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  • 1. The Doctorate ofThe Doctorate of Nursing Practice:Nursing Practice: Responding to aResponding to a Changing Health CareChanging Health Care EnvironmentEnvironment Geraldine Polly Bednash, PhD, RN, FAANGeraldine Polly Bednash, PhD, RN, FAAN Executive DirectorExecutive Director American Association of Colleges of NursingAmerican Association of Colleges of Nursing
  • 2. Dramatic Changes in Health CareDramatic Changes in Health Care  Aging populationAging population  Growing diversityGrowing diversity  Bio-medical advancesBio-medical advances  New areas of knowledge, i.e. genetics,New areas of knowledge, i.e. genetics, environmental healthenvironmental health  Internationalization of Health Care IssuesInternationalization of Health Care Issues
  • 3. Acuity LevelsAcuity Levels  Acuity level in general, non-intensiveAcuity level in general, non-intensive care units of a hospital is higher thancare units of a hospital is higher than acuity levels in ICUs ten years ago.acuity levels in ICUs ten years ago.
  • 4. Lusting for the Purple PillLusting for the Purple Pill  Creating demand – Direct to ConsumerCreating demand – Direct to Consumer marketingmarketing  Billions in advertisingBillions in advertising  TV – Newspapers – MagazinesTV – Newspapers – Magazines
  • 5. How Safe is It?How Safe is It?  Institute of Medicine –Institute of Medicine –  To Err is HumanTo Err is Human  Crossing the Quality ChasmCrossing the Quality Chasm Joint Commission on Accreditation of HealthcareJoint Commission on Accreditation of Healthcare Organizations –Organizations – Sentinel Events – 25% nurse relatedSentinel Events – 25% nurse related Competence/Orientation/TrainingCompetence/Orientation/Training
  • 6. What error?
  • 7. Converging Realities –Converging Realities – Nursing and the Quality DilemmaNursing and the Quality Dilemma  Keeping Patients Safe – Transforming the Work Environment ofKeeping Patients Safe – Transforming the Work Environment of Nurses:Nurses: “Research is now beginning to document what“Research is now beginning to document what physicians, patients, other health care providers, andphysicians, patients, other health care providers, and nurses themselves have long known: how well we arenurses themselves have long known: how well we are cared for by nurses … can be a matter of life andcared for by nurses … can be a matter of life and death.”death.”
  • 8. Health Professions Education:Health Professions Education: A Bridge to QualityA Bridge to Quality  Education for the health professions is in needEducation for the health professions is in need of a major overhaul. …education simply has notof a major overhaul. …education simply has not kept pace with or been responsive enough tokept pace with or been responsive enough to shifting patient demographics and desires,shifting patient demographics and desires, changing health system expectations, evolvingchanging health system expectations, evolving practice requirements…a focus on improvingpractice requirements…a focus on improving quality or new technologies.quality or new technologies.  IOM, 2003IOM, 2003
  • 9. A Paradigm Shift is Underway inA Paradigm Shift is Underway in Graduate Education in NursingGraduate Education in Nursing  Expansion of Knowledge Underlying Practice;Expansion of Knowledge Underlying Practice;  Increased Complexity of Patient Care;Increased Complexity of Patient Care;  New expectations for competent and safe practice-New expectations for competent and safe practice- systems savvy, business acumen, policy,systems savvy, business acumen, policy, interprofessional, use of data sets;interprofessional, use of data sets;  Shortages of Prepared Nursing Faculty, Leaders inShortages of Prepared Nursing Faculty, Leaders in Practice, and Nurse Researchers, andPractice, and Nurse Researchers, and  Increasing Educational Expectations for theIncreasing Educational Expectations for the Preparation of other Health ProfessionalsPreparation of other Health Professionals
