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					The Evolution of the Doctor of Nursing
           Practice Degree
        A BRIEF HISTORY
What sparked the DNP movement
• The focus on clinical practice vs. pure research
• Evidence-based practice – required research knowledge
• Other health professionals – Pharm. D., DPT
• Multiple nursing practice degree names and initials
What gives the DNP movement impetus
• Supporting professional organizations & nursing agencies
• Institute of Medicine
• Magnet Status
• Health Care Reform
• Research Data
Process and Activities – From early 2000s until the present
The process of focusing on clinical practice first started in the
early 1980’s with the first practice-focused nursing doctorate
- Doctor of Nursing (NDs) - started as an entry level degree
program
American Association of Colleges of Nursing Task Force on
the Practice Doctorate in Nursing 2002 – to looked at trends
in doctorates & recommendations as to the needs for &
nature of these programs
AACN released a Position Statement on the Practice
Doctorate in Nursing (2004) - two types of nursing
doctorates: practice-focus and research-focus - and the
practice focus will be called the DNP
PROCESS – Building Consensus

Got the National Professional Nursing Organizations on board
(45)
Convened Deans and other key faculty from major
universities across the nation
Joined the task force to write the Essentials of DNP Education
(2006) – To be a transparent process
• Secured information from multiple sources about existing
  programs, trends & benefits of a practice doctorate
• Providing multiple opportunities for open discussion of
  related issues at AACN and other professional meetings
I Remember School Nurses…..
DNP Position (2004) statement about the benefits of practice focused doctoral
programs:

• development of needed advanced competencies for increasingly complex practice,
  faculty & leadership roles
• enhanced knowledge to improve nursing & patient outcomes
• enhanced leadership skills to strengthen practice & health care delivery
• better match of program requirements and credits and time with the credential
  earned
• provision of an advanced educational credential for those who require advanced
  practice knowledge but do not need or want a strong research focus (e.g., practice
  faculty)
• enhanced ability to attract individuals to nursing from non-nursing backgrounds
• increased supply of faculty for practice instruction
• bring about a transformational change in nursing education
DNP Position (2004) statement:
Key Issues to consider
“Practice demands associated with an
increasingly complex health care system
created a mandate for reassessing the
education for clinical practice for all
health professionals, including nurses.”
DNP Essentials of Doctoral Education for Advanced Nursing Practice:
• Scientific underpinnings for practice
• Organizational and systems leadership for quality improvement and
  systems thinking
• Clinical scholarship and analytical methods for evidence-based practice
• Information systems/technology and patient care technology for the
  improvement and transformation of health care
• Health care policy for advocacy in health care
• Interprofessional collaboration for improving patient & population
  health outcomes
• Clinical prevention and population health for improving the Nation’s
  health
• Advanced nursing practice
Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification & Education (LACE Model)
July 2008
Completed through the work of the APRN Consensus Work Group & the
National Council of State Boards of Nursing APRN Advisory Committee
( The Players -- ANA, NONPF, NCSBN, AACN )


LICENSURE, ACCREDITATION, CERTIFICATION
& EDUCATION - LACE MODEL
• Advanced Practice Registered Nurse (APRN) is licensing title used for the
  subset of nurses prepared with advanced, graduate-level nursing
  knowledge to provide direct patient care in four roles: certified registered
  nurse anesthetist, certified nurse-midwife, clinical nurse specialist, and
  certified nurse practitioner. Legal titles – APRN, CRNA, CNP, CNP-Family
• Accreditation of educational program –a foundational requirements for
  accrediting programs that evaluation outcomes related to standards for
  core role courses and population focused core competencies
• Certification to follow established certification testing and
  psychometrically sound, legally defensible standards; national
  certification/licensure
• Education (name the 3 Ps on transcript, state population & APRN role,
  meet Essentials (MSN & DNP); meet national consensus-based core
  competencies (NONPF NP ), preparation across the health-wellness
  continuum
• National Certification in a role and one
  population
• Preparation in a specialty area is optional &
  over and above role + population educational
  experiences (e.g., oncology)
• A specialty may not expand the APRN’s scope
  of practice into another role or population
  focus
• Implications for Licensing Bodies
• Implement the APRN legislative language
• Issue a second APRN license
• License APRNs as independent practitioners with full
  prescriptive authority
• Ensure APRN representation on the Board of Nursing
• Include a grandfathering clause for those APRNs
  already practicing
• APRN’s practice should not be restricted by setting
  but rather patient care needs
• Goal of the LACE model
  – Speak with a unified voice
  – Standardize regulatory requirements, including
    licensure, accreditation, certification & education
  – Increase access to & mobility of APRNs
  – Ensure APRNs are prepared to assume increased
    accountability & role within a transformed
    healthcare system
  – Maintain or increase number of APRNs prepared
    to meet population needs, especially primary care
• Consensus models has been endorsed by 46
  national nursing organizations and all major
  APRN organizations
• Original Timeline: target 2015
  – State Boards of Nursing to have regulations and/or
    legislation enacted by 2015
  – APRN education programs will be transitioned by
    2012
  – Certification examinations will be transitioned by
    2012-2013
• AANA Position on
  Doctoral Preparation
  Nurse Anesthetists
  (2007)
   AANA supports doctoral
   education for entry into
   nurse anesthesia practice
   by 2025
• NONPF Statement on Acute Care & Primary Care CNP
  Practice (2012)
• Fundamental issue is that CNP competencies are not
  setting-specific. “It is inappropriate and restrictive to
  regulate acute and primary care CNP scope and
  practice based on settings. Regulation should be
  based on educational preparation, certification , and
  score of practice.”
• Patient care needs defines acute & primary care CNP
  scope of practice
 DOCTOR OF NURSING PRACTICE


