This FAQ’s page, first published in May 2014, is designed to be a dynamic space for addressing current topics in nurse anesthesia accreditation. Content has been added to address member questions related to educational standards. For additional clarification on these FAQs, or if you have other questions, comments or concerns not addressed here, please contact us.
No—the revisions to the “Certification Examination” policy are effective January 18, 2019 and will not apply to any previously-reviewed pass rate data. The new calculation methods described in the revised policy will be implemented for the first time for programs being reviewed at the May 29-31, 2019 COA meeting.
At its October 2018 meeting, the COA reviewed data provided by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). The data provided by the NBCRNA included a program-by-program listing of all successful NCE takers and identified the number of attempts required for each graduate to pass. Using this information, the COA determined that 96% of test-takers who were successful on their first or second attempts were able to pass within 60 days of program completion. Following careful consideration of these findings and a review of the impact of implementing Method 3 on programs, the COA determined that the timeframe for including second-time successful testers should be established at 60 days from the date of their programs’ completion.
Programs’ pass rates are reviewed twice per year, with half of all accredited programs’ National Certification Examination pass rate data reviewed at the COA’s Spring Meeting, and the other half reviewed at the COA’s Fall Meeting. If a program fails to meet the COA’s pass rate requirement (i.e., 80%) using any of the three methods established in the “Certification Examination” policy, it will be placed on monitoring. The program will be instructed to submit a status report for review alongside its next graduation cohort’s pass rate data (i.e., one year from the meeting at which it was placed on monitoring). Programs are not considered out of compliance with the accreditation Standards the first time they do not meet the pass rate requirement.
If a program that is already on monitoring fails to meet the pass rate requirement for a second time, it will not only remain on monitoring but also be considered out of compliance with Standard I, Criterion A11 and Standard III, Criterion C21c8 of the master’s Standards or Standard A.12 and Standard D.24 of the practice doctorate Standards. In accordance with the COA’s “Deadline for Compliance with the Standards and Criteria of the Council on Accreditation” policy, programs that have been notified by the COA of non-compliance with the Standards have a maximum of two years in which to comply with the COA’s requirements. An adverse accreditation decision for revocation will be made at the end of the two-year deadline, though programs can request a one-year extension for good cause.
The monitoring period shall not exceed five years from the date a program is placed on monitoring. A program will be removed from monitoring as soon as it meets or exceed the COA’s pass rate requirement for two consecutive years. Sample flowcharts demonstrating the possible outcomes of the monitoring process are available in the COAccess Reference Library.
Per “Certification Examination” policy item #1h, programs are required to:
Publish honest, reliable, accurate data and information to the public regarding its performance. Publications can be in various formats but must include posting the following information on a website that is linked to the Council’s List of Accredited Educational Programs. The information must include: Certification examination pass rate for first-time takers (refer to Public Disclosure of Accreditation Decisions and Performance Data, P-24).
If a program meets the COA pass rate requirement of 80% under Method 2 or Method 3 it can post its pass rates using these calculations; however, the website posting must include the first-time pass rate for the cohort (i.e., the Method 1 calculation) as well.
The COA provides information regarding the nurse anesthesia programs it accredits to the public in accordance with its policies and procedures. It also requires programs to provide student achievement information on their websites. Examples of information provided by the COA include: (1) List of Accredited Programs – program address, contact information, degrees awarded, program start/end dates, dates of last and next accreditation review by the COA; (2) CRNA School Search programs’ tuition costs, admission requirements, class size, program length, curriculum; (3) Report of Actions – following each COA accreditation decision-making meeting the COA distributes a Report of Actions that indicates the accreditation decisions made at the meeting. The Report of Actions indicates the COA’s accreditation decisions and the number of years awarded programs reviewed for initial and continued accreditation. The report also identifies if standards were found to be not in full compliance.
The COA follows its policies and procedures in providing programs’ accreditation related information to the public. The policies and procedures are consistent with the U.S. Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA) recognition requirements for accrediting agencies. Maintaining confidentiality within the accreditation process promotes candor. Assurance of confidentiality allows programs to submit sensitive and sometimes proprietary information without fear that it will be disclosed outside the accreditation process. Disclosure of programs accreditation information outside the accreditation process would have a “chilling effect” on the COA’s ability to receive full and frank information and would ultimately reduce confidence in the quality assurance aspect of accreditation.
