all professions, except nurse anesthesia, a baccalaureate is not required by accreditation standards. Doctor of Chiropractic Doctor of Optometry Doctor of Podiatric Medicine Doctor of Pharmacy Graduate Degree standards, with the average length of a program being 27 months and some programs lasting up to 36 months. 9 This is comparable to some professional doctoral programs. The level of education in a nurse anesthesia education program today is at the graduate level and requires additional knowledge and problem-solving skills. Awarding a doctoral degree to acknowledge an enhanced graduate curriculum that includes such subjects as research methodology and statistical analysis may be quite appropriate for nurse anesthesia. Doctoral education would permit additional education time for further development of specialized clinical expertise, clinical thinking skills, and research. An additional benefit of earning a doctorate is gaining the prestigious title that inherently holds public recognition and, for CRNAs, would better acknowledge their extensive educational preparation. Because CRNAs are the "face behind the mask," the mystery of who a CRNA is or what a CRNA does is baffling to the public. 1 Even though public campaigns have been launched over the years to increase the visibility of CRNAs, the term doctor is an easier term for the public to understand and recognize. Therefore, the title "doctor" would not only bring recognition to the CRNA as an anesthesia provider, but also better describe, by title, the academic preparation essential to becoming a CRNA. The debate regarding doctoral education for CRNAs has been lively and required further analysis and input. Based on the members' ongoing discussions, the AANA Board recognized the need to definitively explore the issue. A Doctoral Task Force was appointed to study the issue of doctoral education for nurse anesthetists and report back to the AANA Board with recommendations. Materials and methods Christine Zambricki, CRNA, MS, the AANA president, appointed a Doctoral Task Force of five CRNAs who represented different areas of nurse anesthesia education (Table II). The Task Force was given the assignment of gathering input from the membership regarding doctoral education. After the Task Force was formed, input from two distinct member groups was identified as essential to the study: (1) general membership and (2) program directors. Table II Doctoral task force Diane Ritter, CRNA, MSN, Chair Francis Gerbasi, CRNA, PhD Kathleen Hanna, CRNA, PhD Betty Horton, CRNA, MA, MSN Lorraine Jordan, CRNA, PhD Education Committee Education-at-Large Council on Accreditation Council on Accreditation Education Committee June 1998/Vol. 66/No

4 The general membership's input was necessary to determine whether there was a perceived need or desire for doctorally prepared CRNAs. The program directors' input was fundamental in assessing the feasibility of developing and implementing nurse anesthesia doctoral programs. The general membership was queried via three methods: 1. An announcement in the AANA NewsBulletin requesting written input regarding the issue. 2. Verbal comments during the open forum at two AANA meetings (1996 Fall Assembly of States and 1997 Assembly of School Faculty). 3. Surveying meeting attendees at the 1996 Fall Assembly of States and 1997 Assembly of School Faculty. The program directors were mailed the same survey given to the membership at the above two meetings, with additional questions posed to specifically address the ability to move their nurse anesthesia educational program to a doctoral level. This article is a report of only the survey results. The verbal and written comments received independently from the survey reflected responses similar to those obtained from the survey. The survey was developed in several phases. The initial draft of the survey was developed from information obtained from focus groups. Responses and discussion items were analyzed, and the resulting information was used to develop a quantitative instrument. Once the initial survey was developed, it was pilot tested and revised based on input from AANA Editorial Board members, CRNA speakers, educational leaders in nurse anesthesia, and CRNAs attending the Spinal/Epidural Workshop. Final revisions of the instruments were made, and the AANA Doctoral Task Force approved the surveys for dissemination to CRNAs attending meetings (Figure 1) and to program directors (Figure 2). The results reported are from the completed surveys. Unless otherwise indicated, the surveys from all samples were combined for analysis. Results