1. Issues and Trends
Nursing 870

2. Issues and Trends Where are we going and who is driving?
Why is it important?
The present day concept of the APRN as a primary care provider was created in the mid-1960s, spurred on by a shortage of medical doctors. The first official training for nurse practitioners was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965, with a vision to help balance rising healthcare costs, increase the number of healthcare providers, and correct the inefficient distribution of health resources.

3. Issues and Trends NP Issues Health Care Educational Preparation
Barriers to Practice
Health Care
Primary Care Shortage & Access to care
Health Care Quality
Cost of Care

4. NP Issues: Education The Consensus Model (2008)
(Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, 2008)
Available online:
Joint effort of 32 organizations
Now endorsed by 46 national nursing organizations
Intended that education, certification, and licensure are all compatible and uniform in all states
Will be implemented by 2015 (LACE)
Educational programs transitioned in 2012
Certification exams transition by 2013
Licensure will transition by 2015

5. NP Issues: Education The Consensus Model
(Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, 2008)
Available online:
Individuals will be licensed as independent practitioners for practice at the level of one of the four APRN roles within at least one of the six identified population foci. Education, certification, and licensure of an individual must be congruent in terms of role and population foci. APRNs may specialize but they cannot be licensed solely within a specialty area. In addition, specialties can provide depth in one’s practice within the established population foci. Education and assessment strategies for specialty areas will be developed by the nursing profession, i.e., nursing organizations and special interest groups. Education for a specialty can occur concurrently with APRN education required for licensure or through post-graduate education. Competence at the specialty level will not be assessed or regulated by boards of nursing but rather by the professional organizations.

6. APRN REGULATORY MODEL (AACN, 2008)
APRN SPECIALTIES
Focus of practice beyond role and population focus linked to health care needs
Examples include but are not limited to: Oncology, Older Adults, Orthopedics,
Nephrology, Palliative Care 
POPULATION FOCI
Family/Individual
Across Lifespan
Adult-
Gerontology*
Women’s Health/Gender- Related
Psychiatric-Mental Health
Neonatal
Pediatrics
Licensure occurs at Levels of Role & Population Foci       
APRN ROLES
Nurse
Anesthetist
Nurse-
Midwife
Clinical Nurse
Specialist
Nurse
Practitioner *

7. Relationship Between Educational Competencies, Licensure and Certification (NCSBN.org)
Measures of competencies
Competencies
Identified by Professional Organizations
(e.g. oncology, palliative
care, CV)
Specialty Certification*
Specialty
Population Foci
CNP, CRNA, CNM, CNS in Population context
Licensure: based
on Education
And certification**
Role
APRN Core Courses:
Patho/phys,
Pharmacology,
Physical/health assess
APRN

8. NP Issues: Education The DNP (AACN, 2004) Practice focused
Proposed as entry to practice for APRNs by 2015
Congruent with other professions
AACN, Available at:

9. DNP 7 Essential Components Proposed
Scientific underpinnings of practice
Advanced nursing practice
Organization and system leadership
Analytic methodologies to evaluate practice
Utilization of IT to improve and transform health care
Health policy development
Interdisciplinary collaboration to improve outcomes

10. DNP: Where are We? No movement at this time
Will occur when either national certifying bodies or SBON make it a requirement for certification and/or state licensure

11. The DNP
Can you think of pro’s and con’s?

12. IOM Report “The Future of Nursing”
The Institute of Medicine (IOM)
Established in 1970 by the National Academy of Sciences
To secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public.
The Institute acts under the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education (IOM)
Implications for education and policy

13. IOM Report “The Future of Nursing”
Assumption that nurses can fill expanded roles in a redesigned health care system
Key messages
Nurses should practice to the full extent of their education and training
Nurses should achieve higher levels of education and training through an improved educations system that promotes seamless academic progression
Nurses should be full partners, with physicians and other health professionals, in redesigning health care systems in the US
Effective workforce planning and policy making require better data collection and an improved information infrastructure

14. NP Issues Practice Barriers
IOM’s Report on the “Future of Nursing” identified practice barriers as limiting to the NP role
Identified State and Federal initiatives required to remove practice barriers
Federal : Home health
PA: Collaborative agreement required

15. Health Care Issues Primary Care Provider Shortage (Kaiser Foundation)
36% of physicians practice in primary care
8% of new med school graduates select primary care
NP population growing
60 million Americans without adequate access to care (1 in 5)
Influence outcomes

16. Primary Care Shortage PA 5th highest number of elderly
6th highest number of HPSAs in US
Greatest in rural areas
PA with 48 of 67 counties as rural (HRSA)
5th highest number of elderly
Acute in rural areas
3rd highest of rural elders

17. Health Care Disparities
Multiple factors
Insurance
Socioeconomics
Delivery system
System capacity
Accessibility
Affordability
Age
Ethnicity
Attitudes and preferences
Location
Provider attitudes

18. Health Care Disparities
50 million Americans without health insurance (U.S. Census Bureau, 2010)
Private versus Public
Less Hispanic and African Americans covered through private insurance
All ethnicities have greater access to private insurance if married
Caucasians up to 80% if married
Hispanics up to 50% if married
Hispanics highest without any health insurance

19. Health Care Disparities

20. Health Care Disparities
Socio-economics
Poverty level rose to 11.9%; highest since 1993
All ethnicities affected
Highest for Hispanics, then African Americans
Highest for non-natives
Age groups
22% of children in poverty
Older adults
Highest for African Americans (33%), Hispanics (22%), Women
Rural dwellers

21. Health Care Disparities

22. Health Care Disparities
Delivery system
System capacity
Accessibility
Affordability

23. Health Care Disparities
Age
Ethnicity
Attitudes and preferences
83,000 deaths/yr related to racial disparities
Location
Barriers in urban and rural locations
Minorities may receive care in lowering performing hospitals
Provider attitude

24. What’s the Take Home? NPs increase access to high quality primary care
Know the population served
Become culturally competent
Work on removal of barriers to NP practice
Keep up on the issues
Become involved!

25. References
Alliance for Health Reform Disparities Available at:
American Association of Colleges of Nursing AACN Position Statement on the Practice Doctorate in Nursing. Available at:
Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press.
U. S. Census Bureau Data. Available at:
The Kaiser Foundation The Primary Care Shortage. Available at: Shortage/Background-Brief.aspx
U.S. Department of Health and Human Services. Health Resources and Services Administration Shortage Designation: Health Professional Shortage Areas and Medically Underserved Areas/Populations. Available at: