This study examines the important contributions of clinical faculty toward the education of the future workforce of Ceertified Registered Nurse Anesthetists (CRNAs). Differences in workload, work activities and income amoung clinical faculty, academic faculty and nonfaculty are examined.crnas, labor makret

Elizabeth Merwin, RN

Lorraine Jordan

Steven Stern, PhD

English

Research Papers in Economics

www.aana.com/aanajournal.aspx AANA Journal ￿ June 2008 ￿ Vol. 76, No. 3 167
This study examines the important contributions of clin-
ical faculty toward the education of the future workforce
of Certified Registered Nurse Anesthetists (CRNAs). Dif-
ferences in workload, work activities and income
among clinical faculty, academic faculty and nonfaculty
are examined.This is Part 2 of a 2-part column. Part 1,
published in the April 2008 AANA Journal discussed
salaries, recruitment, and retention of CRNA faculty.
Keywords: CRNA clinical faculty, salary, workload.
Elizabeth Merwin, RN, PhD, FAAN
Steven Stern, PhD
Lorraine M. Jordan, CRNA, PhD
Clinical Faculty: Major Contributors to the Education of
New CRNAs – Part 2
EDUCATION NEWS
The Certified Registered Nurse
Anesthetist (CRNA) faculty work-
force is in healthcare settings
delivering anesthesia throughout the
country. The faculty workforce con-
sists of a small core of academic
faculty employed full time or part
time by educational institutions and
is joined by a large number of volun-
teer clinical faculty. Many studies of
nursing programs focus on the aca-
demic faculty with much less focus
on clinical faculty whose main
responsibility is the delivery of
patient care. This less visible compo-
nent of the CRNA faculty workforce
includes the largest number of fac-
ulty and provides much of the
clinical teaching vital to the prepara-
tion of future CRNAs. The volunteer
clinical faculty are critical to the suc-
cess in education to ensure clinically
competent nurse anesthetists; how-
ever, little is known about this large
component of the faculty workforce.
With the decision to move to doc-
toral preparation for entry into
“nurse anesthesia practice by the
year 2025”1 it is important to con-
sider the important role fulfilled by
unpaid clinical faculty and the impli-
cations of such a change on the
workforce.
Seventy-two nurse anesthesia pro-
grams provided data in the 2007
Survey of Program Directors on fac-
ulty within their programs. These
programs identified a total of 294
full-time equivalent (FTE) employed
faculty with 263 of these FTEs being
CRNAs and 27 being non-CRNAs.
There were 4,851 affiliated volunteer
faculty of whom 3,465 were CRNAs.
These programs employed from 0 to
24 FTE funded faculty members
with an average of 4.09 (SD, 3.44)
per program (median, 3). An average
of 0.37 were non-CRNA positions.
In sharp contrast, there was an aver-
age of 69.3 (SD, 104.5) and a
median of 23.5 volunteer faculty per
nurse anesthesia program, which
included individuals who taught in
the program clinically and/or aca-
demically. Of these, an average of
48.8 (SD, 71.7) and a median of 18
of these volunteer faculty were
CRNAs, and an average of 20.08
(SD, 35.4) and a median of 4.5 were
volunteer faculty other than CRNAs.
The program directors identified
a current need to fill an additional
287 CRNA volunteer faculty posi-
tions (average, 4.2; SD, 18.5;
median, 0) and 84 other volunteer
faculty (average, 1.2; SD, 6.2;
median, 0). Program directors antici-
pate needing 330 volunteer CRNA
faculty and 112 other volunteer fac-
ulty within the 72 programs over the
next 5 years.
There are a number of barriers
making it difficult to fill current
and future volunteer faculty posi-
tions. Program directors ranked
these barriers as seen in Figure 1.
The lack of financial incentive was
the most frequently identified fol-
lowed by the amount of work
involved. Always being required to
teach a student was ranked third,
and the potential barrier of individ-
uals lacking the appropriate
credential was ranked last.
The importance of salary to fill
positions for CRNA academic and
clinical faculty has been previously
discussed, and the need to consider
