the doctorate of nursing practice: responding to a changing

The Doctorate of The Doctorate of Nursing Practice: Nursing Practice: Responding to a Responding to a Changing Health Changing Health Care EnvironmentCare Environment

Geraldine Polly Bednash, PhD, RN, FAANGeraldine Polly Bednash, PhD, RN, FAAN

Executive DirectorExecutive Director

American Association of Colleges American Association of Colleges of Nursingof Nursing

Dramatic Changes in Dramatic Changes in Health CareHealth Care

Aging populationAging population Growing diversityGrowing diversity Bio-medical advancesBio-medical advances New areas of knowledge, i.e. New areas of knowledge, i.e.

genetics, environmental healthgenetics, environmental health Internationalization of Health Internationalization of Health

Care IssuesCare Issues

Acuity Levels Acuity Levels

Acuity level in general, non-Acuity level in general, non-intensive care units of a intensive care units of a hospital is higher than acuity hospital is higher than acuity levels in ICUs ten years ago.levels in ICUs ten years ago.

Lusting for the Purple Lusting for the Purple PillPill

Creating demand – Direct to Creating demand – Direct to Consumer marketingConsumer marketing

Billions in advertisingBillions in advertising TV – Newspapers – MagazinesTV – Newspapers – Magazines

How Safe is It?How Safe is It?

Institute of Medicine –Institute of Medicine – To Err is HumanTo Err is Human Crossing the Quality ChasmCrossing the Quality Chasm

Joint Commission on Accreditation of Joint Commission on Accreditation of Healthcare Organizations –Healthcare Organizations –

Sentinel Events – 25% nurse relatedSentinel Events – 25% nurse related

Competence/Orientation/Training Competence/Orientation/Training

What error?

Converging Realities – Converging Realities – Nursing and the Quality Nursing and the Quality

DilemmaDilemma Keeping Patients Safe – Transforming the Keeping Patients Safe – Transforming the

Work Environment of Nurses: Work Environment of Nurses: “Research “Research is now beginning to document what is now beginning to document what physicians, patients, other health care physicians, patients, other health care providers, and nurses themselves have providers, and nurses themselves have long known: how well we are cared for by long known: how well we are cared for by nurses … can be a matter of life and nurses … can be a matter of life and death.”death.”

Health Professions Health Professions Education: Education:

A Bridge to QualityA Bridge to Quality Education for the health professions is Education for the health professions is

in need of a major overhaul. …in need of a major overhaul. …education simply has not kept pace with education simply has not kept pace with or been responsive enough to shifting or been responsive enough to shifting patient demographics and desires, patient demographics and desires, changing health system expectations, changing health system expectations, evolving practice requirements…a focus evolving practice requirements…a focus on improving quality or new on improving quality or new technologies.technologies.

IOM, 2003IOM, 2003

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

Expansion of Knowledge Underlying Expansion of Knowledge Underlying Practice;Practice;

Increased Complexity of Patient Care; Increased Complexity of Patient Care; New expectations for competent and safe New expectations for competent and safe

practice- systems savvy, business acumen, practice- systems savvy, business acumen, policy, interprofessional, use of data sets; policy, interprofessional, use of data sets;

Shortages of Prepared Nursing Faculty, Shortages of Prepared Nursing Faculty, Leaders in Practice, and Nurse Leaders in Practice, and Nurse Researchers, and Researchers, and

Increasing Educational Expectations for the Increasing Educational Expectations for the Preparation of other Health ProfessionalsPreparation of other Health Professionals

Changing Perspectives on Changing Perspectives on Doctoral Education in Doctoral Education in

NursingNursing Strong history of growth in research Strong history of growth in research

focused doctoral programsfocused doctoral programs AACN set standards for the research AACN set standards for the research

programs – Indicators of Quality in programs – Indicators of Quality in Research Focused Doctoral ProgramsResearch Focused Doctoral Programs

Both PhD and DNSc programs have a Both PhD and DNSc programs have a focus on development of researchers to focus on development of researchers to create the evidence base for nursingcreate the evidence base for nursing

