the state of the dnp: analysis of four years of data 6 th national dnp conference september 25-27,...

The State of the DNP: Analysis of Four

Years of Data

6th National DNP ConferenceSeptember 25-27, 2013

David G. O’Dell, DNPKaren Crowley, DNP

6th National DNP Conference 2013 2

DNP Outcomes Survey2010 Team

Development Team: Stephanie Ahmed, DNP, FNP-BC Catherine S. Bishop, DNP, NP, AOCNP Karen Crowley, DNP, APRN-BC, WHNP, ANP Donald Grimes, DNP, RN Star Evangelista Hoffman, DNP, Med, CNL David G. O’Dell, DNP, FNP-BC Marie G. Young, DNP, MPH, FNP, PMHNP


Objectives (2010-2013)

• Compare DNP program curriculum as they relate to the AACN essentials

• Evaluate current practice trends of DNP graduates

• Identify future challenges and opportunities for DNP programs and DNP graduates

Annual DNP Outcomes Survey: Background

Planned and developed by DNP, Inc. Goal is to determine the “state of the practice” of

DNP graduates Disseminate at annual DNP conferences Two “arms” of this survey:

1. Graduates in practice2. Current DNP programs

6th National DNP Conference 2013

IRB approval through Regis College


Purpose of the DNPAward a degree that reflects the expert clinical competencies required by healthcare providers to meet the challenging healthcare needs of individuals and changing healthcare systems (AACN, 2008).


Accrediting Organizations* Commission on Collegiate Nursing Education (CCNE)

Accredited 132 DNP programs (AACN, 2013)

* Accreditation Commission for Education in Nursing (ACEN) (formerly National

League for Nursing Accreditation NLNAC)• Seven known DNP programs accredited


AACN Essentials Foundational component: AACN Essentials 1-8

1. Scientific underpinning of practice2. Organizational and system leadership for quality improvement and

systems thinking3. Clinical scholarship and analytical methods for EBP4. Information systems/technology and patient care technology for the

improvement and transformation of health care5. Health care policy for advocacy in health care6. Inter-professional collaboration for improving patient and population

health outcomes7. Clinical prevention and population health for improving the nation’s

health8. Advanced nursing practice

Specialty component: required by national certification or specialty organizations


Overarching Questions

1) Are DNP programs offering the core curricular required to meet the degree competencies?

2) Are graduates of DNP programs utilizing these core competencies in practice?


DNP Program Data

Methodology• Program Evaluation– Comparison of DNP programs• Collected from Web-sites• Confirmed with Institutions• Multiple messages (individual email, email blasts, snail-

mail, and fax communications)• Data collected from template forms• Data reviewed for accuracy (example: Credit Hours vs.

Clinical Hours; Semester vs. Quarter hours)


Overall Doctorate Degree in Nursing Picture (per AACN)

Number of active programs in the U.S.DNP PhD2006: 20 2006: 1032007: 53 2007: 1112008: 92 2008: 1162009: 120 2009: 1202010: 131 2010: 1242011: 154 2011: 1262012: 184 2012: ?2013: 233 (data on 200) 2013: ?

10

DNP 6th National Conference 2013 11

Growth of Doctoral Nursing Programs: 2006-2012

AACN 2012, Updated April 2, 2013


DNP Program Entry Point(%)

2010 (n=131) 2011 (n=153) 2012 (n=184) 2013 (n=200)0

10

20

30

40

50

60

70

80

90

100

BSN to DNPMSN to DNP


Curriculum Delivery Models (%)

Unknown

Onground

Online

Hybrid

5 15 25 35 45 55 65Unknown Onground Online Hybrid

2013 (n=200) 21 6 21 52

2012 (n=184) 10 4 24 62

2011 (n=153) 3 22 16 59

2011 (n=153)2012 (n=184)2013 (n=200)

16

DNP Program Rigor: CREDIT hoursRange / Variability (BSN to DNP only)


Low High Average Variability

2010 34 100 67 66

2011 50 120 85 70

2012 50 125 87.5 75

2013 40 125 82.5 85

10

30

50

70

90

110

130

Axis Title


DNP Program Rigor: CREDIT hoursRange / Variability (MSN to DNP only)


2010 24 86 55 62

2011 24 90 57 66

2012 22 90 56 75

2013 22 90 56 68

5

15

25

35

45

55

65

75

85

Axis Title


DNP Program Rigor: CLINICAL hoursRange / Variability (BSN to DNP only)


2010 380 1260 820 880

2011 1000 1860 1430 860

2012 475 1860 1167.5 1385

2013 475 1860 1167.5 1385

100

300

500

700

900

1100

1300

1500

1700

1900

Axis Title


DNP Program Rigor: CLINICAL hoursRange / Variability (MSN to DNP only)


2010 300 1125 712.5 825

2011 40 1220 630 1180

2012 40 1220 630 1180

2013 120 1220 670 1100

100

300

500

700

900

1100

1300

Axis Title


DNP Program Rigor: Comments

* The variation in hours for BSN to DNP and MSN to DNP in both clinical and credit hours continues to show increased diversity in the intensity and rigor of DNP programs around the country. * The inconsistency in educational rigor, as reflected in hours, intimates that the DNP is not yet a degree with a uniform understanding of intent, capabilities and possible outcomes.