A response rate of 65% (N = 186) was obtained for the general survey given to CRNAs attending the the 1996 Fall Assembly of States and 1997 Assembly of School Faculty. The program directors' response rate was 8% for the nurse anesthesia program survey regarding the feasibility of offering a doctoral degree at their academic institution. Data were analyzed from all the returned surveys. The demographic characteristics of the sample are summarized in Table III. More than half of the respondents (57%) were women. Sixty percent (6%) were CRNAs with certificates in anesthesia, 5% had their primary responsibility in education, and 64% had a hospital as their primary practice setting. The median age was 45 years, the median planned retirement year was 21, and the median graduation year was Membership. Several doctoral degree options were presented and defined by the researchers in the introduction to the survey (Table IV). All of these degrees were currently available except the Doctor of Nursing Anesthesia, which was defined as "a professional degree in nursing anesthesia awarded by a university. Degree requirements usually take 1 year post-master's study or approximately 3.5 years of post-baccalaureate study including a research project in nurse anesthesia." Respondents preferred the nursing anesthesia doctorate over the other doctoral degrees, with 56% favoring this degree. The doctorate of philosophy, doctorate in nursing science, nursing doctorate, and doctorate in education were also selected in descending order of frequency (Figure 3). Seventy-three percent of respondents supported the AANA in promoting the development of doctoral programs (Figure 4). Respondents who indicated that the AANA should support the development of doctoral programs also indicated that AANA's support should consist of developing a model curriculum (58%), offering scholarships for faculty (53%), educating the membership about doctoral education (42%), providing financial assistance programs (31%), and offering classes (23%) (Figure 5). A majority of the respondents (65%) did not support a doctoral degree for entry into practice for CRNAs. Reasons given for opposing a doctoral degree for entry into practice were additional educational time, additional expenses, lack of financial benefit to the CRNA, elimination of the profession, lack of benefit to the patient, lack of additional respect, and failure to focus on the development of the baccalaureate degree and/or master's degree for CRNAs (Figure 6). The two most frequently cited reasons for supporting the doctoral degree for entry into practice were sufficient hours in the curriculum already to earn a doctoral degree (41%) and educational parity among providers (41%) (Figure 7). * Program Directors. Program directors were surveyed regarding the feasibility of offering a nursing anesthesia doctorate at their institution, the feasibility of obtaining a doctorate for faculty at their institution, and the doctoral resources and requirements at their institution. With a response rate of 8% (N = 72), the majority (6%) of the program directors indicated that offering a doctoral degree at their institution was not feasible (Figure 8). Seventy-eight percent (78%) of the respondents 29 Journal of the American Association of Nurse Anesthetists

5 Figure 1 Assemblies' doctoral feasibility survey Please circle only one answer or write the appropriate answer: Gender: Male Female Age: yr. Planned year of retirement: 19_ or 2 State employed: Year graduated from anesthesia program: Anesthesia education: Certificate Associate Baccalaureate Master's Highest earned degree excluding anesthesia education: Diploma Certificate Associate Baccalaureate Master's Doctorate lthar Primary responsibility: Administrator Educator Practitioner (Definitions enclosed) Primary practice setting: Hospital University Surgicenter Office Clinic Doctoral Degree Programs for Student Nurse Anesthetists 1. Do you support the concept of having nurse anesthesia programs prepare students with a doctorate for entry into practice? Yes No A. If yes, why?... Create educational parity with physicians Programs already have the number of hours B. If no, why?... Eliminate the profession Increased educational time Expenses No additional financial benefit 2. Indicate the type(s) of doctoral degree you would favor (definitions enclosed). No doctorate Doctor of Philosophy (PhD) Doctor of Nursing Science (DNSc) Doctor of Nursing (ND) Doctor of Education (EdD) Doctor of Nursing Anesthesia (NAD) A. Why did you choose the degree in question #2? Educational parity with