   Schools of Nursing DNP Consortium
CSU Fullerton, Long Beach and Los Angeles
Background
• 2004 American Association of Colleges of Nursing
  Position Statement on the Practice Doctorate
• 2008 CSU Chancellor’s Nursing Doctorate Study
• 2010 Institute of Medicine Future of Nursing:
  Leading Change, Advancing Health
• 2010 Patient Protection and Affordable Care Act
Authority
• Assembly Bill 867 authorized CSU to grant
  doctorates in physical therapy and nursing
• California Code of Regulations Title 5 revised and
  Chancellor’s Executive Order established to direct
  DNP curriculum and other degree requirements
• Chancellor selected CSUF to lead a consortium
  along with CSULB and CSULA; SJS and Fresno are
  offering a joint DNP degree in Northern CA
Support
• Strong external support for CSU’s DNP
  – Legislature
  – Policy Makers in Health Care
  – Clinical Partners in Nursing Education
  – Employers
• Strong potential student interest
Systemwide Collaborative Effort
• Northern & Southern California Consortia
• Unified model in the CSU – conference calls, meetings,
   nursing consultants
• Brought in University Administrators and faculty; budget staff
• Assessment standards, outcome measures, reporting back to
   the Legislative Analyst Office
• Review process – BOT, Academic Senates, Curriculum Review
   Committees; MOUs
• WASC – substantive change, CCNE
Consortium Model
• Capitalizes on existing strengths in nursing
  specializations, such as nurse-midwifery and
  nurse anesthesia
• Builds doctoral education capacity across each
  CSU School of Nursing in the consortium
• Centralized admission and enrollment with
  input from each campus
• Faculty and students interact throughout the DNP
  Core classes
  – Evaluation and Measurement
  – Leadership and Management
  – Faculty Development
• Move to specialization in Clinical Practicum and
  culminating Clinical Practice and Scholarship
  – Cross-campus participation in doctoral project
    committees is envisioned
Cal State Fullerton     Cal State Long Beach         Cal State Los Angeles
Nurse Practitioner      Nurse Practitioner (Adult-    Nurse Practitioner (Acute,
(Women’s Health Care)   Geriatric, Family, Pediatric, Adult, Family, and Psych-
                        Psych-Mental Health, and      Mental Health)
                        Women’s Health Care)

Nurse Midwifery         Clinical Nurse Specialist

Nurse Anesthesia        Community Health

Nursing Leadership      Nursing Leadership           Nursing Leadership
Nature of the DNP Degree
• Post-master’s degree
• 5 semester, 36 unit program
• 1000 hours of clinical practice
• Meets AACN accreditation requirements and
  legislative requirements to prepare nurse
  educators
• Scholarly Doctoral Project—3 semester
  Integrative Clinical Scholarship course embedded
  in the clinical setting
Cost of Attendance                      9 month school year
Fees*                                   $14,100**
Books and Supplies                         1,656
Room/Board                               12,000
Misc.                                      2,900
Transportation                             1,300
Total                                   $33,956
*Note: All CSU tuition fees listed are estimates that are subject to change
upon approval by the CSU Board of Trustees.

** Semester Tuition and Nursing Fee are $7,050 each semester, regardless of
number of units taken. There are other student fees, such as Health Center,
which are not included in this amount.
Study Plan
• Evaluation and Measurement 12 units
• Management and Leadership 6 units
• Clinical Practicum 3 units minimum
• Faculty Development 6-9 units
• Doctoral Project 9 units
• Qualifying Doctoral Assessment end of year 1
• Doctoral Project Defense end of year 2

				
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posted:12/21/2012
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