Welcome. This module's focus is on the significance of understanding and adhering to the rules, regulations, and standard operating procedures in nurse anesthesia educational programs. The learning objectives for this module are shown here. I'm going to discuss how compliance with program, institutional, and federal guidelines shape our program culture, and I'll also talk about some strategies for effectively managing the challenges and unique risks that failure to comply with these rules and regulations might present. Let's start with just a few of the reasons why this module is important. Of course, the rules and regulations in higher education differ slightly from those in clinical practice or in clinical education environments. Some of these may seem very intuitive to us, and others might not be so immediately obvious, so it's important to walk through some of them. It's also about protecting ourselves. Meeting the regulatory standards protects our institutions from legal issues, may protect us personally from legal issues, and ensures that everyone's rights are respected. It's about fairness. When we follow these guidelines, we're making sure every resident, faculty, and staff member is treated fairly and with dignity. That's the foundation of academic integrity and professionalism. It's about our program's reputation. By showing we're committed to these standards, we build trust with residents and other stakeholders, showing we're serious about providing high-quality education. And finally, it's about not just avoiding trouble, but creating a culture, being proactive. This is a culture where integrity, fairness, and excellence thrive. Some examples. When we strictly enforce rules on academic integrity, it protects the value of the degrees and shows that we take learning seriously. When programs fully comply with Title IX, we create safer, more inclusive environments where everyone feels respected and supported. So as we explore this topic further, I'd like to challenge you to think about how each of us can play an important role in upholding these important standards in our daily work. So let's dive into the specifics. What does compliance mean in the domain of higher education? What are we complying with? It means ensuring that all aspects of our program operations meet legal and regulatory standards in areas such as academic integrity, financial management, student and staff rights, safety, and importantly, privacy. So we're going to walk through some of the standards that are applicable to our everyday work, starting with the local program-level standards in somewhat general terms because there is certainly some variability across institutions, types of institutions, and variability in state laws. And then we'll move into more overarching standards, federal regulations, which are national standards that affect all programs in the United States. The program-level, for good reasons, such as it's required by the Council on Accreditation of Nurse Anesthesia Educational Programs, or the COA, and frankly, intuitively, we know that we have to have program-level policies and procedures. It's important that we articulate those very clearly. Each of our programs typically has a program handbook, or similar, guidance document that outlines the standards and practices that are unique to our program and our discipline. Some of these are outlined in the handbook because the Council on Accreditation, or the COA, requires it, and it's important to note that sometimes these standards that may or may not be COA-mandated are, in many cases, more stringent than those of what the institution might otherwise have in play. One example of this might be Standard H from the COA Doctoral Standards Evaluation. The COA expects programs to assess or allow students to evaluate many aspects of program operations on a regular basis. There's a very prescriptive list of the many program qualities that have to be evaluated, such as the resident self-evaluation of learning. While engaging in regular self-reflection may seem intuitive to us as nurse anesthetists, it may not be something that our institutions mandate, usually, for other students, so that's just one example. We know we have to know and follow, of course, the COA standards. A discussion of the details of each COA standard and the consequences for failure to achieve them is beyond the scope of this presentation. Generally, however, I'm going to emphasize here that the COA gives programs flexibility in terms of the specific policies and procedures that we devise to ensure that our program meets the COA standards. What is not negotiable is that our programs have to follow these policies that we have in writing. All program requirements must be clearly outlined in our written program documentation so residents also know the expectations of them and the consequences, if any, of their failure to adhere to those program policies. There are a lot of examples of my institution, likely many other institutions, where professional degree programs, particularly in the health sciences, have the need to dictate expectations that are different from the institution at large. So one common example of this is with regard to federal holidays, whereas most institutions of higher education observe holidays by not holding classes or business operations. These are federal holidays, for example, like Juneteenth or Veterans Day. It is very commonly the case, however, that local healthcare facilities, operating rooms, carry on. In that situation, our residents are expected to be there because CRNAs are there in the operating room on those holidays. We must ensure that expectations are outlined clearly in our program materials so there is no confusion about when attendance is required or not. Essentially, we have to write our program policies to reflect the culture of the job we're training our residents to do, not just the norms of the university environment where they spend three years of their lives. Another example might be where program standards are more stringent than the institution standards is with respect to academic benchmarks. So acceptable academic progression may be defined more often than not in nurse anesthesia programs by the requirement for students to have nearly all Bs or better in order to progress. So you must have an A or a B in all of your classes. Many institutions don't hold learners to such a high academic standard and may have graduate school or institutional policies that, for example, will allow a certain number of Cs in courses. Because of the seriousness of the job we're training our learners to do and in the interests of patient safety, we must uphold our high standards. Upholding those as residents progress through the academic standing committee or similar and all the processes that go along with that to implement a student