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What is a Doctor of Nurse Anesthesia Practice (DNAP)?

Nursing Degrees & Schools / DNAP

A Doctor of Nurse Anesthesia Practice, or DNAP, is the highest practice degree in nurse anesthesia. It is one of two types of degrees available for nurses pursuing careers as Certified Registered Nurse Anesthetists (CRNAs). The other is a Doctor of Nursing Practice (DNP).

In this article, we will explore:

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DNAP vs. DNP: What’s the difference?

Both the DNAP and DNP degree programs prepare nurses to become Certified Registered Nurse Anesthetists (CRNA). Essentially, the DNAP and DNP degrees are similar and lead to a CRNA. Some DNAP jobs include the utilization of research findings for evidence-based clinical practice, education, and administration. The type of education and certification is slightly different. They are both practice degrees, unlike research degrees such as the DNS/DSN or Ph.D. 

Where a DNAP works

Nursing professionals who hold a DNAP can work in a variety of settings that benefit from their level of expertise and skill in anesthesia. Some of the most common choices for DNAPs include:

  • Colleges and universities
  • Critical access hospitals
  • Hospital administration
  • Mobile surgery centers
  • Research facilities

How to become a DNAP

Before nurses can earn a DNAP, they must become Certified Registered Nurse Anesthetists. To become a CRNA, nursing students must earn a Master of Science in Nursing (MSN). The most common steps for obtaining an MSN include:

  1. Earning a Bachelor of Science in Nursing (BSN) from an accredited nursing program.
  2. Becoming a licensed Registered Nurse (RN) by passing the NCLEX-RN exam.
  3. Pursuing nursing certifications while working as an RN in an acute care setting.
  4. Gaining admission into an accredited Nurse Anesthesia Program.

Some nurses choose to work as acute-care RNs while completing an MSN degree program. There are many options for earning an MSN. The most popular are bridge programs (RN to MSN, BSN to MSN) that help accelerate the process of earning an advanced degree. This program can help nurses complete an MSN program in about 2 years. Accelerated programs build on previous education and learning experiences to fast-track nursing students through the process.

Once nurses have earned their Master of Science in Nursing degrees, they can begin the next step in their journeys to becoming a DNAP.

DNAP education requirements

After completing an MSN degree, nurses must continue with their education to complete a DNAP program through an accredited college or university. Most doctoral nursing degrees take between 12 and 36 months to complete depending on whether nurses attend part-time or full-time. These programs include 30 to 40 credits and 1,000 clinical hours. Coursework includes in-depth study of some of the following topics:

  • Anesthesia biology
  • Anesthesia pathophysiology
  • Anesthesia pharmacology
  • Geriatric anesthesia
  • Obstetric anesthesia

Nursing students can expect to complete DNAP programs with a deeper understanding of anesthesia and more advanced skills in nursing anesthetics that open the doors to more lucrative nursing opportunities.

DNAP certification options

Specialty certifications that align with a DNAP can be obtained through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). To earn certification, nurses must pass an exam that contains between 100 and 170 comprehensive questions. Once certification is awarded, it must be renewed every four years. DNAPs who earn NBCRNA certification demonstrate their expertise in anesthesia, education, surgery, training, and testing. Nurses must complete continuing education credits to maintain their certifications.  

Job and salary outlook for DNAPs

Nurse anesthetists earn a median annual wage of $202,470, according to official figures from the U.S. Bureau of Labor Statistics (BLS). Demand for DNAPs is projected to grow by 40% from 2021 to 2031. 

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What is an Accelerated Bachelor of Science in Nursing?

Nursing Degrees & Schools / ABSN

An Accelerated Bachelor of Science in Nursing (ABSN) helps individuals who already possess a bachelor’s degree in another field become Registered Nurses (RNs). Deciding it is time for a career change can be scary for some professionals. But, if someone already holds a baccalaureate in another discipline, they can easily convert that knowledge into a job in the healthcare field.

In this article, we will explore:

What is an ABSN?

Accelerated BSN programs facilitate a change from one unrelated field to a career in nursing. This builds on the foundation of general courses previously completed as part of a bachelor’s degree. Students enrolled in these fast-track nursing education models focus on nursing best practices, allowing them to finish their schooling and begin their new careers within one to two years.

