University of Washington _ UW _ School of Nursing _SoN__ Seattle by zhouwenjuan


									University of Washington (UW) School of Nursing (SoN), Seattle: Educational Programs, 2012
and beyond                                                                Appendix M

Internal Talking Points (12/12/11) and background for UW use regarding proposed transitioning to the Doctor of Nursing
Practice (DNP) as the primary entry point for advanced practice at the Seattle Campus. This document is for preparation
purposes only and not for circulation. An external message is available from Phillippa Kassover, senior director for
advancement, for circulation. The Seattle Campus Fact Sheet is linked here.

This document describes the key recommendation and rationale, timing, degree programs offered and Tri-Campus
collaboration, impact to students, communication plan, local and national nursing programs, points of information, and
background/benefits of this transition.

Key Recommendation and Rationale: The faculty of the School of Nursing (SoN), Seattle, met in late November 2011 to
discuss offering the Doctor of Nursing Practice (DNP) as the primary entry point for advanced practice. After much
deliberation, the faculty voted to recommend this change, effective academic Year 2012-2013. Planning is now underway
to fully evaluate this proposed transition to DNP to prepare advanced practice registered nurses (APRNs) at the UW SoN.
Admissions to the Master of Nursing (MN) specialties (see table at the back) will be paused for the 2012-2013 academic
year until final decisions are made utilizing University resources for “Reorganization, Consolidation, and Elimination
Procedures” (RCEP), a set of procedures outlined in the Faculty Code, Chapter 26, Section 26-41.

The DNP was established at the SoN, Seattle, in 2005. The first cohort was post master’s APRNs; the first post-baccalaureate
cohort was admitted in 2007. This move would complete the transition from Master of Nursing (MN) entry into Advanced
Practice Registered Nurse roles to DNP entry, and would align with escalating national demand to prepare APRNs to assume
leadership and educator roles in academia and practice settings. Given compelling health care needs of the state and the
nation, the timing for this change is critical.

The SoN Strategy Map, adopted in August 2011, set strategic imperatives to Advance Research, Education and Practice;
Achieve Operational Excellence; Create a Secure Financial Future; and Build a Sustainable Organization. This proposed
transition is consistent with longstanding and current strategies of the School, national trends in nursing education,
changing needs in the profession, and nursing workforce issues. This transition would also serve the School’s goals to
develop a sustainable, transparent and effective financial model focused on the need to reduce program offerings and
increase efficiency, and align fiscal resources with academic programs. Additionally, the SoN would be able to reduce
program costs, streamline curricular offerings, capitalize on faculty strengths and continue to provide leadership for the
state and nation.

Timing: The timing of this recommendation was made after careful consideration for the students. Any changes to
offerings needed to be made prior to application review and offers of admission for 2012.

Degree Programs: Even after the proposed changes, SoN Seattle will continue to offer six degrees:

    •   Bachelor of Science in Nursing (BSN)
    •   Accelerated Bachelor of Science in Nursing (ABSN)
    •   Masters of Science in Nursing (MS)
    •   Masters of Nursing (MN)
    •   Doctor of Philosophy in Nursing Science (PhD)
    •   Doctor of Nursing Practice (DNP)

Tri-Campus Commitment: The three campuses of the UW SoN – Bothell, Tacoma, and Seattle – will continue to collaborate
in maintaining the Master of Nursing degree. Furthermore, the SoN supports the need to expand student access as needed
to the Master’s level degree at UW Bothell and UW Tacoma campuses. UW’s tri-campus commitment leverages the
complementary strengths of each campus, resulting in expansion of commitment to the continuum of future nursing
educational needs, from Bachelor’s through Master’s and Doctoral levels.