success plan or sadly in some cases to process a dismissal will require that our programs have clearly articulated expectations and policies to protect the student's rights and to guide the progression through that process. The importance of strictly following policies on the process for academic standing committee proceedings cannot be overstated. It is often the major point of discussion in consideration during appeals of decisions about academic standing. The question is going to be asked, was the process clear, fair, and did the program follow it? If we did, as unfortunate as such situations always are, we can at least make the process as predictable as possible for all involved and attenuate to some degree the stresses and added unnecessary stress of the uncertainty of the process. Because academic performance standards for nurse anesthesia and residents are often set and enforced at the local or program level, I'm just going to further emphasize the importance of adhering to such program policies and procedures through an example of a lawsuit in Massachusetts. The case was Doe versus Williams and in it, a student alleged among other complaints that the university had failed to conduct disciplinary procedures that were consistent with what might be considered fair in a court of law. So the student's allegation was that I did not get the same fair process that I would have gotten if this particular situation had been heard by a court. In the final case summary, it was noted, quote, under Massachusetts law, a private college, like the defendant in this case, breaches its obligations to students if it fails to conduct disciplinary proceedings with basic fairness. But to meet that required standard, colleges must follow the rules they establish for themselves, but they do have a great deal of flexibility to adopt diverse approaches to student discipline matters that do not meet federal due process requirements. So it's not about what would be seen as fair in a court of law, it's about what is the fair process and what is the process according to your institution and the policies that they have in writing that are in place at the time of that situation. Again, cannot possibly stress it enough, the council and federal law gives us the flexibility to be able to set the policies that we feel are most appropriate for the context, but once we set those, we must follow them to the letter. I think it's safe to say that the goal of avoiding legal complaints altogether and to increase the likelihood of successfully defending oneself in the event a suit is filed are great reasons to ensure that we comply with program rules and procedures. So let's move up now to a level of the institutional policies and procedures. Our institutions will have, of course, many policies and procedures that will cover a wide range of areas such as things like course attendance, grading, student conduct, faculty responsibilities, campus safety, to name a few. Again here, it can't be stressed enough that while an institution has a great deal of flexibility to set policies and standards that make the most sense to them, once the institutional policies are set, they have to be followed. We don't have to agree with them, but we do have to follow them. So it's important that you learn the institutional policies and culture, and that's one of the major goals of becoming a new faculty member. Over that first few months to even the first few years, after making that jump to academia, it's really worth putting the time and effort into that initiative. Know the policies, seek them out, and make sure you stay up to date with them. One of the many reasons it's so important to know and strictly adhere to institutional policies is that many are in place to ensure compliance with Title IV, the Higher Education Act, which relates to, in the most general terms, the individual and the institution's eligibility for receiving federal financial aid. For example, Title IV requires strict adherence to Standards for Satisfactory Academic Progression, or SAP. We sometimes get questions from residents who might assume that within that nurse anesthesia program we have a lot of liberty, even though it's a lockstep curriculum, they may feel that there's, and we know that is to mean that there's one entry point and one finish point, we may be asked about the option of tweaking the program of study or allowing students to take more or less than is outlined in the prescribed curriculum. Not only is this not often ideal from a pedagogical standpoint, but even more importantly, alterations in the number of credits that a student takes per semester can have a major implication on their eligibility for financial aid. The sad truth is that given the cost of tuition and fees, most students, if that's the case, if they lose financial aid, they simply cannot afford to continue their education in the absence of financial aid. Program administrators, of course, have the additional requirements to ensure accurate financial reporting and the responsible use of funds, particularly those from federal or state sources, and this includes compliance with financial aid regulations, all of them, and maintaining transparency in budgeting and spending. On a final note related to Title IV, the requirements for maintaining eligibility for federal financial aid, the statute further includes of note the Clery Act, which relates to campus security and reporting of all incidents to the necessary stakeholders. A detailed overview of institutional policies related to the Clery Act is, again, beyond the scope of this module, but I will highlight, once again, knowing your institutional responsibilities and taking them seriously is key to being able to avoid repercussions from failure to adhere. All right, so let's talk a little bit more. There's a lot of blurry lines between the institutional policies and why they're in place. Often they are in place because of federal regulations that dictate that that must be so. Let's zoom out a little further to the federal level to talk about regulations we need to know about in the setting of higher education. Of note, all of the following laws that I'm going to discuss are enforced by the U.S. Department of Education's Office for Civil Rights. Institutions can be sanctioned by OCR, forced to enact changes to address concerns, have accreditation revoked, and as I just mentioned, perhaps just as importantly, students and institutions can lose the ability to be eligible for financial aid. Many don't know this, but even when such sanctions are imposed on an institution due to improper actions, inaction that results in a violation of rights, or simply not following the established rules, policies, and procedures that are in place, it is the institution and in fact most likely the department or the program that will absorb