physician Just my personal preference 3. What would be the benefit(s) of having the doctorate as a requirement for entry into practice? No benefits Increases respect Enhances credibility Increases knowledge Creates uniformity among providers Creates parity in the work place Promotes image 4. What would be the disadvantage(s) of having the doctorate as a requirement for entry into practice? No disadvantages Decrease the number of graduates Increased time in nurse anesthesia program Additional educational costs from nurse anesthesia Deny CRNAs entry into practice Discourage nurses entering nurse anesthesia I 5. Doctoral Degree Programs for CRNAs Should the AANA promote the development of doctoral programs for those who are already CRNAs? Yes No 6. Is there an institution accessible to you that offers a doctoral degree? Yes No 7. How should the AANA support the development of doctoral programs for CRNAs? Should not support Educate members and the public Conduct classes in specific cities Financially assist educational programs Develop a model curriculum Offer scholarships to individuals 8. What is the advantage(s) of a doctoral degree for a practicing CRNA? No advantages Enhance research skills Nlecessary for leverage to lobby Enhance CRNA education Offer parity among providers Personal satisfaction Enhance CRNA quality care Increase income potential Cther 9. What is the disadvantage(s) of a doctoral degree for a practicing CRNA? No disadvantages Increased distance from other nurses Potential conflict with physicians Educational time No financial incentive Possibly lose CRNAs (1th r vu Ivi June 1998/ Vol 66/No

6 Figure 2 Program directors' doctoral feasibility survey Please circle only one answer or write the appropriate answer: Gender: Male Female Age: yr. Planned year of retirement: 19 or 2 State employed: Year graduated from anesthesia program: Anesthesia education: Certificate Associate Baccalaureate Master's Highest earned degree excluding anesthesia education: Diploma Baccalaureate Certificate Master's Associate Doctorate Primary responsibility: Administrator Educator Practitioner (Definitions enclosed) Primary practice setting: Hospital University Surgicenter Office Clinic Doctoral Degree Programs for Student Nurse Anesthetists 1. Do you support the concept of having nurse anesthesia programs prepare students with a doctorate for entry into practice? Yes No A. If yes, why?... Create educational parity with physicians Programs already have the number of hours B. If no, why?... Eliminate the profession Expenses Increased educational time No additional financial benefit 2. Indicate the type(s) of doctoral degree you would favor (definitions enclosed). No doctorate Doctor of Philosophy (PhD) Doctor of Nursing Science (DNSc) Nursing Doctor (ND) Doctor of Education (EdD) Doctor of Nursing Anesthesia (NAD) A. Why did you choose the degree in question #2? Educational parity with physician Just my personal preference 3. What would be the benefit(s) of having the doctorate as a requirement for entry into practice? No benefits Enhances credibility Promotes image Creates parity in the work place Increases knowledge Creates uniformity among providers Increases respect 4. What would be the disadvantage(s) of having the doctorate as a requirement for entry into practice? No disadvantages Decrease the number of graduates Increased time in nurse anesthesia program Additional educational costs from nurse anesthesia Deny CRNAs entry into practice Discourage nurses entering nurse anesthesia Doctoral Degree Programs for CRNAs 5. Should the AANA promote the development of doctoral programs for those who are already CRNAs? Yes No 6. Is there an institution accessible to you that offers a doctoral degree? Yes No 7. How should the AANA support the development of doctoral programs for CRNAs? Should not support Educate members and the public Conduct classes in specific cities Financially assist educational programs Develop a model curriculum Offer scholarships to individuals 8. What is the advantage(s) of a doctoral degree for a practicing CRNA? No advantages Enhance research skills Necessary for leverage to lobby Enhance CRNA education Offer parity among providers Personal satisfaction Enhance CRNA quality care Increase income potential 9. What is the disadvantage(s) of a doctoral degree for a practicing CRNA? No disadvantages Increased distance from other nurses Potential conflict with physicians Educational time No financial incentive Possibly lose CRNAs _ Continued on next page 292 Journal of the American Association of Nurse Anesthetists

