Department of Nursing

11

Department of Nursing

Graduate Program

New Program Proposal

Doctorate in Nursing Practice Program

(i)Rationale for the Doctorate in Nursing Practice Program

The Doctorate of Nursing Practice (DNP) degree prepares graduates to provide the most advanced level of nursing care for individuals, families, groups, and communities. This includes the direct care of individual patients, management of care for individuals and populations, administration of nursing systems, and the development and implementation of health policy. Similar to other disciplines, doctoral programs in nursing can be categorized into two distinct types: research-focused and practice-focused. The DNP is a practice-focused program and therefore analogous to professional degrees offered in other disciplines including entry-level degrees [e.g. the Doctor of Medicine (MD), Doctor of Dental Surgery (DDS), and the Doctor of Pharmacy (PharmD)], and those that offer advanced degrees (e.g., the Doctor of Psychology or PsyD).

The proposed DNP program provides registered nurses (RN) and masters prepared nurse practitioners with the advanced knowledge and clinical skills to serve as change agents through system redesign and evidence based decision making within a variety of clinical, academic, and other organizational settings. Graduates will be providing health care services in primary, secondary, and tertiary settings in primarily rural, medically underserved communities with the capability of practicing across clinical settings. The proposed program consists of two tracks, an MSN to DNP and a BSN to DNP. The patient population focus for the advanced nursing practice component of the program consists of families and individuals across the lifespan [Family Nurse Practitioner, (FNP)]. Courses will be delivered on a part-time basis, using a combination of on-campus and online (hybrid) methods. Clinical internship hours may be completed in the students community with an approved preceptor.

In addition to the advanced nursing practice component, students will take elective courses in nursing education. The nursing education emphasis will provide the necessary means and preparation to enable graduates to function as nurse educators. The proposed DNP program fulfills a local, regional, and national need for doctorally prepared advanced practice nurses. Our program was designed to be in full compliance with professional standards for the practice doctorate as set forth by the American Association of Colleges of Nursing (AACN, 2006). The AACN is considered to be the national voice for baccalaureate and higher-degree nursing education programs and has recommended that all masters in nursing programs transition to the Doctorate of Nursing Practice by 2015. The AACN developed this position after an intensive study of the health care system based on an analysis of findings and recommendations from many national groups. Results from the analysis indicated that the nursing professions current practice of preparing advanced practice nurses in masters degree programs is no longer adequate based upon the growing complexity of health care compounded by an escalating demand for services, burgeoning growth in scientific knowledge, and increasing sophistication in technology.

The need for transformation in healthcare delivery has been supported by several national studies including the November 1999 report by the Institute of Medicine (IOM) on medication errors; To Err is Human: Building a Safer Health System. This report, extrapolating data from two previous studies, estimated that somewhere between 44,000 and 98,000 Americans die each year as a result of errors in health care. These numbers, even at the lower levels, exceed the number of people that die each year from motor vehicle accidents, breast cancer, or AIDS. The national costs of preventable adverse healthcare events (injury and errors) were estimated to be between $17 billion and $29 billion, of which health care costs represented over one-half. The IOM report focused on the fragmented nature of the healthcare system and the context in which health care is provided as being major contributors to the high and inexcusable error rate that compromises patient safety. To combat this problem, a focus of DNP programs is to educate nurses who are able to effect systems level change to improve patient care outcomes.

Other IOM reports also support the need for the DNP. The report, Crossing the

Quality Chasm (2001), stresses that our health care system as it is currently structured does not make the best use of resources. Changing demographics in our country including the increase in the numbers of elderly and development of new services and technologies have contributed to increasing costs. Waste of resources, however, is a significant problem. One of the recommendations in the report calls for all health care organizations and professional groups to promote health care that is safe, effective, client-centered, timely, efficient, and equitable (p.6). In a follow-up report, Health Professions Education: A Bridge to Quality (2003a), the IOM Committee on Health Professions Education stated that All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics (p.3). DNP programs are a direct outcome of nursings plan to address the IOM challenges. Nurses prepared in practice doctoral programs have a blend of advanced practice (clinical), advanced inquiry, organizational, economic, and leadership skills to enable them to critique nursing and other clinical scientific findings and design programs of care delivery that are locally acceptable, economically feasible, and have significant impact on health care outcomes.

In a more recent report, The Future of Nursing: Leading Change, Advancing Health (2010), the IOM and the Robert Wood Johnson Foundation (RWJF) provided recommendations for the future of nursing. These recommendations included enabling nurses to practice to the full extent of their education, providing seamless academic progression so that nurses can achieve higher levels of education and training, encouraging nurses to be full partners with physicians and other health care providers in redesigning health care in the U.S., and improving the infrastructure for collecting and analyzing workforce data. In this report, the committee strongly suggested that nurses obtain the highest levels of education, consistent with the DNP, with competencies in leadership, health policy, system improvement, research, and evidence based practice to ensure that patients receive safe, high-quality care across settings.

During the past three decades, the doctorate has become firmly established as the terminal degree in nursing. As doctoral programs developed, priority was placed on research focused education that would lay the groundwork for knowledge development in the nursing profession. Tremendous strides have been made in the development of nursing science because of PhD programs. Unfortunately, according to the Agency on Healthcare Research and Quality (AHRQ, 2005) it can take up to 20 years for new knowledge to be integrated into practice. This agency calls for the preparation of a nursing professional that has the capacity to evaluate new knowledge and apply this new knowledge to improve health care outcomes and develop new systems of care. The nurse prepared in a DNP program is a valuable counterpart to the nurse prepared in a PhD program in nursing. While the PhD prepared nurse conducts research to provide new knowledge, the DNP prepared nurse focuses on developing systems of care based on research utilization. DNP graduates are experts in designing, implementing, managing, and evaluating health care delivery systems and patient populations. DNP graduates are prepared to lead at the highest practice and executive ranks in nursing.

Nursing Shortages

There is a current shortage of all types of registered and advanced practice nurses including an acute shortage of doctorally prepared nurses. Although the economic recession has eased the nursing shortage temporarily, the number of nurses needed is still expected to grow to 260,000 by 2025 and workforce analysts continue to predict significant nursing shortages (AACN, 2010). In addition, current nursing faculty shortages have led to reductions in student admissions to nursing programs, thus furthering nursing shortages in the service sector. The AACN reports that 54,000 qualified applicants to baccalaureate and graduate nursing programs were denied admission in 2009, including more than 9,500 applicants to masters and doctoral degree programs. Faculty shortages were identified as the primary barrier to accepting qualified students with contributing factors consisting of budget constraints, aging faculty, and increasing job competition from clinical sites. AACN data shows a national nurse faculty vacancy rate of 6.6 % with most faculty vacancy positions (90.6%) requiring a doctoral degree. Of the three million nurses in the U.S., fewer than one percent have a doctoral degree, and just over ten percent hold a masters degree in nursing. The proposed DNP program will facilitate the preparation of more doctorally prepared nurses and thereby increase the numbers of well prepared professional nurses to assume leadership positions in health care and in nursing education.

Physician Shortages According to a recent report on physician supply and demand estimates by the U.S. Department of Health and Human Services (HHS, 2006), physician supply is estimated to increase from 817,000 active physicians in 2005 to approximately 952,000 active physicians by 2020. However, during th