1. The Evolution of the Doctor of Nursing Practice Degree
A BRIEF History

3. 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

5. 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

6. 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

7. I Remember School Nurses…..

8. 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

9. 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.”

10. 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

12. 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

13. 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

14. 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

16. 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

17. 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

18. 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

19. AANA Position on Doctoral Preparation Nurse Anesthetists (2007)
AANA supports doctoral
education for entry into
nurse anesthesia practice
by 2025

20. 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

22. Doctor of Nursing Practice
Schools of Nursing DNP Consortium
CSU Fullerton, Long Beach and Los Angeles

23. 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 ,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

24. 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

25. Strong external support for CSU’s DNP
Legislature
Policy Makers in Health Care
Clinical Partners in Nursing Education
Employers
Strong potential student interest

26. 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

27. 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

28. 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

30. 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

31. 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

32. 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.

33. 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