Continuing Competency in Health Care
Health care credentialing
exists to ensure compliance with high standards for delivery of care in a profession. Credentialing
demonstrates that providers remain up-to-date with industry best practices.
One of the big shifts in
credentialing is a move toward continuing competency. This is not new. In fact,
most physician specialties, including anesthesia, have made the shift to
competency-based credentialing systems, as have many nursing organizations.
The research shows that
initial certification is just a start. Certification establishes a baseline
competency at an entry level of performance. Knowledge at one point in time,
however, is not enough to ensure currency with evolving knowledge, skills, and
technologies or to allow the profession to respond quickly to changing
trends. Professional knowledge and skills,
especially in anesthesia, require continuous updating and enhancement with the
most current evidence that informs practice.
Continuing competency is a lifelong learning process of acquiring
skills and knowledge and the
ability to apply those skills and knowledge to practice.
Limitations of the Current 2-Year Recertification System
For certified registered nurse anesthetists, credentialing is currently a two-stage
process: initial certification upon entering the profession and a recertification
process that includes continuing education on a 2-year cycle.
The NBCRNA recertification process was established in 1978, with little to no change since that time. The NBCRNA has developed the CPC Program to keep pace with current credentialing best
practices and to support lifelong learning.
The History of Changes to the Continuing Professional Certification (CPC) Program
The CPC Program has
undergone revision since its first introduction in August 2011. The purpose of
the revision process was to ensure that the final criteria reflected a flexible
and relevant program for CRNAs, regardless of their practice situation.
First CPC Criteria
Proposed (August 2011); Revision Process Begins
The first proposed
criteria for the CPC Program were presented to the CRNA community and the AANA
in August 2011. Shortly after this, the
proposed CPC Program was opened for full comprehensive public review and comment. The NBCRNA reviewed and
considered over 13,000 comments received from CRNAs and from the AANA.
CPC public comment period process, NBCRNA representatives attended state meetings to engage with members, CRNAs, and other
stakeholders to talk about the proposed CPC Program, as well as answer
questions and solicit input.
the introduction of the initial draft of the CPC Program at the August
2011 AANA Annual Meeting and the ensuing 3-month
open comment period, the NBCRNA established a CPC Committee comprising
practicing CRNAs and consultants to collect and review CRNAs' comments,
questions, and recommendation.
The CPC Committee, informed by many factors, revised the
initial criteria of the CPC Program, including:
- Feedback from CRNAs and the AANA during the open comment period and subsequently during key stages in the process;
- Information and research from medical and scientific resources;
- New standards from the certification community;
- Benchmarking other anesthesia and nursing recertification programs;
- Review of a nurse anesthetist professional practice analysis; and
- The increasing demands of the healthcare industry and patient safety on educational medical education and continuing competency.
The revised criteria for
the CPC Program were then shared with a panel of individuals identified within
the nurse anesthetist profession as leaders in certification, education, and
practice development. This panel worked to refine the committee's list of
recommendations, using a consensus-building process known as the Delphi
First Major Revision of
CPC Criteria, January 2012
In January 2012, the CPC
Committee presented the information collected and refined recommendations
for changes to the CPC Program, based on results from the public comment period.
- The professional work requirement for a specified number of hours of practice was removed.
- The continuing education requirement was reduced to 15 assessed CE units per year.
- Professional development education credits were first introduced to the CPC program.
- Credit earned from the Core Modules could be applied to meet assessed CE credits.
- The CPC Examination would be phased into the CPC Program, with the requirement date for meeting the passing standard moved to 2032.
- The CPC Program start date was moved back 1 year, to January 1, 2016.
Second Major Revisions of
CPC Criteria, January 2014 through August 2014
In the fall
of 2013, a second CPC survey was conducted of the CRNA community. As a result of direct discussions with the AANA and with members of the CRNA community and a review of survey feedback, additional revisions to the CPC criteria were made.
Life support courses will be able to be reported as Class A credits or Class B credits, at the nurse anesthetist’s discretion.
For each domain area in which a nurse anesthetist does not meet a performance standard on the CPC Examination administered during the second 4-year cycle (beginning January 2020), the nurse anesthetist will take an additional Core Module.
The NBCRNA and the AANA agreed that the AANA Continuing Education Committee will develop the criteria for assessed CE.
Core Module delivery mode was expanded beyond web-only and the cap on CE credits was removed. Further, vendors will determine which module performance objectives will be covered in a module based on the latest evidence.
Third Major Revision of CPC
Criteria, August 2014 through December 2014
In the fall of 2014, the NBCRNA
Board of Directors approved additional revisions to the CPC program components:
- At the request of
the AANA, on behalf of the membership, NBCRNA Board of Directors approved
changes to the terminology of CPC Program components:
The term assessed
continuing education requirement was changed to Class A credits.
The term Professional
Activity Unit (PAU) was changed to Class B credits.
Diagnostic was removed from the CPC Examination description. Both the
performance standard and passing standard CPC Examinations will be called CPC
- The CPC Program start date was moved back to August 1, 2016.
- CPC Core Modules will be voluntary for the first 4-year cycle.
- Additional options will be explored beyond retaking a CPC module for CRNAs who do not meet the performance standards of the "low stakes" CPC Examination during the 2020-2024 recertification cycle.
The Final Criteria for the
CPC Program, December 2014
Since the initial proposed
criteria for the CPC Program, the CPC Committee and NBCRNA Board have continued
to refine the components, based on input from the AANA, certificants, and other
stakeholders. Every component of the CPC Program has been analyzed and revised
to ensure that the CPC Program will have practice-related validity and that the
requirements of the CPC Program are essential, regardless of practice setting,
patients, and conditions.