  • 10. Changing Perspectives on DoctoralChanging Perspectives on Doctoral Education in NursingEducation in Nursing  Strong history of growth in research focusedStrong history of growth in research focused doctoral programsdoctoral programs  AACN set standards for the research programsAACN set standards for the research programs – Indicators of Quality in Research Focused– Indicators of Quality in Research Focused Doctoral ProgramsDoctoral Programs  Both PhD and DNSc programs have a focus onBoth PhD and DNSc programs have a focus on development of researchers to create thedevelopment of researchers to create the evidence base for nursingevidence base for nursing
  • 11. History of Practice DoctoratesHistory of Practice Doctorates  DNS and DNSc originally conceived as practiceDNS and DNSc originally conceived as practice doctoratesdoctorates  Over time these programs also focused uponOver time these programs also focused upon development of researchersdevelopment of researchers  Nursing Doctorate programs (ND) originallyNursing Doctorate programs (ND) originally focused on development of an entry levelfocused on development of an entry level generalist but over time changed dramaticallygeneralist but over time changed dramatically with little congruence across the four NDwith little congruence across the four ND programsprograms
  • 12. Evolution of the Practice DoctorateEvolution of the Practice Doctorate  1999 -Task Force on Research Intensive Doctoral1999 -Task Force on Research Intensive Doctoral Programs EstablishedPrograms Established  2001 –Indicators of Quality in Research-Focused2001 –Indicators of Quality in Research-Focused Doctoral Programs Published and Recommended thatDoctoral Programs Published and Recommended that Task Force on Clinical Doctorates be EstablishedTask Force on Clinical Doctorates be Established  2002 –Task Force on Clinical Doctorate Established –2002 –Task Force on Clinical Doctorate Established – Obtained Data, Input, and Consultation from a BroadObtained Data, Input, and Consultation from a Broad Range of Constituencies and Developed 13Range of Constituencies and Developed 13 RecommendationsRecommendations
  • 13. Focus on the DNPFocus on the DNP  Task Force that created standards for researchTask Force that created standards for research focused programs recommended that AACNfocused programs recommended that AACN create a standard set of assumptions andcreate a standard set of assumptions and guidelines for the terminal practice degreeguidelines for the terminal practice degree programsprograms  Emergence of DNP with first program at U ofEmergence of DNP with first program at U of Kentucky and many others in developmentKentucky and many others in development
  • 14. Task Force on Practice DoctorateTask Force on Practice Doctorate  Created in March 2002 to makeCreated in March 2002 to make recommendations on the future of the practicerecommendations on the future of the practice doctoratedoctorate  Quickly became apparent that the issue wasQuickly became apparent that the issue was more complex than a focus on the single degreemore complex than a focus on the single degree program and included issues that were universalprogram and included issues that were universal in health professions educationin health professions education
  • 15. Charge to the Task ForceCharge to the Task Force  clarify the purpose of the professional clinicalclarify the purpose of the professional clinical doctorate, specifically core content and coredoctorate, specifically core content and core competencies;competencies;  describe trends over time in clinical doctoraldescribe trends over time in clinical doctoral education;education;  assess the need for clinically focused doctoralassess the need for clinically focused doctoral programs;programs;  identify preferred goals, titles, outcomes, andidentify preferred goals, titles, outcomes, and resources;resources;
  • 16. Charge to the Task ForceCharge to the Task Force  discuss the elements of a unified approachdiscuss the elements of a unified approach versus a diverse approach;versus a diverse approach;  determine the potential implications fordetermine the potential implications for advanced practice nursing (APN) programs;advanced practice nursing (APN) programs;  make recommendations regarding related issuesmake recommendations regarding related issues and resources; andand resources; and  describe potential for various tracks or roledescribe potential for various tracks or role options.options.
