International Federation of International Federation of Nurse Anesthetists: Where Nurse Anesthetists: Where

We Have Been, Where We’re We Have Been, Where We’re Going?Going?

Sandra M. Ouellette, CRNA, Sandra M. Ouellette, CRNA, MEd, FAANMEd, FAAN

President IFNA 2004-2010President IFNA 2004-2010

Historical Development of Historical Development of IFNAIFNA

19719788

Jan Frandsen (Denmark) and Hermi LJan Frandsen (Denmark) and Hermi Lohnert ohnert (Switzerland) attend AANA Annual Meeting(Switzerland) attend AANA Annual Meeting

19819855

First international symposium held Lucerne, First international symposium held Lucerne, SwitzerlandSwitzerland 250 nurse anesthetists250 nurse anesthetists 11 countries11 countries

19819888

Second international symposium held in Second international symposium held in AmsterdamAmsterdam 511 nurse anesthetists511 nurse anesthetists 16 countries16 countries

19819888

September first organizational meeting held, September first organizational meeting held, Teufen, SwitzerlandTeufen, Switzerland

Historical Development Historical Development (cont.)(cont.)

19819899

May Sandy Maree and Ron Caulk attend ICN May Sandy Maree and Ron Caulk attend ICN 1919thth Quadrennial Congress in Seoul, Korea Quadrennial Congress in Seoul, Korea

June country representatives met in Tuefen, June country representatives met in Tuefen, Switzerland to adopt bylaws; 11 charter Switzerland to adopt bylaws; 11 charter countries acceptedcountries accepted

Charter signed on June 10, 1989Charter signed on June 10, 1989

World Congress Nurse World Congress Nurse AnesthetistsAnesthetists

1991 Oslo, Norway with 1,100 participants1991 Oslo, Norway with 1,100 participants 1994 Paris, France with 2,606 participants1994 Paris, France with 2,606 participants 1997 Vienna, Austria with 1,646 1997 Vienna, Austria with 1,646

participantsparticipants 2000 Chicago, USA with 4,384 present2000 Chicago, USA with 4,384 present 2002 Helsinki, Finland with 1,047 present2002 Helsinki, Finland with 1,047 present 2006 Lausanne, Switzerland with 1278 2006 Lausanne, Switzerland with 1278

presentpresent

Objectives of IFNAObjectives of IFNA

To promote cooperation between nurse To promote cooperation between nurse anesthetists internationallyanesthetists internationally

To develop and promote educational standards in To develop and promote educational standards in the field of nurse anesthesiathe field of nurse anesthesia

To develop and promote standards of practice in To develop and promote standards of practice in the field of nurse anesthesiathe field of nurse anesthesia

To assist nurse anesthetists’ association improve To assist nurse anesthetists’ association improve standards and competence of nurse anesthetistsstandards and competence of nurse anesthetists

To promote recognition of nurse anesthetistsTo promote recognition of nurse anesthetists To promote cooperation among all in health care To promote cooperation among all in health care

communitycommunity

Functions of the International Functions of the International Federation of Nurse Federation of Nurse

AnesthetistsAnesthetists To promote continual high quality patient To promote continual high quality patient

carecare To serve as the authoritative voice of nurse To serve as the authoritative voice of nurse

anesthetists and nurse anesthesia anesthetists and nurse anesthesia internationallyinternationally

To provide a means of communication among To provide a means of communication among nurse anesthetists throughout the worldnurse anesthetists throughout the world

To promote the independence of the nurse To promote the independence of the nurse anesthetist as a professional specialist in anesthetist as a professional specialist in nursingnursing

To advance the art and science of To advance the art and science of anesthesiologyanesthesiology

IFNA Member Countries and Year of IFNA Member Countries and Year of AdmissionAdmission

*Austria (1989)*Austria (1989) Gabon (1994)Gabon (1994) Jamaica (1997)Jamaica (1997) *South Korea *South Korea (1989)(1989)

Belgium ( 2009)Belgium ( 2009) *Germany (1989)*Germany (1989) Luxembourg Luxembourg ( 2005)( 2005)

Spain (1992)Spain (1992)

Benin (1994)Benin (1994) Ghana (1993)Ghana (1993) Morocco (1997)Morocco (1997) *Sweden (1989)*Sweden (1989)

