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

Licensure, Accreditation, certification & education - lace Model 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

Original Timeline: target 2015 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

2008 CSU Chancellor’s Nursing Doctorate Study 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 Need to have Doctorate as entry to advanced practice by 2015 17,000 APN’s in CA potentially need this degree 17 years Evidence to practice Nursing shortage and need for increased nurses at BS, Doctoral levels and need for nurse educators to close the gap PPACA—additional support for expanded nursing roles in primary care increased financial aid for nursing students

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

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 (Women’s Health Care) Nurse Practitioner (Adult-Geriatric, Family, Pediatric, Psych-Mental Health, and Women’s Health Care) Nurse Practitioner (Acute, Adult, Family, and Psych-Mental Health) Nurse Midwifery Clinical Nurse Specialist Nurse Anesthesia Community Health 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