Editorial MAY 2005, VOL 81, NO 5

E D I T O R I A L

Possible new career options

he nursing profession contin- ues to coduse itself and the rest of the world with who we are and what we do. Just T when we get used to the

career options and titles available-and you must admit there are a lot of them-along come two more that presently are being discussed: clinical nurse leader (CNL) and doctor of nurs- ing practice (DNP). The CNL is a new title and role. The DNP is not really a new role, but it has a new focus. These career options are being investigated and promoted by the academic com- munity with buy-in from practicing institutions.

BACKGROUND Last summer, I attended an invita-

tional meeting in Washington, DC, sponsored by the American Association of Colleges of Nursing (AACN). The purpose of the conference was to hear a presentation and obtain buy-in for part- nership pilot programs for the CNL. In addition, some mformation was shared on career progression from CNL to DNP. Representatives from 75 academic institutions attended along with repre- sentatives from their partner health care institutions.

ment of these new roles are similar to those identified by the recent AORN and National League for Nursing think tank.’ New types of nurses are needed in today’s world. The nursing profes- sion agrees that changing patient popu- lations and treatment methodologies require new ways of practicing nursing and, therefore, new ways of educating nurses. The AACN recognizes that there is national concern about a decline in the quality of health care. Many of us can confirm these concerns with exam- ples from our own experiences and

The concerns that prompted develop-

those of our family members and friends. In addition to concerns about the quality of care, nursing has never come together to define the differences in practice between individuals with different educational preparation or agreed on one educational entry level for practice. To answer these concerns, an AACN task force proposed the new CNL master’s level degree. This new practitioner will not be an advanced practitioner, and a new license and legal scope of practice wlll have to be defined for this role? More information about the CNL role can be found on AACNs web site at http://www..aacn/nche.edu.

CLINICAL NURSE LEADER The AACN defines a

CNL as a master’s pre- pared nurse who

leads evidenced-based care for patients and families, creates an envi- ronment of clinical excel- lence, has clinical responsibility and au- thority for decision- making regarding patient care, and engages in peer practice with other health profe~sionals.~

This may be an entry- level position, and the CNL will be a unit-based generalist. The CNL role

Nancy J. Gilard, RN

Nursing has never defined differences in

practice among the dinerent educational preparation

levels. I

kill not include administrative or man- agement duties. It will necessitate new definitions of practice and new legal requirements, such as licensure.

where academic institutions already have implemented educational pro- grams for CNLs. These include the University of Virginia, Charlottesville,

There are many areas of the country

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MAY 2005, VOL 81, NO 5 Editorial

Va; College of New Jersey, Ewing, NJ; Cleveland State University, Cleveland; University of Florida, Gaines- ville, Fla; University of San Francisco, San Francisco; and University of Iowa, Iowa City. Information about these and other programs can be found on the web sites of these organizations.

Debate is growing about the CNL role.‘ Some organi- zations support the concept and others adamantly oppose it. One organization that sup- ports the CNL role is the American Organization of Nurse Executives (AONE). The organization published guidelines with principles for patient care in spring 2004 that are similar to those defining the role of the CNL.’

The National Association of Clinical Nurse Specialists (NACNS) has published a strong position statement against the CNL role. They state in part that ”the pro- posed competencies of the new nurse duplicate the com- petencies of the CNS.”h

DOCTOR OF NURSING PRACTICE The DNP is a practice doc-

torate rather than a research doctorate.’ The research PhD is considered the ”gold stan- dard” of doctoral education. Most national and interna- tional organizations recognize this degree and accept it. Other less recogruzable doc- toral degrees are EdD (ie, doc- torate in education), DNS (ie, doctorate in nursing science), and ND (ie, nursing doctor- ate). The DNP would replace

the ND as a practice doctor- ate. The National Organiza- tion of Nurse Practitioner Faculties (NONPF) provides information on the practice doctorate resource center web site at http://w~o7u.nonpf.com lcdliome. htm .6

Will other health cure

professionals and admin is tra tors recognize and

support these new

Case Western Reserve University, Cleveland, is one university that offers the DNP. A position statement from AACN says that the DNP should be the graduate degree for advanced practice nursing preparation

including but not Iirnifed to thefour czirrent [ad- vanced practice nurse] roles: clinical nzirse special- ist, ntirse anesthetist, nurse midzuqe, nnd ntirse practitioner by 2015.9

CONTINUING DEBATE There will be much discus-

sion and debate in the future about these two new roles, and many questions will need to be answered. The major

issues to be determined are whether other health care pro- fessionals and administrators will recognize and support these new roles, and whether patients and their family members will understand who these nurses are and what their role is. The follow- ing questions also will need to be answered.