Standard V, Criterion E8 (2004 Standards) and Standard G.8 (PDS) require the program to forbid the employment of nurse anesthesia students as nurse anesthetists by title or function. The clinical education of nurse anesthesia students should be primarily focused to benefit the education of the students. Students’ clinical assignments should be primarily based on their educational needs. Students should be assigned to activities that have a legitimate educational purpose, considering the professional role of a nurse anesthetist. For example, routine reassignment of students in the middle of a case to benefit the facility, and not the students’ educational needs, would be inappropriate.
Standard III, Criterion C19 (2004 Standards) and Standard E.10 (PDS) require programs to provide “opportunities for students to obtain clinical experiences outside the regular clinical schedule by a call experience or other mechanism.” Call experiences are planned clinical experiences outside the normal operating room schedules. Assigned duty on shifts falling within these hours (e.g., 3-11PM, 11PM-7AM, weekends, etc.) is considered the equivalent of an anesthesia call, during which a student is afforded the opportunity to gain experience with urgent and emergent cases. Although a student may be assigned to a 24-hour call experience, at no time may a student provide direct patient care for a period longer than 16 continuous hours.
The 2004 Standards and PDS limit student time commitment to a reasonable number of hours that does not exceed 64 hours per week (ref. 2004 Standards – Standard V, Criterion E9 and PDS Standard F.9). This limitation is meant to support patient safety and promote effective student learning. The Glossary defines “reasonable time commitment” as the sum of the hours spent in class and all clinical hours averaged over 4 weeks. Students must have a 10 hour rest period between scheduled clinical duty periods (i.e., assigned continuous clinical hours). At no time may a student provide direct patient care for a period longer than 16 continuous hours.
Clinical hours are defined in the Glossary of the 2004 Standards and PDS. Clinical hours include time spent in the actual administration of anesthesia (i.e., anesthesia time) and other time spent in the clinical area. Examples of other clinical time would include in-house call, preanesthesia assessment, postanesthetic assessment, patient preparation, operating room preparation, and time spent participating in clinical rounds. Total clinical hours are inclusive of total hours of anesthesia time; therefore, this number will be greater than the total number of hours of anesthesia time.
Both the 2004 Standards and PDS require that the nurse anesthesia clinical curriculum prepares the student for the full scope of current practice in a variety of work settings and requires a minimum of 600 clinical cases and 2000 clinical hours including a variety of procedures, techniques, and specialty practice (ref. 2004 Standards – Standard III, Criterion C18 and PDS Standard E.2.3, as well as the Appendices of the Standards). The case requirements defined in the Appendices of the 2004 and PDS Standards identify mandatory minimums as well as preferred case numbers. While all students must meet the minimum case requirements in order to be eligible for the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) National Certification Examination, normally students exceed the minimums in various categories during their clinical rotations.
All accredited nurse anesthesia programs are required to develop clinical curricula that provide students with opportunities for experiences in the perioperative process that are unrestricted and promote their development as competent, safe nurse anesthetists (ref. 2004 Standards – Standard III, Criterion C17 and PDS Standard E.9). Clinical curricula are to prepare graduates for the full scope of nurse anesthesia practice; programs are required to demonstrate that their graduates have acquired knowledge, skills, and competencies in patient safety, perianesthetic management, critical thinking, communication, and the competencies needed to fulfill their professional responsibilities. The PDS Standards support the AANA Scope of Nurse Anesthesia Practice. The graduate competencies are identified in the 2004 Standards – Standard III, Criteria C21a-e and PDS Standards D1-51.
The clinical supervision ratio of students to instructors must be coordinated to support patient safety by taking into consideration: the student’s knowledge and ability; the physical status of the patient; the complexity of the anesthetic and/or surgical procedure; and the experience of the instructor (ref. 2004 Standards – Standard V, Criterion E13 and PDS Standard F.9). Clinical oversight of graduate students in the clinical area must not exceed two graduate students to one CRNA, or two graduate students to one anesthesiologist (if no CRNA is involved).
