Chris Gill, PhD, CRNA, chief credentialing officer of the National Board of Certification and Recertification for Nurse Anesthetists, the credentialing organization for CRNAs, joined Becker’s to discuss how continuous certification is helping sustain patient trust, support workforce growth and keep pace with a rapidly changing healthcare landscape.
Question: Could you talk about the role of CRNA certification, more generally, in maintaining patient trust and quality care?
Editor’s note: Responses have been lightly edited for clarity and length.
Dr. Chris Gill: As you know, CRNAs are often the backbone of anesthesia services, frequently the primary providers in key settings: understaffed, rural or critical access hospitals. In many places, they’re the sole provider. We’re seeing care teams shift from strict anesthesia care teams to supervision or independent practice. To me, that makes board certification and its rigor even more important — not that it wasn’t before. But, as you see an expansion of independent practice, people are questioning at a deeper level what the board certification represents.
At the NBCRNA, we emphasize uniform, continuous standards. We talk about the fact that regardless of the setting where you receive care from a CRNA, you have consistency and that’s what we provide. We ensure the same rigorous certification standards at the national level. Quite simply, that means the care you receive in an academic medical center from a CRNA is the same as care delivered in a rural or critical access hospital by a CRNA. Health systems and patients have confidence knowing CRNAs are staying up to date and current on their anesthesia knowledge.
Most recently, we’ve really leveraged continuous knowledge measurement and knowledge checks, just like many other healthcare providers and nursing specialties. We’ve moved away from the single, high-stakes exam you took once after school and were then certified in perpetuity. That time period is gone. Patients expect more from their healthcare providers. They expect an ongoing, rigorous process.
To extol the value proposition to practitioners and the public, you have to measure public sentiment. Nearly all — 96% — of patients believe it’s important for CRNAs to have regular, continuous knowledge checks, professional development and continuing education. That kind of seals it.
When you subdivide that [share of public sentiment], 81.5% say it increases trust in the CRNA brand, 82% say continuous [education] and acquiring new knowledge [are] essential and must be ongoing, not on a four- or eight-year interval. Eighty-one percent of patients, when we shared the new program of continuous knowledge measurement and quarterly check-ins, said it increases the level of respect and trust they place in CRNAs.
The take-home messages with certification: uniformity across settings, assurance for the public that you have a safe, qualified provider at the head of the bed who’s regularly having their knowledge measured and getting insight into where they’re strong and where they can improve.
When my family is receiving care, I want to know the person caring for my loved one is qualified. Board certification as a rigorous standard assures that CRNAs are ready to practice in diverse environments with consistent quality.
Q: Could we dive a little bit deeper into the changes in the healthcare industry more broadly that are bringing about the need for more rigorous certifications?
CG: I’ve been a nurse for 20 years and a CRNA for over 14. The speed with which information is transmitted now is so much faster. It used to be that getting licensed in another state took time — mailing, faxing information. Now it’s sent directly, electronically. That speed has really changed how licensing and regulatory data are shared, and has upped the game.
Looking at the broader healthcare landscape, alongside that speed is an expectation of continual learning. Medical knowledge changes rapidly. This is probably old news, but the shelf life of medical school knowledge used to be about seven years. I think that’s even shorter now with ChatGPT, open evidence and other platforms. As knowledge transmission speeds up, the measurement of knowledge and board certification must keep pace.
Q: Could you talk about the role of the certification process amid the general anesthesia shortages?
CG: To your point about supply: the number of nurse anesthesia training programs has increased. Just in my career, I’ve seen 20 to 30 more programs created, alongside increased cohort sizes — classes of 20 now being 30 or 35.
We’re seeing two trends: expansion of training programs and increased seats. That’s then married up to the certification process. We used to see high-1,800s, 1,900s, 2,000 graduates. We’re now seeing closer to 3,000 certifying each year. That shows bandwidth in the system — both educational programs and the certifier [being] able to spool up and support that expansion.