Nursing professionals who hold an ABSN have options beyond bedside nursing. They can work as nurse educators, nurse informaticists, forensic nurses, or clinical researchers to name a few.

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What will you learn in an ABSN program?

An ABSN program is designed to fast-track nursing students through the educational process. Since individuals who qualify for these accelerated programs already hold bachelor’s degrees in other concentrations, they can skip all the prerequisites associated with earning a BSN and get right to the heart of the clinical nursing subject matter.

The nursing-specific courses taught in an Accelerated Bachelor of Science in Nursing program may be condensed to accommodate a faster pace. Some of the most common classes taught in ABSNs include:

  • Anatomy and physiology
  • Chemistry 
  • Community health
  • Ethics
  • Gerontology
  • Leadership
  • Microbiology
  • Nursing fundamentals
  • Pharmacology
  • Research

Each ABSN program is different. Nursing students must choose the one that best aligns with their career goals and timeline for completion.

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What are the requirements and prerequisites for ABSN programs?

Accelerated BSN programs have prerequisites candidates must meet before enrolling. Each ABSN is different, so it is best to check with the individual programs before applying to ensure all qualifications have been met. Here are some of the most common requirements and prerequisites:

  • Prerequisite courses include subjects like anatomy and physiology, microbiology, and statistics. If these courses were completed as part of an original bachelor’s degree program, check with the nursing program to ensure they will accept those credits.
  • Entrance exams are common for ABSN programs. Subject material covered includes English, math, reading, and science. Nursing students can prepare for entrance exams like the ATI TEAS and the HESI using a variety of resources available online.
  • Grade Point Average is weighed heavily by ABSN programs, with most requiring a minimum GPA for applicants. Most range between 3.0 and 3.5.

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Once nursing candidates complete an ABSN program and become licensed RNs by passing the NCLEX-RN exam, they can pursue certifications if they choose. To qualify for most certifications, licensed RNs must first complete designated hours in a nursing specialty or have experience in the specialization (or both). Continuing education credits can be a part of the process for initial certification and to maintain credentials once earned.

Several nursing associations offer certifications for RNs, including the American Association of Critical-Care Nurses (AACN) and the American Nurses Credentialing Center (ANCC).

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How much does an ABSN cost?

Shorter programming does not equal lesser cost. Individuals pursuing an ABSN can expect to pay more for the privilege of pushing through faster. The cost to complete an ABSN varies depending on the program chosen. Most public colleges and universities are usually cheaper than private schools. Most nursing schools offer financial aid, scholarships, and low-interest student loans for qualified applicants.

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Are nursing school waitlists for ABSNs common?

Accelerated Bachelor of Science in Nursing degree programs are highly competitive. Limited seating can result. ABSN candidates can do several things to help their applications stand out in the crowd. One of the most important things they can do is ensure their grade point averages (GPAs) meet the minimum requirements of the school to which they apply.

Take the time to craft a compelling statement explaining the desired career shift to nursing. Candidates who have personal statements from other professionals included with their applications might fare better than the applicants without them.

Lastly, applicants must be patient and prepared to wait, even if they are highly qualified and meet every entrance requirement. Sometimes hundreds of applicants vie for 50 or fewer seats in these programs.

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What are the job and salary outlooks for nurses with ABSNs?

According to the most recent data form the U.S. Bureau of Labor Statistics (BLS), nurses with ABSNs can expect to earn a median annual wage of $82,750. The BLS predicts demand for RNs will grow by 6% between 2021 and 2031. 

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How to Become a Pain Management Nurse

Nurse Types / Pain Management Nurse

A pain management nurse is part of a healthcare team tasked with providing care to patients who suffer from chronic or debilitating pain. Relieving pain has become a public health challenge in the United States. More than 50 million people currently live with chronic pain that affects their daily living, according to the U.S. Centers for Disease Control and Prevention (CDC). Among the conditions that can trigger it include arthritis, cancer, fibromyalgia, Lyme’s disease, and nerve damage.

In this article, we will explore:

What is a pain management nurse?

Pain management nurses are Registered Nurses (RNs) who pursue specialty certification in pain management. They care for patients living with acute or chronic pain as part of their healthcare team. Whether recovering from a traumatic injury or learning to cope with a debilitating disease or illness, patients rely on the empathy and expertise of pain management nurses to provide relief.

