NURS 7000 DNP proseminar AACN Task Force Article and DNP History – Flashcards

In two years, formal discussions about a practice doctorate in nursing (2002) morphed into an official position statement on the Practice Doctorate in Nursing (2004) by the American Association of Colleges of Nursing (AACN). recommendation that the Doctor of Nursing Practice (DNP) would become the terminal degree for nursing practice by 2015. This statement set off a chain of events that led to the development of a new model for nursing education.

On the other hand, nursing has a long history of healthcare leadership and advancing nursing education. .. Advance practice nurses in particular have worked hard to achieve recognition, legitimacy, and access to the health care system.

Describe health system and nursing practice and educational factors that served as motivation factors for development of the DNP degree (practice doctorate in nursing).

key events in the evolution of advanced nursing practice in the United States.

and contrast DNP and PhD degree educational components, foci, and outcomes.

http://www.aacn.nche.edu/dnp/about/talking-points

Chism, Ch. 1 (Chapter is available on course E-Reserve)

Edwardson, S. R. (2010). Doctor of philosophy and doctor of nursing practice as complementary degrees. Journal of Professional Nursing, 26 (3), 137-140 (Article is available on course E-Reserve)

AACN Position statement http://www.aacn.nche.edu/publications/position/DNPpositionstatement.pdf November 1999, the Institute of Medicine (IOM) issued the comprehensive report on medical errors, To Err is Human: Building a Safer Health System The report, extrapolating data from two previous studies, estimates that somewhere between 44,000 and 98,000 Americans die each year as a result of errors in health care.

IOM Health Professions Education: A Bridge to Quality (2003a), "All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics (p. 3)."

IOM committee recommended several strategies to get the best prepared clinical nursing leadership at the most senior levels of management, including the acquisition of nurse leaders for all levels of management and the participation by nursing management in executive decisions within the healthcare organization (IOM, 2003b, p.8).

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

Doctoral programs in nursing and other practice disciplines can be categorized into two distinct types: research-focused and practice-focused. The term practice, specifically nursing practice, as conceptualized in this document refers to any form of nursing intervention that influences health care outcomes for individuals or populations,including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy. Preparation at the practice doctorate level includes advanced preparation in nursing, based on nursing science, and is at the highest level of nursing practice.

Examples of practice-focused degrees offered in other disciplines include entry- level degrees [e.g., the Doctor of Medicine (MD), Doctor of Dental Surgery (DDS)], and those that offer advanced practice degrees [e.g., the Doctor of Psychology (PsyD)].

Recommendation 1: The Task Force recommends that the terminology, practice doctorate be used instead of clinical doctorate.

Discernable differences between the practice-focused programs and the research-focused programs do exist. • less emphasis on theory and meta-theory; • less research methodology content, with the focus being on evaluationand use of research rather than conduct of research; • different dissertation requirements, ranging from no dissertation to theses or capstone projects that must be grounded in clinical practice and designed to solve practice problems or to inform practice directly; an emphasis on practice in any research requirement; • clinical practica or residency requirements; and • emphasis on scholarly practice, practice improvement, innovation and testing of interventions and care delivery models, evaluation of health care outcomes, and expertise to inform health policy and leadership in establishing clinical excellence (Marion, Viens, O'Sullivan, Crabtree, Fontana, & Price, 2003).

tracks within the existing practice-focused programs revealed that in general they fall into three major categories of practice: 1) direct care of individual patients; 2) care of patient populations, including community health nursing; and 3) practice that supports patient care. The latter category includes organizational and professional leadership, management, health policy, and nursing/health informatics.

the five common content areas are (in order of decreasing emphasis): • advanced clinical practice, including both patient and practice management (on average, this constituted 33% of content emphasis within programs); • organizations and systems, and leadership skills (average 19% of content emphasis); • research methods, including accrual and use of evidence to improve practice (average 19%); • basic scientific underpinnings for practice, including emerging areas of science, such as genetics and psychoneuroimmunology (average 9%); and • informatics, use of technology and information (average 8.5%).

Based on this information, two challenges are evident: • Master's prepared advanced practice nurses identify additional knowledge that is needed for a higher level of advanced practice. • The time spent in master's level nursing education is not congruent with the degree earned.

Based on input from several stakeholder groups,... benefits of practice-focused doctoral programs include: • development of needed advanced competencies for increasingly complex clinical, faculty and leadership roles; • enhanced knowledge to improve nursing practice and patient outcomes;3 Advanced Practice Nurses (APNs) is used here to refer to the four direct care roles: certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and nurse practitioner (NP). • enhanced leadership skills to strengthen practice and health care delivery; • better match of program requirements and credits and time with the credential earned; • provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g., clinical faculty); • parity with other health professions, most of which have a doctorate as the credential required for practice; • enhanced ability to attract individuals to nursing from non-nursingbackgrounds; • increased supply of faculty for clinical instruction; and • improved image of nursing.