Cambodia (1997)Cambodia (1997) Great Great Britain(1995) Britain(1995)

Netherlands Netherlands (1995)(1995)

*Switzerland *Switzerland (1989)(1989)

Croatia (1999)Croatia (1999) Hungary (1999)Hungary (1999) Nigeria (1993)Nigeria (1993) Taiwan (1999)Taiwan (1999)

Democratic Democratic Republic of the Republic of the Congo (1992)Congo (1992)

*Iceland (1989)*Iceland (1989) *Norway (1989)*Norway (1989) Uganda (1996)Uganda (1996)

Denmark (1997)Denmark (1997) Indonesia Indonesia (2006) (2006)

Poland (1998)Poland (1998) *United States *United States (1989)(1989)

*Finland (1989)*Finland (1989) Italy (2001)Italy (2001) Serbia (2008)Serbia (2008) Tunisia (2004)Tunisia (2004)

*France (1989)*France (1989) Ivory CoastIvory Coast (1994)(1994)

*Slovenia (1989)*Slovenia (1989) *Charter countries

.

Educational Activities of IFNAEducational Activities of IFNA

Educational Standards: 1990; revised 1999Educational Standards: 1990; revised 1999 Practice Standards:1991; revised 1996Practice Standards:1991; revised 1996 Code of Ethics: 1992Code of Ethics: 1992 Guidelines for Starting a Nurse Anesthesia Guidelines for Starting a Nurse Anesthesia

ProgramProgram Monitoring GuidelinesMonitoring Guidelines Teachers SessionTeachers Session( IFNA International Standards are endorsed by ( IFNA International Standards are endorsed by

the International Council of Nurses (ICN) the International Council of Nurses (ICN) 20022002

Liaison With Other Liaison With Other OrganizationsOrganizations

European Economic Community (EU)European Economic Community (EU) International Council of Nurses (ICN)International Council of Nurses (ICN) World Health Organization (WHO)World Health Organization (WHO) Center for Quality Assurance in International Center for Quality Assurance in International

Education (CQAIE)Education (CQAIE) World Federation of Societies of World Federation of Societies of

Anaesthesiologists (WFSA)Anaesthesiologists (WFSA) International Hospital Federation International Hospital Federation International Society for Quality in Health CareInternational Society for Quality in Health Care

IFNA Recognized By IFNA Recognized By International Council Of NursesInternational Council Of Nurses There are 7 nursing organizations with ICN There are 7 nursing organizations with ICN

affiliate status:affiliate status: 1European Federation Of Nursing 1European Federation Of Nursing

Associations (EFN)Associations (EFN) 2 Council on International Neonatal Nurses 2 Council on International Neonatal Nurses

(CINN)(CINN) 3 International Federation of Nurse 3 International Federation of Nurse

Anesthetists (IFNA)Anesthetists (IFNA) 4 International Federation of Perioperative 4 International Federation of Perioperative

Nurses (IFPA)Nurses (IFPA)

ICN’s Affiliate Nursing ICN’s Affiliate Nursing OrganizationsOrganizations

5 International Society of Nurses in 5 International Society of Nurses in Cancer Care (ISNCC)Cancer Care (ISNCC)

6 International Skin Care Nursing 6 International Skin Care Nursing Group (ISNG)Group (ISNG)

7 World Federation of Critical Care 7 World Federation of Critical Care Nurses (WFCCN)Nurses (WFCCN)

IFNA Education And Research FoundationIFNA Education And Research Foundation

Collaborative study of IFNA (Dr Maura McAuliffe) and Collaborative study of IFNA (Dr Maura McAuliffe) and World Health Organization: 1996 and 1999World Health Organization: 1996 and 1999

1Nurses administer anesthesia in 107 countries1Nurses administer anesthesia in 107 countries 2 Provide 77% in rural areas and 75% in urban areas of 2 Provide 77% in rural areas and 75% in urban areas of

the world.the world. 3 57% reported they were required to have a physician 3 57% reported they were required to have a physician

anesthetist present (mostly European countries)anesthetist present (mostly European countries) 4 All had a formal educational program but some were 4 All had a formal educational program but some were

outside the countryoutside the country 5 50% reported continuing education was not available5 50% reported continuing education was not available 6 74% reported hospital policies as well as governmental 6 74% reported hospital policies as well as governmental

regulation (60%) guide the practice of nurse regulation (60%) guide the practice of nurse anesthesia. anesthesia.