  • 17. Evolution of the ConceptsEvolution of the Concepts  Original charge was to focus on education to acquire aOriginal charge was to focus on education to acquire a “clinical doctorate”“clinical doctorate”  Outgrowth of the work and recommendations of theOutgrowth of the work and recommendations of the task force that established the AACN Indicators oftask force that established the AACN Indicators of Quality in Research-focused Doctoral ProgramsQuality in Research-focused Doctoral Programs  That task force recommended the validation of theThat task force recommended the validation of the differences between the research and clinical doctoratedifferences between the research and clinical doctorate  The Clinical Doctorate task force recommended thatThe Clinical Doctorate task force recommended that the term “practice doctorate” be used to reflect rolethe term “practice doctorate” be used to reflect role
  • 18. Advanced Practice for the FutureAdvanced Practice for the Future  Growing trend to extend MSN programsGrowing trend to extend MSN programs beyond the traditional master’s credits – needbeyond the traditional master’s credits – need to give the right degree for the educationto give the right degree for the education requiredrequired  Increased practice demands same for APNsIncreased practice demands same for APNs as for entry level generalists – moreas for entry level generalists – more complexity and more acuitycomplexity and more acuity
  • 19. Stakeholder ObservationsStakeholder Observations  Need to develop advanced competencies forNeed to develop advanced competencies for increasingly complex clinical, faculty and leadershipincreasingly complex clinical, faculty and leadership roles;roles;  Need for enhanced knowledge to improve nursingNeed for enhanced knowledge to improve nursing practice and patient outcomes;practice and patient outcomes;  System change requires enhanced leadership skills toSystem change requires enhanced leadership skills to strengthen practice and health care delivery;strengthen practice and health care delivery;  Credits and time invested in master’s programs notCredits and time invested in master’s programs not congruent with the credential earned;congruent with the credential earned;
  • 20. National Academy of Sciences 2005National Academy of Sciences 2005 Report on Nursing ResearchReport on Nursing Research  The Report Focuses on Increasing the NumberThe Report Focuses on Increasing the Number of Nurse Scientists and Increasing the Numberof Nurse Scientists and Increasing the Number of Productive Research Years for Nursesof Productive Research Years for Nurses Prepared in PhD ProgramsPrepared in PhD Programs
  • 21. National Academy of Sciences 2005National Academy of Sciences 2005 ReportReport  ““The need for doctorally prepared practitionersThe need for doctorally prepared practitioners and clinical faculty would be met if nursingand clinical faculty would be met if nursing could develop a new nonresearch clinicalcould develop a new nonresearch clinical doctorate, similar to the M.D. and Pharm.D. indoctorate, similar to the M.D. and Pharm.D. in medicine and pharmacy, respectively.”medicine and pharmacy, respectively.”
  • 22. ““Nurses prepared at the doctoral level with aNurses prepared at the doctoral level with a blend of clinical, organizational, economic andblend of clinical, organizational, economic and leadership skills are most likely to be able toleadership skills are most likely to be able to critique nursing and other clinical scientificcritique nursing and other clinical scientific findings and design programs of care deliveryfindings and design programs of care delivery that are locally acceptable, economicallythat are locally acceptable, economically feasible, and which significantly impact healthfeasible, and which significantly impact health care outcomes.”care outcomes.” The Mission Becomes ApparentThe Mission Becomes Apparent AACN Position Paper on the Practice DoctorateAACN Position Paper on the Practice Doctorate
  • 23. Position Statement on thePosition Statement on the Practice Doctorate inPractice Doctorate in NursingNursing October 2004October 2004
  • 24. Practice doctoratePractice doctorate  Recommendation 1Recommendation 1:: The Task ForceThe Task Force recommends that the terminologyrecommends that the terminology, practice, practice doctoratedoctorate be used instead ofbe used instead of clinicalclinical doctoratedoctorate..
  • 25. Practice DoctoratePractice Doctorate  The termThe term practicepractice, specifically nursing practice, as conceptualized in this, specifically nursing practice, as conceptualized in this document refers to any form of nursing intervention that influences health caredocument refers to any form of nursing intervention that influences health care outcomes for individuals or populations, including the direct care ofoutcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations,individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and theadministration of nursing and health care organizations, and the development and implementation of health policy. Preparation at the practicedevelopment and implementation of health policy. Preparation at the practice doctorate level includes advanced preparation in nursing, based on nursingdoctorate level includes advanced preparation in nursing, based on nursing science, and is at the highest level of nursing practice.science, and is at the highest level of nursing practice.
  • 26. RecommendationsRecommendations  Recommendation 2:Recommendation 2: The practice-focused doctoralThe practice-focused doctoral program be a distinct model of doctoral educationprogram be a distinct model of doctoral education that provides an additional option for attaining athat provides an additional option for attaining a terminal degree in the discipline.terminal degree in the discipline.  Recommendation 3:Recommendation 3: Practice-focused doctoralPractice-focused doctoral programs prepare graduates for the highest level ofprograms prepare graduates for the highest level of nursing practice beyond the initial preparation innursing practice beyond the initial preparation in the discipline.the discipline. ..
