Life as a CRNA

Let me first preface by sharing my opinion surrounding this topic is evolving and that, at some point, I’m sure I will come around and see the benefit of acquiring the DNAP. My post isn’t anti-intellectual nor is it a post railing against the ever changing professional landscape of nurse anesthesia.

Posted below is a response I had for an SRNA who had recently e-mailed me regarding my thoughts surrounding the DNAP as the entry level degree versus obtaining an MSN.

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The Argument For A DNP/DNAP

The move towards the DNP as an entry level practice degree is a huge positive for nurse anesthetists. The provisioning of health care services, including anesthesia services, is much more complex today than it was 30 years ago. This increased complexity requires a nuanced and sophisticated understanding of assessing quality control measures, health delivery systems, policy, leadership and management issues, all while incorporating an evidence based approach to our clinical practice. We live in an age where we have access to huge reams of data that require us to analyze and improve our practice from a quality and a financial perspective.

When you approach this topic from that angle, I find myself empathizing with the necessity of obtaining a DNP/DNAP. My understanding (and correct me if I’m wrong) of the additional 3rd year of didactic training isn’t an extra year of learning advanced concepts in physiology/pharmacology, but rather the additional year is focused on research and quality improvement projects, which are very important topics to learn and actually enhances our value as CRNAs beyond the clinical arena.

I think it’s important for CRNAs to understand this and not be shortsighted in their approach to the profession. It’s easy to get caught up with just being a clinical provider, meaning you go to work, provide anesthesia and then go home….which is fine…at the same time though, you cannot turn a blind eye to how health care is changing and you can’t let yourself become blindsided by the changes that are, have and will come (e.g., lower reimbursements, higher expectations to provide quality care, etc.).

My conclusion for the pro-DNP/DNAP is that you’re acquiring a skill set that will help you become more marketable as you begin your career. Sure, when you first start off as a CRNA, you’re not really going to be thinking about these macro level processes. You’re going to be thinking about, “Oh my god, please don’t kill this patient.”

However, at some point in your career, you’ll find a comfort zone with your clinical skills and will start to look for opportunities to broaden your horizon…and knowing that you have an additional skill set that a DNP/DNAP program has provided you can potentially be a boon to your career in more ways than you can imagine!

 The Argument Against A DNP/DNAP

Everything I just said is straight baloney. 🙂 Who cares about the DNP/DNAP? What added value does this degree really add to your education as a clinician? Even if the previous argument about being engaged in ways beyond the clinical arena is true, does it really justify the expenses incurred for an additional year? After all, the costs of higher education are increasingly becoming more burdensome for the student. Many CRNAs these days incur over $100,000 in student loan debt! Is it really worth the extra $10, $15, $20K of debt just so you can say that you’re proficient in research utilization and quality improvement? Isn’t this a skill set that you can learn while working on the job? Why do you really need a degree to validate that?

Currently, there really isn’t a financial incentive in obtaining a DNP/DNAP. If one has a desire to teach at a nurse anesthesia school, then it’s perfectly understandable for one to pursue a clinical doctorate. However, if one is interested in research, well, that’s a completely different topic as that requires an even greater commitment since research doctorates (i.e., PhD) typically take several years to acquire. As far as leadership and management positions, aren’t there other master’s degrees (e.g., MBA, MHA, MPH, etc.) that one should pursue as they tend to offer a broader perspective on health care that might be of greater benefit than if you obtained a DNAP.

As far as I know, getting a DNAP in order to take a leadership and/or management position seems to be, in its current format, self-limiting in that the information/education you’re learning is only relevant provisioning of anesthesia. It just seems like if you’re the type of individual with an aspiration to be in hospital management, it would better serve you to acquire a degree that allowed you to have a broader understanding of the health care system beyond just anesthesia and that’s where there’s a part of me that feels like perhaps an MHA, MPH, or MBA may be a more appropriate path.

If your primary goal is to be a clinician, I don’t see the added value of making students complete an extra year of school to obtain a doctorate to entry level practice. The goal upon completing school (much like bedside nursing) is to come out and be as strong of a clinician as you can be and no amount of credentials or ability to discern the difference between a one-way versus two-way ANOVA model is going to prepare you for that. Furthermore, no one in the workplace cares about your credentials if you can’t manage an ASA 3 undergoing an emergent exploratory laparotomy in the middle of the night.

Lastly, You get paid the same whether you have a certificate in anesthesia, a Master’s in anesthesia or a doctorate in anesthesia. Perhaps pursuing a doctorate would be an incentive if the education were subsidized, but it’s not, so it’s a tough economic argument to make when you’re basically telling students to incur tens of thousands of additional student loans but in the end, when they graduate, they’re not going to be in any kind of advantageous position versus the student who graduated with a Master’s.