The COA is composed of 13 directors including 6 CRNA educators, 2 CRNA practitioners, 1 hospital administrator, 1 nurse anesthesia student, 1 university administrator and 2 public members. The composition of the COA reflects a mix of qualified CRNA educators and CRNA practitioners that is appropriate for rendering accreditation decisions regarding nurse anesthesia educational offerings at the master’s and doctoral degree levels and for the accreditation of Fellowships.
The composition of the COA represents the publics within the nurse anesthesia community of interest. The COA follows the Accreditation Policies and Procedures for the recruitment and selection of COA directors. The policies and procedures are consistent with the U.S. Department of Education and Council for Higher Education recognition requirements for accrediting agencies.
A candidate for directorship must meet written criteria for the specific group to be represented. Nominations are solicited from the community of interest by notices posted in the AANA NewsBulletin, AANA E-ssential and by direct communication with groups and organizations such as nurse anesthesia program administrators and the AANA Board. Candidates for the nurse anesthesia student directorship are solicited based on AANA Region on a rotational basis.
In establishing the minimum total case number requirement, the Standards Revision Task Force (SRTF) carefully assessed over a 3 year period the clinical requirements of other accrediting agencies such as the Accreditation Council for Graduate Medical Education (ACGME) requirements for anesthesiology residents, comments from the community of interest obtained through 4 Calls for Comments and 8 Hearings and Focus Sessions held on the draft Standards, 2 surveys, and the analysis of NBCRNA transcript data. The SRTF considered various options in establishing the minimum total case number requirement. This included a review of the literature related to clinical competency and the use of a benchmarking process. In addition the COA established a minimum number of clinical hours. This new requirement recognizes the value of students providing anesthesia care for longer and more complex cases versus an increased number of less complex cases (refer FAQ below).
The COA established a minimum number of clinical hours as a new requirement that recognizes the value of students providing anesthesia care for longer and more complex cases versus an increased number of less complex cases. The required number of clinical hours was increased from a proposed number of 1,600 hours in draft one to a required number of 2,000 hours (refer Trial Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate, Glossary, pg.33).
In the Standards for Accreditation of Nurse Anesthesia Programs – Practice Doctorate (trial guidelines- effective 1/2015) the requirements for clinical experience numbers for regional anesthesia techniques, overall case numbers, and total clinical hours are all increased over the current Standards for Accreditation of Nurse Anesthesia Programs clinical experience requirements. When creating the new Standards, the Standards Revision Task Force performed a comprehensive literature review to determine whether the literature supported increasing the number of regional anesthesia case requirements. Of the literature available and reviewed, the most relevant studies (see below), as well as the requirements specified for other anesthesia learners, were among the factors used to support the rationale for the decision. There are no conclusive studies to support how many experiences are required to reach competence with the techniques. The opportunity for nurse anesthesia students to perform regional anesthesia techniques varies greatly from one clinical site to another (as it does for the CRNAs at these sites). The minimal clinical experience requirements take this variation into consideration, while also ensuring that all students have a minimum number of case experiences in these techniques.
Pre- and post-anesthesia assessment and management of patients is a requirement of the AANA Standards for Nurse Anesthesia Practice (2/2013), and the AANA Scope of Nurse Anesthesia Practice (6/2013). Students are required to perform a comprehensive history and physical assessment (Standard C21, b10) and perform a pre-anesthetic assessment and formulate an anesthesia care plan (Standard C21, c3) according to the current Standards for Accreditation of Nurse Anesthesia Programs. These same requirements are included in the Standards for Accreditation of Nurse Anesthesia Programs – Practice Doctorate (Standards D.8 & D.15). Post-anesthesia assessment is a component of the perianesthetic process/continuum, which is addressed in Standards C17 and C21, b1 (Standards for Accreditation of Nurse Anesthesia Educational Programs). The Standards for Accreditation of Nurse Anesthesia Programs – Practice Doctorate addresses the perianesthesia continuum in Standard D.5.
De Oliveira Filho GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesthesia & Analgesia. 2002; 95(2): 411-416.