  • 27. Recommendation 4Recommendation 4  Practice-focused doctoral nursing programsPractice-focused doctoral nursing programs include seven essential areas of content.include seven essential areas of content. The seven essential areas of content include:The seven essential areas of content include:  scientific underpinnings for practice;scientific underpinnings for practice;  advanced nursing practice;advanced nursing practice;  organization and systemorganization and system leadership/management; qualityleadership/management; quality improvement and system thinking;improvement and system thinking;
  • 28. Recommendation 4Recommendation 4  analytic methodologies related to the evaluation ofanalytic methodologies related to the evaluation of practice and the application of evidence forpractice and the application of evidence for practice;practice;  utilization of technology and information for theutilization of technology and information for the improvement and transformation of healthcare;improvement and transformation of healthcare;  health policy development, implementation andhealth policy development, implementation and evaluation; andevaluation; and  interdisciplinary collaboration for improvinginterdisciplinary collaboration for improving patient and population healthcare outcomes.patient and population healthcare outcomes.
  • 29. Congruent TitlingCongruent Titling  Recommendation 7Recommendation 7: One degree title should: One degree title should be chosen to represent practice-focusedbe chosen to represent practice-focused doctoral programs that prepare graduates fordoctoral programs that prepare graduates for the highest level of nursing practice.the highest level of nursing practice.  Recommendation 8Recommendation 8: The Doctor of Nursing: The Doctor of Nursing Practice (DNP) be the degree associatedPractice (DNP) be the degree associated with practice-focused doctoral nursingwith practice-focused doctoral nursing education.education.  Recommendation 9Recommendation 9: The Doctor of Nursing: The Doctor of Nursing (ND) degree title be phased out.(ND) degree title be phased out.
  • 30. RecommendationsRecommendations  Practice doctoral nursing programs shouldPractice doctoral nursing programs should include development and/or validation ofinclude development and/or validation of expertise in one area of advanced nursingexpertise in one area of advanced nursing practice.practice.  Practice-focused doctoral nursing programsPractice-focused doctoral nursing programs prepare leaders for clinical practice. Theprepare leaders for clinical practice. The practice doctorate prepares individuals atpractice doctorate prepares individuals at the highest level of practice and is thethe highest level of practice and is the terminal practice degree.terminal practice degree.
  • 31.  Recommendation 10:Recommendation 10: The practiceThe practice doctorate be the graduate degree fordoctorate be the graduate degree for advanced nursing practice preparation,advanced nursing practice preparation, including but not limited to the four currentincluding but not limited to the four current APN roles: clinical nurse specialist, nurseAPN roles: clinical nurse specialist, nurse anesthetist, nurse midwife and nurseanesthetist, nurse midwife and nurse practitioner.practitioner.
  • 32.  Recommendation 11Recommendation 11: A transition period be: A transition period be planned to provide nurses with master’splanned to provide nurses with master’s degrees, who wish to obtain the practicedegrees, who wish to obtain the practice doctoral degree, a mechanism to earn adoctoral degree, a mechanism to earn a practice doctorate in a relatively streamlinedpractice doctorate in a relatively streamlined fashion with credit given for previousfashion with credit given for previous graduate study and practice experience. Thegraduate study and practice experience. The transition mechanism should providetransition mechanism should provide multiple points of entry, standardizedmultiple points of entry, standardized validation of competencies, and be timevalidation of competencies, and be time limited.limited.
  • 33.  Recommendation 12:Recommendation 12: Practice doctoratePractice doctorate programs, as in research-focused doctoralprograms, as in research-focused doctoral programs, are encouraged to offer additionalprograms, are encouraged to offer additional coursework and practica that would preparecoursework and practica that would prepare graduates to fill the role of nurse educatorgraduates to fill the role of nurse educator
  • 34.  Recommendation 13:Recommendation 13: Practice-focusedPractice-focused doctoral programs need to be accredited bydoctoral programs need to be accredited by a nursing accrediting agency recognized bya nursing accrediting agency recognized by the U.S. Secretary of Education (i.e.the U.S. Secretary of Education (i.e. Commission on Collegiate NursingCommission on Collegiate Nursing Education or the National League forEducation or the National League for Nursing Accrediting Council).Nursing Accrediting Council).
