The Evolving Roles of the Doctorally Prepared Nurse Doctoral Symposium 2016 GA Nursing Leadership Coalition Joan Stanley, PhD, CRNP, FAAN, FAANP Chief Academic Officer, AACN
Disclosures !  There
are no conflicts of interest or relevant financial interest by the presenters.
!  There
is no commercial support of this activity.
Objectives ! Describe
the current state of doctoral education in nursing ! Discuss the rationale for moving all advanced nursing practice to the doctoral level ! Describe the opportunities and needs for nurses with advanced education now and in the near future
AACN’s Scope !
Serves as the national voice for baccalaureate and graduate nursing education
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Membership includes more than 780 colleges and universities with more than 457,000 students and more than 19,000 full-time faculty employees
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Represents the entire academic unit including deans, faculty, staff, and students
AACN Strategic Framework
Introducing a bold new direction for AACN and academic nursing‌
Vision Statement Nurses are leading efforts to transform health care and improve health.
noun: something that you see or dream
Mission Statement As the collective voice for academic nursing, AACN serves as the catalyst for excellence and innovation in nursing education, research, and practice. noun: a task or job that someone is given to do
About AACN !
Sets standards for higher education in nursing, focuses on professional development for deans and faculty, collaborates with a wide spectrum of stakeholders on key issues, and advocates for federal support for the programs we represent
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Accreditation arm for baccalaureate and graduate degree programs – Commission on Collegiate Nursing Education (CCNE)
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Certification arm to credential Clinical Nurse Leaders – Commission on Nurse Certification (CNC)
AACN Member Institutions by State
IOM The Future of Nursing (2010) Key Messages: !
!
!
!
!
Nurses should practice to full extent of their education and training Nurses should be full partners with physicians and other HPs in redesigning HC in U.S. Remove scope of practice barriers for APRNs Expand opportunities for nurses to lead improvement efforts Double the number of nurses with a doctorate by 2020
3,500,000 3,000,000
Number of RNs with Doctoral Degrees 2000-2008 3,063,162
2,909,357 2,694,540
2,500,000 2,000,000
Target = 56, 738 by 2020
1,500,000 1,000,000 500,000 17,256
26,100
28,369
0 2000
2004 Number of RNs with a Nursing Doctorate
2008 Number of RNs
U.S. Department of Health and Human Services, Health Resources and Services Administration. (2010). 2008 National Sample Survey of Registered Nurses. Rockville, MD.
AACN Vision for Nursing Education !
AACN Parallel positions/initiatives " BSN is the minimum education required for entry into
professional nursing practice
" Master’s education should focus on preparation of
individuals practicing at the microsystem level but with higher level and additional knowledge and skills, e.g. the Clinical Nurse Leader (CNL) (clinical manager) and administrative manager are two examples
" All advanced nursing practice education should be at the
practice doctorate level (DNP), including all APRNs
" Preparation of nurses in research-focused programs is
imperative to advance the science of nursing
AACN’s Position on DNP !
In 2004, PS on the Practice Doctorate in Nursing " Membership endorsed transition of all advanced
nursing practice education, including the 4 APRN roles, to the practice doctorate " Set a target goal for transition of APRN programs to the DNP by 2015 !