Examples of the positions for which respondents would hire graduates included Vice President for Clinical Services, Program Director, Vice President for Patient Care, Chief Executive Officer, Health Officer or Commissioner, Quality Improvement Director, Director of Clinical Services, Clinical Information Technology Specialist, Direct Care Clinician, and Faculty Member.

Recommendation 1: The Task Force recommends that the terminology, practice doctorate be used instead of clinical doctorate. Recommendation 2: The practice-focused doctoral program be a distinct model of doctoral education that provides an additional option for attaining a terminal degree in the discipline. Recommendation 3: Practice-focused doctoral programs prepare graduates for the highest level of nursing practice beyond the initial preparation in the discipline Recommendation 4: Practice-focused doctoral nursing programs include seven essential areas of content. The seven essential areas of content include: 1. scientific underpinnings for practice; 2. advanced nursing practice; 3. organization and system leadership/management, quality improvement and system thinking; 4. analytic methodologies related to the evaluation of practice and the application of evidence for practice; 5. utilization of technology and information for the improvement and transformation of healthcare; 6. health policy development, implementation and evaluation; and 7. interdisciplinary collaboration for improving patient and population healthcare outcomes. Recommendation 5: Practice doctoral nursing programs should include development and/or validation of expertise in at least one area of specialized advanced nursing practice. Recommendation 6: Practice-focused doctoral nursing programs prepare leaders for nursing practice. The practice doctorate prepares individuals at the highest level of practice and is the terminal practice degree. Recommendation 7: One degree title should be chosen to represent practice-focused doctoral programs that prepare graduates for the highest level of nursing practice. Recommendation 8: The Doctor of Nursing Practice (DNP) be the degree associated with practice-focused doctoral nursing education. Recommendation 9: The Doctor of Nursing (ND) degree title be phased out. Recommendation 10: The practice doctorate be the graduate degree for advanced nursing practice preparation, including but not limited to the four current APN roles: clinical nurse specialist, nurse anesthetist, nurse midwife, and nurse practitioner. Recommendation 11: A transition period be planned to provide nurses with master's degrees, who wish to obtain the practice doctoral degree, a mechanism to earn a practice doctorate in a relatively streamlined fashion with credit given for previous graduate study and practice experience. The transition mechanism should provide multiple points of entry, standardized validation of competencies, and be time limited. Recommendation 12: Practice doctorate programs, as in research-focused doctoral programs, are encouraged to offer additional coursework and practica that would prepare graduates to fill the role of nurse educator. Recommendation 13: Practice-focused doctoral programs need to be accredited by a nursing accrediting agency recognized by the U.S. Secretary of Education.

it is reasonable to endorse a plan that will permit practice-focused programs to focus on any area of advanced nursing practice that influences health care outcomes for individuals or populations, while adhering to a consistent set of standards regarding areas of core content, supporting resources, student qualifications, and faculty expectations.

outcome-based competencies would be identified for the core content areas for all graduates of practice-focused doctoral programs. In addition, outcome- based competencies for graduates of programs designed to prepare nurses in one of the advanced nursing practice focus areas (such as advanced direct care practice, care of populations, leadership, or policy) specialized competencies would be identified by the individual specialty areas of practice (e.g., family primary care, psych-mental health, nurse anesthesia, public health). A validation process similar to that developed by AACN and NONPF for NP primary care competencies could be used.

Working Paper on the Clinical Nurse Leader Role (AACN, 2003), which subsequently was accepted by the AACN Board in October 2003. The development of this new nurse role, Clinical Nurse Leader (CNL) The CNL is a generalist, provides care in all health care settings at the point of care, and assumes accountability for client care outcomes by coordinating, delegating, and supervising the care provided by the health care team.

They should be prepared to mobilize interdisciplinary teams of clinicians, administrators, policy makers, and members of the public to solve highly complex clinical problems. It is no longer sufficient to apply clinical, organizational, or economic skills to the resolution of complex health problems in a singular fashion. While still much can and should be gained from interdisciplinary teamwork by experts in each of these areas, the highly integrated health problems faced in the 21st century will be better served by clinicians who have the creativity and knowledge base to combine these domains in novel ways to create new models of care delivery.

The Task Force believes that the benefits of such a move will outweigh the costs but recognizes that the transition plan will need to take into account the timing of costs and benefits.

just as for graduates of research-focused doctoral programs, graduates of practice-focused nursing programs may need additional education in the educator role and pedagogical methodologies (AACN, 2001).