Advanced Practice Clinical Role: DNP Program Entry (%)

NP (n=189) CNS (n=119) CNM (n=92) CRNA (n=86)

2010 (n=131) 73 51 41 37

2011 (n=153) 91 61 45 40

2012 (n=184) 98 61 46 43

2013 (n=200) 95 60 46 43

5

15

25

35

45

55

65

75

85

95

2010 (n=131)2011 (n=153)2012 (n=184)2013 (n=200)


Advanced Practice Non-Clinical Role: DNP Program Entry (%)

Exec (n=85) Educ (n=36) Policy (n=23) Inform (n=25) Other (n=41)

2010 (n=131) 30 15 7 8 29

2011 (n=153) 45 23 12 11 12

2012 (n=184) 43 20 11 12 19

2013 (n=200) 43 18 12 13 21

2.5

7.5

12.5

17.5

22.5

27.5

32.5

37.5

42.5

2010 (n=131)2011 (n=153)2012 (n=184)2013 (n=200)


DNP Program Entry: Comments • The majority of those entering DNP programs

continue to come from clinical tracks, with the NP with larger numbers over the CNS, CNM, and CRNA. All clinical tracks are showing an increasing trend except for the NP.

• Of non-clinical tracks, the largest group is the Executive with increasing trends.

• Those that identify a nursing education track availability are decreasing

• Informatics as a designated area of practice continues a slow upward trajectory


DNP Program Core Courses (%)

Policy Info Epi Stats Pop HPDP Elective

2010 (n=131) 54 59 57 36 25 6 24

2011 (n=153) 79 68 64 51 43 28 39

2012 (n=184) 85 71 69 87 49 33 42

2013 (n=200) 83 71 67 57 50 32 39

5

15

25

35

45

55

65

75

85

2010 (n=131)2011 (n=153)2012 (n=184)2013 (n=200)


DNP Program Research Courses and Publication Expectations (%)

EBP/Transl Qual Quant Thesis Publication

2010 (n=131) 63 3 12 3 8

2011 (n=153) 68 15 31 3 18

2012 (n=184) 83 36 39 5 27

2013 (n=200) 81 22 35 6 21

5

15

25

35

45

55

65

75

85

2010 (n=131)2011 (n=153)2012 (n=184)2013 (n=200)


DNP Program Leadership Courses (%)

Pract Mgt Org Mgt N Leadership

2010 (n=131) 30 33 37

2011 (n=153) 38 46 66

2012 (n=184) 37 49 73

2013 (n=200) 38 49 73

5

15

25

35

45

55

65

75

2010 (n=131)2011 (n=153)2012 (n=184)2013 (n=200)


DNP Program End Product (%)

Capstone Seminar Pract/Residency

2010 (n=131) 62 17 36

2011 (n=153) 78 58 46

2012 (n=184) 80 45 39

2013 (n=200) 80 44 47

5

15

25

35

45

55

65

75

2010 (n=131)2011 (n=153)2012 (n=184)2013 (n=200)


Core Courses, Outcomes, and Leadership Course Tends: Comments

• More programs are identifying specific courses, or combinations of courses to include elements specific to the Eight Essentials.

• There is an upward trend in the identification of EBP or Translational courses in DNP programs

• A small number of DNP programs report a thesis or publication requirements as an expectation of graduation, but those characteristics are showing an upward trend.


Core Courses, Outcomes, and Leadership Course Tends: Comments (continued)

• There is an across-the-board upward trend in Practice Management, Organizational Management, and Leadership courses offered.

• A capstone project is still the number one identified outcome expectation of all DNP programs, yet Seminars and Residencies are flat or showing a slight decline.


DNP Program Summary

• Collectively, DNP programs are showing trends of development and evolution

• More programs are being accredited resulting in trends of course expectations

• Program development shifting to the BSN-DNP entry point

• Re-structuring of current programs – Still wide variation on credit and clinical hours for each entry

point– Percentage of programs that do not identify the core

competencies in curriculum is decreasing slightly


DNP Graduate Outcomes Survey

• Question #2 of the annual survey:– Are graduates of DNP programs utilizing these

core competencies (i.e. core courses reflecting the essentials) in practice?