In 2010 & again in 2015, AACN Board reaffirmed its position on the DNP
Growth in Doctoral Nursing Programs: 2005-2015 350 288
300
269 241
250
217
200
182 153
150 103
111
134 132 124 126 131 131 116 120
120 92
100 53 50
20
0 Number of PhD Programs 2006
2007
2008
Number of DNP Programs 2009
2010
2011
2012
2013
2014
2015
25000
20000
Enrollments in Doctoral Nursing Programs: 2006-2015
21995
18352 15000
14699 11575
10000
8973 7037
5000
3927
3982
3976
5165 4177
3415 0
862 2006
4611
4907
5110
5098
5290
5035
2014
2015
1874 2007
2008
2009
2010
Research-Focused Doctorate (PhD)
2011
2012
2013
Doctor of Nursing Practice (DNP)
Enrollments and Graduations in Doctor of Nursing Practice (DNP) Programs, 2003-2015 Enrollments
24,000 23,000 22,000 21,000 20,000 19,000 18,000 17,000 16,000 15,000 14,000 13,000 12,000 11,000 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0
Graduations 21,995
18,342
14,688 11,575 9,094 7,034 5,165 1,874 70
17
2003
Programs: 2 Response: 100%
170
7
392 44
2004
2005
3 100%
11 100%
862
74
2006
20 100%
122 2007
53 100%
3,065
3,415 1,595 361 2008
91 100%
4,055
2,443 660
1,282
1,858
2009
2010
2011
2012
2013
2014
2015
120 100%
153 99.2%
183 99.5%
217 99.5%
247 98.4%
264 98.1%
288 99.0%
Source: AACN IDS 2008-2014 ; Data is result of an agreement between AACN and NACNS
Enrollments and Graduations in DNP Programs Post-Baccalaureate DNP Enrollment Graduations
2007
2008
2009
2010
2011
2012
2013
2014
2015
186
575
1,060
1,887
3,036
5,031
6,299 8,916
11
23
48
40
103
280
483
715
2009
2010
2011
2012
2013
2014
2015
1,688 2,840 4,105 5,147 6,058 6,455 8,389
9,436
10,889
2,350
2,917
11,106 1,183
Post-Master’s DNP 2007 Enrollment Graduations
111
2008
338
Source: AACN IDS 2008-2016
612
1,242 1,492 1,578 1,960
Schools Offering PhD and Other Research-focused Doctoral Degrees in Nursing in Georgia, Fall 2015* (N=6) 5 4
4
Number of Schools
4 3 3 2 2 1
1
1
EdD in Nursing Educa6on
Doctor of Nursing Science (DNS)
1 0 PhD in Nursing
Five-Year Research-focused Doctoral Enrollment and GraduaJon Changes in the Same Schools in Georgia (N=6*) 160 140
140
Number of Students
120
138
130 118
110
100 80
Enrollment Gradua6ons
60 40 20
13
18
15
10
18
0 2011
2012
2013
2014
Year
Total Graduations = 74
2015
Five-Year DNP Enrollment Changes in the Same Schools in Georgia (N=8*) 350
312
300 250
220
200 150
90 96
100 50
185
172 111 100
125
137
Post-Baccalaureate DNP
127
Post-Master's DNP
83
DNP Total
47 6
11
0 2011
2012
2013
2014
2015
Year
Five-Year DNP GraduaJon Changes in the Same Schools in Georgia (N=8*) 50 45 40 35 30 25 20 15 10 5 0
43 39
42 42 34 34
Post-Baccalaureate DNP
21 21 15 15
0 2011
0 2012
0 2013 Year
Post-Master's DNP 0 2014
4 2015
DNP Total
Number of Schools Offering DNP Programs Source: AACN IDS 2016 (# of programs in GA) Area of Study
Post-Baccalaureate (2 schools in GA)
Post-Master’s (8 schools in GA)
Nurse Midwifery
11
12
Nurse Anesthesia
31
31 (1)
CNS
26
31 (1)
151 (2)
146 (4)
Administration
29
51 (2)
Informatics
7
10
CH/PH
16
17
Leadership
42
88 (2)
40 (1)
113 (8)
NP
Other
Number of DNP NP Programs Source: AACN IDS 2016 Track/National Certification
Post-Baccalaureate
Post-Master’s
Family NP
138
63
Pediatric Primary Care NP
40
17
Pediatric Acute Care
12
7
Neonatal NP
19
10
Women’s Health NP
13
6
Adult-Gero Primary Care
71
28
Adult-Gero Acute Care
37
18
Psych/MH across the Lifespan
58
29
Why do we need more nurses prepared at the doctoral level? What is happening in healthcare and higher education?
Forecasting ------------Jeffrey Bauer (2016) Acute care
disease management Increase in information and communication sciences No Growth in spending Increased population health focus
Individualized care = cost-effective care Patient-centered care teams
Improving Health and Health Care Simultaneous pursuit of three aims: ! ! !
improving the experience of care, improving the health of populations, and reducing per capita costs of health care
To deliver care that is: ! ! ! ! ! !