Impact on UW-Seattle Students:
   • All currently enrolled MN students in advanced practice specialties are able to complete their degrees intact with
       strong faculty support for their individual and collective needs.
   • MN and DNP entry to Community Health Nursing (CHN) will not be affected, as CHN is not an Advanced Practice
       Registered Nurse role as defined by the APRN Consensus Model. The Master of Science – Clinical Informatics and
       Patient Centered Technologies (CIPCT) option is not affected for the same reason.
   • All clinical specialties are expected to continue, however, discussions are being held about further streamlining of
       the curriculum, including creating a more robust core curriculum. This new approach will consider fewer offerings
       with larger enrollments, a focus on interprofessional education, improved student advising, and increased
       consistency among specialty offerings. Reduced costs are expected for administrative support due to improved
       processes and fewer offerings.
   • The Master’s—in—Passing (MIP) option is available for students who choose this option while in the Doctor of
       Nursing Practice (DNP) program. They receive a Master’s of Nursing degree. The MIP allows students to complete
       their advanced practice certification exam in their specialty and obtain a Washington license as an APRN while
       finishing the DNP. Since 2007, 36 DNP students have received MIPs, 16 of whom eventually graduated with the
       DNP and 14 of whom are currently finishing their DNP. To date, 3 students have exited with the MIP and 3 are on
   • Additional scholarship money will be identified to meet unmet need.

Communication Plan:
   • The following message was sent to Faculty, Staff and Students and has also been posted on the SoN web site in
     several places for prospective students:
         o The SoN is considering temporarily pausing admissions to MN advanced practice nursing specialties for the
              2012-13 academic year. If this occurs, all affected applicants will be personally contacted and advised of
              alternative program options. A pause would have no effect on currently enrolled students, who would be
              able to complete their current programs in MN specialties. No changes are envisioned for the Master of
              Nursing – Community Health, or the Master of Science – Clinical Information and Patient Centered
              Technologies (CIPCT). All faculty, staff, and students will be informed as soon as a final decision has been
   • Application fees paid by prospective students with current-in-process applications to the affected Master of Nursing
     specialties will be refunded or transferred to the DNP application.

Pausing/RCEP Planning

    •   The faculty voted to pause admission to MN entry into Advanced Practice specialties (Nurse Practitioner, Clinical
        Nurse Specialist, Nurse Midwifery) for 2012-13 while a cost/benefit and impact analysis is conducted. These
        analyses are planned for completion in early Winter 2012, led by the Shared Leadership Council (faculty council
        and department/unit leadership). (see Table on page 7)
    •   Analyses will be used to develop recommendations for faculty consideration. Faculty will vote on RCEP. This will
        likely be done in Winter 2012 as well.
    •   The Master’s—in—Passing is and will continue to be available to DNP students.
    •   Provost and SCPB will receive the RCEP request and make their determinations.
    •   Formal announcement of the decisions would be made to the School and prospective students soon thereafter.

Local and National Nursing Programs:

   •    Washington State University and Seattle University are launching DNP programs in 2012. The UW SoN shared
        proposals, and information about funded grants and programs experience to assist WSU to begin its program.
   •    In response to national and professional initiatives to make the DNP the standard academic preparation for
        advanced practice registered nursing education by 2015, 260 Schools of Nursing (AACN website) now offer or are
        poised to offer the DNP.

   •   National enrollment in the DNP programs has increased exponentially from 170 students in 2004 to 7,037 in 2010.
       From 2007 through 2011, 221 SoN students matriculated into DNP advanced practice specialties. With the change
       to DNP-only for advanced practice, we expect to admit 70 students in academic year 2012-2013.
   •   The Peer Deans who visited UW SoN in November 2011 from University of Pittsburgh, Indiana University and the
       Medical College of South Carolina recommended UW Seattle offer only the DNP for entry into advanced practice.
   •   As a point of interest, a current UW DNP student recently interviewed with University of Wisconsin, Madison for a
       job. The student’s DNP preparation was enthusiastically recognized. A 2010 post baccalaureate DNP graduate
       reported being hired by a health care organization in Seattle primarily because she had the DNP. She reported that
       without the DNP she would not have been called to interview.
   •   SoN tuition rates are comparable to our peers including Johns Hopkins, Michigan and University of Illinois.

