The Doctorate of Nursing Practice and Advanced Community/Public Health Nursing Christine L. Savage, RN, PhD, CARN University of Cincinnati Derryl E. Block, RN, PhD, APHN-BC University of Wisconsin-Green Bay
Public health nursing has a rich tradition in the field of nursing that extends back to the work of Florence Nightingale.
After World War II, in conjunction with the growth in the medical industrial complex, the majority of nursing graduate programs provided students with education for highly specialized individualized direct care rather than population-focused care. The Medical Industrial Complex
The AACN (1996) Essentials of Masters Education For APN document included Graduate nursing core for all masters degree students Three tracks with separate courses needed Administration APN clinical Community health track The APN clinical was defined as direct client care. PHN in Masters Essentials
The AACN (2006) The Essentials of Doctoral Education for Advanced Nursing Practice document included two tracks: Advanced Practice Nursing (APN) Aggregate/systems/organization (ASO) The ASO track includes Community/Public Health nursing (C/PHN) as well as nursing administration, informatics and other non APN specialty areas. PHN in DNP Essentials Document
Lack of AACN guidance re curriculum for the Aggregate/Systems/ Organization (ASO) category PHN in DNP Essentials Document
Graduate Education for Advanced Public Health Nursing: At the Crossroads (2007) The Association of Community Health Nurse Educators (ACHNE) Supports the national movement towards the practice doctorate as a terminal degree for advanced nursing practice Confirms that doctoral education for specialty practice is defined by the specialty nursing organization Implementation of DNP programs in PHN is an evolutionary process that may follow multiple pathways: Collaboration with schools of public health Collaboration between schools of nursing to create centers of excellence Position paper on APHN Graduate Education
Terms as defined by AACN Advanced Practice Nursing - involving the care and management of individuals and families Advanced Nursing Practice - any form of nursing intervention that influences health care outcomes for individuals or populations Aggregate/systems/organizations focusing practice on aggregates (AACN, 2004) Blurring of Terms
Implementation of Doctorate of Nursing Practice (DNP) programs in C/PHN faces numerous challenges including the ability of the institution to support doctoral programs and the lack of definition of the ASO specialty track. Challenges for PHN DNPs
If the DNP becomes the desired degree will there be enough programs to meet increasing workforce demand for advanced public health nurses? Are nursing schools instituting DNP programs that include an aggregate/systems/organization or C/PHN track? What are the characteristics of current C/PHN graduate programs? Challenges for PHN DNPs
To answer these questions we conducted a survey of nursing schools. Cross sectional survey Unit of analysis nursing academic institutions Convenience sample Distribution of the survey through the ACHNE lit serve The purpose: Identify and count the institutions having or planning to have a DNP in Community/Public Health Nursing Identify potential barriers to implementing DNP programs Survey
Questions: Are nursing schools instituting DNP programs? If so, do they include a PHN track? What is the rationale for instituting a DNP program or not instituting one? What are the characteristics of graduate program in PHN related to title and clinical hours? The Research Questions
Online survey using Survey Monkey Email invitation to ACHNE electronic mailing list members: This survey is for CPHN educators working at an institution that offers graduate programs in nursing. If your institution only offers Baccalaureate or Associate degrees, please do not complete the survey. Data reviewed for outliers or multiple answers from the same institution Data analysis via SPSS frequency distributions Methods
Respondents 86 completed surveys (all reported graduate programs in nursing) 44 reported graduate program in public health nursing Response Rate Unknown Unknown number of programs with graduate nursing degrees represented on ACHNE electronic mailing list 332 active members on the electronic mailing list Respondents
46 (54%) have a DNP program in place or by fall of 2010 Reasons for implementing the DNP at the institution level (n=22) Requirements for NP certification (27%) AACN directives (27%) Increase number of doctorally prepared nurses (10%) Future of nursing (18%) Institution part of original initiators of DNP (ND) (18%) Findings: Are you instituting a DNP program?
Institutions with a graduate C/PHN program (n = 40) 29 current DNP or by fall 2010 (73%) 13 have ASO or C/PHN track (33%) Institutions without a graduate C/PHN program (n = 39) 17 current DNP or by fall 2010 (41%) Findings
For programs with a DNP currently or by Fall 2010 (n=48), entrance to DNP program is: 38% post masters only 4% post BSN only 58% both Findings: At what level will students enter the DNP program
Tracks in DNP Programs (n = 46) 37% Aggregate/Systems/Organization (ASO) 41% C/PHN 37% Neither ASO nor C/PHN Findings: ASO and C/PHN Tracks
Reasons (n=17) Institution does not support doctoral programs (29%) No market for DNPs (12%) Lack of qualified faculty (23.5%) Other (35.5%) Other comments Budget problems State regulations Findings: Reasons for not having DNP?
Names for C/PHN graduate programs varied (n =39) Community/public health 33.3% Public health nursing 23% Community health nursing 12.8% CNS 7.6% Other 23.4% Findings: Characteristics of C/PHN graduate programs
Clinically supervised hours (n = 27) Mean 512 hours Range 100 to 1000 18.5% less than 500 hours Require the three P s (n = 43) 19% Include an MPH option (n = 36) 25% Findings: Characteristics of C/PHN Graduate Programs
Respondents reported: Over half of their institutions will have a DNP program in place by the fall of 2010 The main reasons given for developing a DNP program were: AACN directive that all advanced nursing practice degrees require a DNP by 2015 NP certification requirements 4 out of 10 DNP programs have a specific C/PHN track Over one third of the DNP programs include APN only Conclusions
For the C/PHN graduate programs varied in: Titles of programs CNS designation is being used by some institutions Almost one quarter of programs did not include CH or PH The number of clinical hours required. 20% of the C/PHN MSN programs required less than 500 hours Conclusions: C/PHN Graduate Programs
Convenience sample Some missing data regarding institution name Respondents may have had limited information about institutional plans and/or types of programs Limitations
Rationale for the DNP is driven by direct care/micro level specialties. Potential redundancy and blurring of population-focused care with individual care is present in the DNP Essentials. Challenges
No clear reference to the C/PHN advanced nursing practice in the DNP Essentials. Students may flock to MPH or APN tracks, causing nursing to loose its voice in Public Health and public health to lose its voice in nursing. Challenges
Some graduate nursing programs are in institutions that lack authorization to provide doctoral degrees. Will this make it difficult for those seeking an advanced degree in C/PHN to find graduate nursing programs? DNP as Terminal Degree