The Henderson Repository is a free resource of the HonorSociety of Nursing, Sigma Theta Tau International. It isdedicated to the dissemination of nursing research, research-related, and evidence-based nursing materials. Take credit for allyour work, not just books and journal articles. To learn more,visit www.nursingrepository.org

Item type Presentation

Format Text-based Document

Title The Future of Nursing: The Call for Advanced Degrees

Authors Thomas, Anne; Toms, Robin; Kirkpatrick, Jane M.

Downloaded 5-May-2018 11:29:46

Link to item http://hdl.handle.net/10755/253996

A N N E T H O M A S , P H D , A N P - B C , G N P , F A A N P D E A N , U N I V E R S I T Y O F I N D I A N A P O L I S S C H O O L O F N U R S I N G

J A N E M . K I R K P A T R I C K , P H D , M S N , R N C - O B H E A D , P U R D U E U N I V E R S I T Y S C H O O L O F N U R S I N G – L A F A Y E T T E

R O B I N T O M S , P H D , M N , R N , N E A - B C D I R E C T O R - A T - L A R G E , S I G M A T H E T A T A U I N T E R N A T I O N A L

THE FUTURE OF NURSING: THE CALL FOR ADVANCED

DEGREES

OBJECTIVES

• Identify the need and benefits of

obtaining an advanced degree.

• Identify and discuss the types of

advanced nursing degrees.

THE INTERNATIONAL AGENDA

• Improving Global Health

• Concept of Advance Practice Nursing: Potential for collaboration across the globe

• Importance of work with other disciplines as these roles evolve

THE AGENDA IN THE UNITED STATES

• Health care reform/ IOM Report

• Accountable care organizations

• Medical home model

• Workforce predictions

• Degree Choices

• Masters

• Doctor of Nursing Practice

• PhD

INSTITUTE OF MEDICINE REPORT: FUTURE OF NURSING: LEADING CHANGE,

ADVANCING HEALTH

• Involves legislative actions, interprofessional collaboration, removal of practice barriers

• Patient center, patient-driven HEALTH care system

www.iom.edu/nursing

FUTURE OF NURSING CALLS FOR NURSES TO:

• practice to the full extent of their education

• achieve higher levels of education and training

through an education system that promotes

seamless academic progression

• be full partners, with physicians and other health

care professionals, in redesigning the health care in

the U.S.

• engage in effective workforce planning and policy

making require better data collection and in

improved information infrastructure

TRANSFORMATIVE HEALTHCARE/ EDUCATION MODELS

• Accountable Care Organizations

• Patient-Centered

• Medical Home

• Interprofessional Education Competencies

INTERPROFESSIONAL EDUCATION COLLABORATIVE

• Perform effectively in various team roles to deliver

patient/population-centered care that is safe,

timely, efficient, effective, and equitable.

• Leverage the unique roles and responsibilities of interprofessional partners to appropriately assess and

address the health care needs of patients and

populations served.

• Communicate with patients, families, communities, and other health professionals in support of a team

approach to preventing disease and disability,

maintaining health, and treating disease. http://www.aacn.nche.edu/Education/PDF/IPECReport.pdf

IMPLEMENTING THE RECOMMENDATIONS

• Changes in Medicare, Medicaid for reimbursement

• Reform scope of practice acts

• Prepare the workforce to assume leadership positions at all levels

• Infrastructure to collect nursing workforce data

• Implement nurse residency programs

• BSN 80/20; Doctorates 50/20

• Engage in lifelong learning

NURSING’S RESPONSE

Licensure, Accreditation, Certification &

Education (LACE) Guidelines

APRN consensus model

2015 statement about the DNP

IMPLEMENTATION OF MODEL

• Licensure

• Accreditation

• Credentialing

• Education

THE APRN CONSENSUS MODEL

• Four roles:

• Nurse Practitioner

• Clinical Nurse Specialist

• Nurse Midwife

• Nurse Anesthesia

• Six population foci:

• family/individual across the lifespan

• adult-gerontology

• pediatrics

• neonatal

• women’s health/gender-related

• psych/mental health

APRN CONSENSUS MODEL

• Certification occurs within a role and

population foci

• All APRNs must have three “P’s” within

educational programs

AACN

American Association of Colleges of Nursing is the

national voice for America’s Baccalaureate and higher

degree nursing education programs

•Sets quality standards for nursing education

•Provides resources for member schools

•Influences the nursing profession to improve health

care

•Develops leadership capacity to advance nursing

education, research and practice

AACN’s Selected Recommendations (Paraphrased)

1. DNP prepare graduates for the highest level of nursing practice

beyond the initial preparation

2. DNP should serve as the terminal degree.

3. DNP title should be chosen to represent practice-focused doctoral

programs that prepare graduates for the highest level of nursing

practice

4. All master’s degrees except for CNL will migrate to a DNP curriculum

Advocates: The DNP as an entry requirement for nurse practitioners,

clinical nurse specialists, nurse midwives and nurse anesthetists * Specialized nursing should occur at the doctoral level

The Doctorate of Nursing Practice, DNP, as an entry

requirement for:

• nurse practitioners,

• clinical nurse specialists,

• nurse midwives

• nurse anesthetists

• everyone except CNLs

AACN Advocates the Following:

BSN………………………MSN…………………...DNP

(generalist: CNL) (specialist)

BSN ………………………………………DNP

AACN’s Vision / Position

Moving the current level of preparation necessary

for advanced nursing practice from the master’s

degree to the doctoral level by 2015

Who will this affect?