compensation in relation to work-
load has been recognized.2 The
existence of salary differentials for
clinical faculty as compared to
CRNAs with no faculty or student168 AANA Journal ￿ June 2008 ￿ Vol. 76, No. 3 www.aana.com/aanajournal.aspx
supervision responsibilities is an
important concern for the future
comparisons of salary and workload.
Using data from the American
Association of Nurse Anesthetists
(AANA) 2004 Practice Profile
Database, 3 groups were studied,
and they are: (1) clinical faculty (N =
2,320) who supervise student nurse
anesthetists for some percentage of
their time and who may or may not
be employees of colleges or universi-
ties (but if they are employees of
colleges or universities, they identi-
fied practice, not education or
administration as their primary posi-
tion, and more than 80% of these
individuals practice at a university
hospital); (2) all nonfaculty CRNAs
(N = 8,892) reflecting those who do
not supervise student anesthetists
and are not academic faculty; and
(3) academic faculty (N = 76),
defined as those employed by a col-
lege or university who identify
education (N = 68) or administra-
tion (N = 3) as the main focus of
their position. The sample was lim-
ited to those who work full time and
did not change positions within the
prior year.
Some CRNA programs are admin-
istratively linked to hospitals (or
sometimes to practice groups).
Academic faculty affiliated with
these programs cannot be identified
within available data. Salaries of
clinical faculty who are employed by
CRNA programs have been
described2; however, most clinical
faculty are unpaid volunteers. A
comparison of work settings, work-
load, and income across clinical
faculty, nonfaculty CRNAs, and
other academic faculty provides
information for planning, recruit-
ment, and retention initiatives for
clinical faculty.
Figure 2 shows different settings
of practice for clinical faculty, non-
faculty CRNAs, and academic
faculty. As expected, academic fac-
ulty have higher rates of practicing
in university hospitals than either
clinical faculty or nonfaculty
CRNAs. Hospitals remain the pre-
dominant setting for practicing
CRNA clinical faculty and practicing
CRNAs that are not faculty.
Differences between workload
and income may influence an indi-
vidual’s choices to assume clinical
faculty or nonfaculty positions.
Clinical faculty administered fewer
anesthetics with an average of 777
anesthetics in calendar year (CY)
2003 compared to 847 administered
by nonfaculty CRNAs (t = 4.85, P =
.0001). No significant difference was
noted in total income (t = 1.75, P =
.08) for clinical faculty (CY 2003,
$136,447) compared to other
CRNAs (CY 2003, $138,800). Figure
3 shows that the average number of
anesthetics administered is lower for
clinical faculty than for nonfaculty
CRNAs, but clinical faculty members
administer more anesthetics than
academic faculty. The difference
among the 3 groups is even more
striking when the medians and
modes are compared. The composi-
tion of work activities also varies by
faculty status as seen in Figure 4.
Academic faculty
Clinical faculty
Other CRNAs
60
80
40
100
20
0
Hospital University
hospital
ASC Office
based
Other
Figure 2. Comparison of Practice Setting byType of Faculty Status
ASC indicates ambulatory surgical center.
Lack of financial incentive
Too much work
Lack of appropriate credential
Always being required to teach
N
u
m
b
e
r
1 = Greatest barrier
4
60
50
40
30
20
10
0
3 2 1
Figure 1. Barriers to Filling Vacant Volunteer Clinical Faculty Positionswww.aana.com/aanajournal.aspx AANA Journal ￿ June 2008 ￿ Vol. 76, No. 3 169
The total number of hours
worked over a 2-week time period is
roughly the same for the 3 groups
over the identical time period as
seen in Table 1. The median hours
for academic faculty are 100 hours
compared to 96 hours for clinical
faculty and 99 for nonfaculty. The
mode of 80 hours is the same for all
groups. The average hours range
from 98 hours for academic faculty
to 108 hours for clinical faculty and
118 hours for nonfaculty. The num-
ber of on-call hours are included in
the number of hours worked. There