Konrad C, Schupfer G, Wietlisbach M, Gerber, H. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesthesia & Analgesia. 1998; 86(3): 635-639.
Kopacz D. The regional anesthesia “learning curve”: what is the minimum number of epidural and spinal blocks to reach consistency? Regional Anesthesia. 1996; 21(3): 182-190.
Smith MP, Sprung J, Zura A, Mascha E, Tatzlaff J. A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs. Regional Anesthesia and Pain Medicine. 1999; 24(1): 11-16.
The scope of nurse anesthesia practice is determined by education, experience, state and federal law, and facility policy. The Standards for Accreditation of Nurse Anesthesia Educational Programs and the Standards for Accreditation of Nurse Anesthesia Programs – Practice Doctorate are designed to prepare graduates with competencies for entry into anesthesia practice. A crosswalk between the AANA Scope of Nurse Anesthesia Practice and the Standards for Accreditation of Nurse Anesthesia Programs – Practice Doctorate shows how the standards address the elements of the scope (refer reference below). Entry into practice competencies for the nurse anesthesia professional prepared at the practice doctoral level are those required at the time of graduation to provide safe, competent, and ethical anesthesia and anesthesia-related care to patients for diagnostic, therapeutic, and surgical procedures. Entry into practice competencies should be viewed as the structure upon which nurse anesthetists continue to acquire knowledge, skills, and abilities along the practice continuum that starts at graduation (proficient), and continues throughout their entire professional careers (expert). The Standards require that the curriculum be designed to focus on the full scope of nurse anesthesia practice (Standard E.2).
CRNAs practice in a variety of settings; the level of autonomy of practice is determined by many factors. All CRNAs, regardless of whether they work with anesthesiologists, should be prepared to practice autonomously; however, nurse anesthesia educational programs must provide supervision for nurse anesthesia students according to the Standards for Accreditation of Nurse Anesthesia Educational Programs (Standard V, Criteria E10, E11, and E13) and the Standards for Accreditation of Nurse Anesthesia Programs – Practice Doctorate (Standards F.5, F.7, and F.8). While students may experience clinical training in practices where CRNAs function autonomously, the students themselves should never be practicing completely independent of supervision by a CRNA and/or anesthesiologist.
Although the COA does not require students to obtain clinical experience in rural and small practice settings, many programs provide students with opportunities in these clinical settings based on their availability. While experience within CRNA-only practices is desirable it is not always possible for programs to establish clinical rotations of this nature. The COA recently conducted a survey of owners and partners of CRNA-only practice groups in order to determine their willingness to provide clinical education for anesthesia students, as well as to identify barriers to groups serving as clinical sites. Several anesthesia providers in CRNA-only practice settings responded that they would be willing to be contacted by a nurse anesthesia program to discuss receiving anesthesia students; the COA provided their names and contact information to anesthesia program administrators. As an additional resource for programs, the COA maintains a list of CRNA-only practices that have expressed interest in serving as clinical sites. Individuals at CRNA-only practices may contact the COA if willing to be contacted by programs.
Gombkoto RLM, Walker JR, Horton BJ, Martin-Sheridan D, Yablonky MJ, Gerbasi FR. Council on Accreditation of Nurse Anesthesia Educational Programs Adopts Standards for the Practice Doctorate and Post-graduate CRNA Fellowships. AANA J. 2014; 82(3):177-183.
The process for major revision of the Standards is described in the “Standards for Accreditation: Development, Adoption, and Revision” policy in the COA’s Accreditation Policies and Procedures manual. Please refer to this policy for a complete description.
For a description of the most recent major revision of the Standards, please see the following article:
Gombkoto RLM, Walker JR, Horton BJ, Martin-Sheridan D, Yablonky MJ, Gerbasi FR. Council on Accreditation of Nurse Anesthesia Educational Programs Adopts Standards for the Practice Doctorate and Post-graduate CRNA Fellowships. AANA J. 2014;82(3):177-183.
Highlights of the process are described below but please refer to the Accreditation Policies and Procedures manual for the complete policy.