Advanced nursing practice roles:

•Clinical Nurse Specialist*

•Advanced Nurse Practitioner*

•Nurse Midwife*

•Nurse Anesthetists*

•Public Health

•Nurse Executives / Leaders

•Nurse Informaticists

•Health Policy Analysts

•Nurse Educators*

Goal 2015

Some Challenges:

• Not enough DNP programs yet rapidly

increasing

• Insufficient faculty

• State regulations

• Regulatory requirements

• Need for APRN’s

• Challenges at some educational institutions

C. Fay Raines, PhD, RN

President AACN 3/21/10

http://www.aacn.nche.edu/dnp/pd

f/DNPForum3-10.pdf

Organizational Responses

American Association of Nurse Anesthetists

•Mandate that all CRNA programs transition to the practice

doctorate, DNP, by 2022.

•All new CRNA grads must hold a practice doctorate by 2025

to be eligible for certification.

The Nurse Practitioner Coalition Statement

•7 NP organizations (AANP, ACNP, AFPNP, NCGNP, NONPF,

NPWH, NPNP): “the DNP degree more accurately reflects

current clinical competencies and includes preparation for the changing healthcare system.”

C. Fay Raines, PhD, RN

President AACN 3/21/10

http://www.aacn.nche.edu/dnp/pd

f/DNPForum3-10.pdf

Organizational Responses

National Organization of Nurse Practitioner Faculties

Endorsed the DNP and developed competencies for NP

practice at the doctoral level.

National Association of Clinical Nurse Specialists

Neutral position on the DNP; has developed DNP level

competencies for CNS graduates.

American College of Nurse Midwives

Recognizes the DNP as an option for some midwifery

programs.

American Organization of Nurse Executives (AONE)

• AONE supports the work of AACN that aligns with the AONE

Guiding Principles of Future Care Delivery

• AONE acknowledges the work of AACN ...and the intent of

higher level preparation of nurses working in advanced practice

roles

• AONE looks forward to working with stakeholders (AONE, April 2007)

Council on Graduate Education for Administration in Nursing*

(CGEAN)

CGEAN Mission: To further the development and improvement

of graduate education in nursing administration

* The voice for education in nursing administration

Organizational Responses

American Nurses Association (ANA)

ANA Board of Directors approved a recommendation

to support both practice and research focused doctoral preparation for

nurses as a terminal degree. (2009)

Organizational Responses

The Essentials of Master’s Education in Nursing

There are ten Essentials which :

•Delineate the knowledge and skills that all nurses

prepared in master’s nursing programs acquire

•Guide the preparation of graduates for all health care

settings

•Prepare leaders at the microsystem level (i.e. managers)

“Master’s level preparation is broader than the practice

specialization achieved at the Doctor of Nursing Practice Level”

(p.1)

MASTERS OPTIONS

• Clinical Nurse Leader

• Nursing Administration

• Nursing Education

• Community Health

• APRN Roles

KEY DESCRIPTORS FOR THE CNL AND CNS

CNL

• Microsystem

• Generalist

• Communication,

collaboration at the

unit level

• Cohort of patients

• Responsible to unit

manager usually

CNS

• Macrosystem

• Specialist

• Communication within & across the organization, systems

• Population of patients at the system (even if unit based)

• Responsible to Director level position or CNO

KEY ACTIVITIES OF THE CNL

• Resource for other caregivers on the unit

• Provides a comprehensive health assessment of

patient and family/caregiver at initial contact

• Responsible for ongoing assessment and careplan

modification

• Patient/family caregiver education

CNL EDUCATION

• Master’s degree

• Curriculum prepares CNL in core competencies

that span 3 primary role functions

• nursing leadership

• clinical outcomes management

• care environment management

• Immersion experience (clinical practicum)

• Formal collaboration between academia and service

• Projects = real time problems within organization

KEY ACTIVITIES FOR THE CNS

• Serve as a mentor for nurses (even CNLs)

• Educational programs for the macrosystem

• Generate and evaluate evidence for practice

• Implementation of guidelines, standards

• Appraise research studies

• Conduct research

• Leadership for multidisciplinary groups across the system

• Innovation

CNS EDUCATION

• Master’s or doctoral degree

• 7 competencies • Direct care/clinical expert

• Consultation

• Collaboration

• Coaching/teaching/mentoring

• Moral agency/advocacy

• Research/evidence based practice

• Systems leadership

• 3 spheres of influence (patient, nursing, system)

RELATIONSHIP OF DNP AND PHD

• In order to truly advance the profession, we need

both DNPs and PhDs

• Complimentary roles

• Practice informs research just as research informs

practice

Practice

Research Practice

Research

The preferred environment is to have DNP and PhD

prepared nurses working together to:

1. Identify clinical problems (DNP & PhD)

2. Generate solutions through research (PhD)

3. Translate research into clinical practice (DNP)

What’s the Difference Between DNP & PhD?