History of Practice History of Practice DoctoratesDoctorates

DNS and DNSc originally conceived as DNS and DNSc originally conceived as practice doctoratespractice doctorates

Over time these programs also focused Over time these programs also focused upon development of researchersupon development of researchers

Nursing Doctorate programs (ND) Nursing Doctorate programs (ND) originally focused on development of originally focused on development of an entry level generalist but over time an entry level generalist but over time changed dramatically with little changed dramatically with little congruence across the four ND congruence across the four ND programsprograms

Evolution of the Practice Evolution of the Practice DoctorateDoctorate

1999 -Task Force on Research Intensive 1999 -Task Force on Research Intensive Doctoral Programs EstablishedDoctoral Programs Established

2001 –Indicators of Quality in Research-2001 –Indicators of Quality in Research-Focused Doctoral Programs Published and Focused Doctoral Programs Published and Recommended that Task Force on Clinical Recommended that Task Force on Clinical Doctorates be EstablishedDoctorates be Established

2002 –Task Force on Clinical Doctorate 2002 –Task Force on Clinical Doctorate Established – Obtained Data, Input, and Established – Obtained Data, Input, and Consultation from a Broad Range of Consultation from a Broad Range of Constituencies and Developed 13 Constituencies and Developed 13 RecommendationsRecommendations

Focus on the DNPFocus on the DNP

Task Force that created standards Task Force that created standards for research focused programs for research focused programs recommended that AACN create a recommended that AACN create a standard set of assumptions and standard set of assumptions and guidelines for the terminal practice guidelines for the terminal practice degree programsdegree programs

Emergence of DNP with first Emergence of DNP with first program at U of Kentucky and many program at U of Kentucky and many others in developmentothers in development

Task Force on Practice Task Force on Practice DoctorateDoctorate

Created in March 2002 to make Created in March 2002 to make recommendations on the future of recommendations on the future of the practice doctoratethe practice doctorate

Quickly became apparent that the Quickly became apparent that the issue was more complex than a focus issue was more complex than a focus on the single degree program and on the single degree program and included issues that were universal included issues that were universal in health professions educationin health professions education

Charge to the Task ForceCharge to the Task Force

clarify the purpose of the professional clarify the purpose of the professional clinical doctorate, specifically core clinical doctorate, specifically core content and core competencies;content and core competencies;

describe trends over time in clinical describe trends over time in clinical doctoral education;doctoral education;

assess the need for clinically focused assess the need for clinically focused doctoral programs;doctoral programs;

identify preferred goals, titles, identify preferred goals, titles, outcomes, and resources;outcomes, and resources;

Charge to the Task ForceCharge to the Task Force

discuss the elements of a unified discuss the elements of a unified approach versus a diverse approach;approach versus a diverse approach;

determine the potential implications determine the potential implications for advanced practice nursing (APN) for advanced practice nursing (APN) programs;programs;

make recommendations regarding make recommendations regarding related issues and resources; andrelated issues and resources; and

describe potential for various tracks describe potential for various tracks or role options.or role options.

Evolution of the Evolution of the ConceptsConcepts

Original charge was to focus on education to Original charge was to focus on education to acquire a “clinical doctorate” acquire a “clinical doctorate”

Outgrowth of the work and recommendations Outgrowth of the work and recommendations of the task force that established the AACN of the task force that established the AACN Indicators of Quality in Research-focused Indicators of Quality in Research-focused Doctoral ProgramsDoctoral Programs

That task force recommended the validation That task force recommended the validation of the differences between the research and of the differences between the research and clinical doctorateclinical doctorate

The Clinical Doctorate task force The Clinical Doctorate task force recommended that the term “practice recommended that the term “practice doctorate” be used to reflect role doctorate” be used to reflect role

Advanced Practice for Advanced Practice for the Futurethe Future

Growing trend to extend MSN Growing trend to extend MSN programs beyond the traditional programs beyond the traditional master’s credits – need to give the master’s credits – need to give the right degree for the education right degree for the education requiredrequired

Increased practice demands same Increased practice demands same for APNs as for entry level for APNs as for entry level generalists – more complexity and generalists – more complexity and more acuitymore acuity

