The Doctor of Nursing Practice: Defining Best Practices

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1 The Doctor of Nursing Practice: Defining Best Practices Margaret Grey, DrPH, RN, FAAN Annie Goodrich Professor & Dean Yale University School of Nursing August 25, 2012

2 Overview Review themes from presentations & discussions Report major findings Identify areas of consensus Identify continuing controversies Suggest pathways to solutions

3 Evidence Conference presentations Review of the literature Reported as consensus and controversies

4 Doctor of Nursing Practice Similar to other practice disciplines MD, PharmD, DrPH Based on several major national reports 2004 Position Statement - all APNs to hold the DNP by 2015 Designed to prepare experts in population-based practice

5 DNP Programs Over accredited & 105 in process 50/50 public/private Accreditation mostly CCNE >50% post-msn only Wide range of credits, requirements

6 Enrollment 9094 in 2011; 4000 in PhD programs DNP enrollment rapidly growing Majority in NP emphasis Many others in admin, policy, education

7 Roles of Graduates (n=1600) Hospital administration Faculty Hospital clinical Smaller numbers in other areas Unclear roles in generation/summary of evidence

8 Indicators of Impact Based on anecdotal data Acute care leadership Academic leaderhip Primary care

9 Dissemination by DNPs Broad range of articles Mostly in practice journals Increasing publications yearly > 30% data-based Little translational science or practice guidelines

10 Areas of consensus Interest in DNP is high Post-master s programs predominate Extends the role of the APN to populations, health policy, and management/leadership

11 Areas of Controversy What is the product? What is clinical? What is the capstone? What are the outcomes?

12 What is the Product? Entry-level APN or advanced, advanced practice Educator Administrator Health policy analyst All of the above Vincent, D. et al. (2010) DNP-prepared nurses as practitioner-researchers: closing the gap between research and practice. American Journal for Nurse Practitioners, 14 (11-12), 32-34; Florczak, K. L. (2010). Research and the doctor of nursing practice: A cause for consternation. Nursing Science Quarterly, 23 (1),

13 What is clinical experience? Traditional APN practice in clinical settings Health policy/leadership experiences Teaching experience Little consistency in requirements across programs Need appropriate sites/preceptors

14 What is the capstone? Research Evidence-based practice projects Leadership projects Evidence synthesis Translational science Group projects? Necessary?

15 What are the outcomes? Mostly faculty and administrative roles, not NP BSN-DNP different expectations from MSN-DNP Tenure vs. clinical track Unclear how practice/role has changed Unclear how DNP embraced in clinical environments

16 Impact on Schools Very large PT programs, many specialties Faculty development esp. for IT Availability of qualified faculty Impact on research productivity Impact on other programs, e.g., PhD programs Financial investment & projections Cronewett, L. et al. (2011). The Doctor of Nursing Practice: A national workforce perspective. Nursing Outlook, 59 (1), 9-17.

17 Defining Best Practices Seen one DNP Program, you have seen 1 DNP program Impact of the DNP will depend on the type/quality of programs Lack of consistency may lead to negative perceptions Need serious, respectful dialogue about program quality

18 Define the product What roles do we expect DNP grads to fulfill? Where do we expect them to work? Are we really preparing them to fill these roles (e.g., educator/academic)? Not this, but??

19 Clinical Need to define link of clinical experiences to outcomes Why 1000 hours? Depends on the expectations for roles

20 Curricula Great deal of variability Inconsistency in objectives Interprofessional vs. intraprofessional May need flexibility as curricula and programs evolve

21 Capstone Define it more consistently Impact on outcomes Evidence-based practice projects Implementation/Translational Science

22 Impact on Schools Need for scholarship about the impact positive & negative of DNP implementation Faculty & staff costs Faculty socialization Tenure vs. clinical track

23 Impact on the Profession Inclusive vs. dismissive Respectful dialogue Clear standards Interprofessional collaboration

24 Impact on society 2015 looms IOM report Critical to look at outcomes Schools Systems Patients Bellini, S. & Cusson, R. M. (2012). The DNP for entry into advanced practice: The controversy continues as 2015 looms. Newborn & Infant Nursing Reviews, 12(1),

25 Conclusions DNP programs have potential to advance nursing and health care, but yet unproven Standards of quality programs need to be established and supported to assure quality across programs

26 Suggestions Summit on the DNP Define the product Examine curricula, etc. Implement standards

27 Thoughts?

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