  • 35. Moving ForwardMoving Forward  AACN has created two task forces:AACN has created two task forces:  Essentials of the Doctorate of Nursing PracticeEssentials of the Doctorate of Nursing Practice  Task Force on the Roadmap to the DNPTask Force on the Roadmap to the DNP  Goal is to complete transition to the DNP byGoal is to complete transition to the DNP by 20152015
  • 36. The Essentials of the Doctorate ofThe Essentials of the Doctorate of Nursing PracticeNursing Practice Task Force charged to develop the curricularTask Force charged to develop the curricular and content requirements for the DNP asand content requirements for the DNP as well as identify the competencies to bewell as identify the competencies to be acquired in a DNP program.acquired in a DNP program. The document follows the model of the BSNThe document follows the model of the BSN and Masters Essentialsand Masters Essentials Provides direction for program developmentProvides direction for program development and accreditation.and accreditation.
  • 37. Charge to Task ForceCharge to Task Force Develop the curricular and content requirements forDevelop the curricular and content requirements for the DNP as well as identify the competencies to bethe DNP as well as identify the competencies to be acquired in a DNP programacquired in a DNP program Establish a clear strategy for educational changesEstablish a clear strategy for educational changes and transition, and hallmarks that distinguish theand transition, and hallmarks that distinguish the DNP from existing programs that offer the MasterDNP from existing programs that offer the Master of Science in Nursingof Science in Nursing Identify the critical curricular content that should beIdentify the critical curricular content that should be present and competencies that should be acquiredpresent and competencies that should be acquired in the DNP programs in which master’s preparedin the DNP programs in which master’s prepared nurses seek to acquire the DNPnurses seek to acquire the DNP Develop recommendations and strategies for AACN,Develop recommendations and strategies for AACN, and the full contingent of AACN’s academicand the full contingent of AACN’s academic programs to respond to this transition.programs to respond to this transition.
  • 38. Essentials Reflect Competencies forEssentials Reflect Competencies for All GraduatesAll Graduates DNP MS-APN MS-non-APN BS (nursing) BS (non-nursing) B A C C A L A U R E A T E C O M P
  • 39. Task Force StrategyTask Force Strategy Re-confirm 7 essentials identified by original PracticeRe-confirm 7 essentials identified by original Practice Doctoral Task ForceDoctoral Task Force Read a lot, and consult constituents and leadersRead a lot, and consult constituents and leaders Discuss and deliberate—8Discuss and deliberate—8thth essential addedessential added ““Clinical Prevention and Population HealthClinical Prevention and Population Health for Improving the nation’s Health”for Improving the nation’s Health” Draft document core—the essential competencies andDraft document core—the essential competencies and related curricular contentrelated curricular content Hold regional and stakeholder meeting for feedbackHold regional and stakeholder meeting for feedback Post draft document on web site for feedbackPost draft document on web site for feedback
  • 40. Preliminary Content for the EssentialsPreliminary Content for the Essentials IntroductionIntroduction Background/Trends leading to this paradigm shiftBackground/Trends leading to this paradigm shift Summary of process and purpose of the documentSummary of process and purpose of the document Context of Graduate Education in NursingContext of Graduate Education in Nursing Relationship of MSN, DNP, and PhDRelationship of MSN, DNP, and PhD Integration of faculty/teaching role in graduate nursing educationIntegration of faculty/teaching role in graduate nursing education Doctoral Education for nursing practiceDoctoral Education for nursing practice Broad curricular model—includes links to specialty certifying bodiesBroad curricular model—includes links to specialty certifying bodies Description of 8 Essentials (document circulated at regionals)Description of 8 Essentials (document circulated at regionals) Curricular Elements (content circulated at regionals)Curricular Elements (content circulated at regionals) DNP Programs in the Academic EnvironmentDNP Programs in the Academic Environment Curricular parameters (eg, typical length/credit hours)Curricular parameters (eg, typical length/credit hours) ResidencyResidency Capstone ProjectCapstone Project Faculty characteristicsFaculty characteristics GlossaryGlossary
  • 41. Format of Section of the DNP EssentialFormat of Section of the DNP Essential Draft Currently Under ReviewDraft 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
  • 42. Overview of the Curriculum ModelOverview 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.