Stakeholder Stakeholder ObservationsObservations

Need to develop advanced competencies for Need to develop advanced competencies for increasingly complex clinical, faculty and increasingly complex clinical, faculty and leadership roles;leadership roles;

Need for enhanced knowledge to improve Need for enhanced knowledge to improve nursing practice and patient outcomes;nursing practice and patient outcomes;

System change requires enhanced leadership System change requires enhanced leadership skills to strengthen practice and health care skills to strengthen practice and health care delivery;delivery;

Credits and time invested in master’s Credits and time invested in master’s programs not congruent with the credential programs not congruent with the credential earned;earned;

National Academy of National Academy of Sciences 2005 Report on Sciences 2005 Report on

Nursing ResearchNursing Research

The Report Focuses on Increasing The Report Focuses on Increasing the Number of Nurse Scientists and the Number of Nurse Scientists and Increasing the Number of Productive Increasing the Number of Productive Research Years for Nurses Prepared Research Years for Nurses Prepared in PhD Programsin PhD Programs

National Academy of National Academy of Sciences 2005 ReportSciences 2005 Report

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

““Nurses prepared at the doctoral level with a Nurses prepared at the doctoral level with a blend of clinical, organizational, economic and blend of clinical, organizational, economic and leadership skills are most likely to be able to leadership skills are most likely to be able to critique nursing and other clinical scientific critique nursing and other clinical scientific findings and design programs of care delivery findings and design programs of care delivery that are locally acceptable, economically that are locally acceptable, economically feasible, and which significantly impact health feasible, and which significantly impact health care outcomes.”care outcomes.”

The Mission Becomes ApparentThe Mission Becomes Apparent

AACN Position Paper on the Practice DoctorateAACN Position Paper on the Practice Doctorate

Position Statement Position Statement on the Practice on the Practice

Doctorate in Doctorate in NursingNursing October 2004 October 2004

Practice doctoratePractice doctorate

Recommendation 1Recommendation 1: : The Task The Task Force recommends that the Force recommends that the terminologyterminology, practice doctorate , practice doctorate be used instead of be used instead of clinical clinical doctoratedoctorate..

Practice DoctoratePractice Doctorate The term The term practicepractice, specifically nursing practice, , specifically nursing practice,

as conceptualized in this document refers to any as conceptualized in this document refers to any form of nursing intervention that influences form of nursing intervention that influences health care outcomes for individuals or health care outcomes for individuals or populations, including the direct care of populations, including the direct care of individual patients, management of care for individual patients, management of care for individuals and populations, administration of individuals and populations, administration of nursing and health care organizations, and the nursing and health care organizations, and the development and implementation of health development and implementation of health policy. Preparation at the practice doctorate policy. Preparation at the practice doctorate level includes advanced preparation in nursing, level includes advanced preparation in nursing, based on nursing science, and is at the highest based on nursing science, and is at the highest level of nursing practice.level of nursing practice.

RecommendationsRecommendations

Recommendation 2:Recommendation 2: The practice-focused The practice-focused doctoral program be a distinct model of doctoral program be a distinct model of doctoral education that provides an doctoral education that provides an additional option for attaining a terminal additional option for attaining a terminal degree in the discipline. degree in the discipline.

Recommendation 3: Recommendation 3: Practice-focused Practice-focused doctoral programs prepare graduates for doctoral programs prepare graduates for the highest level of nursing practice the highest level of nursing practice beyond the initial preparation in the beyond the initial preparation in the discipline.discipline.

. .

Recommendation 4Recommendation 4

Practice-focused doctoral nursing Practice-focused doctoral nursing programs include seven essential programs include seven essential areas of content. The seven essential areas of content. The seven essential areas of content include:areas of content include:

scientific underpinnings for practice;scientific underpinnings for practice; advanced nursing practice;advanced nursing practice; organization and system organization and system

leadership/management; quality leadership/management; quality improvement and system thinking;improvement and system thinking;

Recommendation 4Recommendation 4

analytic methodologies related to the analytic methodologies related to the evaluation of practice and the application evaluation of practice and the application of evidence for practice; of evidence for practice;

utilization of technology and information utilization of technology and information for the improvement and transformation for the improvement and transformation of healthcare;of healthcare;

health policy development, health policy development, implementation and evaluation; andimplementation and evaluation; and

interdisciplinary collaboration for interdisciplinary collaboration for improving patient and population improving patient and population healthcare outcomes.healthcare outcomes.

