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.
Reference:
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.