  • 43. Core Essentials 1-7 Specialty Focused Competencies** *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
  • 44. Recommended DNP ContentRecommended DNP Content Some content overlaps or is noted multiple times due to the synergistic nature of competencies and the utility of some content for more than one essential. Content ≠ Course
  • 45. Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates 1. Scientific underpinnings for practice Recognizes the philosophical and scientific underpinnings essential for the complexity of nursing practice at the doctoral level. 2. Organizational and systems leadership for quality improvement and system thinking Recognizes the competencies essential for improving and sustaining clinical care and health outcomes, eliminating health disparities, and promoting patient safety and excellence in care.
  • 46. Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates 3. Clinical scholarship and analytical methods for evidence-based practice Recognizes competencies essential for translation of research into practice, evaluation of practice, practice improvement, and the development and utilization of evidence-based practice. 3. Technology and information for the improvement and transformation of patient-centered health care Recognizes competencies essential to manage, evaluate, and utilize information and technology to support and improve patient care and systems.
  • 47. Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates 5. Health care policy for advocacy in health care Recognizes the responsibility nurses practicing at the highest level have to influence safety, quality, and efficacy of care, and the essential competencies required to fulfill this responsibility. 5. Interprofessional collaboration for improving patient and population health outcomes Recognizes the critical role collaborative teams play in today’s complex health care systems and the competencies essential for doctorally prepared nurses to play a central role on these teams.
  • 48. Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates 7. Clinical prevention and population health for improving the nation’s health Added to original competencies in response to: • IOM 2001 call for transformation “…of health professional education in response to the changing needs of the population and the demands of practice.” • Health People 2010 support of IOM and objective to include “core competencies in health promotion and disease prevention” in clinical education • In consideration of nursing’s the longstanding focus on health promotion and prevention
  • 49. Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates 8. Advanced nursing practice for improving the delivery of patient care Recognizes the essential competencies reflectiveRecognizes the essential competencies reflective of the distinct, in-depth knowledge and skills thatof the distinct, in-depth knowledge and skills that form the basis for nursing practice at the highestform the basis for nursing practice at the highest level regardless of practice role.level regardless of practice role.
  • 50. To Divide or Not to Divide: That is theTo Divide or Not to Divide: That is the Question (Apologies to Hamlet)Question (Apologies to Hamlet) 8a. APN or individual and population-focused8a. APN or individual and population-focused competencies for the DNP graduatecompetencies for the DNP graduate Recognizes the unique competencies associated with theRecognizes the unique competencies associated with the specialized knowledgespecialized knowledge and clinical expertise essentialclinical expertise essential for the direct care of individuals, families, or discretefor the direct care of individuals, families, or discrete population aggregates.population aggregates. 8b. Systems or organization-focused competencies for8b. Systems or organization-focused competencies for the DNP graduatethe DNP graduate Recognizes the unique competencies associated with theRecognizes the unique competencies associated with the organizational expertise and specialized knowledgeorganizational expertise and specialized knowledge essential for leadership of health care delivery systems.
  • 51. Transforming Professional NursingTransforming Professional Nursing PracticePractice  Issues are centrally focused on preparingIssues are centrally focused on preparing professional nurses with the highest level ofprofessional nurses with the highest level of education to provide expert nursing careeducation to provide expert nursing care  Will not disenfranchise current APNsWill not disenfranchise current APNs  DNPs will serve as the natural allies ofDNPs will serve as the natural allies of researchers for the full implementation ofresearchers for the full implementation of evidence for practiceevidence for practice  Discipline needs both researchers and high levelDiscipline needs both researchers and high level clinicians to provide high quality careclinicians to provide high quality care
  • 52. What Are the Issues?What Are the Issues? Perspectives from the AnesthetistPerspectives from the Anesthetist  Should all APNs be expected to meet theShould all APNs be expected to meet the requirements for the foundational framework ofrequirements for the foundational framework of the DNP Essentials?the DNP Essentials?  How long?How long?  Who set the expectations for specialty practiceWho set the expectations for specialty practice education? The DNP is specialty focusededucation? The DNP is specialty focused education.education.  Do we really need that content? Reframing whatDo we really need that content? Reframing what is – not always adding more.is – not always adding more.
