Development of APN Nurse

Education and Educators

Joyce Pulcini, PhD, RN, FNP-BC, FAAN, FAANP

Professor

George Washington University School of Nursing

October 6, 2016

Purpose

• This presentation will discuss the experience of

APN nurse education and of mentoring APN

nurse educators in the U.S. with application to

Latin America and the Caribbean

• This will include a history of NP Education and

the successes experienced when nurse

educators work together to create common

goals. It will also discuss strategies for

incorporating existing and new educators into

APN education.

Definición: Práctica Avanzada en Enfermería

La Nurse Practitioner/Enfermera de PrácticaAvanzada es una enfermera registrada la que ha adquirido conocimiento de experto, habilidades para tomar decisiones complejas y competencias clínicas para una prácticaexpandida, cuyas características varían segúnel context y o país en el cual esta autorizada a ejercer. Se recomienda tenr un grado de Magister para desempeñarse en este rol.

En los Estados Unidos se exige el grado de Magister.

ICN, 2002: http://icn-apnetwork.org/

Preparación Educacional

• La preparación educacional es a un nivel

avanzado

• Reconocimiento formal de los programas

educacuionales para formar enfermeras

de práctica avanzada/ nurse practitioners

y sus roles estan aprbados y acreditados

• Sistema formal de licencia, registro,

certificación y credencialICN, 2002: http://icn-apnetwork.org/

Naturaleza de la Práctica

• Integra investigación, educación, práctica clínica y

administración

• Alto grado de autonomía profesional y práctica

independiente

• Gestión de casos

• Habilidades avanzadas para la valoración en salud,

habilidades para la toma de decisiones y habilidades para

el razonamiento diagnóstico

• Reconocidas competencias clínicas avanzadas

• Servicios de consultoría a proveedores de salud

• Planificación, implementación y evaluación de programas

• Reconocida como primer contacto con clientesICN, 2002: http://icn-apnetwork.org/

Mecanismos Regulatorios

• Regulaciones específicas para la práctica de NP/APN acorde a

cada país

• Derecho a diagnosticar

• Autoridad para prescriber medicamentos

• Autoridad para prescriber tratamiento

• Autoridad para referir clients a otros profesionales

• Autoridad para ingresar pacientes al hospital

• Legislación para conferir y proteger el título de Nurse Practitioner/

Advanced Practice Nurse

• Legislación u otro tipo de mecanismo regulatorio específico para

advanced practice nurse

• Títulos oficialmente reconocidos para enfermeras que desempeñan

roles de práctica avanzada

ICN, 2002: http://icn-apnetwork.org/

Primary Health Care

WHO (1978)

“essential health care; based on practical,

scientifically sound, and socially acceptable

method and technology; universally

accessible to all in the community through

their full participation; at an affordable cost;

and geared toward self-reliance and self-

determination.”

History of Nurse Practitioner education

in the US: 1965 to 20001965:1st NP program at U. of Colorado--PNP, certificate: educated

public health nurses to be Pediatric Nurse Practitioners

1971: 1st FNP Program at U. of Washington

1973: over 65 NP programs in place

1974: 1st meeting to discuss NP curriculum at Chapel Hill,

Mid1970s: first national certification examinations for NPs, CNSs

Nurse Training Act of 1975--federal support for NP programs

1980: NONPF Guidelines for FNP curriculum planning published and

revised every 5 years until 1995 (domains and competencies)

1983: 22-24,000 NPs in US

By 1987 $100 million spent on NP education via federal grants

1990: 90% of NP programs now master’s granting

1997: National Task Force Criteria for Evaluation of NP Programs

2000: > 60,000 NPs in US/ 323 NP programs

2016: ~200,000 NPs in US (www.aanp.org)

Educating the Educators

• Like Latin America and the Caribbean, the earliest graduate

programs in the U.S. focused on nursing theory and on

preparing teachers and administrators

• Doctoral education in nursing was well established in the

1970’s and 1980s.