To succeed in this nursing specialty, candidates must possess top-notch assessment skills that include interpreting non-verbal cues. These specialized RNs can work in healthcare settings like hospitals, pain management clinics, private physician offices, and trauma centers.

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What does a pain management nurse do?

People living with chronic pain must balance relief with risk. Pain management RNs assess patients to determine their level of discomfort, then decide which medication, or alternative form of pain management, is most appropriate. A central focus of the job is educating patients about coping strategies to help prevent addiction to narcotics or other pain medications.

To combat the growing number of patients living with constant suffering, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) established standards for healthcare providers that address pain assessment and management. Within 10 years, 2 million people had developed substance use disorders involving prescription pain medications. The opioid epidemic forces healthcare providers to find alternative pain management techniques that are safer for their patients. Suggestions can include:

  • Acupuncture
  • Chiropractic
  • Exercise
  • Diet
  • MassageTranscutaneous Electrical Nerve Stimulator (TENS) units
  • Yoga

Most pain management nurses cannot prescribe medications directly. Only Nurse Practitioners (NPs) have that privilege.

NURSE TIP

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"Not sure if a pain management nurse is the right role for you? Join Incredible Health's Nurse Community for input from RNs of all specialties."
-Jami, RN & nurse advocate @Incredible Health

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What are the education requirements for pain management nurses?

Step 1: Education

Attend an accredited nursing school to earn either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). An ADN will take between 18 and 24 months to complete, while you can expect to spend roughly four years to earn a BSN. If you already have an ADN, there is an ADN to BSN bridge program that allows you to earn a BSN in 12-18 months. There is also an RN to BSN bridge which takes three semesters of nursing courses to be completed in one year. These programs will save you time and money. The more education you have, the better your chances of landing your dream job.

Step 2: Examination

When you are six weeks away from graduation, you can apply to sit for the NCLEX-RN exam. There are 75 to 265 questions on the NCLEX-RN with a five-hour time limit for completion. If you do not pass the NCLEX-RN on your first attempt, you must wait 45 days before you can try again.

The NCLEX includes questions on the following topics to test nursing candidates’ knowledge:

  • Safe and effective care environment
  • Health promotion and maintenance
  • Psychosocial integrity
  • Physiological integrity

Step 3: Experience 

This step in the process is to gain hands-on experience. This will provide you with invaluable opportunities to work with patients making you attractive to future employers.

Step 4: Certification

To be considered for employment in this nursing specialty, RNs must obtain the Registered Nurse Board Certified Credential in Pain Management (RN-BC) from the American Nurses Credentialing Center (ANCC). A competency-based exam, the credential verifies entry-level clinical knowledge and skills needed for RNs working in pain management.

To be eligible to sit for the credentialing exam, nurses must:

  • Hold a current RN license or legally recognized equivalent
  • Complete 30 hours of continuing education in pain management nursing within the most recent three years
  • Accrue 2,000 hours of clinical practice in pain management nursing within the last three years
  • Practice the equivalent of two years as a full-time RN

The RN-BC credential is valid for five years. Renewal requirements include seven professional development categories that provide evidence that credentialed nurses remain competent in their specialization.  

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What is the job & salary outlook for pain management nurses?

According to the professional salary tracking website Salary.com, pain management nurses make an average hourly wage of $48 per hour or $96,000 per year. National averages for this nursing specialty fluctuate between $45 and $52 and can be even higher in some locations where the field is in demand. Job demand is difficult to gauge since the U.S. Bureau of Labor Statistics (BLS) does not specifically track pain management nursing careers. The BLS outlook for RNs projects a 9 percent growth between now and 2030. 

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How to Care for LGBTQIA+ Patients

How to deliver culturally competent healthcare to LGBTQIA+ patients continues to evolve within the healthcare industry. Disparities that minorities and the LGBTQIA+ community experience in healthcare have a direct correlation to health risks and higher rates of psychiatric disorders, substance abuse, and suicide. It is crucial that nurses treat all patients with dignity and respect.

These are some things nurses can do to increase their sensitivity:

Expand your LGBTQIA+ knowledge

System-wide awareness and inclusive care remain top priorities for healthcare providers. Providing a welcoming environment requires a commitment from every worker in a healthcare setting. Nurses can start by making a personal commitment to improve their awareness of the LGBTQIA+ community and adjust the delivery of care to ensure equitable patient outcomes.