Major (substantive) revisions are defined as major revisions to the Standards that may affect the nature of the educational program, its mission and objectives, and the allocation of its resources. The COA is responsible for determining the need for major changes to the Standards and for initiating such actions, and will consider recommendations for major revisions received from appropriate persons, councils, programs, or institutions.
If the COA determines a major revision is in order, a Standards Revision Task Force (SRTF) is appointed and a multiyear timeline is prepared for completing the change. The timeline affords the constituencies of the SRTF, including the AANA Board of Directors and AANA Education Committee, a meaningful opportunity to provide input into the change and presents a progress report to the COA.
In the Development and Adoption Phase, the SRTF develops and reviews consecutive drafts of the new Standards based on input from the communities of interest.
In the Implementation Phase, an orientation to the new Standards is offered by the COA at the first Assembly of School Faculty held after the adopted Standards have been published and distributed. Open discussion relative to the new Standards is conducted at the Assembly of School Faculty (ASF) relative to the need for and/or feasibility of the changes. From the reports received and the recommendations made at the ASF, the revised Standards (and revised self study, if needed) will be finalized. If at any point during the revision process inadequate consensus on a given point in the revision is present, selected steps in this process may be repeated.
The adopted Standards will be implemented by programs within one year. Programs undergoing onsite visits during this year can elect to be reviewed under the adopted Standards or the previous Standards. Following implementation of the Standards, the COA will conduct reviews of the standards on a yearly basis (or as needed).
In developing Standards (both master’s and doctoral) related to admissions requirements, the COA strengthened the existing standard and defined “Critical Care Experience” to ensure students enrolled in nurse anesthesia programs possess the appropriate professional preparation.
Master’s Standard III, C13b: At least one year of experience as a RN in a critical care setting (see Glossary “Critical Care Experience”)
Practice Doctorate Standard C.2.3: A minimum of one year full-time work experience, or its part-time equivalent, as a RN in a critical care setting. The applicant must have developed as an independent decision-maker capable of using and interpreting advanced monitoring techniques based on knowledge of physiological and pharmacological principles (see Glossary “Critical Care Experience”)
Critical Care Experience – Critical care experience must be obtained in a critical care area within the United States, its territories or a U.S. military hospital outside of the United States. During this experience, the registered professional nurse has developed critical decision making and psychomotor skills, competency in patient assessment, and the ability to use and interpret advanced monitoring techniques. A critical care area is defined as one where, on a routine basis, the registered professional nurse manages one or more of the following: invasive hemodynamic monitors (such as pulmonary artery catheter, CVP, arterial); cardiac assist devices; mechanical ventilation; and vasoactive infusions. Examples of critical care units may include but are not limited to: Surgical Intensive Care, Cardiothoracic Intensive care, Coronary Intensive Care, Medical Intensive Care, Pediatric Intensive Care, and Neonatal Intensive Care. Those who have experiences in other areas may be considered provided they can demonstrate competence with managing unstable patients, invasive monitoring, ventilators, and critical care pharmacology.
The COA considered the following evidence and expert opinion in defining the clinical experience pre-requisite for entry into nurse anesthesia programs:
- While one year was the minimum for acute care experience, an average of 3.4 years was reported by the NBCRNA FY2013 Annual Summary of NCE Performance Data. Furthermore, the Council has strengthened the Standard to require a minimum of one year of critical care experience.
- There are no data that demonstrate the number of years of critical care experience improves critical thinking abilities, nor does it enhance nurse anesthesia skill acquisition or success within the program.
- This requirement is unique to nurse anesthesia education: none of the other advanced practice professions (e.g., physicians, dentists, optometrists, physician assistants, or other APRNs) has critical care experience pre-requisites.
- Required critical care experience can be likened to a required internship. Following a four-year baccalaureate degree, two years of critical care experience, in addition to three years of doctoral education, would ostensibly lengthen the nurse anesthesia education process to nine years.
- An article by Burns (AANA Journal, June 2011) concluded that the amount of critical experience was negatively correlated to academic success and progression. Candidates most likely to succeed demonstrated positive correlation with overall GPA and science GPA.
- An article by Wong and Li (AANA Journal, June 2011) concluded that personality characteristics (i.e., confidence and commitment) may be more accurate predictors of academic and clinical success in nurse anesthesia education.