IFNA Education And Research IFNA Education And Research FoundationFoundation

1 Supported a collaborative program 1 Supported a collaborative program with the World Federation Society of with the World Federation Society of Anesthesiologists in Malawi, Africa in Anesthesiologists in Malawi, Africa in 1999.1999.

2 Provided a seminar in Kumasi, 2 Provided a seminar in Kumasi, Ghana for over 100 nurse Ghana for over 100 nurse anesthetists in 2005anesthetists in 2005

IFNA: Accomplishments, IFNA: Accomplishments,

Needs, Its FutureNeeds, Its Future

The FutureThe Future

IFNA Education Committee: Anesthesia IFNA Education Committee: Anesthesia Program Approval ProcessProgram Approval Process

WCNA 2010 The Hague, The Netherlands WCNA 2010 The Hague, The Netherlands June 4-7, 2010.June 4-7, 2010.

WCNA 2012 Slovenia; 2014 TunisiaWCNA 2012 Slovenia; 2014 Tunisia History Book marking 20History Book marking 20thth Anniversary of Anniversary of

IFNA: 1989-2009IFNA: 1989-2009 Appointment of An IFNA Practice Appointment of An IFNA Practice

CommitteeCommittee

IFNA’s Anesthesia Program IFNA’s Anesthesia Program Approval Process: APAPApproval Process: APAP

Betty Horton CRNA, PhDBetty Horton CRNA, PhD

Chairperson IFNAChairperson IFNA

Education CommitteeEducation Committee

IFNA’s BeliefIFNA’s Belief

“ “ If nurses are utilized for preoperative If nurses are utilized for preoperative or postoperative preparation of the or postoperative preparation of the patient and if they perform venous and patient and if they perform venous and arterial cannulation, induction and arterial cannulation, induction and emergence of anesthesia, intubation, emergence of anesthesia, intubation, and extubation, and if they are left and extubation, and if they are left alone for any reason, they should be alone for any reason, they should be appropriately educated.”appropriately educated.”

IFNA’s BeliefIFNA’s Belief

“ “ If nurses are being utilized in such a If nurses are being utilized in such a manner…IFNA is concerned that their manner…IFNA is concerned that their educational process is sufficient to educational process is sufficient to support anesthesia practice and patient support anesthesia practice and patient safety.”safety.”

Professional Study & ResourceProfessional Study & Resource Guide For the CRNAGuide For the CRNA

Philosophy of APAPPhilosophy of APAP

““IFNA believes that it is possible to improve IFNA believes that it is possible to improve the health and welfare of humanity by the health and welfare of humanity by promoting international educational promoting international educational standards for non-physician anesthesia standards for non-physician anesthesia programs. Based on this belief and for the programs. Based on this belief and for the purpose of program approval. It is the purpose of program approval. It is the policy of IFNA to approve programs that policy of IFNA to approve programs that admit students who are nurses or who are admit students who are nurses or who are educated in another scientific area which educated in another scientific area which prepares students to succeed in their prepares students to succeed in their anesthesia education.”anesthesia education.”

Philosophy Of APAPPhilosophy Of APAP

““Although IFNA strongly supports a Although IFNA strongly supports a nursing background for admission, it nursing background for admission, it also believes in an approval process also believes in an approval process that recognizes the differences that that recognizes the differences that currently exist in the educational currently exist in the educational preparation of health professionals preparation of health professionals worldwide that have contributed to worldwide that have contributed to nurses and non-nurses being enrolled nurses and non-nurses being enrolled in anesthesia programs.”in anesthesia programs.”

Philosophy of APAPPhilosophy of APAP

““IFNA believes that an inclusive process IFNA believes that an inclusive process provides the greatest opportunity to provides the greatest opportunity to improve anesthesia care to patients improve anesthesia care to patients now and in the future.”now and in the future.”