Methodology• DNP outcomes– Quantitative design eliciting perceptions and

demographics– Voluntary Electronic National Survey– Data Collected: 3/8/13-8/22/13– 619 respondents this year, yet 370 valid – 249 initial respondents were not DNP graduates – Implied consent


Respondents’ Demographics• Age Distribution• Gender• National Region• Years of Practice Before and After degree• Reason for pursuing the degree• Income / Salary before and after the degree


Age and Years in Practice

• Age DNP earned – Mean: 47.9– SD: 10.1– Range: 23-70 years

• Years in practice prior to DNP:– Mean: 23 years– SD 10.1– Range: 1-42 years

• Years in practice after DNP– Mean: 6.85 years– SD 10.4


Respondents’ Gender

2010 (n=294) 2011 (n =359) 2012 (n=248) 2013 (n=310)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

11.9 11.1 10.9 14.8

88.1 88.6 88.3 84.9

Male Female


Respondents’ Geographical Region of DNP Program Attended

Northeast South Midwest West

0

5

10

15

20

25

30

35

2011 (360)2012 (246)2013 (315)

Region 2011 (360) 2012 (246) 2013 (315)Northeast 33.1 28 20South 28.3 33.7 30.5Midwest 22.5 21.1 21.1West 16.1 17.1 13.5


Respondents’ Geographical Region of Practice

Northeast South Midwest West0

5

10

15

20

25

30

35

40

2010 (292)2011 (360)2013 (311)

Region 2010 (292) 2011 (360) 2013 (311)Northeast 22 30.6 18.1South 40 31.1 31.9Midwest 21 21.1 19.5West 17 17.2 14.6


Respondents’ Reasons for Pursuing a DNP degree

5.9

77

38.4

13.2

35.9

7.3

4.3

2013

Job RequirementPersonal GoalClinical AdvancementAdministrative ad-vancementAcademic advancementPractice FociTenure


Respondents’ Report of Program Outcomes

• Prepared to meet AACN Essentials– 95.5 % reported program prepared them to meet

the AACN essentials– 4.5 % had a negative response

• Prepared for Doctoral Practice– 95.2% reported program prepared them for

doctoral practice– 4.8 % had a negative response


Respondents’ Salary Change Report

Up: Same UP: Dif Same:Same Same: Dif Dec: Same Dec: Dif0

5

10

15

20

25

30

35

40

45

50

201120122013

Change 2011 2012 2013Up: Same 23.7 20.1 27.2UP: Dif 3.1 16.8 11.4Same:Same 46.9 47.4 44.2Same: Dif 7.8 8.2 5.4Dec: Same 0.6 0.8 1.6Dec: Dif 6.4 4.5 7.4


Respondents’ Salary Change Report: Comment

• Seventy three percent of DNP’s remain in the same position after earning their degree, but report having the same salary as before earning degree.

• Take home? If a salary increase is desired, it will need to be negotiated.


Respondents’ Program Experience and Practice Habits

• Program Concentration• Practice Initiatives• Area of Practice• Practice Environment / Point of Care Delivery• Professional Affiliations• DNP Faculty and DNP Faculty Tenure?• Perceived value of the DNP degree


Respondents’ Program Concentration

Clinical Leadership Policy Education Public Health0

10

20

30

40

50

60

70

80

2010201120122013


Respondents’ Program Concentration:End Product

Capsto

ne

Thesis/D

isserta

tion

Residency

/clinica

l

Article

for P

ublicati

on0

102030405060708090

2010201120122013


Respondents’ Program Concentration:End Product

• DNP Graduate responses do correlate with the types of programs offered in the survey of colleges and universities.

• Clinical tracks and leadership / executive are the top two practice emphasis as reported by graduates.

