The Doctor of Nursing The Doctor of Nursing Practice at UAAPractice at UAA

How We Got To Where How We Got To Where We AreWe Are

The Institute Of Medicine Called AttentionThe Institute Of Medicine Called Attentionto Problems Facing Health Careto Problems Facing Health Care

1999—1999—To Err is HumanTo Err is Human, focused on fragmented nature of health , focused on fragmented nature of health carecare

2001—2001—Crossing the Quality ChasmCrossing the Quality Chasm, calls for a restructuring of , calls for a restructuring of healthcarehealthcare

20032003—Health Professions Education: A Bridge to Quality —Health Professions Education: A Bridge to Quality call for call for educators to prepare health care providers for a new type educators to prepare health care providers for a new type of practice as members of interdisciplinary teams that of practice as members of interdisciplinary teams that emphasize evidence-based practice, quality improvement, emphasize evidence-based practice, quality improvement, and informaticsand informatics

National Academy of Sciences 2005 National Academy of Sciences 2005 Report on Nursing ResearchReport on Nursing Research

• The Report Focuses on the need for:– Increasing the Number of Nurse Scientists and – Increasing the Number of Productive Research

Years for Nurses Prepared in PhD Programs

National Academy of Sciences National Academy of Sciences 2005 Report2005 Report

• Calls for a distinction between

“the educational needs and goals of nursing as a practice profession that require practitioners with clinical expertise from Nursing as an academic discipline and science that requires independent researchers and scientists to build the body of knowledge” (p.74)

National Academy of Sciences National Academy of Sciences 2005 Report2005 Report

“The need for doctorally prepared practitioners and clinical faculty would be met if nursing could develop a new nonresearch clinical doctorate, similar to the M.D. and Pharm.D. in medicine and pharmacy, respectively.”

A Paradigm Shift is Underway in A Paradigm Shift is Underway in Graduate Education in NursingGraduate Education in Nursing

• A Number of Factors are Converging to Build Momentum for a Major set of Shifts

• These Include: – Aging of the Population; – Expansion of Knowledge Underlying Practice; – Increased Complexity of Patient Care; – Major Concerns about Quality of Care and Patient Safety; – Shortages of Nursing Personnel Demanding a Higher Level of

Preparation for Leaders Who Can Design and Assess Care and Lead; – Shortages of Prepared Nursing Faculty, Leaders in Practice, and Nurse

Researchers, and – Increasing Educational Expectations for the Preparation of other

Health Professionals

A Paradigm Shift is Underway in A Paradigm Shift is Underway in Graduate Education in NursingGraduate Education in Nursing

• Credits required to complete the MSN are approaching the number of Credits required to complete the MSN are approaching the number of credits most disciplines need for doctoral degreecredits most disciplines need for doctoral degree– many 60+ hrs and 3 yrsmany 60+ hrs and 3 yrs– didactic and clinical increased by 72 and 36 hours respectively for NP programs didactic and clinical increased by 72 and 36 hours respectively for NP programs

between 1995-2000 between 1995-2000 (AACN & NONPF 2002)(AACN & NONPF 2002)

• Graduates and employers identify even more content is needed (Graduates and employers identify even more content is needed (e.g., e.g., information and practice management, health policy, risk management, information and practice management, health policy, risk management, evaluation of evidence, and advanced diagnosis and management, evaluation of evidence, and advanced diagnosis and management, genomicsgenomics) (Bellack, Graber, O’Neil, Musham, & Lancaster, 1999; Lenz, Mundinger, ) (Bellack, Graber, O’Neil, Musham, & Lancaster, 1999; Lenz, Mundinger, Hopkins, CHopkins, Clark, & Lin, 2002).lark, & Lin, 2002).

An Important Driver is the Growing An Important Driver is the Growing Desire Clinically Focused Nurses Have in Desire Clinically Focused Nurses Have in Advanced Study that will Enhance their Advanced Study that will Enhance their

Effectiveness Effectiveness

The Doctor of Nursing PracticeThe Doctor of Nursing Practice

Why? Perceived benefits –

• Development of needed advanced competencies for increasingly complex clinical and leadership roles- global health care, genetics, biomedical advances

• Better match of program requirements and credits/time with credential earned

• Terminal degree and advanced educational credential for those who do not need/want a research-focused degree

• Enhanced knowledge to improve practice

• Enhanced leadership skills to strengthen practice and health care delivery

• Increased number of faculty for clinical instruction

• Improved Patient Care Outcomes!

AACN Position Statement on the Practice AACN Position Statement on the Practice Doctorate in NursingDoctorate in Nursing

• The Doctor of Nursing Practice (DNP) Title

• The practice doctorate is the graduate degree for advanced nursing practice preparation, including but not limited to the four current advanced practice nursing (APN) roles: clinical nurse specialist, nurse anesthetist, nurse midwife, and nurse practitioner.

• A transition period should be planned to provide nurses with master’s degrees, who wish to obtain the practice doctoral degree, an efficient mechanism to earn a practice doctorate.

• Practice-focused doctoral programs will be accredited by a nursing accrediting agency recognized by the U.S. Secretary of Education (i.e., the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission).