Healthcare professionals should not wait for employers to take the lead with equity in healthcare services. Nurses can seek out information to help them better understand the LGBTQIA+ community. Some continuing education courses focus on subjects like sexual orientation, gender identity, and how to be inclusive within the healthcare setting. Another resource is the National LGBT Center for Health Education. Part of the Fenway Institute, the center provides educational programs, consultations with experts, and other valuable resources.

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Understand definitions and terminology

The National LGBT Center for Health Education provides a guide that breaks down definitions and terms used by the LGBTQIA+ community. Some of the terms that nurses can find in the handbook include:

  • Gender identity: A person’s internal sense of being a male, female, both, neither, or another gender. Some identify with a gender that is different from the one they were assigned at birth.
  • LGBTQIA+: An acronym that stands for Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, and Asexual. The plus symbol at the end was added to signify the evolving nature of the acronym to cover any new subsects of the community.
  • Lesbian: A sexual orientation that describes women who are emotionally and sexually attracted to other women.
  • Gay: A sexual orientation that describes men and women who are emotionally and sexually attracted to the same sex.
  • Bisexual: A sexual orientation that describes a person who is emotionally and sexually attracted to people of all genders.
  • Transgender: Those whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth.

Best Life defines ‘QIA+’ as:

  • Questioning/Queer: Non-heterosexual people who are still “questioning” their place within the queer community. Questioning and queer do not necessarily mean the same thing.
  • Intersex: People who are born with reproductive or sexual anatomy that doesn’t fit the typical definitions of male and female.
  • Asexual: People who are defined as those who do not feel a sexual attraction to others. This does not mean that they can’t be romantically attracted to others.
  • 2s: This is a new designation that means ‘Two-Spirited’ which is a term used by Indeginous people to describe their sexuality or gender.

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Never guess gender identity

It is never a good idea to try to guess someone’s gender identity based on their name or the way they present physically. Avoid using gender-specific pronouns when meeting a patient for the first time. Gender-neutral terms or complete avoidance of gender greetings is recommended. For instance, instead of saying, “Hi sir, I’m here to take your vitals before the doctor comes in,” try saying, “Hello, I’m going to take your vitals before the doctor sees you.” Nurses can politely ask patients for their preferred pronouns, especially if it is a patient who will be in their care for a few days or longer.

Ideally, healthcare communities should use a system that allows patients to provide their preferred names, gender identities, and pronouns. Some already do this, while others have not caught up to current best practices regarding gender identity inclusion.

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Create a welcoming environment

Asking open-ended questions is an effective strategy for helping LGBTQIA+ patients feel comfortable enough to share information with their nurses. An example could be, “Is there anything else I can do to help you get the most out of your visit?” For some, that will be enough prompting to help patients be open about their gender identity and preferred pronouns. If patients do share, be sure to thank them for their trust and openness. A great way to do that is by saying something like, “Thank you for sharing that with me. It will help me provide you with better care.”

Never overwhelm patients with questions that have nothing to do with their visit. Even if a patient shares their preferred gender identity and pronouns, that is never an invitation to ask them personal questions about their lifestyle. It is not their job to educate nursing professionals. Asking intrusive questions can make the patient uncomfortable.

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Show respect

LGBTQIA+ patients take risks when they confide in medical professionals. Ensuring they have a positive experience is paramount to providing quality healthcare. Nurses, like all healthcare practitioners, take an oath to maintain and elevate the standards of their profession. Nurses must put aside any personal beliefs or feelings they have and provide the absolute best care to all their patients. Compassion and respect are hallmarks of the nursing profession. The quality of the interaction nurses have with LBGTQIA+ patients can make a difference in both their health and lives. 

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Joining a Nursing Union: Pros and Cons

Joining a nursing union can be challenging because no single union represents the nationwide healthcare industry. According to the U.S. Bureau of Labor Statistics, only 20.4 percent of RNs and 10 percent of LPNs/LVNs currently identify as union members.

Like anything else in life, there are both advantages and disadvantages to joining a nursing union. While nurses in unions tend to earn higher wages than non-union nurses, that should not be the only consideration. Here is a quick review of the pros and cons of unionizing.

In this article, we will cover:

The role of a nursing union

Unions have existed for more than a century. Interest in unionization among the healthcare industry has increased only recently, with much of the newfound interest fueled by the Covid pandemic.