Congruent TitlingCongruent Titling Recommendation 7Recommendation 7: One degree title : One degree title

should be chosen to represent practice-should be chosen to represent practice-focused doctoral programs that prepare focused doctoral programs that prepare graduates for the highest level of graduates for the highest level of nursing practice.nursing practice.

Recommendation 8Recommendation 8: The Doctor of : The Doctor of Nursing Practice (DNP) be the degree Nursing Practice (DNP) be the degree associated with practice-focused associated with practice-focused doctoral nursing education. doctoral nursing education.

Recommendation 9Recommendation 9: The Doctor of : The Doctor of Nursing (ND) degree title be phased Nursing (ND) degree title be phased out.out.

RecommendationsRecommendations

Practice doctoral nursing programs Practice doctoral nursing programs should include development and/or should include development and/or validation of expertise in one area validation of expertise in one area of advanced nursing practice.of advanced nursing practice.

Practice-focused doctoral nursing Practice-focused doctoral nursing programs prepare leaders for programs prepare leaders for clinical practice. The practice clinical practice. The practice doctorate prepares individuals at doctorate prepares individuals at the highest level of practice and is the highest level of practice and is the terminal practice degree.the terminal practice degree.

Recommendation 10: Recommendation 10: The The practice doctorate be the practice doctorate be the graduate degree for advanced graduate degree for advanced nursing practice preparation, nursing practice preparation, including but not limited to the including but not limited to the four current APN roles: clinical four current APN roles: clinical nurse specialist, nurse nurse specialist, nurse anesthetist, nurse midwife and anesthetist, nurse midwife and nurse practitioner.nurse practitioner.

Recommendation 11Recommendation 11: A transition : A transition period be planned to provide nurses period be planned to provide nurses with master’s degrees, who wish to with master’s degrees, who wish to obtain the practice doctoral degree, a obtain the practice doctoral degree, a mechanism to earn a practice mechanism to earn a practice doctorate in a relatively streamlined doctorate in a relatively streamlined fashion with credit given for previous fashion with credit given for previous graduate study and practice graduate study and practice experience. The transition mechanism experience. The transition mechanism should provide multiple points of should provide multiple points of entry, standardized validation of entry, standardized validation of competencies, and be time limited.competencies, and be time limited.

Recommendation 12:Recommendation 12: Practice Practice doctorate programs, as in doctorate programs, as in research-focused doctoral research-focused doctoral programs, are encouraged to programs, are encouraged to offer additional coursework and offer additional coursework and practica that would prepare practica that would prepare graduates to fill the role of nurse graduates to fill the role of nurse educatoreducator

Recommendation 13: Recommendation 13: Practice-Practice-focused doctoral programs need focused doctoral programs need to be accredited by a nursing to be accredited by a nursing accrediting agency recognized by accrediting agency recognized by the U.S. Secretary of Education the U.S. Secretary of Education (i.e. Commission on Collegiate (i.e. Commission on Collegiate Nursing Education or the Nursing Education or the National League for Nursing National League for Nursing Accrediting Council).Accrediting Council).

Moving ForwardMoving Forward

AACN has created two task forces:AACN has created two task forces: Essentials of the Doctorate of Nursing Essentials of the Doctorate of Nursing

PracticePractice Task Force on the Roadmap to the DNPTask Force on the Roadmap to the DNP

Goal is to complete transition to the Goal is to complete transition to the DNP by 2015DNP by 2015

The Essentials of the Doctorate of The Essentials of the Doctorate of Nursing PracticeNursing Practice

Task Force charged to develop the curricular Task Force charged to develop the curricular and content requirements for the DNP as well and content requirements for the DNP as well as identify the competencies to be acquired in as identify the competencies to be acquired in a DNP program.a DNP program.