that cost. So that is to say that if a student loses the ability to be eligible for financial aid because of your actions, there are laws in place to protect them and they don't have to pay for that tuition and fees. So these are very serious consequences when situations like this arise. So I'm going to talk very briefly about each of these in turn, starting with FERPA. In part because it's a regulation we may or may not even have known about as clinicians or clinical educators and in part because in my experience it's a federal regulation that we encounter frequent opportunities to violate, often without even thinking about it. FERPA is the Family Educational Rights and Privacy Act. It was enacted in 1974 and it's a federal law that protects the privacy of student educational records. Before I talk further about the details of this, let me define student records, which at this point seems straightforward but actually sometimes isn't. These are any records that are directly related to a student and are maintained by the educational agency or institution or by a party acting on behalf of that agency or institution. So it's pretty clear that documents such as grade transcripts or evaluations are part of the student record. What becomes a little bit more complicated are documents such as faculty notes from advising sessions or documents that relate to health information, such as immunization records. We know well that these are data that are also protected from disclosure by HIPAA, but the nuances related to FERPA and HIPAA are different. There are nuances and it becomes important to distinguish the territory in which you're operating. The easiest way to distinguish between health records and treatment records is to think about the reason for which that information is collected and transferred, if it is transferred. And I think about it in this way, that if a person is collecting information for the purpose of enabling a therapeutic intervention, behavioral therapy, treating an illness at student health, that's a health record. If the information is collected or transferred for the purposes of screening for eligibility, such as screening for eligibility for clinical rotation placements, it becomes a part of the educational record and the relative laws apply. So FERPA applies to all schools that receive federal funds under the U.S. Department of Education. It grants adult students, so all of those over 18, certain rights that include the right to access their own records at any time upon request. When they request to review or have possession of their student records, we are required to comply with that request within 45 days. The right to request amendment of the student's education records. So upon their review of these records, they can request a correction to any records that they believe are inaccurate, misleading, or otherwise in violation of their privacy rights. They have the right to consent to disclose personally. They have the right to consent to any disclosures of their personal information. So schools must have written policies that will give them permission to release any information from an eligible student's educational record. You can't release that information without explicit permission from the student. So it does allow us to disclose records without consent to certain parties under certain specific conditions, if it's subpoenaed for example. Students have the right to file a complaint if they feel that their rights under FERPA have been violated with the U.S. Department of Education through a body called the Family Policy Compliance Office or FPCO of the U.S. Department of Education. This is taken outside the institution's hands and it's up to the FPCO if there's proof that a violation of a student's right under FERPA has occurred. For educational records, we academic program officials are directly responsible for ensuring the privacy of such information. We must have consent to disclose that information and we must provide students with access to those records upon request. If you ever have any doubt about whether or not you need permission to disclose information about students, my advice is to err on the side of privacy. Do not collect or store any information that you do not need to have for legitimate operating purposes. Don't disclose that information if you can possibly avoid it. Get written permission from students to disclose even something as simple as a student's name on a roster at a sponsored event. Have students sign their own name on rosters with full disclosure at the time of signing it that the third party will be keeping that information. Allow students the opportunity to opt out if that's available. Truly allow them to opt out. Don't make it coercion if you will. Well you can opt out if you want. A simple internet search reveals many cases of situations where formal complaints or lawsuits have been filed and won by students related to disclosure of their personal information. Again, it gets particularly difficult to navigate when there's information that could be considered health information that's part of a student record. Reach out to your institution's privacy officer, registrar, or general counsel about disclosure of student information if you have any questions. So let's shift now to the other federal civil rights laws that protect students' basic rights, all again enforced by the U.S. Department of Education. First, the Civil Rights Act of 1964. There's Title VI of the Civil Rights Act of 1964 that prohibits discrimination on the basis of race, color, or national origin. There's the Age Discrimination Act of 1975 where educational institutions that receive federal funding must ensure non-discrimination on the basis of age in all programs and activities. There's Title IX of the Education Amendments of 1972 which prohibits sex-based discrimination in any educational program or activity that receives federal financial assistance. Title IX, I'm going to spend a little bit more time on, arguably because we're more familiar with this because of some of the high-profile cases and situations that we might have heard of in the news or that have happened at our institutions that relate to gender-based discrimination in sports or institutions mishandling of sexual harassment or assault. Title IX was intended to ensure a safe and equitable learning environment free from harassment, discrimination, promoting academic success, and institutional integrity. We are also more familiar with Title IX because our institutions are required to provide annual employee training, so we've all done this, and maintain a dedicated Title IX coordinator to ensure compliance with this important law. So we may have seen this person, met them, or participated with them in annual training. What are the kinds of issues that come up that are related to Title