A valid, reliable entrance examination, specific to nurse anesthesia, does not exist. Programs are required to enroll students who are academically and experientially prepared for nurse anesthesia education in the following ways:
- Applicants have achieved academic success in baccalaureate-level degrees thereby demonstrating critical thinking abilities consistent with that level of education.
- Successful completion of the NCLEX requires critical thinking abilities appropriate for the registered nurse role and responsibilities.
- Applicants are required to complete one year of full-time work experience as a registered nurse in a critical care setting. Critical care nursing experience fosters the development of clinical competencies and critical thinking abilities gained at the entry-into-nursing practice level.
- The COA’s Standards for Accreditation of Nurse Anesthesia Educational Programs and Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate glossaries define “Critical Care Experience” to ensure that applicants and programs have a clear understanding of the minimum critical care acumen for admission to nurse anesthesia programs. The knowledge, skills, and abilities outlined in this definition require the RN to possess and utilize critical thinking abilities.
- Students enrolled in programs awarding doctoral degrees are required to possess both ACLS and PALS certification before beginning clinical activities. These certifications verify adult and pediatric life support competencies, including the diagnosis and management of life-threatening conditions.
Given the variability in the definition of critical thinking, and the paucity of valid/reliable tools to assess critical thinking, universities and programs are provided the latitude to assess these attributes in ways consistent with institutional policy and available evidence. Examples include submitted essays, spontaneous writing exercises, the Graduate Record Examination, Miller’s Analogy Test, and others. In addition, a variety of critical care nursing examinations are offered by several certifying organizations. Given that universities and anesthesia programs establish their own admissions requirements and there are many examinations available, it would be very difficult to a) define which examination(s) would be acceptable, b) produce evidence supporting why they are acceptable, and c) convince universities that any specific examination is a critical admission criterion. No evidence exists that any certification examination available to registered nurses (for example, the CCRN) predicts success in nurse anesthesia educational programs.
The Council does not play a role in the profit margins of anesthesia programs. However, the COA’s Standards require programs to provide evidence that adequate resources exist to support the size and scope of the program to appropriately prepare students for practice and to promote the quality of graduates including:
- Financial resources that are budgeted and used to meet accreditation standards,
- Physical resources including facilities, equipment, and supplies,
- Learning resources including clinical sites, library, and technological access and support,
- Faculty and support personnel, and
- Student services including but not limited to assistance (such as financial aid), health services, insurance, placement services, and counseling.
The Practice Doctorate Standard B.7* and 2004 Standard II, Criteria B3 also require that the CRNA program administrator has the authority to prepare and administer the program budget. Failure to fully comply with one or more of the COA Standards marked with an asterisk is considered to be of critical concern in decisions regarding nurse anesthesia program accreditation.
The Council reviews the financial and other resources of programs through several mechanisms: programs are required to provide budget and resource information each year when they complete their annual reports for submission to the Council; evaluations of programs are completed by faculty and students at the midpoint of their accreditation cycle (or more often if required) and in preparation for an onsite visit; and programs submit a completed self study and host an onsite review when the program is due for review for continued accreditation. If the Council determines there may not be sufficient resources available to meet the Standards, the program administrator is notified and requested to address the Council’s concerns in writing, and include supporting documentation.
Please note that at its January 2014 meeting the COA approved a new “Program Resources and Student Capacity” policy. This policy establishes benchmarks for each program’s class size based on adequacy of resources. Programs cannot increase their class sizes without obtaining prior approval. Programs must demonstrate reasonable assurance there are adequate resources as delineated in Practice Doctorate Standard A10* and current Standard II, Criteria B1*,B2, B4*, and B5.
The COA’s process for the accreditation of a new nurse anesthesia program is focused on ensuring the program’s compliance with the accreditation Standards. The process, as identified in the COA’s Accreditation Policies and Procedures, is consistent with the recognition requirements of both the U.S. Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). Please note the COA does not consider workforce (i.e. the supply and demand for CRNAs) in its accreditation review process. This would be inconsistent with USDE and CHEA recognition requirements and have antitrust implications.
Prospective programs need to undergo a series of activities required by the COA prior to receiving their initial accreditation.
