Converging Realities – Nursing and the Quality Dilemma
Keeping Patients Safe – Transforming the Work Environment of Nurses: “Research is now beginning to document what physicians, patients, other health care providers, and nurses themselves have long known: how well we are cared for by nurses … can be a matter of life and death.”
Health Professions Education: A Bridge to Quality
Education for the health professions is in need of a major overhaul. …education simply has not kept pace with or been responsive enough to shifting patient demographics and desires, changing health system expectations, evolving practice requirements…a focus on improving quality or new technologies.
A Paradigm Shift is Underway in Graduate Education in Nursing
Expansion of Knowledge Underlying Practice;
Increased Complexity of Patient Care;
New expectations for competent and safe practice- systems savvy, business acumen, policy, interprofessional, use of data sets;
Shortages of Prepared Nursing Faculty, Leaders in Practice, and Nurse Researchers, and
Increasing Educational Expectations for the Preparation of other Health Professionals
Changing Perspectives on Doctoral Education in Nursing
Strong history of growth in research focused doctoral programs
AACN set standards for the research programs – Indicators of Quality in Research Focused Doctoral Programs
Both PhD and DNSc programs have a focus on development of researchers to create the evidence base for nursing
“ The need for doctorally prepared practitioners and clinical faculty would be met if nursing could develop a new nonresearch clinical doctorate, similar to the M.D. and Pharm.D. in medicine and pharmacy, respectively.”
“ 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.” The Mission Becomes Apparent AACN Position Paper on the Practice Doctorate
Position Statement on the Practice Doctorate in Nursing October 2004
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.
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 (i.e. Commission on Collegiate Nursing Education or the National League for Nursing Accrediting Council).
Format of Section of the DNP Essential Draft Currently Under Review Not the complete document or final format—only a section Introduction Review of 2004 TF recommendations Summary of Process Task Force creation Regional meetings Definition of advanced nursing practice Curriculum Model Essential Competencies
Overview of the Curriculum Model DNP is a degree preparing individuals for multiple roles . Seven of the core competencies are for all graduates regardless of role. Core competencies form the basic foundation for advanced nursing practice (essential 8) where competencies bifurcate with the DNP program of study focusing on either: Roles involving the direct delivery of care to individuals, families, and/or populations Roles that influence the delivery of care indirectly through organizational and system leadership.
*For those students who may choose a career in healthcare education or academia, additional pedagogical courses should be provided **Competencies, Content and Practica are delineated by specialty nursing organizations. Optional coursework in pedagogical methods* Advanced Nursing Practice Competencies for: A) Graduates focused on individuals & families B) Graduates focused on populations, systems & organizations Core Essential 8 Core Essentials 1-7 Specialty Focused Competencies**
Advanced nursing practice for improving the delivery of patient care
Recognizes the essential competencies reflective of the distinct, in-depth knowledge and skills that form the basis for nursing practice at the highest level regardless of practice role.
To Divide or Not to Divide: That is the Question (Apologies to Hamlet) 8a. APN or individual and population-focused competencies for the DNP graduate Recognizes the unique competencies associated with the specialized knowledge and clinical expertise essential for the direct care of individuals, families, or discrete population aggregates. 8b. Systems or organization-focused competencies for the DNP graduate Recognizes the unique competencies associated with the organizational expertise and specialized knowledge essential for leadership of health care delivery systems.
While the nurse anesthetist of today is safe and competent, the provider of the future will have to possess enhanced skills in analysis and synthesis of research and be able to apply them in the practice setting.