APAP Operational PoliciesAPAP Operational Policies

Eligibility CriteriaEligibility Criteria

ApplicationsApplications

Programs can apply for one of 3 categories:Programs can apply for one of 3 categories:

RegistrationRegistration

RecognitionRecognition

AccreditationAccreditation

Three Categories Of Three Categories Of ApprovalApproval

RecognizesRecognizes

1 Diversity of nurse anesthesia programs 1 Diversity of nurse anesthesia programs throughout the world;throughout the world;

2 The economic stage of development of a 2 The economic stage of development of a country;country;

3The resources available to individual 3The resources available to individual programs;programs;

4 A commitment of diverse programs to a 4 A commitment of diverse programs to a common standard of educational quality.common standard of educational quality.

Process To Develop APAPProcess To Develop APAP

First draft of application process First draft of application process developed by Education Committee with developed by Education Committee with members from Switzerland, Africa, Taiwan, members from Switzerland, Africa, Taiwan, Sweden & USA.Sweden & USA.

Three programs completed the pilot Three programs completed the pilot project and were awarded “Recognition.”project and were awarded “Recognition.”

1 Sweden1 Sweden

2 The Netherlands2 The Netherlands

3 USA3 USA

Goals OF APAPGoals OF APAP

To encourage programs to comply with IFNA’s To encourage programs to comply with IFNA’s Educational Standards for Preparing Nurse Educational Standards for Preparing Nurse Anesthetists through an approval process Anesthetists through an approval process that takes cultural differences into that takes cultural differences into consideration.consideration.

To improve the health and welfare of To improve the health and welfare of humanity by promoting international humanity by promoting international educational standards.educational standards.

To categorize educational preparation and To categorize educational preparation and scope of practice throughout the world.scope of practice throughout the world.

IFNA Practice CommitteeIFNA Practice CommitteeObjectivesObjectives

Define the scope of practice in IFNA Define the scope of practice in IFNA member and nonmember countries.member and nonmember countries.

Define required credentials to Define required credentials to practice as a nurse anesthetists and practice as a nurse anesthetists and identify regulatory body responsible.identify regulatory body responsible.

Identify various payment models for Identify various payment models for anesthesia services in member and anesthesia services in member and nonmember countries.nonmember countries.

Practice Committee Practice Committee Objectives ContinuedObjectives Continued

Develop a model for continuing Develop a model for continuing education for nurse anesthetists.education for nurse anesthetists.

Review and revise Practice Standards Review and revise Practice Standards and Ethical Standards as needed.and Ethical Standards as needed.

Work with the IFNA Education Work with the IFNA Education Committee to identify speakers and Committee to identify speakers and topics to CPC for all future congress. topics to CPC for all future congress.

Financial Status Of IFNAFinancial Status Of IFNA

Stable now since dues were adjusted in Stable now since dues were adjusted in 2004.2004.

We should, however, approach the future We should, however, approach the future with cautious optimism:with cautious optimism:

1 Must fund congress more often with a two 1 Must fund congress more often with a two year cycle.year cycle.

2 Congress may be successful or fail; ie 2 Congress may be successful or fail; ie Volcanic eruption in IcelandVolcanic eruption in Iceland

3 Unstable world economy3 Unstable world economy

Action Steps For Action Steps For Establishing A Global Establishing A Global

ProfessionProfession Act as an international witness for Act as an international witness for

the need for professional standards the need for professional standards in nurse anesthesia.in nurse anesthesia.

Interact effectively with appropriate Interact effectively with appropriate regional and international regional and international organizationsorganizations

Act as a liaison to other globalizing Act as a liaison to other globalizing professions.professions.

Action Steps For Action Steps For Establishing A Global Establishing A Global Profession ContinuedProfession Continued

Consider the development of an IFNA quality Consider the development of an IFNA quality assurance process for nurse anesthesia assurance process for nurse anesthesia educational and professional development educational and professional development programs.programs.

Monitor and record its own progress through Monitor and record its own progress through research, publication, and international forums.research, publication, and international forums.

Dr Marjorie Peace LennDr Marjorie Peace Lenn

Executive Director CQAIE (1997)Executive Director CQAIE (1997)

IFNA RelationshipsIFNA Relationships

“ “ Moving ahead to be the best, Moving ahead to be the best, reaching behind to help the rest”reaching behind to help the rest”