7 Figure 2-Continued Program directors doctoral feasibility survey Program Specific Information 1. Is it feasible to offer a doctoral program for nurse anesthesia students at your institutution? Yes No Explain 2. How difficult would it be to identify and receive needed resources to conduct a doctoral program at your institution? Not difficult Difficult Impossible Explain 3. Are there enough academically prepared faculty members to conduct a doctoral program at your institution? Yes No 4. Is it feasible for the faculty at your institution to eam a doctoral degree? Yes No 5. If some of the faculty at your institution are unable to earn a doctoral degree, why are they unable to earn the degree? 6. How many doctorally prepared CRNA faculty members would you need to support a doctoral program at your institution? 7. How many doctorally prepared CRNA faculty do you have teaching in your program? 8. Which type of academic degree is required to teach in a doctoral program at your institution? No doctorate required Doctor of Philosophy (PhD) Doctor of Nursing Science (DNSc) Doctor of Nursing (ND) Doctor of Education (EdD) : Additional Information We may want to talk to individuals to obtain additional input If you are willing to talk to us in the future regarding doctoral degrees, please complete the following: Name: Institution: Phone: Please send the completed survey by January 3, 1997 to AANA, Doctoral Task Force, 222 South Prospect Avenue, Park Ridge, IL 668 stated that identifying resources to conduct a doctoral program was difficult to impossible at their institution (Figure 9). Seventy-two percent (72%) revealed there was not a sufficient number of prepared academic faculty to conduct a doctoral program at their institution. Sixty-five percent (65%) indicated that it was feasible for faculty to earn a doctoral degree. However, the barriers to earning a doctoral degree for faculty ranged from not enough time to devote to earning a degree (43%) to lacking a master's degree (Figure 1). Possible relationships between demographic variables and the following variables were investigated: * Support for a nursing anesthesia doctorate as an entry requirement (doctorate entry support). * Support for AANA promotion of doctoral program development (doctorate promotion support). * Reasons for doctorate support or opposition. * Perceived advantages and disadvantages of a doctorate for entry or for a practicing CRNA. The x 2 test of association was used to evaluate relationships between nominal variables. The nonparametric Mann-Whitney test was done to compare groups defined by nominal variable categories with respect to variables that were at least ordinal. A.5 significance level was used for all statistical tests. Means are presented as mean - standard deviation (SD). There were no statistically significant relationships between gender and doctorate entry or promotion support. Female respondents, however, were more likely than male respondents to believe that doctorates would provide personal satisfaction for practicing CRNAs (56% versus 38%; P =.35). There were no statistically significant relationships between gender and reasons, other perceived ad- June 1998/ Vol. 66/No

8 Table III Summary of demographic characteristics Variable Percentage Mean ± SD* Median Minimum/Maximum Gender-female Age - 46 ± /65 Planned retirement year /229 Anesthesia graduation year /1995 Anesthesia education Certificate Baccalaureate Master's Highest nonanesthesia degree Diploma Associate Baccalaureate Master's Doctorate Primary responsibility Administrator Educator Practitioner Educator and practitioner Primary practice setting Hospital University Hospital and university *SD-Standard deviation vantages, or perceived disadvantages. There were no statistically significant relationships between doctorate entry or promotion of doctoral program development and: * Accessibility to an academic institution that offers a doctoral degree. * Employment location. * Anesthesia education. * Highest nonanesthesia degree. * Primary practice responsibility. In addition, there were no statistically significant relationships between other reasons, other perceived advantages, or perceived disadvantages and: I I I I I Employment location. Anesthesia education. Highest nonanesthesia degree. Primary practice responsibility. Graduation year. * Age. * Planned year of retirement. However, there was a statistically significant relationship between age and doctorate entry support for women (P =.38) but not for men. Women who supported doctorate entry tended to be younger (44 years ± 8 years) than women who did not support doctorate entry (48 years ± 8 years). Respondents who felt that the AANA should promote doctoral programs tended to be younger (46 years + 7 years) than respondents who did not agree with this (48 years ± 8 years) (P =.23). There was a statistically significant relationship between planned retirement year and doctorate entry support for women (P =.28) but not for men. Women who supported doctorate entry tended to plan to retire later (median retirement year, 215) than did women who did not support doctorate entry (median retirement year, 28). Re- 294 Journal of the American Association of Nurse Anesthetists