• Clinical Nurse Specialist roles preceded the NP and these

were mostly in acute care

• As we moved to a primary care and a direct care focus for

NPs, educators needed to understand the new role.

• Many were skeptical in the beginning and were concerned

that we were training mini-doctors

• Faculty also had to practice to maintain their skills and teach

• NONPF advocated for formal faculty practice arrangements

so that faculty would not loose their skills.

Educating the Educators

• From 1976 to 1982, The Robert Wood Johnson

Foundation offered the Nurse Faculty Fellowship so that

nurse faculty could be prepared to practice as NPs.

• Goal: to create a core of leaders in nurse practitioner

education who would help establish master’s degree

programs at schools of nursing

• This led to a proliferation of NP programs and a

“tipping point” in the mid 1990s when most graduate

programs offered these programs

Source: http://www.rwjf.org/en/library/articles-and-news/2012/01/four-decades-of-championing-nursing.html

Educational Expansion: Key Documents

-Masters Programs

• NONPF: National Task Force Criteria for Evaluation of Nurse

Practitioner Programs (1997) revised 2002, 2008, 2012, 2016

• Set standards for programs and in 2003 were integrated

into accreditation standards.

• American Association of Colleges of Nursing: Revised in

2011: AACN Essentials for Master’s Education

• 2008: Consensus Model for APRN Regulation: Licensure,

Accreditation, Certification & Education (LACE) Model

• Set standards for population foci and roles for APNs

• Identified curricular components for APN education

APRN REGULATORY MODEL

APRN SPECIALTIESFocus of practice beyond role and population focus

linked to health care needsExamples include but are not limited to: Oncology, Older Adults, Orthopedics,

Nephrology, Palliative Care

Lic

en

su

re o

ccu

rs a

t L

evels

of

Ro

le &

Po

pu

lati

on

Fo

ci Family/Individual

Across Lifespan

Adult-

Gerontology*Neonatal Pediatrics

POPULATION FOCI

APRN ROLES

Nurse

Anesthetist

Nurse-

MidwifeClinical Nurse

Specialist

Nurse

Practitioner *

Women’s

Health/Gender

- Related

Psychiatric-

Mental Health**

AACN, 2011

APRN Modelo Regulatorio

APRN EspeciaidadesFoco de la practica más allá del rol y foco poblacional

Vinculado a las necesidades de atencion de salud

Ejemplos: : Oncología, Adulto Mayor, Ortopedia, nefrología, CuidadosPaliativos

Lic

en

su

re o

ccu

rs a

t L

evels

of

Ro

le &

Po

pu

lati

on

Fo

ci Familia/Individuo

Ciclo Vital

Adulto-

Gerontologia*Neonatal Pediatrico

Foco Poblacional

Roles de Enfermeras de práctica Avanzada

Enfermera

Anestesista

Enfermera-

MatronaEnfermera

Especialista

Clínica

Nurse

Practitioner *

Salud de la

Mujer/ Enfoque

Género

Psiquiatría

Salud Mental**

AACN, 2011

Building a Curricula: LACE Model (AACN, 2011)

APRN

Role

Population

foci

Specialty

Regulation

Competencies

3 Ps (Advanced Pathophys,

Pharmacology,

Health Assessment)

NP, CRNA, CNM CNS

Core competencies in

Population context

Professional Organizations

(e.g. oncology, palliative

care, nephrology)

Professional Certification

Graduate Core Master’s or

DNP Essentials

Construyendo un Curriculum: Modelo

LACE (AACN, 2011)

Enfermería de Practica

Avanzada

Rol

Foco población

Especialidad

Regulación

Competencias

3 Ps (patofisiología

Avanzada, Farmacología,

Valoración de la SAlud

NP, CRNA, CNM CNS

Competencias esenciales en

el contexto poblacional

Organizaciones profesinales

(ej. oncología, cuidados

paliativos, nefrología)

Certificación Profesional

Cuerpo de

GraduadosEsenciales para

Magister y DNP

Graduate Programs

Offer additional routes to advancing the expertise of

registered nurses:

• Master’s Degree (MSN) programs offer a number of

tracks designed to prepare Advanced Practice Nurses,

nurse administrators, and nurse educators.

