The Doctor of Nursing Practice at UAA

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The Doctor of Nursing Practice at UAA
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How We Got To Where We Are
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The Institute Of Medicine Called Attention to
Problems Facing Health Care 1999To Err is
Human, focused on fragmented nature of health
care 2001Crossing the Quality Chasm, calls for a
restructuring of healthcare 2003Health
Professions Education A Bridge to Quality call
for educators to prepare health care providers
for a new type of practice as members of
interdisciplinary teams that emphasize
evidence-based practice, quality improvement, and
informatics
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National Academy of Sciences 2005 Report on
Nursing Research

• The Report Focuses on the need for
• Increasing the Number of Nurse Scientists and
• Increasing the Number of Productive Research
  Years for Nurses Prepared in PhD Programs

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National Academy of Sciences 2005 Report

• Calls for a distinction between
• the educational needs and goals of nursing as
  a practice profession that require practitioners
  with clinical expertise from Nursing as an
  academic discipline and science that requires
  independent researchers and scientists to build
  the body of knowledge (p.74)

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National Academy of Sciences 2005 Report

• 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.

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A Paradigm Shift is Underway in Graduate
Education in Nursing

• A Number of Factors are Converging to Build
  Momentum for a Major set of Shifts
• These Include
• Aging of the Population
• Expansion of Knowledge Underlying Practice
• Increased Complexity of Patient Care
• Major Concerns about Quality of Care and Patient
  Safety
• Shortages of Nursing Personnel Demanding a Higher
  Level of Preparation for Leaders Who Can Design
  and Assess Care and Lead
• Shortages of Prepared Nursing Faculty, Leaders in
  Practice, and Nurse Researchers, and
• Increasing Educational Expectations for the
  Preparation of other Health Professionals

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A Paradigm Shift is Underway in Graduate
Education in Nursing

• Credits required to complete the MSN are
  approaching the number of credits most
  disciplines need for doctoral degree
• many 60 hrs and 3 yrs
• didactic and clinical increased by 72 and 36
  hours respectively for NP programs between
  1995-2000 (AACN NONPF 2002)
• Graduates and employers identify even more
  content is needed (e.g., information and
  practice management, health policy, risk
  management, evaluation of evidence, and advanced
  diagnosis and management, genomics) (Bellack,
  Graber, ONeil, Musham, Lancaster, 1999 Lenz,
  Mundinger, Hopkins, Clark, Lin, 2002).

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An Important Driver is the Growing Desire
Clinically Focused Nurses Have in Advanced Study
that will Enhance their Effectiveness
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The Doctor of Nursing Practice

• Why? Perceived benefits
• Development of needed advanced competencies for
  increasingly complex clinical and leadership
  roles- global health care, genetics, biomedical
  advances
• Better match of program requirements and
  credits/time with credential earned
• Terminal degree and advanced educational
  credential for those who do not need/want a
  research-focused degree
• Enhanced knowledge to improve practice
• Enhanced leadership skills to strengthen practice
  and health care delivery
• Increased number of faculty for clinical
  instruction
• Improved Patient Care Outcomes!

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AACN Position Statement on the Practice Doctorate
in Nursing

• The Doctor of Nursing Practice (DNP) Title
• The practice doctorate is the graduate degree for
  advanced nursing practice preparation, including
  but not limited to the four current advanced
  practice nursing (APN) roles clinical nurse
  specialist, nurse anesthetist, nurse midwife, and
  nurse practitioner.
• A transition period should be planned to provide
  nurses with masters degrees, who wish to obtain
  the practice doctoral degree, an efficient
  mechanism to earn a practice doctorate.
• Practice-focused doctoral programs will be
  accredited by a nursing accrediting agency
  recognized by the U.S. Secretary of Education
  (i.e., the Commission on Collegiate Nursing
  Education (CCNE) or the National League for
  Nursing Accrediting Commission).
• Approved by AACN Membership October 2004

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AACN Position Statement on the Practice Doctorate
in Nursing

• In a separate motion,
• the target date for implementation of the
  recommendations was set at 2015.
• The level of entry for advanced practice nurses
  will be the DNP by 2015.