Bridging the gap between evidence and implementation

Essentials of Doctoral Education for Advanced Nursing Practice

(AACN)

Direct care provided by APRN

• CRNA

• CNM

• NP

• CNS

Indirect care provided by:

• Nurse execs

• Policy makers

• Nurse informaticians

DNP

• Practice Expertise

• Addition of Policy expertise

• Finance and Economic

• Evidence-based Practice

• Implementation/Evaluation skills

Tracks

• Post BSN

• Post MSN

BENEFITS OF DNP

• Empowers APRN’s with the tools to make

change in healthcare systems

• Is the “terminal” degree for clinical practice

• Advanced credentials for those who do not

want a research-focused degree

• Addresses our historical challenge of

credential to credit hour ratio

• Parity with other professionals

PHD

• Research Expertise

• Roles:

• Education

• Faculty

• Service positions

• Research Directors

• NIH, NINR, AHRQ roles

PLANNING YOUR CAREER PATH

Options for Advanced Education

• Career goals

• Practice?

• Education?

• Both?

PLANNING YOUR CAREER PATH

What questions should you ask?

• What is your goal?

• What type of program matches my

goal?

KEEPING INFORMED

Choose wisely

Multiple entry/exit points

CHOOSING THE PROGRAM THAT’S RIGHT FOR YOU

Program Delivery options

• All online,

• Hybrid model

• All onsite

Questions to ask

• Practice supervision

• Accreditation of the Program

• Outcomes of previous graduates

CURRICULUM GUIDED BY ACCREDITATION BODIES AND CERTIFICATION BODIES

• LACE, CCNE, NLNAC

• Core

• Implementation crafted by each school

• Practice hours – vary on the degree specialization

• Master APRN minimums set by certification requirements

• DNP total of 1000 hours (includes master’s hours if post-masters)

FUNDING YOUR EDUCATION

• Grants

• Faculty Loan program

• Traineeships

• State initiatives

• Link with professional organizations for

funding sources

• Grad offices at the schools

TIME FRAMES

• Dependent on entry point

• Full-time vs. Part time

NURSES: KEY TO IMPROVING HEALTH

REFERENCES / RESOURCES

Ahmed, S., Andrist, L., Davis, L. & Fuller, V. (Eds.) (2013). DNP Education, Practice, and Policy: Redesigning

Advanced Practice Roles for the 21st century (2nd ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

American Association of Colleges of Nursing. A Working Statement Comparing the CNL and CNS Roles:

Similarities, Differences, and Complementarities; February, 2004.

http://www.aacn.nche.edu/CNL/pdf/CNSComparisonTable.pdf

American Association of Colleges of Nursing. Position statement on the practice doctorate

in nursing. October 2004. Retrieved from http://www.aacn.nche.edu/dnp/dnppositionstatement.htm

August 16, 2010.

American Organization of Nurse Executives (2007) Consideration of the doctorate of nursing practice.

Retrieved from http://www.aone.org/aone/docs/position statement 060607.doc August 16, 2010.

American Organization of Nurse Executives. AONE position statement: Doctorate of nursing practice:

April, 11, 2007. Retrieved from http://www.hospitalconnect.com/hospitalconnect_app/search/

August 16, 2010.

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

nursing practice. Washington, DC. American Association of Colleges of Nursing.

REFERENCES / RESOURCES

American Association of College of Nursing. About AACN. Retrieved from http://www.aacn.nche.edu/contactus/about.htm August 20, 2010.

American Association of Colleges of Nursing. March 21, 2011: The essentials of master’s education in nursing. Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf September 3, 2012.

CGEAN: About CGEAN. Retrieved from http://cgean.org/about-cgean.php. August 16, 2010.

Chism, L.A. (2010). The doctor of nursing practice: A guidebook for role development and

professional issues. Sudbury, MA: Jones and Bartlett.

Foster, J., Clark, A., Heye, M., Wilkinson, S., Villagomez, N., Rosenow, D. (2011). Differentiating the Clinical Nurse Specialist and Clinical Nurse Leader. Nursing Management 42(1), 51-54.

American Association of Colleges of Nursing: About AACN. AACN briefing (2010).

3-7-05.doc. Retrieved from http://depts.washington.edu/ccph/pdf.../

Institute of Medicine (2003). Health professions education: A bridge to quality. Washington, DC, National Academies Press.

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.:

Interprofessional Education Collaborative. Retrieved from http://www.aacn.nche.edu/education-resources/ipecreport.pdf September 3, 2012

Q U E S T I O N S ?

It is journey … not a destination