• Doctor of Philosophy (PhD) programs are research-

focused whose graduates typically teach and/or conduct

research

• Doctor of Nursing Practice (DNP) programs focus on

clinical practice or leadership roles

Educational Expansion: Key

Documents- Doctoral Programs

• 2001: Work began on the Doctor of Nursing Practice

• 2006: Practice Doctorate NP Entry Level

Competencies

• 2006: AACN Essentials of Doctoral Education for

Advanced Nursing Practice

• 2010: The Future of Nursing Report (IOM, RWJF)

• 2012: NONPF- Nurse Practitioner Core

Competencies

• 2014: NONPF- Nurse Practitioner Core

Competencies (revised)

National Organization of Nurse

Practitioner Faculties (NONPF)

• Educational/Curricular Resources

• Faculty/student supports

• Practice competencies

• Research

• Networking

• See: http://www.nonpf.org

NONPF History & Competencies

•First competencies introduced in 1990.

•Competencies tied to domains (Brykczynski, K.A, 1989)

•Core competencies revised in 1995, 2002, 2006 for

Master’s level.

•2006 core introduced for doctoral level – tied to

competency areas and not domains.

Source: www.nonpf.org

Population Focused Competencies

Primary Care set completed in 2002:

– Adult

– Family

– Gerontological

– Pediatric

– Women’s Health

Psych Mental Health completed in 2003

Acute Care completed in 2004

Source: www.nonpf.org

Population Focused Competencies

Consensus Model for APRN Regulation (2008) led

to new competencies:

2013

– Family/Across Lifespan,

– Neonatal Pediatric AC, Pediatric AC,

– Psychiatric-Mental Health Across Lifespan, &

– Women’s Health/Gender-Related

2016

-AGNP- PC and AGNP- AC

(Source: www.nonpf.org)

DNP Competencies

2011 core competencies reflects merger of

doctoral and master’s level into 1 set of NP

core competencies.

2012 core competencies updated – current

set of NP core competencies for all NP

graduates.

(Source: www.nonpf.org)

Nine NP Core Competencies

Scientific Foundation

Leadership

Quality

Practice Inquiry

Technology and Information Literacy

Policy

Health Delivery System

Ethics

Independent Practice

(Source: www.nonpf.org)

Selected ReferencesAmerican Association of Colleges of Nursing. (2011). Consensus Model for APRN Regulation:

Licensure, Accreditation, Certification and Education. Washington, DC: AACN. Available at:

http://www.aacn.nche.edu/education-resources/aprn-consensus-process.

American Association of Colleges of Nursing. (2006). Essentials of doctoral education for advanced

nursing practice. Washington, DC: Author. Available at:

http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

American Association of Colleges of Nursing (2011). Essentials of masters education for advanced

practice nursing. Washington, DC: Author. Available at: http://www.aacn.nche.edu/education-

resources/essential-series

INP/APN Network, ICN. (2009).Nurse Practitioner/Advanced Practice Nurse: Definition and

Characteristics. Nursing Matters. Available at:

https://acnp.org.au/sites/default/files/33/definition_of_apnnp.pdf.

National Organization of Nurse Practitioner Faculties. (2016). National Task Force Criteria for Evaluation

of Nurse Practitioner Programs. Available at: www.nonpf.org

U.S. Department of Health and Human Services, Health Resources and Services Administration,

National Center for Health Workforce Analysis. (2014). Highlights from the 2012 National Sample Survey

of Nurse Practitioners. Rockville, Maryland: U.S. Department of Health and Human Services. Available

at:

http://bhpr.hrsa.gov/healthworkforce/supplydemand/nursing/nursepractitionersurvey/npsurveyhighlights.

pdf

U.S. Department of Health and Human Services, Health Resources and Services Administration. (2013).

The U.S. nursing workforce: Trends in supply and education. Available at:

http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/