(Sandra Edwardson sat on the task force!) SUMMARY OF RECOMMENDATIONS The Task Force recommends: 1: The term practice doctorate be used instead of clinical doctorate. 2: The practice-focused doctoral program be a distinct model of doctoral education that provides an additional option for attaining a terminal degree in the discipline. 3: Practice-focused doctoral programs prepare graduates for the highest level of nursing practice beyond the initial preparation in the discipline. 4: Practice-focused doctoral nursing programs include seven essential areas of content. The seven essential areas of content include: 1. scientific underpinnings for practice; 2. advanced nursing practice; 3. organization and system leadership/management, quality improvement and system thinking; 4. analytic methodologies related to the evaluation of practice and the application of evidence for practice; 5. utilization of technology and information for the improvement and transformation of healthcare; 6. health policy development, implementation and evaluation; and 14 Position Statement on the Practice Doctorate in Nursing 7. interdisciplinary collaboration for improving patient and population healthcare outcomes. 5: Practice doctoral nursing programs include development and/or validation of expertise in one area of specialized advanced nursing practice. 6: Practice-focused doctoral nursing programs prepare leaders for nursing practice. The practice doctorate prepares individuals at the highest level of practice and is the terminal practice degree. 7: One degree title be chosen to represent practice-focused doctoral programs that prepare graduates for the highest level of nursing practice. 8: The Doctor of Nursing Practice (DNP) be the degree associated with practice-focused doctoral nursing education. 9: The Doctor of Nursing (ND) degree title be phased out. 10: The practice doctorate be the graduate degree for advanced nursing practice preparation, including but not limited to the four current APN roles: clinical nurse specialist, nurse anesthetist, nurse midwife, and nurse practitioner. 11: A transition period be planned to provide nurses with master's degrees, who wish to obtain the practice doctoral degree, a mechanism to earn a practice doctorate in a relatively streamlined fashion with credit given for previous graduate study and practice experience. The transition mechanism should provide multiple points of entry, standardized validation of competencies, and be time limited. 12: Practice doctorate programs, as in research-focused doctoral programs, are encouraged to offer additional coursework and practica that would prepare graduates to fill the role of nurse educator. 13: Practice-focused doctoral programs need to be accredited by a nursing accrediting agency recognized by the U.S. Secretary of Education (i.e., the Commission on Collegiate Nursing Education or the National League for Nursing Accrediting Commission).

The changing demands of the nation's complex healthcare environment require that nurses serving in specialty positions have the highest level of scientific knowledge and practice expertise possible. Research from Drs. Linda Aiken, Mary Blegen, Carole Estabrooks, Christopher Friese, and others have established a clear link between higher levels of nursing education and better patient outcomes. Some of the many factors which are accelerating momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of patient care; national concerns about the quality of care and patient safety; shortages of nursing personnel which demands a higher level of preparation for leaders who can design and assess care; shortages of doctorally prepared nursing faculty, and increasing educational expectations for the preparation of other health professionals. The Institute of Medicine, Joint Commission, and other authorities have called for reconceptualizing health professions education to meet the needs of the healthcare delivery system. Nursing is answering that call by moving to prepare APRNs for evolving practice. In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with this call to action. Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT) and Audiology (AudD) all offer practice doctorates.

Historically advanced practice nurses, including Nurse Practitioners, Clinical Nurse Specialists, Nurse-Midwives, and Nurse Anesthetists, were prepared in master's degree programs, some of which carry a credit load equivalent to doctoral degrees in the other health professions. DNP curricula build on current master's programs by providing education in evidence-based practice, quality improvement, leadership, policy advocacy, informatics, and systems thinking among other key areas. Transitioning to the DNP will not alter the current scope of practice for APRNs. State Nurse Practice Acts describe the scope of practice allowed, and these differ from state to state. The transition to the DNP will better prepare APRNs for their current roles given the calls for new models of care delivery and the growing complexity of health care. The DNP is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs. DNP-prepared nurses will be well-equipped to fully implement the science developed by nurse researchers prepared in PhD, DNS and other research-focused nursing doctorates. The title of Doctor is common to many disciplines and is not the domain of any one health profession. Many APRNs currently hold doctoral degrees and are addressed as doctors, which is similar to how clinical psychologists, dentists, podiatrists, and other experts are addressed. Like other providers, DNPs would be expected to display their credentials to insure that patients understand their preparation as a nursing provider. Nursing and medicine are distinct health disciplines that prepare clinicians to assume different roles and meet different practice expectations. DNP programs will prepare nurses for the highest level of nursing practice.

With 243 DNP programs now enrolling students nationwide, more than 70 additional practice doctorates are also under development at U.S. nursing schools. The movement to the DNP has raised many questions about the future of nursing education, certification, regulation and practice. AACN created two task forces, the DNP Essentials and the DNP Roadmap task forces, which defined the essential curricular elements of nursing practice doctorates and to addressed key operational and transition concerns. The results of these two task forces are posted on the Web atwww.aacn.nche.edu/publications/position/DNPEssentials.pdf and www.aacn.nche.edu/dnp/roadmapreport.pdf. AACN also created the Implementation of the DNP Task Force in July 2013 to provide greater clarity regarding the DNP scholarly project and the clinical practice hours requirement outlined in the DNP Essentials. A white paper from this task force will be released in July 2015. The Commission on Collegiate Nursing Education (CCNE), the leading accrediting agency for baccalaureate and higher degree nursing programs in the U.S., has initiated a process for accrediting DNP programs. Currently, 158 DNP programs are CCNE accredited, and an additional 33 programs are seeking CCNE accreditation. In October 2013, the AACN Board of Directors commissioned the RAND Corporation to conduct a national study to assess the facilitators and barriers for schools transitioning their master's level APRN programs to the DNP. The final report is due in July 2014.