EMERGENCY NURSES ASSOCIATION WHITE PAPER The Essentials of Doctoral Education for Advanced Nursing Practice in Emergency Care The Emergency Nurses Association (ENA) Board of Directors in consultation with the ENA Nurse Practitioner (NP) Validation Work Team approved the concept of the Doctorate of Nursing Practice (DNP) and the American Association of Colleges of Nursing s Essentials of Doctoral Education for Advanced Nursing Practice (American Association of Colleges of Nursing [AACN], 2004). The intent of this white paper is to review the definition of an advanced practice nurse (APN), present information regarding existing doctoral education in nursing, interpret the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2004), and describe the ENA s initiatives related to specialty-focused competencies. APN Definition The Emergency Nurses Association (ENA) defines an advanced practice registered nurse as a registered nurse who has completed a graduate degree in a specialty area of nursing and has a direct and/or indirect clinical practice in the specialty area (Emergency Nurses Association [ENA], 2007). The advanced practice registered nurse is prepared to assume responsibility and accountability for health promotion and the assessment, diagnosis, and management of patient problems which [may include] the use and prescription of pharmacologic and nonpharmacologic interventions (AACN, 2006). Advanced practice registered nurses are seen not Page 1 of 7
only as clinical patient care experts, but the expanded roles of advanced practice registered nurses involve leadership, administration, consultation, education, and research (Chan & Garbez, 2006). APN is the umbrella term used to identify the advanced practice roles of the Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). Existing Doctoral Education in Nursing Research- and practice-focused doctoral programs in nursing share rigorous and demanding expectations: a scholarly approach to the discipline and a commitment to the advancement of the profession. Both are terminal degrees in the discipline, one in practice and one in research (AACN, 2004). Examples of traditional doctoral programs in nursing include the following: Research-focus Doctor of Philosophy (PhD) Doctor of Nursing Science (DNS) Doctor of Science in Nursing (DSN) Doctor of Nursing Science (DNSc) Practice-focus Doctor of Nursing (ND) no longer offered Hybrid of research and practice focus Doctor of Nursing Practice (DrNP) Page 2 of 7
The Doctorate in Nursing Practice (DNP) is an evolving model within advanced practice nursing. According to the AACN, DNP education is by definition specialized, and DNP graduates assume a variety of differing roles upon graduation. Consequently, a major component of DNP curricula focuses on providing the requisite specialty knowledge for graduates to enact particular roles in the larger healthcare system (AACN, 2004). The eight competencies delineated in the DNP Essentials must be demonstrated by all graduates (AACN, 2004): The Essentials of Doctoral Education for Advanced Nursing Practice I. Scientific Underpinnings for Practice based on nursing process, human behavior, and holistic care II. Organizational and Systems Leadership for Quality Improvement and Systems Thinking works with organizations and leadership to meet the needs of groups of patients and communities in order to promote patient safety and evidence-based best practice III. Clinical Scholarship and Analytical Methods for Evidence-Based Practice actively participates and utilizes research to advance health care IV. Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care is proficient and utilizes information technology to advance health care Page 3 of 7
V. Health Care Policy for Advocacy in Health Care advocates for health care through partnerships with government, institutional, and organizational agencies VI. Interprofessional Collaboration for Improving Patient and Population Health Outcomes collaborates with different health care specialties in the care of groups of patients and communities VII. Clinical Prevention and Population Health for Improving the Nation s Health evaluates disease prevention and promotion and advocates for healthy lifestyles VIII. Advanced Nursing Practice establishes specializations through validation of competencies and skills ENA s Initiatives Related to Specialty-Focused Competencies Emergency care currently supports the CNS and NP roles. The ENA has undertaken a Delphi study to verify and gain consensus on competencies and skills for nurse practitioners in emergency care. The ENA NP Validation Work Team has utilized the ENA s Core Competencies (ENA, 2000) as part of the framework for the Delphi study. Competencies and skills for NPs in emergency care are intended to supplement the National Organization of Nurse Practitioner Faculties (NONPF) 2006 Domains and Core Competencies (NONPF, 2006), which are recognized by the ENA Board of Directors and the NP Validation Work Team as the Page 4 of 7
foundation for all nurse practitioner practice. Future initiatives of the ENA include the validation and verification of competencies for the CNS in emergency care. References American Association of Colleges of Nursing (2004). The Essentials of Doctoral Education for Advanced Nursing Practice. Retrieved October 26, 2007, from http://www.aacn.nche.edu/dnp/pdf/essentials.pdf American Association of Colleges of Nursing. (2006, May 24). Advanced Practice Nursing Consensus Work Group Report, May 2006 (Draft report from May 24, 2006 APRN Consensus Work Group meeting). Washington, DC: Author. Chan, G. K. & Garbez, R. O. (2006). Education of advanced practice nurses for emergency care settings: Emphasizing shared competencies and domains. Advanced Emergency Nursing Journal, 28, 216-225. Emergency Nurses Association. (2000). Emergency nursing core curriculum (5 th ed.). Philadelphia: W. B. Saunders. Emergency Nurses Association. (2007). Position statement: Advanced practice in emergency nursing. Des Plaines, IL: Author. Retrieved October 31, 2007, from http://ena.org/about/position/ National Organization of Nurse Practitioner Faculties. (2006). Domains and core competencies of nurse practitioner practice. Retrieved October 31, 2007, from http://www.nonpf.org/nonpf2005/corecompsfinal06.pdf Page 5 of 7
Bibliography American Academy of Nurse Practitioners (2007). Discussion Paper: Doctor of Nursing Practice. Retrieved October 31, 2007, from http://www.aanp.org/nr/rdonlyres/eohypbva5ab2yefiszlbl3nttmi3czv2lojklfechu5w3lecy uy6gmnn6ykpzv6xhjmropsmeo2wou3ebo6qhdsafgf/doctor+of+nursing+practice+_dnp _+Discussion+Paper.pdf American Association of Colleges of Nursing (2004). The Essentials of Doctoral Education for Advanced Nursing Practice. Retrieved October 26, 2007 from http://www.aacn.nche.edu/dnp/pdf/essentials.pdf American Association of Nurse Anesthetists (2007). The Doctorate in Nursing Practice (DNP) Background, Current Status and Future Activities. Retrieved October 31, 2007 from http://www.aana.com/professionaldevelopment.aspx?ucnavmenu_tsmenutargetid=13 1&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1742 American College of Nurse-Midwives (2007). Midwifery Education and the Doctor of Nursing Practice. Retrieved October 31, 2007 from http://www.midwife.org/sitefiles/position/midwifery_ed_and_dnp_6_07.pdf Campo, T. (2007). Nurse practitioners in the emergency care setting: Procedures, independence, confidence and education. Unpublished doctoral dissertation, Case Western Reserve University, Cleveland, OH. Page 6 of 7
National Association of Clinical Nurse Specialists (2005). White Paper on the Nursing Practice Doctorate 2005. Retrieved October 26, 2007 from http://www.nacns.org/nacns_dnpwhitepaper2.pdf National Organization of Nurse Practitioner Faculties (2006). Practice Doctorate Nurse Practitioner Entry-Level Competencies 2006. Retrieved October 31, 2007 from http://www.nonpf.com/nonpf2005/practicedoctorateresourcecenter/pdresourcecent er.htm Ramirez, E., Tart, K., & Malecha, A. (2006). Developing nurse practitioner treatment competencies in emergency care settings. Advanced Emergency Nursing Journal, (28), 4, 346-359. Page 7 of 7