Will all staff nurses in the future be required to have a CNL? Will all advance practition- ers be required to have a DNP in the future? Will the new roles improve the quality of nursing care? What type of certification and licensure will be required? How will these roles affect third-party reimbursement for advanced and expand- ed practitioners? How will perioperative nursing be affected by these new roles? Will these new roles really be the answer to our prob- lems today? Nurses should be prepared

to discuss these new ;ol& and be knowledgeable about what could happen with their careers and professional ad- vancement. At the present time, I would advise you all to stay tuned, stay informed, and stay involved. *:*

NANCY J. GIRARD RN, PHD, FAAN

EDITOR

NOTES 1. N Girard, “Perioperative edu- cation-Perspective from the think tank,” AORN Journal 80

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(November 2004) 827. 2. "Clinical nurse leader," American Association of Colleges of Nursin .aacn.nche.edu/CNL klhttp://www isfouy.htm (accessed 23 March 2005). 3. AACN Guiding Principlesfor the Partnership Model (Washing- ton, DC: American Association of Colleges of Nursing, June 2004). 4. J Erickson, "The clinical nurse leader: New in name only," (Guest Editorial) Nursing Education 44 no 3 (2005) 99-100.

5. "Clinical nurse leader update," American Association of Colleges of Nursing, http://www.aacn.nche .edu/CNL/Updates.htm#JanOS (accessed 23 March 2005). 6. "Working paper on the role of the clinical nurse leader," American Association of Col- leges of Nursing, http://www.aacn . nche.edu/Publications/WhifePapers/ ClinicalNurseLeader.htm (accessed 23 March 2005). 7. A Whall, "Lest we forget: An issue concerning the doctorate

in nursing practice (DNP)," Nursing Outlook 53 no 1 (2005) 1. 8. "Practice doctorate resource center," National Organization of Nurse Practitioner Faculties, h f fp://www. nonpf. org/cdhorne. h t nz (accessed 23 March 2005). 9. "AACN position statement on the practice doctorate in nurs- ing," American Association of Colleges of Nursing, http://www .aacn.nche.edu/DNP~NPPosition Sfatement.htm (accessed 23 March 2005).

Rubella Virus No Longer Endemic in the United States he rubella virus. a major cause of serious birth T defects such as deafness and blindness, is no

longer considered to be a major public health threat in the United States, according to a March 21, 2005, news release from the Centers for Disease Control and Prevention. Currently, about 93% of US children are vaccinated against rubella by age two, and more than 95% are vaccinated by the time they enter school.

cases of rubella and 20,000 cases of congenital rubella syndrome resulted i n 11,250 fetal deaths and 2,100 neonatal deaths. In addition,

11,600 babies were born deaf; 3,580 babies were born blind; and

In 1964 and 1965, an estimated 12.5 million

1,800 babies were born with mental retardation. After vaccine licensure in 1969 and the develop- ment of a vaccination program to prevent rubella infection during pregnancy, incidence of the dis- ease declined rapidly. In 2004, only nine rubella cases were reported in the United States. The elimi- nation of rubella is a public health milestone and a major step in protecting the health of pregnant women and infants.

Rubella No Longer a Major Public Health Threat in the United States (news release, Atlanta: Centers for Disease Control and Prevention, March 21, 2005) http://www.cdc .gov/od/oc/media/pressrel/rO50321. h t m (accessed 23 March 2005).

national, independent survey found that 64% of A smokers are not concerned about developing chronic obstructive pulmonary disease (COPD), even though 55% of them experience at least one symp- tom of COPD one or more times per week, according to a Nov 17, 2004, news release from the American Lung Association. Ranked as the fourth leading cause of death in the United States, COPD kills more than 120,000 Americans annually, and 80% to 90% of all COPD deaths are related to smoking. The sur- vey results indicate t h a t many smokers who may have COPD are ignoring the signs.

a large group of lung diseases, including emphyse- ma and chronic bronchitis, that are characterized by airflow obstruction that interferes with normal

Chronic obstructive pulmonary disease refers to

Smokers Unconcerned About Disease Symptoms breathing. Symptoms of COPD include chronic cough, shortness of breath, a greater effort to breathe, increased mucus production, and frequent throat clearing.

The American Lung Association has materials available to educate smokers and their friends and family members about COPD and encourage smokers who may have COPD to seek diagnosis and treatment options. For more information, call (877) COPD-INFO.

Smokers Not Concerned About Developing 4th Leading Cause of Death, Yet More than Half Experience Symptoms Once a Week (news reiease, New York: American lung Association, Nov 2 7, 2004) http://www.lungusa.org/site /apps/nl/content2.asp?c=dvLUK900E&b=34893&ct=2949 05&notoc=l (accessed 8 Dec 2004).

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