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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
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?
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
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
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