Health
Experience of Care
Cost per Capita
Team-based, integrated delivery systems Practice at the highest level of competence Interprofessional Person-centered Population-focused Moving away from acute care and hospital centered to community, prevention and wellness
25
Leadership in Nursing Education & Practice Issue: Changing Demographics & Care Needs " By 2030, there will be about 72.1 million older persons in
the U.S. representing 19% of the population. " Currently, 54% of citizens under the age of one come from racial/ethnic minority groups. Our present and our future. " Increasing chronicity is being reported in both pediatric and adult populations. " Increasing complexity of care needs and of healthcare system " Increasing globalization
Leadership in Nursing Education & Practice
Issue: Technology-Enhanced Education & Practice Access to health information Open access higher education courses & life long learning (MOOCs, certificates, badges) Patient monitoring Telehealth Integrated access to patient information
! ! ! ! ! " " "
Global health system To assess risks Evaluate outcomes
Leadership in Nursing Education & Practice Issue: Interprofessional Education & practice !
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As health care becomes more team-based, faculty must educate nurses to thrive in a variety of collaborative models. Patient-centered IP team-based care " Nursing led " Nursing designed
Leadership in Nursing Education & Practice Issue: New and Expanding Care Models !
What are nurses’ roles and how can nurses have the greatest impact on care outcomes? " Integrated Care Models " Accountable Care Organizations " Patient-Centered Medical (Health) Homes " Nurse-Managed Health Centers " Community Health Centers
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New payment models " Value Based Purchasing (VBP) " Pay for Performance (PFP)
Leadership in Nursing Education & Practice Issue: Preparing Nurses to Lead !
In keeping with the IOM report’s core recommendations, leadership-related competencies should be embedded in all levels of nursing education programs. " Leadership development must be promoted to ensure
that nurses are full partners in redesigning and overseeing health care in the US. " Nurses should be encouraged to serve on boards and be “at the table” for key policy discussions at all levels.
Leadership in Schools of Nursing Issue: Academic-Practice Partnerships !
Educating nurses to thrive in today’s healthcare system requires a strong commitment and close collaboration from both nurse educators and their counterparts in practice. " Schools seek partners to enhance clinical learning
opportunities, expand faculty expertise, bridge resource gaps, and meet other needs.
AACN – New Era for Academic Nursing
In February 2015, the AACN Board of Directors commissioned Manatt Health to conduct a study on how to position academic nursing to thrive in an era of healthcare transformation.
Recommendations
Opportunities & Needs for Doctorally Prepared Nurses Faculty Practice/ At the POC
End of Life
Information Science
Health Policy
Translational Science Regulation
Prevention
Informatics
Quality Improvement
System Leadership Population Health
Research
APRNs
Public Health
Evaluation Science
Occupational Health
Genomics Chronic Disease Management
Global Health
Characteristics of our doctorally prepared nurses ! ! ! !
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Innovative & flexible Strong IP Communication skills Strong professional identity Understand systems, budgets, economics/ payment systems Understand populations & population health
! ! !
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System thinking Need to be at the table Use language that others at the table and the public understand Confident; Positive clear vision Disseminate our work
Resources !
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AACN (2004) Position Statement on the Practice Doctorate in Nursing www.aacn.nche.edu/DNP/DNPPositionStatement.htm AACN (2006) Essentials of Doctoral Education for Advanced Nursing Practice www.aacn.nche.edu/DNP/pdf/Essentials.pdf AACN (2010) The Research-Focused Doctoral Program in Nursing: Pathways to Excellence.
http://www.aacn.nche.edu/education-resources/ PhDPosition.pdf AACN (2015) WP on the DNP: Current Issues and Clarifying Recommendations http://www.aacn.nche.edu/news/articles/2015/ dnp-white-paper
Resources !
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Manatt. (2016). Advancing Health Transformation : A New Era for Academic Nursing. http://www.aacn.nche.edu/AACN-Manatt-Report.pdf RAND Corp (2014) The DNP by 2015 A Study of the Institutional, Political, and Professional Issues that Facilitate or Impede establishing a Post-Baccalaureate DNP Program http://www.aacn.nche.edu/dnp/DNP-Study.pdf