• Approved by AACN Membership October 2004

AACN Position Statement on the AACN Position Statement on the Practice Doctorate in NursingPractice Doctorate in Nursing

•In a separate motion, In a separate motion,

the target date for implementation of the the target date for implementation of the recommendations was set at 2015.recommendations was set at 2015.

The level of entry for advanced The level of entry for advanced practice nurses will be the DNP by practice nurses will be the DNP by 2015.2015.

““Nurses prepared at the doctoral level with a Nurses prepared at the doctoral level with a blend of clinical, organizational, economic and blend of clinical, organizational, economic and leadership skills are most likely to be able to leadership skills are most likely to be able to critique nursing and other clinical scientific critique nursing and other clinical scientific findings and design programs of care delivery findings and design programs of care delivery that are locally acceptable, economically that are locally acceptable, economically feasible, and which significantly impact health feasible, and which significantly impact health care outcomes.”care outcomes.”

The Mission Becomes ApparentThe Mission Becomes Apparent

AACN Position Paper on the Practice DoctorateAACN Position Paper on the Practice Doctorate

Where Do We Go From Where Do We Go From Here?Here?

How Important are our NP Programs How Important are our NP Programs at UAA?at UAA?

• The UAA FNP and P/MH NP programs are the only advanced practice nursing programs in the state.

• Both programs have been functioning since 1982.

• Both programs offer distance delivery to students throughout the state.

• Both programs positively impact quality and access to care across the state.– Approximately 500 NPs practice as primary care providers in Alaska.

– 73% of NPs accept Medicare reimbursement.

– 38% of NPs practice in underserved areas of the state.

– 36% of NPs’ practices is comprised of patients under 100% poverty level.

– 24% of FNPs practicing in Alaska are graduates of the UAA program.

– These data translate to over 200,000 primary care visits per year in Alaska provided by UAA FNP alumni.

Does the SON Have the Capacity Does the SON Have the Capacity to Offer the DNP?to Offer the DNP?

• There are currently 14 students in each year of the FNP Program.

• An additional eight students have just been admitted to the P/MHNP Program for the spring semester.

• SON FNP and P/MHNP programs have a strong clinical faculty all of whom participate in a clinical practice.

• SON has contracted with a DNP Expert to assist us with the program and curriculum development.

• A Steering Committee made up of both faculty, UAA administrators, NPs in rural areas, and stakeholders statewide has been active in assisting the progress of the DNP proposal for over one year.

• Three NPs, one holding a DNP and the other two in DNP programs, have already contacted the SON to ask for positions when the DNP opens.

• SON is investigating partnering with other UAA programs for course offerings; Public Health and possibly School of Education for leadership courses.

Is There Interest In Attending the DNP Is There Interest In Attending the DNP at UAA?at UAA?

• Student Demand– Post-Master’s

• 2009 survey results (37% return rate)– 22% (34) expressed interest

– 23% (37) were unsure

– 47.9% (34) of those interested or unsure stated that they would attend the DNP at UAA if it were offered

– Post Baccalaureate• 2007 survey results (22% return rate)

– 50% had bachelor’s degree

– 169 (28%) were interested in the FNP Program

– 88 (15%) were specifically interested in the DNP

How Will the Move to the DNP Affect How Will the Move to the DNP Affect the NP Programs at UAA?the NP Programs at UAA?

• The NP Programs will not continue to be accredited if we do not move into the DNP as the entry level for our NP graduates.

• In order for our advanced practice nursing programs to keep pace with other comparable programs, it is imperative for our programs to ramp up to the DNP level.

• Developing a new curriculum would take some time and could not be accomplished in a short time on this campus.

• We need to be working on development of these changes now in order to keep up with the projected timeline for entry into practice.

 

2002—AACN forms practice doctorate Task Force 2002—AACN forms practice doctorate Task Force 2005—(Spring) 8 programs admitting students, 2005—(Spring) 8 programs admitting students,

60 schools considering programs60 schools considering programs2005—(Summer) 80 schools considering programs2005—(Summer) 80 schools considering programs2005—(Fall) 20 programs “approved” 2005—(Fall) 20 programs “approved”

140 schools considering programs 140 schools considering programs 2006--- 16 programs admitting students2006--- 16 programs admitting students

190 schools considering programs190 schools considering programs2007---- 53 programs admitting students2007---- 53 programs admitting students2008---- 92 programs admitting students2008---- 92 programs admitting students2009 --- 103 programs admitting students2009 --- 103 programs admitting students

93 in development93 in development

Doctoral Education for Nursing PracticeDoctoral Education for Nursing Practice

Doctoral Education for Nursing PracticeDoctoral Education for Nursing Practice

• Between 2007 and 2008 the number of students enrolled in DNP programs went from 1874 to 3415, which is almost a doubling in one year.

• In the same period of time, students graduating from DNP programs went from 122 to 361, which is almost a tripling in one year.

• To date, 62 DNP programs have initiated accreditation through CCNE.

• With this rapid increase in the number of DNP programs functioning in the US, the standard of education for advanced practice nursing is rapidly increasing to this DNP entry level.

It is About the It is About the FUTURE !!!FUTURE !!!

Creating the FutureCreating the Future

We have a responsibility to create the We have a responsibility to create the future for our patients, for our future for our patients, for our

profession, and for the health of the profession, and for the health of the public.public.