IX? Sexual harassment and assault, gender discrimination or gender-based harassment in the academic environment, equal access to resources and opportunities. These are just some of the examples of things that come up. How can we as faculty ensure compliance with Title IX? Be informed. Title IX training is required annually for good reason. Take the training seriously. Engage with it and ensure you ask any questions that you might have about your institution's policies and the procedures for reporting incidents. There is a Title IX coordinator at your institution. Reach out to them. Find out more about how your institution supports faculty, students, and all who are involved in the educational environment. Consider inviting your Title IX coordinator to your department for an informational session with your team or your residents. Be intentional about creating a supportive environment. Model appropriate behavior. Show your trainees how a supportive and inclusive leader behaves. Take reports and complaints from others seriously. It is not your place to decide if discrimination, harassment, or an assault actually occurred. If you see something, say something. Document, document, document all of the concerns that were brought to your attention and err on the side of caution by engaging with your Title IX coordinator. That's the person you can make a determination of what level of support is needed and if further actions are warranted. It is our explicit responsibility to report any incidents that could be considered or believed to be sexed or gender-based incidents. Do not rely on your situational judgment or an estimation, your personal estimation of how serious a complaint might be or the impact that it has had or not had on the person involved. Inform your colleagues and your residents about their rights to report and be sure to memorialize these conversations by putting them in writing. Your Title IX coordinator can do much more than investigate these situations. They can connect the involved parties with available supports such as counseling and academic specialists if there's an impact on their academic progression. They're not there to reprimand or point fingers. They're there to help us do better the next time and to attenuate the emotional fallout that so often occurs when gender-based incidents occur. Don't forget the University's Title IX coordinator is there to address students concerned about these incidents no matter where they occurred. If the incident happened while they were a student, the Title IX coordinator can get involved. This includes incidents that occur off-campus, outside of business hours, and importantly in clinical facilities where the residents train. The coordinator will make referrals or contact with other officials such as law enforcement or Title IX coordinators at the hospital facilities which are analogous to their role just on the other side of the fence. The final federal law that I want to address here enforced by the Office of Civil Rights of the U.S. Department of Education are those intended to protect the rights of individuals with disabilities. Two federal laws apply. Section 504 of the Rehabilitation Act of 1973. This prohibits discrimination against individuals with disabilities by programs and activities that receive federal financial assistance. Since most colleges and universities receive federal funding, Section 504 applies to nearly all institutions of higher education. It requires institutions to ensure that students with disabilities have equal access to educational opportunities and benefits. Section 504 mandates that colleges and universities provide reasonable accommodations to students with disabilities. These accommodations are intended to ensure that students with disabilities have equal opportunity to participate in all aspects of academic life. Institutions found in violation of Section 504 risk losing their federal funding. The next is the Americans with Disability Act or ADA. The ADA is a broad civil rights law that protects prohibits discrimination against individuals with disabilities in all areas of public life including employment, public services, public accommodations, and telecommunications. In the higher education realm, Title II of the ADA applies to public colleges and universities. Title III applies to private institutions except those controlled by religious organizations. So ADA applies to most all of our institutions. The ADA ensures that students with disabilities have equal access to all programs, services, and activities offered by the institution. It requires colleges and universities to provide reasonable accommodations with students with to students with disabilities. This might include modifications to academic programs, changes in policies and practice, provision of auxiliary aids and services, and ensuring physical accessibility. It is important to note that accommodations under the ADA must be reasonable and not create an undue burden on the programs. And this is one of the issues that comes up in cases in the courts regarding ADA violations. The best way for nurse anesthesia programs to determine the degree to which a requested accommodation is reasonable or unreasonable is to have clearly defined technical standards that students must be able to meet in order to meet the standards of practice. It's not the case as is commonly stated that we don't make any accommodations in nurse anesthesia programs. I've heard that. It's not true. We do, but we must ensure that any accommodations that we make do not risk compromising standards of clinical practice and care. Best practices in this area of operations is to work closely with your institution's ADA officer to facilitate open dialogue and a safe environment in which the reasonability and feasibility of requested accommodations can be discussed. We really can't stress that enough. There are experts in this domain that can assist you with making a fair and legally defensible decision about what a program can or cannot do to help students with disabilities achieve their dream of becoming a CRNA. It is unfortunately the case that it is not possible in some situations for a person to achieve that dream because of their disability, but it serves us and society to be as inclusive as we can possibly be. In summary, compliance with educational standards and regulations is a cornerstone of our professional responsibilities. By understanding and implementing these guidelines, we not only avoid legal pitfalls, we also contribute to a supportive and respectful learning atmosphere. Let's continue to uphold these values and lead by example in our commitment to excellence in nurse anesthesia education.

rules and regulations

standard operating procedures

nurse anesthesia educational programs

compliance guidelines

legal issues

Title IX

student rights