1. Community Health / Public Health Nursing and the Doctor of Nursing Practice Carolyn A. Williams, RN, PhD, FAAN Dean and Professor, College of Nursing, University of Kentucky

2. Focus 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

3. A Paradigm Shift is Underway in Graduate 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

4. Ferment and Change in Graduate Education 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

5. National Academy of Sciences 2005 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)

6. National Academy of Sciences 2005 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.”

7. 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.

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

9. Position Statement on the Practice Doctorate in Nursing October 2004

10. Possible Parallels Between the Nurse Practitioner Movement and the 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

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

12. The 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

13. DNP 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

14. Core 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

15. 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

16. AACN Website for DNP www.aacn.nche.edu/dnp/index.htm

17. 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

18. 20012002200320042005 Community Health CNS 2.13.23.03.3 Community Health/Public Health Master’s Major 3.33.92.62.8 AVERAGE GRADUATES PER PROGRAM FROM COMMUNITY HEALTH/PUBLIC HEALTH MASTER’S LEVEL PROGRAMS IN SCHOOLS OF NURSING 2001-2005 Source: American Association of Colleges of Nursing, Research and Data Center, 2006

19. CHN/PH ENROLLMENT TOTAL ENROLLMENT % of TOTAL 200191030,5123.7 2002101134,0622.9 200394137,0662.5 200497442,6462.3 200594646,4442.0 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

20. A Window of Opportunity A 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

21. 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)

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