  • 53. What Are the Issues?What Are the Issues? Perspectives from the AnesthetistPerspectives from the Anesthetist  What about the programs that are not housed inWhat about the programs that are not housed in a nursing school? Depends upon who sets thea nursing school? Depends upon who sets the standards for those programs.standards for those programs.  How will we assure that all the programs areHow will we assure that all the programs are requiring similar outcome competencies? Is thisrequiring similar outcome competencies? Is this an accreditation issue – and not an assault on thean accreditation issue – and not an assault on the need to change the degreed?need to change the degreed?  What does it mean to be foundational?What does it mean to be foundational?
  • 54. What Are the Issues?What Are the Issues? Perspectives from the AnesthetistPerspectives from the Anesthetist  There is no compelling evidence to do this?There is no compelling evidence to do this? -------Shouldn’t you get the degree you deserve-------Shouldn’t you get the degree you deserve for the time and energy you are required tofor the time and energy you are required to undertake to complete the program?undertake to complete the program?  Where will we get the faculty? They are there –Where will we get the faculty? They are there – we need to think differently about who willwe need to think differently about who will serve as faculty and remember how we beganserve as faculty and remember how we began other innovations in nursing.other innovations in nursing.
  • 55. How are other health professionsHow are other health professions changing their education?changing their education?  The ACGME requires that all residencyThe ACGME requires that all residency programs evaluate the competence of theirprograms evaluate the competence of their residents in the following areas:residents in the following areas:  patient care,patient care,  Practice-based learning and improvementPractice-based learning and improvement  medical knowledge,medical knowledge,  interpersonal and communication skills,interpersonal and communication skills,  professionalism, andprofessionalism, and  systems-based learningsystems-based learning
  • 56. AANA Summit on the DNPAANA Summit on the DNP  While the nurse anesthetist of today is safe andWhile the nurse anesthetist of today is safe and competent, the provider of the future will havecompetent, the provider of the future will have to possess enhanced skills in analysis andto possess enhanced skills in analysis and synthesis of research and be able to apply themsynthesis of research and be able to apply them in the practice setting.in the practice setting.
  • 57. AANA Summit on the DNPAANA Summit on the DNP  Practitioners will need increased knowledge inPractitioners will need increased knowledge in business skills, management of less invasivebusiness skills, management of less invasive procedures, multicultural healthcare, andprocedures, multicultural healthcare, and biomedical ethics.biomedical ethics.  Subspecialties in practice will continue to emergeSubspecialties in practice will continue to emerge in areas such as pediatrics and pain management.in areas such as pediatrics and pain management. (Populations??)(Populations??)
  • 58. What are the Transition Issues?What are the Transition Issues?  Creating standards to assure quality programsCreating standards to assure quality programs with consistency in goals and outcomeswith consistency in goals and outcomes  Creating partnerships across multiple institutionsCreating partnerships across multiple institutions to achieve goalto achieve goal  Seeking creative solutions to issues related toSeeking creative solutions to issues related to resources, faculty, regulatory structuresresources, faculty, regulatory structures
  • 59. What are the Transition Issues:What are the Transition Issues:  Collaboration with multiple constituents toCollaboration with multiple constituents to create agreement on issues related tocreate agreement on issues related to credentialing – including licensure, certification,credentialing – including licensure, certification, and accreditationand accreditation
  • 60. They say that timeThey say that time changes things. But youchanges things. But you actually have to changeactually have to change them yourselves.them yourselves. Andy WarholAndy Warhol
  • 61. Truth springs fromTruth springs from arguments amongarguments among friends.friends. David HumeDavid Hume
  • 62. Wise SayingsWise Sayings  Remember - this ain’t a dress rehearsalRemember - this ain’t a dress rehearsal  Famous nurse – Carole AndersonFamous nurse – Carole Anderson
  • 63.  ““Today as in the past, nursing remainsToday as in the past, nursing remains pivotal in improving the health status ofpivotal in improving the health status of the public and ensuring safe, effective,the public and ensuring safe, effective, quality care.”quality care.” ANA Scope and Standards of PracticeANA Scope and Standards of Practice
  • 64. Creating the FutureCreating the Future  We have a responsibility to create the future forWe have a responsibility to create the future for our patients, for our profession, and for theour patients, for our profession, and for the health of the public.health of the public.