You guys did a great job. You sent us lots of questions. We decided instead of doing them individually, we would kind of look for themes and create a question. So there are four questions we're going to talk about. The panel has thoughts on these, but I think it would be great if you guys would contribute to the conversation as well. So we are going to just jump in and get started. The first question is, as long as the word student is continued to be used and supported, there will not be increased autonomy. When will we support more accurate terms like rRNA or NAR? Using sRNA is hurting our programs, and the COA needs to support us in the descriptor change. So I will let the panel respond to that and then get your input, and we'll go straight to Laura. Okay, so this actually came up at faculty forum, and there was some good discussion there. In 2018, the council did do a survey to find out what descriptors programs were using, and there was a great response. It was 89%—89 programs, excuse me, responded. And I think at that time, we don't have anywhere near the number of programs we have now. So it was a pretty high percentage responding. And sRNA, or student registered nurse anesthetist, was the most common. Sixty-nine programs used that terminology. That was the majority, obviously. There were four programs that used the terminology nurse anesthesia resident, two used resident registered nurse anesthetist, and then the others used a variety. There was graduate student nurse anesthetist, registered nurse anesthesia intern. Just maybe one or two programs used something other than those. So very small number of programs, six total, included the term resident in the titling of their enrollees or students. So that is from 2018. The council does not require that nurse anesthesia programs use a specific descriptor. It is up to the programs to determine what they want to use to call those who are enrolled in their program. I'll just share a perspective from my own program. So we do use the term student registered nurse anesthetist, or sRNA, in most of our clinical sites. We do have some clinical sites outside of the Houston area that prefer to use the term registered or resident registered nurse anesthetist, and we're comfortable with that. We believe those terms are synonymous. We are located in the Texas Medical Center. We have two, actually now three, anesthesiology residency programs, as well as two nurse anesthesia programs, and the unfortunate circumstance that we are in is that at some of our specialty sites in particular, we have some physicians who I believe would certainly restrict our students' access to some critical clinical experiences if we were to use the term resident. And I'm an N of one, however, I do believe that having flexibility, you know, for programs to have flexibility to use the term that will best suit their needs, particularly with ensuring that students get all of the experiences that they need is really important. I'll chime in on that as well. At the University of Iowa, we use the student nurse anesthetist for very similar reasons, and I want to dive into the comment that, you know, there will not be increased autonomy until the COA weighs in, and, I mean, don't kid yourselves, folks. Just by calling an SRNA an RRNA or an NAR is not going to do anything related to autonomy, you know, so the reality is it could potentially harm, and I think that, you know, if we ask for a statement from the council, we're almost pigeonholing ourselves even more, right, because right now, with what they've done, they allow you, if you have the ability to use RRNA or NAR or SRNA, go ahead and do that if it's not harming you in any way. But if the council comes out and says, well, RRNA is now going to be our term, we have some places that don't want that term, it was brought up in faculty forum yet, they want NAR. So like, so then that's not going to be acceptable to some of those people, and we're still going to kind of have a divided group here, so I'm not convinced that a statement by the COA is really going to help us, in my opinion, because I think that people are still going to kind of do what they want to do in the area that they want to do it. So I think what the council has done is probably the correct method, and again, I think kind of like the nurse anesthesiologist descriptor, if you have the ability to use a term that you feel more comfortable using or that you think can benefit your students, then by all means, I think you should do that. Are there any thoughts from the audience? Oh, I'm sorry. Did Lucy want to? Oh, Lucy. I'm sorry. See, I'm way down here at the very end. You can forget about me. Sorry, I can't see you down there. I'll just speak to what has been done clinically in my facility. Atrium Health Cabarrus is one facility in a large enterprise of hospitals and facilities, and there is an anesthesia program at the Metro location, and we're just going to be starting to get those students soon, but we've had the Wake Forest students for 20 years. And there have been more recent efforts from our clinical site director from Wake Forest in just having a conversation at our last site visit with our department director about consideration of using nurse anesthesia resident, and that has not gone over yet. But there were, a few years ago, just because of, you know, sometimes things get lost in the organization, and their badge were created just saying student. Now, I did act quickly on that in advocating, you know, they're