Points of Information:

   •   The University of Washington SoN began offering the DNP initially to post MN APRNs, graduating the first cohort in
       2008. The post baccalaureate DNP degree option began in 2007. Since that time, several important program and
       policy changes have occurred, making it challenging to use historical application data to forecast future
       applications. The net result is that DNP application trend data cannot be considered in isolation or as a predictor
       for the future.
   •   The UW DNP offerings are unique in the Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) region. Those
       only offered by UW at the DNP level in the WWAMI region are Adult Clinical Nurse Specialist (ACNS); Adult Nurse
       Practitioner (ANS): Pediatric Nurse Practitioner (PNP); Neonatal Nurse Practitioner (NNP); Perinatal Nurse Specialist
       (PNS); Neonatal Clinical Nurse Specialist (NCNS); and Psychiatric Mental Health Nurse Practitioner (PMHNP).
   •   The Psych-Mental Health NP, Family Nurse Practitioner, Adult Nurse Practitioner, and Community Health Programs
       have been ranked one, two or three in US News & World Report.
   •   Looking only to academic year 2011-2012 data, approximately 50% of both MN and DNP applicants were offered
       admission to their respective specialty programs, reflecting relative strength in applicant pool sizes. SoN Academic
       Services staff estimate that approximately 75% of those who might formerly have applied to the MN program will
       convert to DNP applicants. Under this assumption, applicant pool size would likely continue to exceed expanded
       DNP enrollment capacity. The net reduction in total overall applications with the shift to DNP advance practice
       entry may yield application review savings of approximately $12,400.
   •   Tuition rates for the MN and the DNP are identical on a per quarter basis. Some programs are fee based (charge by
       credit hour) and some are state supported (with resident/non-resident differential), but either way rates are
   •   The costs of clinical courses vary among specialties, with the variation coming from the type of clinical courses that
       are needed (scattered vs. central locations and the way that each department conducts their clinical courses—
       Faculty Clinical Advisor (FCA) or no FCA. Using the Adult Nurse Practitioner (ANP) offerings as an illustration, the
       overall cost per credit hour for the combined ANP offerings is $238, clinical course costs are $412/student credit
       hour and independent study courses are $524/student credit hour. Faculty members are currently working on
       curriculum alterations to encourage more cost effective choices by students.
   •   This move to DNP only for advanced practice preparation is expected to save administrative time and cost for staff
       and faculty due to fewer offerings, increased streamlining and standardization, and curriculum consolidation.
   •   By pausing admission to advanced practice specialties at the Master’s level for the academic year 2012-13,
       educational offerings will be reduced by 45%. After careful analysis and decision making, we expect offerings to be
       sent through the RCEP (Reorganization, Consolidation, and Elimination Procedures) process. Ultimately, this
       related reduction in program complexity is expected to result in cost savings. For example, faculty time will be
       reduced by no longer having to supervise MN projects, although they will supervise DNP Capstones. We have
       baseline costs now and will monitor and report cost reduction by specialty and in aggregate.
   •   UW DNP graduates (73 to date) are able to secure jobs and secure them at a higher rate of pay than MN graduates.
       SoN graduates are most frequently hired at UWMC, Veterans Administration, Group Health Cooperative, Pacific
       Medical Center, Virginia Mason, Seattle Cancer Care Alliance, Children’s Hospital and Medical Center, Overlake
       Medical Center (Bellevue), Northwest Hospital, St. Peters Hospital (Olympia), Valley Medical Center, Evergreen
       Medical Center (Kirkland), Harborview Medical Center, Sea Mar Primary Care Clinic, and Providence Everett Clinic.

   •   Nationally, salaries for DNP graduates are higher than for MN graduates. Based on 3 – 5 years of experience, DNPs
       make an average of $96,572 and MN’s make an average of $88,444. Source: National Salary and Workplace Survey
       of Nurse Practitioners. See next section for benefits to health care.

                                          Background and Benefits of this Move:

To Meet Health Care Needs in Washington:

