Comments from Jay Horowitz Friday Night I am the author of these proposed changes. The goal of the proposed changes is to provide the elected AANA Board more flexibility to act in the best interest of AANA members, and update our bylaws in a manner consistent with professional association best practices. That’s it. No spin. No speculation. No rumor. This is not a trivial matter. I spent an enormous amount of time and energy doing the due diligence to get it right. I consulted with 2 parliamentarians, 3 lawyers, 2 not-for-profit association executives, credentialing experts and members of AANA. I researched history, trends, current standards and best practices in credentialing and accreditation within the nursing and medical professional communities. In order to fully understand the present we need to explore a little history. It is well acknowledged that Ira Gunn was hired as a consultant to AANA in the 70s to help formulate and guide the association towards a comprehensive plan for academic program accreditation, practitioner certification and recertification, and a general community of interest voice in the practice of nurse anesthesia. Ira also worked with ANA, having been appointed to their Committee for the Study of Credentialing in Nursing and extrapolated that experience as it relates to these issues for nurse anesthesia in an April 1979 Journal article; “The implications of the report of the studyof credentialing in nursing to nurse anesthesia” Ira’s involvement led to the formation of the AANA Councils; including accreditation, certification and recertification. Of note in Ira’s many writings on the subject are the following basic concepts: “Representation in credentialing systems of the community of interests directly affected by credentialing mechanisms should assure consideration of the legitimate concerns of each group.” “Accountability, within the framework of the standards set by the professions, is an essential dimension of credentialing.” “Accountability includes aspects of shared governance, as well as reporting, explaining, and justifying.” “The structural components of credentialing bodies and credentialing processes should provide for both intra-professional and extraprofessional accountability.” Ira’s philosophy and research on the topic spoke of “a degree of independence” for the councils, never did she elude to complete and utter independence for such entities. The Councils were set up and approved by the members with certain specifications written into the AANA Bylaws that spoke to the roles of the Councils themselves, and the roles of certain AANA Committees; most notably Education and Continuing Education. Things seemed to move along well enough, the system was working. Advances for the profession were made in all areas. We maintained control of the profession despite attempts by others to usurp control. In 2001, under the direction of a new AANA executive director, changes started taking place that led to the Councils incorporating separately, moving away from the traditional collaborative relationship originally formulated by Ira and written into the bylaws by the members. At the 2007 business meeting members were asked to amend the bylaws in a fashion that essentially removed any input form the profession into the actions of the Councils. During the debate at the meeting Louise Hershkowitz gave an impassioned and remarkably prescient speech. I’m reading now from the transcript of that meeting: I speak today both as an active and concerned member and also a past AANA Board member, past CE Chair and past member of the Council on Recertification. Having two of our councils in effect secede from the AANA has changed everything. Having been a member of the Council on Recertification, I have read and studied the accreditation standards for that council and the Council on Certification and understand their need for autonomy. But while they were a part of the AANA, our profession maintained a very important, if not always smooth relationship through which AANA and its members had the opportunity to review and comment on proposed changes, either in accreditation, in certification or re- certification processes. These activities have been conducted for many years without the, quote, undue influence, unquote, that would assail the autonomous decision-making of the councils. But now that these two councils have made themselves an independent entity, that all-important relationship is no longer assured. Let me say as clearly as I can, while the mechanics of accreditation, certification, and recertification certainly are the purview of the councils, setting standards of practice and ethics and accountability to the public for the practice of this profession rests in our professional association, the AANA. No small groups -- no small groups sitting on the councils, be they CRNAs or CRNAs and others, as there should be, no matter how well educated and well intentioned, should have the ability to in effect set and enforce these standards without the advice and consent of the organization that represents the members of this profession. The AANA’s leaders cannot hand this responsibility to any other body. And in the bylaws which govern all the activities and relationships of AANA, the relationship of AANA and the councils must clearly define not just the business relationship of these entities but far more important, also the working relationship. Apparently Louise did sway the members and the amendments did not pass in 2007, but came back in substantially the same format and passed in 2008 with almost no debate. That’s the end of the history lesson. Having confidence in the proposed changes, I then needed to find cosigners. Since the proposals deal with fundamental and historical functions of the AANA, and have been in place since the late 70s, who better to understand and recognize the necessity of the proposed changes than those who have served at the highest level for this association? The past AANA Presidents provide a wealth of unsurpassed experience, dedication and passion. The group that eventually signed on span 3 decades of our leadership and include two that were elected President twice by the membership. One of those was also a former NBCRNA chair. Clearly, this is not some random radical group of members with nefarious ulterior motives. And just for clarity, the content of the CPC had nothing to do with the genesis of these proposals or the Past Presidents support. We’re all far to old to be affected by testing! As part of the bylaw amendment writing process I was required to provide a rationale. Due to the number of proposed changes, I was asked to write a preamble. You can see the philosophy for the changes there. But, you can skip those and just read the actual language in the proposals and decide for yourself. That is all we are voting for. COA and NBCRNA should welcome the changes since they clearly provide even greater autonomy than currently exists. They should welcome the changes because it will solidify their standing with members who otherwise have no means of gaining a respectful understanding of what the intended relationship should be between the AANA as the representative voice for the profession, and the COA and NBCRNA. To be recognized, they will have met the guidelines for recognition, not to be confused with guidelines for accreditation, certification and recertification, developed by our elected AANA Board. We will have chosen them for their effectiveness, value, and excellent partnership, not because of some arbitrary parliamentary requirement. My due diligence revealed no example of hostile takeovers of accreditation or credentialing. No examples of a diminished view of CRNAs in the eyes of regulators, legislators or other stakeholders. No AANA Board would willingly and knowingly give away our voice in accreditation of our schools or credentialing of our members. Any such board would meet strong resistance to such efforts and would be subject to both parliamentary remedies and legal action based on the General Not for Profit Corporation Act of Illinois. I would be first in line to register my dismay (a more familiar role for me)! In contrast, since COA and NBCRNA have self-selected boards and no members, and they can change their bylaws at any time; no such remedies exist for members or AANA to address similar issues. To the best of my knowledge there is no plan to replace COA or NBCRNA. The AANA Board has confirmed that in their statement of support for the amendments. I know of no templates for new entities. In fact, AANA and COA have recently signed a long-term agreement. I did not write these proposed changes to control the Councils. That is simply wrong. That would never fly with regulators and is not a desirable outcome. I get the whole issue of undue influence; AANA cannot exert such influence or control. However, undue influence does not equate to no influence at all. Ever. In perpetuity. As a businessman who has run a CRNA-only practice for 25 years, I have negotiated numerous contracts. Not once did I get an agreement that unconditionally lasts forever. AANAs obsolete bylaws essentially give NBCRNA and COA contracts in perpetuity. That’s just not good business. You now know how these proposals came to be. I can answer any of your questions this evening at this hearing or at a small get together with drinks and snacks in Dan Simonson and Jack Hitchens suite once we adjourn. I urge you to vote in favor of these bylaw amendments.
Posted on: Sat, 10 Aug 2013 15:00:32 +0000
Trending Topics
Recently Viewed Topics
© 2015