was great variation in the average
hours spent on-call based on the
type of position.
A comparison of the number of
hours worked suggests that the com-
position of workload activities and
time committed to work is similar
for clinical faculty and other CRNAs,
but both groups differ from aca-
demic faculty in work activities and
in types of responsibilities during
hours of professional commitment.
Clinical faculty consistently fall
between academic faculty and non-
faculty CRNAs in all workload
measures as does total income for
each of these 3 groups as seen in
Figure 5.
Figure 6 shows a self-identified
breakdown in workload for individ-
uals filling different types of
academic faculty roles relative to
clinical faculty from the 2006 Survey
of Program Directors and Faculty.
The specific breakdowns are pre-
sented in Table 2. The major
difference is seen between clinical
faculty and program directors in
terms of clinical activities, adminis-
trative functions, and research.
Academic faculty
Clinical faculty
Mode
Median
Other CRNAs
Mean
1,000
200
760
708
200
847
Number
0 500 1,000 1,500
1,000
777
328
Figure 3. Total Anesthetics Administered in CalendarYear 2003
Total
Nonclinical
In-house call
Anesthesia administration
On-call home
Academic faculty
Clinical faculty
Other CRNAs
0 50 100 150
Figure 4. Comparison of Workload and Activities byType of Faculty Status
On call On call
(home) (in house) Total call
Role Median Mode Mean mean mean mean
Clinical faculty 96 80 108 15.6 9.8 25
Nonfaculty 99 80 118 30.7 8.4 39
Academic 100 80 98 6.5 1.4 8
Table 1. Hours Worked byType of Position and by Hours Being on Call
Data source: AANA 2004 Practice Profile Database.
Total hours170 AANA Journal ￿ June 2008 ￿ Vol. 76, No. 3 www.aana.com/aanajournal.aspx
A regression analysis was per-
formed to determine factors that
explain total income and evaluate
differences in clinical faculty, nonfac-
ulty CRNAs, and academic faculty
incomes, but it explained only a very
small portion of variation. Being
male increased income as did the
number of anesthetics administered.
Age, being an academic faculty or
being a clinical faculty relative to
nonfaculty CRNAs, was not a signifi-
cant factor in the model.
CRNAs who volunteer their time
to the mission of preparing the next
generation of CRNAs make up the
largest cadre of CRNA faculty. The
heavy reliance on volunteer clinical
faculty together with barriers that
exist to recruit these faculty mem-
bers suggests the need to develop
intrinsic and extrinsic reward mech-
anisms to support professional
development of the existing clinical
faculty and outreach initiatives to
create goodwill to facilitate recruit-
ment of new clinical faculty. The
dependence on volunteer faculty to
teach students places nurse anesthe-
sia programs in a vulnerable position
when faced with the highly competi-
tive market for CRNAs. Programs
may wish to examine their intrinsic
and extrinsic rewards for clinical fac-
ulty to ensure recognition of these
faculty for their critical role in nurse
anesthesia education. Enhancing vis-
ibility and recognition of the clinical
faculty may entice new graduates to
engage in this critical responsibility.
The higher workload (excluding
at home on-call hours) accompany-
Academic faculty
Clinical faculty
Mode Median
Other CRNAs
Mean
0 50,000 100,000 150,000
Mode
Median
Mean
200,000
138,826 130,000 120,000
130,000 136,264 130,000
127,939 125,500 150,000
Figure 5. Comparison of Total Income for CalendarYear 2003 by Faculty Status
Program
director
Assistant
program
director
Clinical
faculty
Academic
faculty
70.0
50.0
40.0
30.0
20.0
10.0
0.0
Laboratory skills teaching
Clinical
Clinical supervision
Classroom teaching
Program administration
Clinical site administration
60.0
Research
Figure 6. Work Activities byType of Roles Filled by CRNA Facultywww.aana.com/aanajournal.aspx AANA Journal ￿ June 2008 ￿ Vol. 76, No. 3 171
ing faculty positions compounded
by balancing between academia and
clinical responsibilities offers chal-
lenges. Those responsible for
programs may wish to examine the
workload of faculty and explore
strategies to support faculty in