   •   Since 2006, UW DNP training programs have been awarded approximately $3 million in federal funding to develop
       and support the education of DNP students, including stipends and tuition support for some. Our data show that
       87% of our DNP alumni stay in Washington to practice and serve patients, families and communities, representing a
       significant federal investment in the Doctoral-level Advanced Practice nursing care for older adults and families in
   •   Every DNP student is required to complete a Capstone Project. Capstone projects are systematic investigations of
       questions about practice and therapies that evaluate and translate evidence into practice. Each student
       collaborates with an agency to solve a real-world clinical problem. Agencies benefit by having students with cutting
       edge education lead and manage difficult projects at no cost to these agencies. A list of capstone projects can be
       found here:
   •   The Veterans Administration Center of Excellence in Primary Care is committed to educating DNP students at the
       Seattle site as future leaders in interprofessional collaboration and in the complex care needed by our veterans.
       SoN is helping to lead this work.
   •   The UW DNP program recruits students from rural areas and the programs emphasize working with underserved
       citizens in urban and rural areas. List of programs:
       programs/graduate-degree-program-specialties.html .
   •   The UW DNP for community health nurses prepares nurse leaders to assure that essential Washington public health
       services are provided with efficient and effective leadership, research-based decision making, and rigorous
       evaluations for continuous quality improvement in community health programs.
   •   Governor Gregoire’s 2011 Healthiest State agenda calls for stopping “out of control cost increases in health care by
       redesigning the system and creating a more valuable and productive health sector.” A key DNP program goal, to
       prepare excellent practitioners who can “create, manage, and evaluate innovative programs and practices of care
       for diverse populations,” carefully aligns with the state’s goal. Source: US Human Resources and Services
       Administration (HRSA). Advanced Practice Education # 71791. : Collaborative Mental Health. E. Walsh, PI, F.W.
       O’Connor & K.G. Schepp, CO-PI. Funded 2011-2014.
   •   The DNP program prepares nurse practitioners to address the increasing complexity of patient needs, including
       chronic illnesses, and health management challenges associated with our rapidly aging population.

To Meet Health Care Needs Nationally:

   •   The National Academies recommended in 2005 that Nursing develop a non-research clinical doctorate (DNP),
       similar to the MD, PharmD, and Physical Therapy to fill the need for clinical practice and for clinical education. They
       recommended that the PhD in Nursing be the focus of those who wished to pursue a research career that adds to
       the body of knowledge of nursing science. DNP-prepared faculty members meet a valuable need to educate the
       future nursing workforce.
            o The UW is a leader in producing faculty for nursing practice instruction.
            o Currently five UW faculty members hold the DNP degree and provide core content and practice mentorship
                 to current students. See the “Student and Faculty Experience (Stories)” section below for specifics.
   •   Recent transformation of health care to evidence-based practice requires the expertise emphasized in the DNP
       program for appraisal and translation of current research and other evidence to guide decision making on a macro
       and micro level for cost effective, quality care.
   •   DNP education includes understanding organizational culture, analysis of initiatives, and budget development (all
       critical in our current and future health care environment).
   •   Nationally, there is consensus on the existence of a current and future nursing faculty shortage. UW Seattle
       prepares future leaders in education, research and practice.

           o   The average age of a doctorally prepared nurse faculty is 60.5 (professors) and 57.1 (associate professors)
               years. American Association of Colleges of Nursing (AACN) reports the current vacancy rate in nursing
               faculty is 7.7% and expects this to rise significantly in the coming decade
           o   A 2010 AACN survey found that 56% of nursing school survey respondents reported faculty positions left

To Best Prepare Practitioners (students):

   •   Prepares students to meet the increasing complexity of the health care system.
   •   Focuses on Evidence-Based Practice and its implementation in care settings to facilitate rapid translation of new
       knowledge into practice standards.
   •   Integrates practice with higher-level content on care systems, leadership, team-building, and evidence appraisal
       that will result in improved quality care and patient safety.
   •   Positions Nurse Practitioners to lead and collaborate in shaping responses to new health care policy and
       reimbursement requirements.
   •   Prepares Nurse Practitioners needed as a result of health care reform and emphasis on an integrated generalist
       approach to primary care

To Advance Leadership in the Profession:

   •   AACN advocates that having one path to APRN practice will provide clarity to students, employers, and the public.
       Nursing specialists will be prepared at the highest level in educational programs on par with those who educate
       professionals from other health disciplines. As a recognized leader in nursing education and research, the UW SoN
       is expected to establish and is committed to the highest standards of DNP education and preparation and to
       disseminating these standards nation-wide.
   •   The UW SoN led the state and region in the development of the DNP program. The UW DNP program educates an
       advanced practice clinician who has the knowledge and skills to integrate advanced clinical practice, leadership, and
       practice inquiry.
   •   The UW DNP program prepares graduates to achieve credentialing and licensure in their chosen field.