• Capstone, thesis, residencies reports correlate with offerings of colleges and universities


Practice InitiativesExpected Level of Achievement = 2.5

Initiative Mean (SD)

Utilize EBP skills 2.97 (.99)

Translate and disseminate relevant research into practice 2.91 (1.04)

Implement EBP practice changes that affect patients 2.84 (1.06)

Translate research to identify gaps in practice 2.81 (1.01)

Utilize EBP to develop practice guidelines 2.77 (1.10)

Participate in inter-professional activities to promote change

2.76 (1.03)

Translate EBP outside my practice setting 2.61 (1.11)

Utilize available technology to promote a change in practice

2.56 (1.11)

4 point Likert scale, with a low of 1 and a high of 4


Practice Initiatives Expected Level of Achievement = 2.5

Initiative Mean (SD)

Function as administrator/ leader within my practice 1.93 (1.15)

Develop, implement or evaluate information systems 2.03 (.99)

Initiated a program that addresses disparities within practice

2.05 (1.14)

Evaluate and implement business plans 2.04 (1.05)

Involved in health policy issues related to my practice 2.29 (1.03)

Incorporate Health promotion and disease prevention 2.32 (1.07)

Utilize understanding of cultural difference in guiding interventions

2.35 ( 1.10)



Scholarly Work After DNP: Presentations and Contributions

Poster Podium Professional Journal Book (author or editor)

2010 (n=235) 62 59 23 25

2011 (n=347) 77 77 70 43

2012 (n=240) 75 73 70 43

2013 (n=311) 49.5176848874598 49.8392282958199 28.9389067524116 7.71704180064309

5

15

25

35

45

55

65

75


Work Environment / Point of DNP Services

Primary Care Acute Care Long Term Care Rehabilitation Community Public Health Academia Other

2010 (n=235) 35 29 3 2 10 5 37 17

2011 (n=347) 45 34 4 1 13 5 46 16

2012 (n=240) 35 30 7 4 18 7 47 16

2013 (n=311) 30 14 6 2 4 4 44 52

5

15

25

35

45

55


Professional Affiliations: Policy Initiatives

2010 (n=235) 2011 (n=347) 2012 (n=240) 2013 (n=311)

State 27 24 30 30

National 8 13 30 18

International 1 3 4 7

2.5

7.5

12.5

17.5

22.5

27.5


Role & ScopeExpected Level of Achievement = 2.5

Role and Scope Mean (SD)

It is important for DNP’s to seek leadership roles in national/state/specialty organizations

3.61 (.57)

Participates in professional organization 2.87 (.87)

Increased scope of practice since earning DNP 2.84 (.96)

Have transitioned into a specialized focus of care 2.81 (.86)

Functioning in fullest capacity 2.79 (.95)



Respondents’ Report: DNP Faculty?

*0-1 *2-3 *4-5 *6-7 *8-9 *>10

2010 (n=235) 52.1 28.6 9.3 4.5 2.1 3.4

2011 (n=347) 54.1 21.2 12.7 5 1 5

2012 (n=240) 49.8 23.3 2.7 5.3 2.9 6.1

2013 (n=311) 46.6 23.5 11.1 6.8 2.9 9.1

5

15

25

35

45

55


Respondents’ Report: DNP Tenure?

Yes No N/A

2011 (n=206) 34.5 41.7 23.8

2012 (n=151) 39.7 33.8 26.5

2013 (n=165) 40.1 38.5 21.4

2.5

7.5

12.5

17.5

22.5

27.5

32.5

37.5

42.5


Value of the DNPExpected Level of Achievement = 2.5

Respondents perception Mean (SD)

Self 3.51 (.74)*

Academic Colleagues 2.23 (.93)

Nurse Colleagues 2.17 (.88)

Administrative Colleague 1.90 (.99)

Physician Colleagues 1.58 (1.03)



DNP Outcomes Summary

• Education– More DNP graduates moving to academic practice– Scope of practice maximized, confidence in essential

competencies– Tenure increasing (slightly) as an option for DNP’s – Utilizing EBP to change entrepreneurial practice

• Research– Bridge the gap of research discovery and application

and integration of scholarship– Continued increase in publications


DNP Outcomes Summary

• Policy– Initiatives reflect local / regional issues, yet

capable of national and international scope• Practice• Education– Can practice expertise be maintained in

academia?


Purpose of the DNP

Award a degree that reflects the expert clinical competencies required by healthcare providers to meet the challenging healthcare needs of individuals and changing healthcare systems (AACN, 2008).


Questions for DNPs to ask: (but can this be quantified?)

• How are DNPs demonstrating improved outcomes?

• How are DNPs demonstrating success?• What stakeholders are involved that can

promote or hinder the growth of the discipline and DNP outcomes?

• Are DNPs guiding their own destiny?


Questions for DNPs to ask: (but can this be quantified?) (continued)

• How do achieved competencies translate to improved patient outcomes?

• How are DNPs manifesting change in their respective practices?

• Do DNP program outcomes correlate with improved patient outcomes?


THANK YOU

Complete presentation available on the DNP web site at

www.DoctorsofNursingPractice.org

the state of the dnp: analysis of four years of data 6 th national dnp conference september 25-27,...

Documents

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graduates of dnp programs

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practice of dnp graduates

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compare dnp program

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