The document follows the model of the BSN The document follows the model of the BSN and Masters Essentials and Masters Essentials

Provides direction for program development Provides direction for program development and accreditation.and accreditation.

Charge to Task ForceCharge to Task ForceDevelop the curricular and content requirements for Develop the curricular and content requirements for

the DNP as well as identify the competencies to be the DNP as well as identify the competencies to be acquired in a DNP programacquired in a DNP program

Establish a clear strategy for educational changes Establish a clear strategy for educational changes and transition, and hallmarks that distinguish the and transition, and hallmarks that distinguish the DNP from existing programs that offer the Master DNP from existing programs that offer the Master of Science in Nursingof Science in Nursing

Identify the critical curricular content that should be Identify the critical curricular content that should be present and competencies that should be acquired present and competencies that should be acquired in the DNP programs in which master’s prepared in the DNP programs in which master’s prepared nurses seek to acquire the DNPnurses seek to acquire the DNP

Develop recommendations and strategies for AACN, Develop recommendations and strategies for AACN, and the full contingent of AACN’s academic and the full contingent of AACN’s academic programs to respond to this transition.programs to respond to this transition.

Essentials Reflect Competencies for Essentials Reflect Competencies for All GraduatesAll Graduates

DNPMS-APN

MS-non-APN

BS (nursing)BS (non-nursing)

BACCALAUREATE

COMP

Task Force StrategyTask Force Strategy

Re-confirm 7 essentials identified by original Practice Re-confirm 7 essentials identified by original Practice Doctoral Task ForceDoctoral Task Force

Read a lot, and consult constituents and leadersRead a lot, and consult constituents and leaders

Discuss and deliberate—8Discuss and deliberate—8thth essential added essential added

““Clinical Prevention and Population Health Clinical Prevention and Population Health

for Improving the nation’s Health” for Improving the nation’s Health”

Draft document core—the essential competencies and Draft document core—the essential competencies and related curricular contentrelated curricular content

Hold regional and stakeholder meeting for feedbackHold regional and stakeholder meeting for feedback

Post draft document on web site for feedback Post draft document on web site for feedback

Preliminary Content for the EssentialsPreliminary Content for the EssentialsIntroductionIntroduction

Background/Trends leading to this paradigm shiftBackground/Trends leading to this paradigm shiftSummary of process and purpose of the documentSummary of process and purpose of the document

Context of Graduate Education in NursingContext of Graduate Education in NursingRelationship of MSN, DNP, and PhDRelationship of MSN, DNP, and PhDIntegration of faculty/teaching role in graduate nursing educationIntegration of faculty/teaching role in graduate nursing education

Doctoral Education for nursing practiceDoctoral Education for nursing practiceBroad curricular model—includes links to specialty certifying bodiesBroad curricular model—includes links to specialty certifying bodiesDescription of 8 Essentials (document circulated at regionals)Description of 8 Essentials (document circulated at regionals)Curricular Elements (content circulated at regionals)Curricular Elements (content circulated at regionals)

DNP Programs in the Academic EnvironmentDNP Programs in the Academic EnvironmentCurricular parameters (eg, typical length/credit hours)Curricular parameters (eg, typical length/credit hours)Residency Residency Capstone ProjectCapstone ProjectFaculty characteristicsFaculty characteristics

GlossaryGlossary

Format of Section of the DNP Essential Format of Section of the DNP Essential Draft Currently Under ReviewDraft Currently Under Review

Not the complete document or final format—only a section

Introduction

Review of 2004 TF recommendations

Summary of ProcessTask Force creation Regional meetingsDefinition of advanced nursing practice

Curriculum Model

Essential Competencies

Overview of the Curriculum ModelOverview of the Curriculum Model

DNP is a degree preparing individuals for multiple roles.

Seven of the core competencies are for all graduates regardless of role.

Core competencies form the basic foundation for advanced nursing practice (essential 8) where competencies bifurcate with the DNP program of study focusing on either:

Roles involving the direct delivery of care to individuals, families, and/or populations

Roles that influence the delivery of care indirectly through organizational and system

leadership.