Opposing Views:

   •   Some Nursing professionals and educators are opposed to the DNP for advanced practice. The primary reason is
       the additional time needed for completion of the program, which in turn increases costs for students. Despite this
       same consideration for nearly all health professions, within the past few years the Physician Assistant’s program at
       UW has transitioned from a bachelor to a master degree, and the physical therapy, occupational therapy,
       audiology, and pharmacy fields have transitioned to a professional doctorate. The main motivation for the longer
       period of study is the explosion of knowledge and the additional skills required to meet the increasingly complex
       needs of our state's residents for health care that is also safe, appropriate, and effective. The aging of the
       population, the increasing ethnic diversity of the state and nation, and the escalating incidence of multiple chronic
       illnesses have been associated with the need to prepare health professionals who can manage complexity.
   •   Several (older) studies also document that nurse practitioners prepared with a master degree are effective and
       comparable to physicians in delivery of primary care. As more recent changes in the complexity of practice can be
       traced to the last two decades, we have learned that our students need more preparation in advanced practice,
       practice inquiry and leadership in order to deliver optimal care.

Student and Faculty Experience (Stories):

   •   Capstone Project: As part of the Immunization Action Coalition, and in partnership with Group Health Cooperative,
       the organization called “Within Reach” aims to increase the level of immunizations for children in Washington
       State. The first DNP student involved with this project developed a toolkit to assist pediatric providers working with
       vaccine hesitant parents. A second DNP student created an innovative resource guide for Obstetric providers at
       Group Health Cooperative regarding newborn Hepatitis B vaccination. The third student is following up on the

     feasibility of and implementation of the Hepatitis B program. In all instances, students have translated the current
     evidence to practice changes for improved patient outcomes. Students also present and publish their findings.
 •   Capstone Project: At the request of Group Health Cooperative, a DNP student worked with the NPs to develop and
     implement a new NP led approach for patients with irritable bowel syndrome based on years of research by UW
     faculty. The program is currently underway and another DNP student is now leading phase 2 of the project to
     evaluate this exciting approach to improving practice
 •   Video from students describing their experience as well as information about the DNP program can be found at:
 •   UW DNP faculty:
         • Clinical Assistant Professor, Christine Hoyle DNP, ARNP, FNP, whose work has been with underserved,
              ethnically diverse patient populations in primary care public health settings in Washington State. Precepts
              DNP students in her clinical practice.
         • Clinical Assistant Professor, Gail Johnson DNP, ARNP, FNP, whose work has also been with underserved,
              ethnically diverse patient populations in community health clinic settings in Washington State. Precepts
              DNP students in her clinical practice.
         • Clinical Instructor Teresa Garrett-Hill DNP, MN, who has worked in tribal health in Washington State and
              uses these experiences with undergraduate students studying community health.
         • Clinical Assistant Professor, Karen E. Hays, DNP, CNM, ARNP is a certified nurse-midwife who has worked in
              community hospitals, home birth, birth centers, and a tertiary hospital. She has also served as a consultant,
              educator, and practitioner in several countries across Asia, Africa, and Latin America.
         • Lecturer Kumhee Ro, DNP, ARNP, FNP-BC whose work with people who are underserved, ethnically diverse
              and homeless in her current NP practice in the emergency department offers extensive expertise for
              teaching adult/geriatric and family NP students.
 •   Washington State University has also hired a UW DNP Graduate:
         • Clinical Assistant Professor, Dawn Rondeau, ACNP, FNP, DNP has been a critical care nurse and inpatient
              department director with 125 employees and a $12 million dollar budget. Similar to her counterparts at
              UW, her teaching responsibilities include advanced pathophysiology, pharmacology, physical assessment,
              and diagnostics.

For more information, please contact: Phillippa Kassover ( or Ruth Johnston (

     School of Nursing Graduate Current Program Offerings/Status 12/12/11

                Master of Nursing
Tuition base    Tuition base                                                           Pause
WA*                                    Adult Clinical Nurse Specialist (ACNS)          yes
                                       Adult Nurse Practitioner (ANP) – includes       yes
                                       Adult Care NP
                                       Neonatal Nurse Practitioner (NNP)               yes
                EO                     Perinatal Nurse Specialist (PNS)
                                       Neonatal Clinical Nurse Specialist (NCNS)
                EO                     Nurse Midwifery (NM)                            yes

WA                                     Pediatric Nurse Practitioner (PNP) and          yes
                                       Pediatric Clinical Nurse Specialist (PCNS)
WA                                     Community Health Nursing                        no
WA                                     Psychiatric Mental Health Nurse Practitioner    yes