9 Figure 3 Types of doctoral degrees favored* S4 a (N = 186) NAD PhD DNSc Degrees ND EdD *Total percentage is greater than 1%; subjects could specify more than one response. DNSc-Doctor of Nursing Science NAD-Doctor of Nursing Anesthesia EdD -Doctor of Education ND -Doctor of Nursing PhD-Doctor of Philosophy Table IV Doctoral degrees* Doctor of Philosophy (PhD)-A research-based academic degree awarded by a university. Degree requirements usually take a minimum of 4 years of post-graduate study and defense of a dissertation. Doctor of Education (EdD)-A professional or academic degree in education awarded by a university. Degree requirements usually take a minimum of 3 years of post-graduate study in education and presentation and defense of a dissertation. Doctor of Nursing Science (DNSc)-A research-based academic nursing degree focusing on clinical research awarded by a university. Degree requirements take a minimum of 4 years of post-graduate study and defense of a dissertation. Doctor of Nursing Anesthesia (NAD)-A professional degree in nursing anesthesia awarded by a university. Degree requirements usually take 1 year post-master's study or approximately 3.5 years of post-baccalaureate study including a research project in nurse anesthesia. (This degree is not offered at any university.) Doctor of Nursing (ND)-A professional degree in nursing awarded by a university. Degree requirements usually take 1 year post-master's study or approximately 3.5 years of post-baccalaureate study including advanced clinical study in a nursing specialty and completion of a research project. *These are broad definitions and there is a wide range of variability in the definitions based on the source. The purpose of the definitions is to serve as a reference point. Figure 4 Should AANA promote the develoment of doctoral programs? Yes 73% (N = 186) Undecided 1% No 26% spondents who felt that the AANA should promote doctoral programs tended to plan to retire later (median retirement year, 214) than did those who did not agree with this (median retirement year, 27) (P =.13). There was no statistically significant relationship between year of graduation from an anesthesia program and doctorate entry support for all respondents, for women, or for men. This finding and the statistically significant relationship between planned retirement year and doctorate entry support for women indicate that it is not when a female CRNA enters the profession that matters with respect to doctorate entry support, but when a female CRNA is planning to leave the profession. June 1998/ Vol. 66/No. 3

10 Figure 5 AANA's support of doctoral programs* r o Classes Model Educate curriculum members Financial assistance Scholarships (N = 186) Types of support *Total percentage is greater than 1%; subjects could specify more than one response. Figure 6 Reasons for opposing doctoral degrees for entry into practice* 6 S3 o Eliminate Expenses Amount of No No patient Focus on profession educational financial benefit BS and MS time benefit (N = 186) Reasons Lack of respect *Total percentage is greater than 1%; subjects could specify more than one response. BS -Bachelor of Science MS-Master of Science However, respondents who felt that the AANA should promote doctoral programs tended to be more recent anesthesia graduates (median graduation year, 1982) than those who did not agree with this (median graduation year, 198) (P =.44). Recommendations and conclusions Based on this survey, the majority did not support doctoral degrees for entry into practice, and more than half of the nurse anesthesia education programs indicated that it was not feasible to offer a doctoral degree. The AANA Board of Directors reviewed the results of this study at its June 1997 Board meeting and took the following actions: 1. The Board of Directors accepted the recommendation from the Doctoral Task Force not to mandate a doctoral degree for entry into practice, and referred this to the Council on Accreditation for its information. 2. The Board approved the recommendation 296 Journal of the American Association of Nurse Anesthetists