student nurse anesthetists, but they are not students, because what's that going to do when they walk into a patient's room and introduce themselves, and suddenly the patient thinks, I've got a high school student that's about to give me anesthesia. So now their badges do identify them from the Wake Forest School of Medicine nurse anesthesia program as a registered nurse. Thank you. I think Sarah might have had a question back there. Okay, I'll be back. Oh, I'm sorry. Yeah, I certainly appreciate the difficulty coming from Colorado. That would not go over well here. But I wonder if the COA could put out a statement that these terms are all acceptable to the COA, that there is not one specific term, because I don't know, and perhaps I'm just ignorant, but I don't know that it's well known that the COA is, you know, feels that RRNA or NAR is acceptable as well. So maybe just a statement saying that these are all acceptable terms to use. Well first, thank you for entering into this discussion. I guess my question is, is those programs that are using RRNA or NAR, what is the impact of that? You know, has that changed billing practices? Has that changed access to experiences? You know, and I think the problem with changing terminology without delving into the data and looking at that data to say, no, it's been beneficial, overwhelming, or no, it's really hurt us overwhelmingly. And I think that's what needs to be done is to look into that and see what happens with that. And the other comment, just to say as far as impact on the education and that, you know, that's still the same thing with CRNAs, is that at the local level, it doesn't matter what your independence is. You could be in New Hampshire with one of the most independent states, but your local institution is going to determine what your credentialing privileges are. So at that local level, they're going to determine what those ratios are, how we're going to do that. And to be honest, it doesn't make sense billing practices for money because they'd be just using all CRNAs and they'd have less answers all just to begin with. So I don't know if it's always the money and the best models that really impacts them and is their interest. So thank you. Very good points. Thank you. There's a question over here. Speak to your question. Hi, I'm Vicki. I'm from Webster. Oh, sorry. Does somebody else want to ask a question? No, go ahead, Vicki. Okay. So Webster University, a newer program in early 2004, I think it was developed. I came on board in 2014. But when they were originally conceived, they started using the term resident registered nurse anesthetist. So they have always used that to describe their students. And our students will introduce themselves that way. We are a private, not-for-profit university. We are not affiliated with a major medical center. We have over 20 clinical sites in the St. Louis region and then outside in the state. So we do have a couple sites that explicitly have told us and our students that they cannot use the term resident. And, you know, we comply with that because the alternative is we don't send our students there. And they do provide good opportunity. And as long as our students don't identify themselves that way, it's all fine. I'm not sure it's had any impact on billing. In terms of how they introduce themselves otherwise, I always tell them to introduce themselves as a registered nurse and graduate student in the nurse anesthesia program at Webster University. Now we could say doctoral program. And there you have it. Hi, I'm Cheryl Parker. I'm from Kentucky. And I am the director of the University of Louisville Nurse Anesthesia Program, which is just opening and entering into the accreditation phase. I'm excited about this opportunity for CRNAs in Kentucky and the future of our profession. But this very topic of how are we going to refer to our learners in this new program, in this environment, it's something that's on the table for me to discuss as soon as I get back. So it is very important to me. I will say that in my personal opinion, I think it does matter what we call a cohort of people. It leaves an indelible impression on who we're communicating with. And it also signifies to everyone around us what that person is capable of. So I don't like the term student. And throughout my practice, when I was working with nurse anesthesia residents, which is what I've referred to them, I try to de-emphasize to the nurses that I'm working with, to the people in the OR, that this is not a person who doesn't come into this room with any merit. So they bring a knowledge basis that is above many people there. It is, and I understand the hot button issue. I really appreciate the position that you're in at Baylor because our program is being funded and supported by the anesthesiology group. And we have residents as well. So while they are promoting and supporting this, they also need to come to some level of agreement with us as far as how to respectfully refer to our learners in a mutual environment. So I'm very interested in knowing how we would move forward. And I agree with some of the other people in this room that I do think the council and our professional organization, the AANA, need to recognize that. Understanding that maybe not push it to, you know, to the ultimate limits, but definitely put a statement out there that this is a more than acceptable term to use.

nurse anesthesia programs

student nurse anesthetist

terminology

Council on Accreditation

credentialing