PD resource





	Practice Doctorate Resource Center
	Topics for Discussion During "The Clinical Doctorate: Innovation or Disruption" Panel Discussion Sunday, April 14, 2002 As we address how to rethink and reshape the future directions for leading edge NP education, NONPF must look at the environment for change and address how the educational industry can best respond to the societal trends, including market demands for high quality health care, with advanced nursing roles. The discussion during the Sunday plenary session will address how clinically-oriented doctoral education in nursing will meet the quality health care requirements. We present the following highlights of the current market forces, the educational responses to date, the potential approaches for the future, and the questions remaining to guide the discussion and to seek meaningful feedback from our members and panelists as NONPF pursues an analysis of the paradigm for the future. Demands from the Health Care Market Society and the health care market have an expectation that Advanced Practice Nurses (APNs) can do the following: Deliver health care with ever higher knowledge, technical skills, and behavioral change (risk reduction and disease management). With the impending shortage of physician primary care providers, the demand for APNs, and specifically nurse practitioners (NPs), in these roles intensifies. Manage care across the health continuum and health delivery system with consumer satisfaction and cost effectiveness. There is a shortage of primary care that includes services at a higher level of complexity and acuity, e.g., primary care across the health continuum, evaluation of client needs in emergency departments and on call, and co-management of care with specialists during hospitalizations. Participate in health systems as leaders and managers. To improve the quality of care in the health care system, all advanced care providers - including nurses - will need to assume leadership roles to ensure a culture of safe, effective, patient-centered, timely, efficient, and equitable care Be held accountable for specific health and system outcomes. APNs, including NPs, need systems- oriented competencies, including care management and continuous quality improvement (CQI). These competencies, as well as those related to managing the business of health care and management of systems, are essential for nurse practitioners. APN/NP Trends Nurse practitioners represent the largest percentage of currently practicing APNs and master's nursing graduates. The largest increase of NP work sites between 1996 and 2000 occurred in hospitals (almost 15,000 more NPs at 126% growth). Other sites with substantial percent growth but smaller actual numbers were in occupational health, student health, and nursing homes. Newly graduated NPs are not only from traditional nursing backgrounds; a new cadre enters educational programs with undergraduate degrees other than in nursing. These students expect credentials that reflect the years of formal schooling and their anticipated contribution to health care. Educational Response to Trends - To date Master's level NP programs adjusted their curricula by: increasing the number of semester and/or clinical contact hours; shifting content; and creating dual/blended/complementary role preparation and joint degrees. Different doctoral programs: The PhD and the DNS for nurses to generate new knowledge. The Nursing Doctorate (ND) with a clinical focus. The Doctorate of Nursing Practice for clinical leaders to improve individual, population, and systems level outcomes (DNP). The Doctorate of Nursing Practice to prepare independent primary care providers with competencies at high levels of acuity and complexity (DrNP). Results of Educational Responses Increased variability among NP educational programs (e.g., titling, blending). Increased time needed for NP role preparation. Rapid growth in NP programs, although now starting to stabilize. Inequity of level of preparation with other disciplines. As the length of the NP program increases with added content and clinical hours, the degree award remains at the master's level whereas graduates of educational programs in other disciplines receive doctoral level degrees for comparable, or even less, time in training. Increasing costs for NP preparation. Increased evidence of NPs practicing and being credentialed for cross-site practice and obtaining reimbursement. Improved image of nursing that draws students from other areas of undergraduate preparation. Possible Educational Approaches to Prepare the NP of the Future Option 1a: A clinical doctorate based on consensus among selected stakeholders - focused on 1) direct care or 2) health systems leadership Option 1b: A clinical doctorate based on consensus among selected stakeholders which has equal foci on advanced direct care and health systems leadership Option 2: One-year residency of intensive clinical preparation either built into the Master's program or into a post-master's. Option 3: Collaborative team preparation through interdisciplinary education. Option 4: Standardized curriculum revision through more specific curriculum guidelines to address competencies at a higher level of acuity and complexity. Option 5: Status quo, i.e., continue Master's level preparation in current form. Questions/Issues to Address for Each Option Does it raise the bar for quality NP/APN education, through preparation of future leaders in and of systems who have achieved high acuity and complexity competency, preparation for delivering the continuum of care, and skill in the business of health care practice? What will be the cost of NP education of the future relative to existing NP and other professions' programs and how will it be funded? How will NPs remain a single credible and recognizable type of health care provider in the health care workforce with different layers of credentials? How do we not disenfranchise the current workforce (medical and nursing)? Will there be a standardized curriculum for all advanced nursing providers/NPs? Is this what we need/want? How will the public understand new credentials or different levels of NP preparation? Will the credentials match the level of preparation? How will different credentials or different preparation level impact (a) regulation, (b) certification, (c) state practice acts, and (d) reimbursement? How will the new educational program fit in the nursing accreditation model? What is the feasibility of change through implementing a different design of the NP program? How will NP education continue to accommodate the working student? What is the value-added portion of the option in today's health care climate? Potential Stakeholders Health care Consumers Students Faculty Educational Administrators National Nursing Organizations Health Care Clinicians (all disciplines) Regulators Legislators Systems Administrators


	National Organization of Nurse Practitioner Faculties (NONPF) 1522 K Street, NW, Ste. 702 Washington, DC 20005 tel: (202) 289-8044 ● fax: (202) 289-8046 nonpf@nonpf.org President: Ann O'Sullivan, PhD, CRNP, CPNP, FAAN