reducing the hours worked. An
examination of the work activities
of all 3 groups revealed little time
spent in research and in faculty
development activities. Opportuni-
ties to contribute to the knowledge
base of nurse anesthesia through
research and to participate in profes-
sional development activities may
provide intrinsic benefits. These
benefits may contribute to the
growth of CRNA educators and to
their retention in the demanding
activity of educating the future
workforce of CRNAs.
When planning for the implemen-
tation of doctoral preparation for
entry into practice is implemented, it
will be necessary to consider the
implications for each type of faculty
position. It is critical to recognize the
important contributions of clinical
faculty and to include these faculty
in the development and transition to
the clinical doctorate. Clinical faculty
are essential collaborators in plan-
ning for the transition to the clinical
doctorate. Strategies to address the
concerns and needs of this important
but sometimes less visible group of
nurse anesthesia educators is critical
to the future of nurse anesthesia edu-
cation.
REFERENCES
1. American Association of Nurse Anes-
thetists. AANA Announces Support of
Doctoral Education for Nurse Anesthetists
by 2025. AANA Annual Meeting News.
August 4, 2007:1, 9.
2. Merwin E, Stern S, Jordan LM. Salaries,
Recruitment and Retention for CRNA
Faculty – Part 1. AANA J. 2008;76(2):
89-93.
AUTHORS
Elizabeth Merwin, RN, PhD, FAAN, a health
services researcher, is the Madge M. Jones pro-
fessor of nursing and the associate dean for
research at the University of Virginia, Char-
lottesville, Virginia. Email: eim5u@virginia.edu.
Steven Stern, PhD, an economist, teaches
labor economics and econometrics at the Univer-
sity of Virginia, Charlottesville, Virginia, where he
is the Merrill Bankard professor in the Depart-
ment of Economics. Email: Sns5r@Virginia.edu.
Lorraine M. Jordan, CRNA, PhD, is the
AANA chief research officer and serves as the
executive director of the AANA Foundation,
Park Ridge, Illinois. Email: ljordan@aana.com.
ACKNOWLEDGMENTS
We appreciate the participation of program
directors whose support made the implementa-
tion of this study possible. We thank all of the
faculty participants. Funding from the Ameri-
can Association of Nurse Anesthetists and from
the AANA Foundation made it possible to con-
duct this study.
The study was reviewed and approved by the
University of Virginia Institutional Review Board.
It was funded by the AANA and the AANA Foun-
dation through a consulting arrangement with
the first 2 authors who are principals of Quanti-
tative Health Care Solutions, Inc.
Direct
clinical
super- Classroom Administra-
vision of teaching Nonclinical, tion of Administra-
Direct students (lectures, laboratory program/ tion of
clinical providing seminars, skills, educational clinical site
Role care care etc) teaching activities activities
Program director 4.1 9.0 16.8 2.9 54.0 5.7
Assistant program director 14.4 22.9 17.1 3.7 28.7 8.6
Academic faculty 11.7 25.6 27 .2 9.3 11.8 6.4
Clinical faculty 57.5 33.5 1.8 0.2 1.9 3.9
Faculty
development –
participant of
continuing
education
Provider of programs or
continuing other faculty Consultant –
education development paid
Role programs activities Research consultations Other Total
Program director 0.9 1.7 2.4 0.4 1.9 100.0
Assistant program director 1.0 1.0 1.6 0.2 0.9 100.0
Academic faculty 0.2 1.6 2.7 0.0 3.4 100.0
Clinical faculty 0.1 0.1 0.0 0.0 0.9 100.0
Table 2. Comparison of Work Activities byType of Academic Faculty Role in Relation to Clinical Faculty (%)
Totals may not add up to 100% due to rounding.

American Association of Nurse Anesthetists. AANA Announces Support of Doctoral Education for Nurse Anesthetists by 2025. AANA Annual Meeting News.

Recruitment and Retention for CRNA Faculty – Part 1.

Clinical Faculty: Major Contributors to the Education of New CRNAs

http://www.virginia.edu/economics/RePEc/vir/virpap/papers/virpap380.pdf

Clinical Faculty: Major Contributors to the Education of New CRNAs

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