Community Health / Public Community Health / Public Health Nursing and the Health Nursing and the

Doctor of Nursing PracticeDoctor of Nursing Practice

Carolyn A. Williams, RN, PhD, FAANCarolyn A. Williams, RN, PhD, FAANDean and Professor, College of Dean and Professor, College of Nursing, University of KentuckyNursing, University of Kentucky

Focus of the PresentationFocus of the Presentation• The Momentum for Change in Graduate

Education in Nursing• The DNP as the Preparation for

Specialization in Nursing by 2015 • Good News/Not So Good News• The DNP May Represent a Window of

Opportunity to Revitalize the Preparation for Specialization in Community Health / Public Health Nursing

A Paradigm Shift is Underway in A Paradigm Shift is Underway in Graduate Education in NursingGraduate Education in Nursing

• A Number of Factors are Converging to Build Momentum for a Major set of Shifts

• These Include: Aging of the Population; Expansion of Knowledge Underlying Practice; Increased Complexity of Patient Care; Major Concerns about Quality of Care and Patient Safety; Shortages of Nursing Personnel Demanding a Higher Level of Preparation for Leaders Who Can Design and Assess Care and Lead; Shortages of Prepared Nursing Faculty, Leaders in Practice, and Nurse Researchers, and Increasing Educational Expectations for the Preparation of other Health Professionals

Ferment and Change in Graduate Ferment and Change in Graduate EducationEducation

• From the Clinical Perspective - The Clinical Nurse Leader at the Master’s Level; For Specialization The Doctor of Nursing Practice

• From the Research Perspective – Proposed Strategies to Encourage Nurses to Enter Doctoral Study at Younger Ages; Rethink the Clinical Requirements for Entry into PhD Programs; Expand the Pool for PhD Programs in Nursing and Increase the Number of PhD Grads

National Academy of Sciences National Academy of Sciences 2005 Report2005 Report

• Calls for a distinction between “the educational needs and goals of nursing as a practice profession that require practitioners with clinical expertise from

• Nursing as an academic discipline and science that requires independent researchers and scientists to build the body of knowledge” (p.74)

National Academy of Sciences National Academy of Sciences 2005 Report2005 Report

• “The need for doctorally prepared practitioners and clinical faculty would be met if nursing could develop a new nonresearch clinical doctorate, similar to the M.D. and Pharm.D. in medicine and pharmacy, respectively.”

What is a DNP?What is a DNP?

• The DNP was first conceptualized as a Post-Master’s degree to prepare for Leadership in Nursing Practice

• As we plan for the future, it is proposed as the preparation for the highest level of preparation for practice in an area of specialization.

It is about Nursing Practice!!! It is about Nursing Practice!!! It is About the Future !!! It is About the Future !!!

Position Statement on the Position Statement on the Practice Doctorate in NursingPractice Doctorate in Nursing

October 2004October 2004

Possible Parallels Between the Possible Parallels Between the Nurse Practitioner Movement and Nurse Practitioner Movement and

the DNPthe DNP• Most would say that What Lee Ford Set in

Motion in the 1960’s was a Major Paradigm Shift in Graduate Education in Nursing and in Nursing Practice

• Only Time will tell if the DNP Represents a Sustained Change in Graduate Education in Nursing and in Nursing Practice

From Chalk Up Another One, The Best of Sydney Harris, © 1992

The DNP EssentialsThe DNP Essentials

• DNP Core Essentials – Outcome Competencies Essential for all Graduates of a DNP Program Regardless of Speciality or Functional Focus

• Speciality Competneices – Those Clinical and Didactic Learning Experiences to Prepare the DNP for a Particular Speciality. These are Delineated by National Speciality Nursing Organizations

DNP Core EssentialsDNP Core Essentials

• l. Scientific Underpinnings for Practice• 2. Organizational and Systems Leadership for

Quality Improvement and Systems Thinking – a focus on the needs of a panel of pts, a target pop, a set of pops, or a broad community

• 3. Clinical Scholarship and Analytical Methods for Evidence-Based Practice

• 4. Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care

Core EssentialsCore Essentials

• 5. Health Care Policy for Advocacy in Health Care

• 6. Interprofessional Collaboration for Improving Patient and POPULATION Health Outcomes

• 7. Clinical Prevention and POPULATION Health for Improving the Nation’s Health

• 8. Advanced Nursing Practice

Advanced Nursing Practice Advanced Nursing Practice

• Speciality preparation falls into two general categories: Roles which specialize as an APN with a focus on care of inds in a speciality and

• Roles which specialize in practice at an aggregate, systems, or organizational level

• Some Specialities, such as Community Health may blend these roles

AACN Website for DNPAACN Website for DNP

• www.aacn.nche.edu/dnp/index.htm

Good News / Not so Good News Good News / Not so Good News

• The Population Perspective is Catching on Throughout Nursing – It is one of the Key Components of the Essentials for the DNP

• The Not so Good News is what is happening in Community/Public Health Nursing Programs

• There is a Question of whether our Current CH/PHN Programs are Sustainable

2001 2002 2003 2004 2005

Community Health CNS

2.1 3.2 3.0 3.3 3.3

Community Health/Public Health Master’s Major

3.3 3.9 2.6 2.8 2.8

AVERAGE GRADUATES PER PROGRAM FROMCOMMUNITY HEALTH/PUBLIC HEALTH

MASTER’S LEVEL PROGRAMS IN SCHOOLS OF NURSING2001-2005

Source: American Association of Colleges of Nursing, Research and Data Center, 2006

CHN/PHENROLLMENT

TOTAL ENROLLMENT

% of TOTAL

2001 910 30,512 3.7

2002 1011 34,062 2.9

2003 941 37,066 2.5

2004 974 42,646 2.3

2005 946 46,444 2.0

ENROLLMENT IN CHN/PH MASTER’S PROGRAMS AND % OF TOTAL MASTER’S ENROLLMENT

Source: American Association of Colleges of Nursing, Research and Data Center, 2006

A Window of OpportunityA Window of Opportunity

• The Time to Rethink the Preparation of Nurses for Community/Public Health Practice is NOW

• The DNP may Represent a Window of Opportunity to Revitalize Preparation for Community/Public Health Nursing

• The DNP with Specialization in Community/Public Health Nursing is a More Viable Alternative for the Future than a Dual Degree Model, Which Many are Advocating

Luther Christman:Luther Christman:“Imagine how different the present level of clinical care might be if all nurses had earned professional doctorates for at least the last two generations…. It is almost impossible to be an equal contributor when the present relative deprivation exists between nurses and other major providers.”

Source: (Image: Journal of Nursing Scholarship, 1980)

Creating the FutureCreating the FutureWe have a responsibility to create We have a responsibility to create the future for our patients, for our the future for our patients, for our profession, and for the health of the profession, and for the health of the public.public.