Core Essentials

1-7

Specialty Focused Competencies**

*For those students who may choose a career in healthcare education or academia, additional pedagogical courses should be provided

**Competencies, Content and Practica are delineated by specialty nursing organizations.

Optional coursework in pedagogical

methods*

Advanced Nursing Practice Competencies for:

A) Graduates focused on individuals & families

B) Graduates focused on populations, systems & organizations

Core Essential 8

Recommended DNP ContentRecommended DNP Content

Some content overlaps or is noted multiple times due to the synergistic nature of competencies and the utility of some content for more than one essential.

Content ≠ Course

Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates

1. Scientific underpinnings for practice

Recognizes the philosophical and scientific underpinnings essential for the complexity of nursing practice at the doctoral level.

2. Organizational and systems leadership for quality improvement and system thinking

Recognizes the competencies essential for improving and sustaining clinical care and health outcomes, eliminating health disparities, and promoting patient safety and excellence in care.


3. Clinical scholarship and analytical methods for evidence-based practice

Recognizes competencies essential for translation of research into practice, evaluation of practice, practice improvement, and the development and utilization of evidence-based practice.

4. Technology and information for the improvement and transformation of patient-centered health care

Recognizes competencies essential to manage, evaluate, and utilize information and technology to support and improve patient care and systems.


5. Health care policy for advocacy in health care

Recognizes the responsibility nurses practicing at the highest level have to influence safety, quality, and efficacy of care, and the essential competencies required to fulfill this responsibility.

6. Interprofessional collaboration for improving patient and population health outcomes

Recognizes the critical role collaborative teams play in today’s complex health care systems and the competencies essential for doctorally prepared nurses to play a central role on these teams.

Essential Competencies for DNP GraduatesEssential Competencies for DNP Graduates7. Clinical prevention and population health for

improving the nation’s health

Added to original competencies in response to:

• IOM 2001 call for transformation “…of health professional education in response to the changing needs of the population and the demands of practice.”

• Health People 2010 support of IOM and objective to include “core competencies in health promotion and disease prevention” in clinical education

• In consideration of nursing’s the longstanding focus on health promotion and prevention


8. Advanced nursing practice for improving the delivery of patient care

Recognizes the essential competencies reflective Recognizes the essential competencies reflective of the distinct, in-depth knowledge and skills that of the distinct, in-depth knowledge and skills that form the basis for nursing practice at the highest form the basis for nursing practice at the highest level regardless of practice role.level regardless of practice role.

To Divide or Not to Divide: That is the To Divide or Not to Divide: That is the Question (Apologies to Hamlet)Question (Apologies to Hamlet)8a. APN or individual and population-focused 8a. APN or individual and population-focused

competencies for the DNP graduate competencies for the DNP graduate

Recognizes the unique competencies associated with the Recognizes the unique competencies associated with the specialized knowledgespecialized knowledge and clinical expertise essential clinical expertise essential for the direct care of individuals, families, or discrete for the direct care of individuals, families, or discrete population aggregates.population aggregates.

8b. Systems or organization-focused competencies for 8b. Systems or organization-focused competencies for

the DNP graduatethe DNP graduate

Recognizes the unique competencies associated with the Recognizes the unique competencies associated with the organizational expertise and specialized knowledge organizational expertise and specialized knowledge essential for leadership of health care delivery systems.essential for leadership of health care delivery systems.

Transforming Professional Transforming Professional Nursing PracticeNursing Practice

Issues are centrally focused on preparing Issues are centrally focused on preparing professional nurses with the highest level professional nurses with the highest level of education to provide expert nursing of education to provide expert nursing carecare

Will not disenfranchise current APNs Will not disenfranchise current APNs DNPs will serve as the natural allies of DNPs will serve as the natural allies of

researchers for the full implementation of researchers for the full implementation of evidence for practiceevidence for practice

Discipline needs both researchers and Discipline needs both researchers and high level clinicians to provide high high level clinicians to provide high quality carequality care

What Are the Issues?What Are the Issues?Perspectives from the Perspectives from the

Anesthetist Anesthetist Should all APNs be expected to meet Should all APNs be expected to meet

the requirements for the foundational the requirements for the foundational framework of the DNP Essentials?framework of the DNP Essentials?