11 Figure 8 Program directors' responses for feasibility of offering a doctoral degree Yes 4% No 6% to support the development of a network of consultants to develop doctoral programs, and referred this to the Education Committee. 3. The Board approved financial support of scholarships to increase the number of doctorally prepared faculty, and referred this to the AANA Foundation. 4. The Board approved research on the feasibility of mandating doctoral degrees for program directors, and referred this to the Education Committee. 5. The Board approved a continued search for financial support for faculty development for doctoral students through federal programs, and referred this to the Director of Education (Doctoral Task Force Committee Report to the AANA Board of Directors, May 7, 1997; correspondence from Luis A. Rivera, BS, executive assistant to the executive director, American Association of Nurse Anesthetists, July 21, 1997). Figure 9 Difficulty of identifying and receiving resources 6 5 S4 A (N = 72) Not difficult Difficult Impossible (N = 72) Procure resources Figure 1 Difficulty for faciulty to earn doctoral degrees 5-4 c (N = 72) No interest Time Finances Reasons Lack of access Lack master's degree June 1998/ Vol. 66/No

12 REFERENCES (1) Standards for Accreditation of Nurse Anesthesia Educational Programs. Park Ridge, Illinois: Council on Accreditation of Nurse Anesthesia Educational Programs. 1994:iv, 4. (2) Standards and Guidelines for Accreditation of Nurse Anesthesia Educational Programs/Schools. Park Ridge, Illinois: Council on Accreditation of Nurse Anesthesia Educational Programs (3) A 5- Year Retrospective of the American Association of Nurse Anesthetists. Park Ridge, Illinois: American Association of Nurse Anesthetists, 1981:6-7. (4) Preparing to Be a Doctor of Chiropractic: Answers to Your Questions About Chiropractic Education. Scottsdale, Arizona: The Council on Chiropractic Education (5) Standards for Chiropractic Programs and Institutions. Scottsdale, Arizona: Commission on Accreditation, Council on Chiropractic Education. January 1997:45. (6) Accreditation Manual: Professional Optometric Degree Program. St. Louis, Missouri: Council on Optometric Education. July 1, 1994:16,18. (7) Standards and Requirements for Accrediting Colleges of Podiatric Medicine. Bethesda, Maryland: Council on Podiatric Medical Education. January 1998:16. (8) Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Chicago: The American Council on Pharmaceutical Education, Inc. 1997:12. (9) 1997 Council on Accreditation Annual Report Data. Park Ridge, Illinois: Council on Accreditation (1) The Face Behind the Mask. Audiotape/Slide Presentation. Park Ridge, Illinois: American Association of Nurse Anesthetists AUTHORS Lorraine M. Jordan, CRNA, PhD, is AANA director of Research. Susan Shott, PhD, is associate professor, Biostatistics Unit, Department of Neurosurgery, Rush Medical Center, Chicago, Illinois. Why Choose between a Great Career and a Great Location? At University of North Carolina Hospitals You'll Have Both. Immediate openings for CRNAs. Must have a minimum of a Master's degree and be a graduate of an accredited school of nurse anesthesia, a graduate nurse anesthetist with certification pending, or a current certified nurse anesthetist, eager to practice all types of anesthetic techniques including regional anesthesia, general anesthesia, and invasive monitoring. As a Level I Trauma Center with 24 ORs, UNC Hospitals offers the CRNA opportunities to provide care to all surgery and diagnostic services including cardiac, burs, neuro, oncology, pediatrics, ENT, and comprehensive solid organ transplantation. Enjoy an anesthesia care team environment that supports collegial relationships. Flexible self-scheduling provides time off to enjoy all the cultural, academic and leisure activities of a university setting, not to mention the exceptional quality of life in Chapel Hill. UNC Hospitals is located on the prestigious University of North Carolina Campus and is centrally located between serene mountains and uncrowded beaches. Excellent salary and comprehensive benefit package, including a sign-on stipend and five paid educational days. For more information, please call Send resume to CRNA Recruiters, UNC Hospitals, Nurse Employment Office, 11 Manning Drive, Chapel Hill, NC or fax to (919) Visit us on the Internet at AA/EOE The University of North Carolina Hospitals NURSE 298 Journal of the American Association of Nurse Anesthetists