This begins with Council Policies: “Capability Review for Accreditation” (pp. C-1—C-3) and establishing “Eligibility for Accreditation” (pp. E-1—E-3).
Prospective programs seeking COA accreditation may not admit students to the nurse anesthesia program or enroll students in courses with anesthesia in the title or with anesthesia-related content before initial COA accreditation is granted.
The first step in the process for a new nurse anesthesia program is for the sponsoring institution to file a letter of intent with the COA. The letter of intent must be from the chief executive officer of the sponsoring institution and reflect the institution’s legal authority to grant the degree and its commitment to provide the necessary resources to establish a program that meets accreditation requirements.
Following the COA’s acceptance of the letter of intent, a new program starts an accreditation review process. The process includes the submission of evidence of eligibility (i.e., legal authority to grant the degree and meet all state regulatory requirements including requirements of the state boards of higher education and state boards of nursing), a self study (i.e., a program’s written explanation regarding how it meets each accreditation criterion with supporting documentation), payment of required fees, and hosting an onsite review. The onsite review is conducted by experienced nurse anesthesia educators and practitioners who are approved and trained by the COA to serve in their capacity as an extension of the COA (ref. policies “Onsite Review,” p. O-2—O-4 and “Onsite Reviewers and Fellowship Review Committee: Application and Appointment,” O-7—O-11).
An applicant program must demonstrate by appropriate documentation within the self study and verification by the onsite reviewers that the program is in compliance with the Standards, including the following requirements:
- Potential for professional and educational growth of students and faculty,
- A curriculum to enable graduates to attain certification as nurse anesthetists, including sequencing of courses for the entire program and a description of each course,
- Written agreements with sufficient accredited clinical sites to provide required cases and experiences for the total number of students to be enrolled when the program is fully implemented (e.g., first-, second-, and third-year classes),
- Appropriately qualified administrative personnel, faculty, and resources to comply with the Council’s Standards for Accreditation of Nurse Anesthesia Educational Programs and/or Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate, and
- A three-year financial plan providing evidence of sufficient financial resources to implement and sustain an accredited program.
After the onsite review is completed, the reviewers’ prepare a written summary report to which the program must respond in writing, with supporting documentation, to all areas identified as partial- or non-compliance with the Standards.
Only after all of these activities have been successfully completed will the COA review the program. During its review, the COA analyzes all of the documentation associated with these steps in the accreditation process and makes an accreditation decision based on the program’s ability to demonstrate compliance with the Standards.
The Council then renders one of the following decisions: deferral, grant initial accreditation, or deny initial accreditation. If initial accreditation is granted, the program may admit students. The Council will determine the program’s initial class size based upon existing documentation of adequate resources, including but not limited to, the following:
- Program space, including classrooms, labs, etc.,
- Volume and variety of clinical experiences/number of sites,
- Number of qualified administrative, didactic and clinical faculty,
- Support personnel, and
- Student services that demonstrate they are sufficient to provide for the total number of students (ref. policy “Program Resources and Student Capacity,” pp. P-15—P-17).
After the program receives initial accreditation, it then must complete a self study and host an onsite review five years after the admission of its first class of students (ref. policy “Accreditation after Graduation of First Class of Students,” p A-1).
Please note that the COA does have a mechanism for third parties to submit comments and concerns regarding programs being considered for initial and continued accreditation. Comments will be limited to the program’s compliance with the Standards. Should anyone desire to submit official comments, please note that the program will be provided a copy of the comments and will have the opportunity to respond to them. The COA will then have the opportunity to consider the comments of both parties (ref. policy “Third-Party Presentation,”pp. T-3—T-5).
None. The COA does not and cannot consider workforce (i.e., supply and demand for CRNAs) in its accreditation decision-making process. COA activities in this regard would be inconsistent with U.S. Department of Education and Council for Higher Education Accreditation recognition requirements. It would also have antitrust implications.