How long?How long? Who set the expectations for specialty Who set the expectations for specialty

practice education? The DNP is practice education? The DNP is specialty focused education.specialty focused education.

Do we really need that content? Do we really need that content? Reframing what is – not always adding Reframing what is – not always adding more. more.


AnesthetistAnesthetist What about the programs that are not What about the programs that are not

housed in a nursing school? Depends housed in a nursing school? Depends upon who sets the standards for those upon who sets the standards for those programs.programs.

How will we assure that all the programs How will we assure that all the programs are requiring similar outcome are requiring similar outcome competencies? Is this an accreditation competencies? Is this an accreditation issue – and not an assault on the need to issue – and not an assault on the need to change the degreed?change the degreed?

What does it mean to be foundational?What does it mean to be foundational?


AnesthetistAnesthetist There is no compelling evidence to do There is no compelling evidence to do

this? -------Shouldn’t you get the degree this? -------Shouldn’t you get the degree you deserve for the time and energy you you deserve for the time and energy you are required to undertake to complete are required to undertake to complete the program?the program?

Where will we get the faculty? They are Where will we get the faculty? They are there – we need to think differently there – we need to think differently about who will serve as faculty and about who will serve as faculty and remember how we began other remember how we began other innovations in nursing.innovations in nursing.

How are other health How are other health professions changing their professions changing their

education?education? The ACGME requires that all residency The ACGME requires that all residency

programs evaluate the competence of programs evaluate the competence of their residents in the following areas:their residents in the following areas: patient care, patient care, Practice-based learning and improvementPractice-based learning and improvement

medical knowledge, medical knowledge, interpersonal and communication skills, interpersonal and communication skills, professionalism, and professionalism, and systems-based learningsystems-based learning

AANA Summit on the AANA Summit on the DNPDNP

While the nurse anesthetist of today While the nurse anesthetist of today is safe and competent, the provider is safe and competent, the provider of the future will have to possess of the future will have to possess enhanced skills in analysis and enhanced skills in analysis and synthesis of research and be able to synthesis of research and be able to apply them in the practice setting.apply them in the practice setting.

AANA Summit on the AANA Summit on the DNPDNP

Practitioners will need increased Practitioners will need increased knowledge in business skills, knowledge in business skills, management of less invasive management of less invasive procedures, multicultural procedures, multicultural healthcare, and biomedical ethics.healthcare, and biomedical ethics.

Subspecialties in practice will Subspecialties in practice will continue to emerge in areas such as continue to emerge in areas such as pediatrics and pain management. pediatrics and pain management. (Populations??)(Populations??)

What are the Transition What are the Transition Issues?Issues?

Creating standards to assure quality Creating standards to assure quality programs with consistency in goals programs with consistency in goals and outcomesand outcomes

Creating partnerships across Creating partnerships across multiple institutions to achieve goalmultiple institutions to achieve goal

Seeking creative solutions to issues Seeking creative solutions to issues related to resources, faculty, related to resources, faculty, regulatory structuresregulatory structures

What are the Transition What are the Transition Issues:Issues:

Collaboration with multiple Collaboration with multiple constituents to create agreement on constituents to create agreement on issues related to credentialing – issues related to credentialing – including licensure, certification, including licensure, certification, and accreditationand accreditation

They say that time They say that time changes things. changes things. But you actually But you actually have to change have to change

them yourselves.them yourselves.

Andy WarholAndy Warhol

Truth springs Truth springs from arguments from arguments among friends.among friends.

David HumeDavid Hume

Wise SayingsWise Sayings

Remember - this ain’t a Remember - this ain’t a dress rehearsaldress rehearsal

Famous nurse – Carole AndersonFamous nurse – Carole Anderson

““Today as in the past, Today as in the past, nursing remains pivotal in nursing remains pivotal in improving the health status improving the health status of the public and ensuring of the public and ensuring safe, effective, quality care.”safe, effective, quality care.”

ANA Scope and Standards of PracticeANA Scope and Standards of Practice

Creating the FutureCreating the Future

We 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.

the doctorate of nursing practice: responding to a changing

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