THE FUTURE OF NURSING: THE CALL FOR ADVANCED DEGREES

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1 THE FUTURE OF NURSING: THE CALL FOR ADVANCED DEGREES 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, PHD, M S N, R N C - OB 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 - BC D I R E C T O R - AT- 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

2 OBJECTIVES Identify the need and benefits of obtaining an advanced degree. Identify and discuss the types of advanced nursing degrees.

3 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

4 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

5 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

6 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

7 TRANSFORMATIVE HEALTHCARE/ EDUCATION MODELS Accountable Care Organizations Patient-Centered Medical Home Interprofessional Education Competencies

8 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.

9 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

10 NURSING S RESPONSE Licensure, Accreditation, Certification & Education (LACE) Guidelines APRN consensus model 2015 statement about the DNP

11 IMPLEMENTATION OF MODEL Licensure Accreditation Credentialing Education

12 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

13 APRN CONSENSUS MODEL Certification occurs within a role and population foci All APRNs must have three P s within educational programs

14 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

15 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

16 AACN Advocates the Following: The Doctorate of Nursing Practice, DNP, as an entry requirement for: nurse practitioners, clinical nurse specialists, nurse midwives nurse anesthetists everyone except CNLs

17 AACN s Vision / Position BSN MSN...DNP (generalist: CNL) (specialist) BSN DNP Moving the current level of preparation necessary for advanced nursing practice from the master s degree to the doctoral level by 2015

18 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*

19 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

20 Organizational Responses American Association of Nurse Anesthetists Mandate that all CRNA programs transition to the practice doctorate, DNP, by 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 f/dnpforum3-10.pdf

21 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. C. Fay Raines, PhD, RN President AACN 3/21/10 f/dnpforum3-10.pdf

22 Organizational Responses 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 Council on Graduate Education for Administration in Nursing* (CGEAN) (AONE, April 2007) CGEAN Mission: To further the development and improvement of graduate education in nursing administration * The voice for education in nursing administration

23 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)

24 The Essentials of Master s Education in Nursing Master s level preparation is broader than the practice specialization achieved at the Doctor of Nursing Practice Level (p.1) 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)

25 MASTERS OPTIONS Clinical Nurse Leader Nursing Administration Nursing Education Community Health APRN Roles

26 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

27 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

28 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

29 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

30 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)

31 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 Research Practice Practice Research

32 What s the Difference Between DNP & PhD? 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) Bridging the gap between evidence and implementation

33

34

35 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

36 DNP Practice Expertise Addition of Policy expertise Finance and Economic Evidence-based Practice Implementation/Evaluation skills Tracks Post BSN Post MSN

37 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

38 PHD Research Expertise Roles: Education Faculty Service positions Research Directors NIH, NINR, AHRQ roles

39 PLANNING YOUR CAREER PATH Options for Advanced Education Career goals Practice? Education? Both?

40 PLANNING YOUR CAREER PATH What questions should you ask? What is your goal? What type of program matches my goal?

41 KEEPING INFORMED Choose wisely Multiple entry/exit points

42 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

43 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)

44 FUNDING YOUR EDUCATION Grants Faculty Loan program Traineeships State initiatives Link with professional organizations for funding sources Grad offices at the schools

45 TIME FRAMES Dependent on entry point Full-time vs. Part time

46 NURSES: KEY TO IMPROVING HEALTH

47 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, American Association of Colleges of Nursing. Position statement on the practice doctorate in nursing. October Retrieved from August 16, American Organization of Nurse Executives (2007) Consideration of the doctorate of nursing practice. Retrieved from statement doc August 16, American Organization of Nurse Executives. AONE position statement: Doctorate of nursing practice: April, 11, Retrieved from August 16, American Association of Colleges of Nursing (2006). Essentials of doctoral education for advanced nursing practice. Washington, DC. American Association of Colleges of Nursing.

48 REFERENCES / RESOURCES American Association of College of Nursing. About AACN. Retrieved from August 20, American Association of Colleges of Nursing. March 21, 2011: The essentials of master s education in nursing. Retrieved from September 3, CGEAN: About CGEAN. Retrieved from August 16, 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), American Association of Colleges of Nursing: About AACN. AACN briefing (2010) doc. Retrieved from 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 September 3, 2012

49 It is journey not a destination Q U E S T I O N S?

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