WA                                     Independent Master of Nursing                   yes
                Master of Science
                                       Clinical Info & Patient Centered Technologies   no
WA                                     Independent option, Master of Science           yes
                MN/MPH Concurrent
                Degree Program

                Doctor of Nursing
WA                                     Adult Clinical Nurse Specialist (ACNS)          no

                                       Adult Nurse Practitioner                        no
                EO                     (ANP)
                EO                     Family Nurse Practitioner (FNP)                 no
WA                                     Pediatric Nurse Practitioner (PNP)              no

                                       Neonatal Nurse Practitioner (NNP)               no
                EO                     Perinatal Nurse Specialist (PNS)
                                       Neonatal Clinical Nurse Specialist (NCNS)

                EO                     Nurse Midwifery (NM)                            no
WA                                     Community Health Nursing (CHN)                  no
WA                                     Psychiatric Mental Health Nurse Practitioner    no
                                       Post Master’s not seeking a new specialty       no
                Doctor of Philosophy
                in Nursing Science
WA                                     PhD in Nursing Science                          no
WA=state supported EO= Fee-based

DRAFT DNP Decision statement for external use (we expect this will be edited as needed)

In response to declining state support and in line with earlier aspirational decisions, the University of Washington School of Nursing
faculty voted on November 28, 2011 to propose that as of Summer Quarter, 2012 the Doctor of Nursing Program will be the only
program to prepare advanced practice registered nurses (nurse practitioners, clinical nurse specialists and nurse midwives) at the
University of Washington School of Nursing, Seattle.

The School will take the following steps immediately:

    •    Pause admission to the Masters level advanced practice specialties for 2012 – 2012
    •    Faculty members will individually contact Masters applicants to offer them the opportunity to apply to the UW DNP programs
    •    Continue to allow students to exit with a Master’s degree with a certification in a specialty prior to completion of the DNP
         program, so students can choose to participate in the workforce as advanced practice nurses and complete their professional
         doctorate concurrently
    •    Allow all current Masters students to complete their program

The Master’s degree in Community Health and the Master of Science in Clinical Informatics and Patient-Centered Technologies will
continue and are not affected by this decision. The University of Washington will also continue its Bachelor’s and Accelerated Bachelor’s
in Nursing and PhD in Nursing Science programs.

The decision was made at this time to enable current applicants to UW Masters advanced nursing practice programs to make decisions
about their course of education. Applications for the masters programs are now closed. Applications for Doctor of Nursing Practice
Programs close on January 15, 2012.

Faculty determined that this important step was needed as part of their work on a comprehensive sustainable academic business plan.
Faculty wished to provide an overall direction for advanced practice education at the UW School of Nursing and will continue the
process of review and prioritization of the range of advanced practice specialties currently taught at the school.

The faculty recommendation was based on their assessment of the direction of the profession and the unique strengths in leadership,
practice and research at the UW School of Nursing. The history of advanced practice nursing education started with a four-month
certificate, which evolved to a two-year Master’s degree and now includes a three-year professional Doctorate in Nursing Practice.
Many UW School of Nursing alumni with early advanced practice degrees have been pioneers in advanced practice and have paved the
way for this evolution toward the professional doctorate in advanced practice nursing.

The University of Washington School of Nursing has long been committed to preparing advanced practice nurses who utilize evidence-
based practice, are equipped to become leaders in health care systems and are primed to educate future advanced practice nurses.
Health care reform and the increasing pressure on all health care systems will require advanced practice nurse leaders to participate in
redesigning health systems that focus on the life span. Advanced practice nurses are also well prepared to lead interprofessional health
care teams that provide coordinated, patient-centered care and offer primary care to patients and their families.

The American Association of Colleges of Nursing (AACN) has set a 2015 target goal for transition of all advanced practice registered
nurse education programs. The Association’s position is that the DNP is the appropriate degree for advanced nursing practice.

About the School of Nursing

The University of Washington School of Nursing’s mission is to advance nursing science and practice through generating knowledge and
preparing future leaders to address local, national and global societal needs. This work is informed by a set of foundational values:
collaboration, social responsibility, integrity, respect, accountability, diversity and excellence.



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