Entry to Practice DNAP


In late 1999, the Institute of Medicine (IOM) publised a report on medical errors, To Err is Human: Building a Safer Health System which suggested somewhere between 44,000 and 98,000 Americans die each year as a result of errors in health care. In a follow-up report, Health Professions Education: A Bridge to Quality (2003), the IOM Committee on the Health Professions Education stated, “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics (p. 3).” Our nation’s health care organizations have expanded the roles of nurses resulting in a need for increased knowledge and skills for clinical and administrative leadership across a broad spectrum of services of healthcare delivery. In response to this critical issue, the IOM committee recommended several strategies to prepare clinical nursing leadership for the most senior levels of management. Given their scope of practice, knowledge base and skill sets, advanced practice nurses are well-positioned to address major health care issues such as those related to advanced age, chronic illness, health disparities and health promotion and disease prevention. It is essential for clinicians in practice to design, evaluate, and continuously improve the context in which care is delivered in order to have a significant impact on quality of care, access to care, and cost of care. Doctoral education for nurses combines clinical and other professional skills and experience with principles of patient safety, leadership, and adult education to examine practice problems and design and implement cost-effective, evidence-based programs that positively impact health care outcomes.

Since 1931, the American Association of Nurse Anesthetists (AANA) has been committed to the advancement of quality education to highly competent and professional nurse anesthetists. Accordingly, the AANA has announced its support of doctoral education for entry into nurse anesthesia practice by 2025.  Leaders in nurse anesthesia believe today’s healthcare environment is rapidly changing requiring providers to expand their knowledge base and skill sets to reach their leadership potential and meet such unprecedented demands. Doctoral level education that addresses technological and pharmaceutical advances, informatics, evidence-based practice, systems approaches to quality improvement, healthcare business models, teamwork, public relations, and other similar subjects will shape the future for nurse anesthetists and the patients they serve. 

Nurse anesthesia educational requirements have evolved extensively since 1933, when the primary objective of developing standards for nurse anesthesia education was identified, to 1998 when the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) required that all nurse anesthesia educational programs award a master’s or higher-level degree.  Beginning in the mid 1980s, the AANA and the COA have continually assessed the need for and feasibility of practice-oriented doctoral degrees for nurse anesthetists. In June of 2005, the AANA Board of Directors met to discuss interests and concerns surrounding doctoral preparation for nurse anesthetists. Soon to follow, the Task Force on Doctoral Preparation of Nurse Anesthetists was formed and charged with developing options relative to doctoral preparation of nurse anesthetists. In June of 2007, the board unanimously adopted the position of supporting doctoral education for entry into nurse anesthesia practice by 2025 (AANA).

From 2005 to 2007, faculty in the Department of Nurse Anesthesia at VCU developed and implemented the first Doctor of Nurse Anesthesia Practice program in the country and has since graduated over 225 graduate students who have earned the Doctor of Nurse Anesthesia Practice degree (either through the post-master's DNAP option or the combined Master of Science in Nurse Anesthesia - Doctor of Nurse Anesthesia Practice (MSNA-DNAP) option).  The entry-to-practice DNAP (etpDNAP) option was approved by the COA in June 2016. The first cohort of students in the etpDNAP program will matriculate in January 2017. Future enrollment into the MSNA program will cease after August 2016.