Council on Accreditation of Nurse Anesthesia Educational Programs
"Supporting Quality Assessment and Improvement in Nurse Anesthesia Education"
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FAQ - Standards Related to Clinical Education

Clinical education: What are some examples of nurse anesthesia students being employed as nurse anesthetists by title or function?

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.
 

How do students obtain clinical experiences outside the regular clinical schedule to meet the call experience requirement?

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.
 

Does the COA have other requirements regarding student time spent in the clinical environment?

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. 
 

How are “clinical hours” defined?

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.
 

What types of procedures, techniques, and specialty practice are required to prepare students for entry into practice?

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.    
 

What other types of clinical opportunities are important for students to obtain in order to promote their development as competent, safe nurse anesthetists?

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.

What are the COA’s clinical supervision requirements?

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).

 


 

[1] Gombkoto R, Walker J, Horton B, Martin-Sheridan D, Yablonky MJ, Gerbasi F. Council on Accreditation of Nurse Anesthesia Educational Programs Adopts Standards for the Practice Doctorate and Post-graduate CRNA Fellowships. AANA Journal. 2014; 82(3), 177- 183.