Instead, the COA requires programs to demonstrate substantial compliance with the Standards, which address program quality assessment and improvement. While the COA does not make accreditation decisions based on the number of CRNA practitioners in the geographic area of a particular program, the Standards do require each program to provide adequate didactic and clinical resources for all students. Recently, the COA revised this requirement by establishing an approved class size for each nurse anesthesia program preparing students for entry into practice, based on the adequacy of resources (refer to Accreditation Policies and Procedures, “Program Resources and Student Capacity,” P-15). The COA requires programs to verify that there are adequate resources to support an educational program that meets the Standards and to secure prior approval before increasing the number of students. Approval is required even if the program increases the number by one student. In addition, programs are required to provide information on student enrollment data annually.
Students can demonstrate compliance with the competencies expressed in Standard III, Criterion C21e4 and Practice Doctorate Standard D.30 by completing class presentations (face-to-face, virtual), making presentations to staff in the clinical setting (such as grand rounds type presentations), podium and poster presentations at local, state, national meetings, patient education (including preoperative interviews), and other methods.
While CRNA and non-CRNA faculty involvement in the scholarly work development process may vary depending on the institution, college/school or program, or project scope, faculty with a CRNA credential must be involved in the process of planning, formation and evaluation of each scholarly project. Evaluation of scholarly work may include a combination of methods including faculty, expert and/or peer evaluation. Programs tailor scholarly work evaluation and approval processes per university, departmental, program or committee requirements.
On average the COA receives one to two formal complaints against nurse anesthesia programs per year. The procedure the COA follows in reviewing complaints is identified in the Accreditation Policies and Procedures Manual (refer Complaints Against Nurse Anesthesia Programs, pgs. C-15 – C-19). The procedures are consistent with the United States Department of Education’s (USDE) and the Council for Higher Education Accreditation’s (CHEA) recognition requirements for accrediting agencies. The nature of the complaints most frequently relates to student dismissals.
Procedures are outlined for lodging a complaint against nurse anesthesia programs and against the COA in the Accreditation Policies and Procedures manual. The procedures are consistent with the accreditation agency recognition requirements of both the U.S. Department of Education and the Council for Higher Education Accreditation. Some important aspects of these procedures are outlined below. Please refer to the manual for the complete policy Complaints Against Nurse Anesthesia Programs.
The COA considers complaints against nurse anesthesia programs related to noncompliance with the Standards or policies and/or procedures. The COA should be contacted after exhausting any and all internal procedures available to the complainant within the institution. The complaint must contain sufficient information explaining how the program is violating a Standard or COA policy and/or procedure and must contain supporting documentation if available. The COA will not accept electronic protected health information.
A written statement that the complaint can be released to the program must be signed by the complainant and provided to the COA. If (for valid reasons) the complainant requests confidentiality, the COA Executive Director or designee will remove all identifying information from the complaint and the letter containing the complaint will be paraphrased. Anonymous complaints will not be considered unless a complaint suggests an imminent threat of harm to the program administrator, students, staff, patients, or others.
The COA will evaluate a complaint to determine if internal procedures within the nurse anesthesia program have been exhausted. The complaint will then be evaluated to determine if it relates to noncompliance with accreditation Standards or the COA’s policies and/or procedures. If the complaint relates to these areas, then the COA will investigate the complaint in a timely manner. The program and appropriate institutional officials will be notified when a valid complaint against a program is received by the COA. If necessary, the COA will refer a complainant to appropriate federal, state, and/or other agencies if the complaint does not relate to the Council’s Standards.
The COA can take a variety of actions based on its investigation, including:
- Take no action and dismiss the complaint,
- Conduct a supplemental onsite review,
- Defer consideration until the next routinely scheduled onsite review, or
- Make a decision affecting the current accreditation status of the program
(see Decisions for Accreditation).
The COA will notify the program administrator, other appropriate institutional personnel, and the complainant of its decision within 30 days of the time the decision is made.
The COA will review any complaint against it that is related to its Standards, criteria, procedures, or conduct. Please refer to the policy “Complaints Initiated Against the Council” located in the Accreditation Policies and Procedures Manual for additional information.
In addition to formal complaints, the COA also receives informal concerns regarding nurse anesthesia education. Informal concerns are more general in nature and most commonly relate to the number and quality of graduates. In response the accreditation staff follows up with the individuals submitting the concerns.