Nursing unions give nurses such as RNs, and LPN/LVNs, the right to advocate as a collective. Unions push for fair contracts that ensure higher wages and safer working conditions while protecting nurses’ rights. Several unions represent the nursing industry, including:

  • American Federation of Teachers and Health Professionals (AFT): This union is the second-largest nurses union in the AFL-CIO. The majority of AFT Nurses and Health Professionals members work in hospitals, although they also work in nursing homes, home health agencies, laboratories, blood banks, and clinics. The division’s membership also includes approximately 15,000 school nurses.
  • National Nurses United: This union is composed of registered nurses (RNs) in the U.S. Founded in 2009, they claim more than 175,000 members among their ranks. Three separate nursing unions combined to form this colossal union – the California Nurses Association, the United American Nurses, and the Massachusetts Nurses Association.
  • United Food and Commercial Workers International Union: The UFCW works for nurses by negotiating contracts that  “enable hard-working women and men in order to provide the best patient care while being fairly compensated with the wages and benefits they need to take care of their own families.”

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Pros of joining a nursing union

The adage that there is strength in numbers is what keeps unions popular in some industries. Unions use their leverage to negotiate enforceable contracts that:

  • Define the role of nurses in fixing the standard of care to ensure better patient outcomes without creating a catalyst for nurse burnout.
  • Establish a process for addressing complaints and other grievances that protects nurses from reprisal from healthcare employers.
  • Guarantee wages and automatic pay increases that cannot be lowered by employers due to budget cuts or other fiscal reasons.
  • Identify safe working conditions, including nurse-to-patient ratios and required breaks. Unions consistently advocate for lower nurse-to-patient ratios, improved safety protocols, and the elimination of mandatory overtime.
  • Provide representation for nurses when their employers initiate disciplinary action against them. Union representatives act as counsel to defend nurses against any accusations and to ensure they receive fair treatment.
  • Set benefits, overtime conditions, pay scales, and procedures for paid and unpaid leave. Sometimes unions can get healthcare employers to include education grants, insurance discounts, and other perks as part of an employment package.

Nurses have dedicated advocates to lobby for beneficial legislation that can improve the overall standards of care and working conditions within the healthcare industry. Having direct representation by union staff in the workplace can help nurses when employers take disciplinary actions or when working conditions require labor-management negotiation.  

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Cons of joining a nursing union

It is hard to ignore the many benefits of joining a nursing union, but that does not mean it is always the best decision. What seems like a perk of unionization can end up being a major disadvantage. For instance, collective bargaining is often touted as an advantage of nursing unions because it waives the responsibility of negotiating benefits, salary, and safety issues and places it in the union leaders’ hands. On the flip side, collective bargaining can reduce pay in the final years of a negotiated pay scale in favor of bigger upfront wages.

Here are some other pitfalls to nursing unions to consider before organizing:

  • Entrenched seniority is a sticking point for some nurses. Unions benefit members with seniority the most. Senior nurses get preference for scheduling requests like time off and receive priority over newer nurses during staff reductions. Unfortunately, seniority takes precedence over performance in most unionized healthcare facilities, meaning even nurses who do not put in 100 percent effort still qualify for raises per the negotiated pay scale schedule. It also can be difficult to dismiss nurses who engage in unprofessional behavior.
  • Mandatory striking without pay is how unions leverage their power over employers. When nurses join unions, they agree to participate in mandatory striking. If they refuse, they may experience retaliatory actions from their colleagues.
  • Membership dues are arguably one of the points of contention many have with unions. Most unions automatically deduct monthly dues directly from nurses’ paychecks, which means less take-home pay. In addition to using membership fees to support members, unions can legally use them for political purposes. Some nurses may object to their money being spent to further candidates and legislation that do not align with their personal beliefs.
  • Required mediation is another issue with unions since most force members to submit to mandatory mediation for every dispute, small or large. Sometimes this practice can make mountains of molehills by overcomplicating disputes with pointless processes.

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Unionizing nurses where you work

Unionizing is not the solution for all nurses. The decision to join ultimately comes down to individual nurses and their preferences. Nurses who want to learn more about unionizing in their workplace can reach out to any of the unions mentioned above. Each has information on their websites about how to launch unionization efforts.

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