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The Mission Becomes Apparent
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.
AACN Position Paper on the Practice Doctorate
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Where Do We Go From Here?
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How Important are our NP Programs at UAA?

• The UAA FNP and P/MH NP programs are the only
  advanced practice nursing programs in the state.
• Both programs have been functioning since 1982.
• Both programs offer distance delivery to students
  throughout the state.
• Both programs positively impact quality and
  access to care across the state.
• Approximately 500 NPs practice as primary care
  providers in Alaska.
• 73 of NPs accept Medicare reimbursement.
• 38 of NPs practice in underserved areas of the
  state.
• 36 of NPs practices is comprised of patients
  under 100 poverty level.
• 24 of FNPs practicing in Alaska are graduates of
  the UAA program.
• These data translate to over 200,000 primary care
  visits per year in Alaska provided by UAA FNP
  alumni.

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Does the SON Have the Capacity to Offer the DNP?

• There are currently 14 students in each year of
  the FNP Program.
• An additional eight students have just been
  admitted to the P/MHNP Program for the spring
  semester.
• SON FNP and P/MHNP programs have a strong
  clinical faculty all of whom participate in a
  clinical practice.
• SON has contracted with a DNP Expert to assist us
  with the program and curriculum development.
• A Steering Committee made up of both faculty, UAA
  administrators, NPs in rural areas, and
  stakeholders statewide has been active in
  assisting the progress of the DNP proposal for
  over one year.
• Three NPs, one holding a DNP and the other two in
  DNP programs, have already contacted the SON to
  ask for positions when the DNP opens.
• SON is investigating partnering with other UAA
  programs for course offerings Public Health and
  possibly School of Education for leadership
  courses.

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Is There Interest In Attending the DNP at UAA?

• Student Demand
• Post-Masters
• 2009 survey results (37 return rate)
• 22 (34) expressed interest
• 23 (37) were unsure
• 47.9 (34) of those interested or unsure stated
  that they would attend the DNP at UAA if it were
  offered
• Post Baccalaureate
• 2007 survey results (22 return rate)
• 50 had bachelors degree
• 169 (28) were interested in the FNP Program
• 88 (15) were specifically interested in the DNP

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How Will the Move to the DNP Affect the NP
Programs at UAA?

• The NP Programs will not continue to be
  accredited if we do not move into the DNP as the
  entry level for our NP graduates.
• In order for our advanced practice nursing
  programs to keep pace with other comparable
  programs, it is imperative for our programs to
  ramp up to the DNP level.
• Developing a new curriculum would take some time
  and could not be accomplished in a short time on
  this campus.
• We need to be working on development of these
  changes now in order to keep up with the
  projected timeline for entry into practice.
•  

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Doctoral Education for Nursing Practice
2002AACN forms practice doctorate Task Force
2005(Spring) 8 programs admitting students,
60 schools considering programs 2005(Summer)
80 schools considering programs 2005(Fall) 20
programs approved 140 schools considering
programs 2006--- 16 programs admitting
students 190 schools considering
programs 2007---- 53 programs admitting
students 2008---- 92 programs admitting
students 2009 --- 103 programs admitting
students 93 in development
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Doctoral Education for Nursing Practice

• Between 2007 and 2008 the number of students
  enrolled in DNP programs went from 1874 to 3415,
  which is almost a doubling in one year.
• In the same period of time, students graduating
  from DNP programs went from 122 to 361, which is
  almost a tripling in one year.
• To date, 62 DNP programs have initiated
  accreditation through CCNE.
• With this rapid increase in the number of DNP
  programs functioning in the US, the standard of
  education for advanced practice nursing is
  rapidly increasing to this DNP entry level.

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It is About the FUTURE !!!
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Creating the Future

• We have a responsibility to create the future for
  our patients, for our profession, and for the
  health of the public.