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
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