President's Point

The Mentor, Volume 13, Number 1, 2002

Shaping New Paradigms for NP/APN Education?

The nurse practitioner of the future—what does s/he look like? We have glimpses of the future today—we just are not sure which phenomena will reach the “tipping point” and become established practice for advanced practice nursing. First, the nurse practitioner (NP) workforce responds to market demands; then NP education follows with new educational programs and ultimately new educational paradigms; and, finally, regulatory bodies act to ensure public safety. The market demand is for advanced nurses who can 1) deliver health care with ever higher knowledge, technical skills, and behavioral change (risk reduction and disease management) competencies, 2) manage care across the health continuum and health delivery system with consumer satisfaction and cost effectiveness, 3) participate in health systems as leaders and managers, and 4) be held accountable for specific health and system outcomes.

The market demands can be seen in the change in NP practice settings. The largest increase of NPs between 1996 and 2000 occurred in hospitals (almost 15,000 more NPs at 126% growth) (Nichols, 2002). Other sites with substantial percent growth but smaller actual numbers were in occupational health, student health, and nursing homes. Yet, without comprehensive NP workforce data, we rely often on anecdotal evidence to guide our forecasts. Cooper (2002) forecasts a shortage of primary care physicians and sees a potential for NPs to fill that void. Also, medical specialty services are hiring primary care NPs, presumably because of their broad scope of practice. Acute care NPs cross sites to serve in primary care roles as well as specialty roles. The clinical nurse specialist (CNS) role has attracted new interest in employers who have re-identified the need for an advanced specialty clinician with system-oriented competencies (including care manage-ment, CQI, and training/support for the dwindling supply of staff nurses).

The educational industry has responded to market demands by increasing the number of semester and/or clinical contact hours, shifting content, creating dual/blended role preparation and joint degrees, and conceptualizing new clinical doctorates which focus either on the systems aspects or the direct practice aspect of advanced practice. The CNS programs, with the APN core of advanced health assessment, pharmacology, physiology/pathophysi-ology, are increasingly similar to traditional NP programs. The NP programs, with enhanced health systems and business content, resemble much of traditional CNS programs. The result is more flexible APN roles, but the overlapping and distinct scopes create challenges for organizations responsible for accreditation, certification, and regulation.

Through all of this change, NONPF remains the major force in advancing quality NP/APN education. We have had the privilege of being leaders and members of numerous collaborative partnerships convened to set NP curriculum guidelines and standards, competencies, and program evaluation criteria and to gather reliable and valid and reliable data to support each quality assurance product. The upcoming annual conference in Minneapolis will address our current dilemmas with stimulating presentations, speaker-audience dialogues, poster sessions, and informative exhibits. Come join the last event of my NONPF presidency and help shape the future paradigm for nurse practitioner education.

Lucy Marion, PhD, APRN, BC, FAAN

P.S. Thank you for a most challenging and rewarding leadership position during the past 3 years. You make up an energetic, creative, and productive membership beyond any other in my experience. I intend to be fully engaged with you in my role as member in the future. Ever onward.

References:

Cooper, R.A., Getzen, T.E., McKee, H.J., & Laud, P. (2002). Economic and demographic trends signal an impending physician shortage. Health Affairs, 21(1), 140-154.

Nichols, L.M. (2002). What role for NPs in a changing health care system? Presented at the American College of Nurse Practitioners Summit, February 2, 2002, Washington, DC.