How did the COA determine the entrance requirements for applicants to nurse anesthesia educational programs, including the requirement for a minimum of one year of critical care experience?

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”) 

Glossary Definition 

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.