17 Mar Nursing Modernizes to Reflect Modern Times
As health care evolves, so has the nursing profession. Advanced Practice Registered Nursing (APRN), an umbrella term to include the 4 roles of advanced practice nurses, have been expanding at a rapid rate. There are over 250,500 APRNs in the country, according to the recently released HRSA report on the nation’s nursing workforce, in 2008, there were:
1) 174,300 Nurse Practitioners
2) 18,500 Nurse Midwives
3) 35,000 Nurse Anesthetists
4) 59,000 Clinical Nurse Specialists.
Landmark reports including the IOM’s Crossing the Quality Chasm and it’s follow up, Health Professions Education: A Bridge to Quality, emphatically recommended that a modern well-functioning health care workforce must be prepared to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement innovation, outcomes results and informatics.
Advanced Practice Nurses Evolve to the Doctoral Level
The American Association of Colleges of Nursing developed a consensus process to address the nursing profession’s current practice of preparing advanced practice nurses in master’s degree programs as no longer adequate to meet modern complexity and demands. A roadmap to adopt the position that all advanced practice nursing programs will move to the doctorate of nursing practice (DNP) by 2015. This curriculum is intended to propel nursing practice forward and keep it grounded in the practice domain. Historically, nurses were often earning PhDs with a focus on generating new knowledge. What was missing was an expert clinician to provide leadership and could translate and infuse evidence into care delivery systems. A clinical doctorate would address the growing complexity of health care, compounded by an escalating demand for services, burgeoning growth in scientific knowledge, and the increasing sophistication in technology. The nursing profession recognizes that in order to transform health care delivery, we must recognize the critical need for clinicians to lead, design, evaluate, and continually improve the context within which care is delivered. Picture an expert nurse practitioner who can also lead quality improvement efforts, build programs to help all providers practicing within the context of an evidence-base, effect cultural change, and engage in executive level decision-making in large, complex health care institutions. A DNP will create a highly qualified APRN to meet evolving models of care delivery that focus on outcomes, a nurse practitioner on steroids, if you will.
National APRN Standards are Established.
The National Council of State Boards of Nursing has internally modernized their standards across a range of issues by creating an advanced practice nursing regulatory model. It requires all APRN programs follow clear, consistent curriculum guidelines with rigorous accreditation standards, that state licensing boards develop standard requirements for APRN licensure, and that educational programs are standard across the 4 APRN roles. It boldly states that the hodge-podge of nurse practice acts across the nation, over half of which are restrictive, must be removed. It recommends that solely boards of nursing regulate advanced practice nurses – which is not the norm in some states. For example, some states require boards of medicine to regulate or co-regulate advanced nursing practice. The profession has set new standards and many states are not in compliance with them. Some states, such as Virginia, have a restrictive practice act, which had not been modernized since the 1970s, creating unnecessary practice restrictions in a time of dire need and workforce shortages. [The report, APRN Consensus, is found below]
IOM Focuses on Nursing’s Future
Last fall the IOM released, The Future of Nursing, which makes several bold recommendations. The report is based on 4 key principles: 1) Nurses should practice to the full extent of their education and training; 2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3) Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States; and 4) Effective workforce planning and policy making require better data collection and an improved information infrastructure. The report recommends that the number of nurses with a doctorate be doubled by 2020 so that nurses are prepared to lead and improve collaborative health care improvement efforts. In order to do this, the report strongly urges all levels of government to remove regulatory barriers to practice. One strategy the IOM recommends is to have Congress limit federal funding for nursing education to states that have not adopted the model rules and regulations described above.
All to say, the times they are a changing. Modern nursing practice has adapted to the surge in chronicity, the broad mandate to make threshold improvements in patient safety, care transitions and quality of care. Advanced practice nurses with doctorates in nursing practice are prepared to lead the way. In this time of transformation, if the health professions stay fixed, immutable, and non-adaptive to the changing landscape, we can expect more of the same bleak health care outcomes, unsafe practices, and out of control health care inflation.
Dr. Eileen O’Grady is a Certified Nurse Practitioner and Wellness Coach and teaches health policy at Pace University’s DNP program. She earned a PhD and wishes she had a DNP degree. www.eileenogrady.net
American Association of Colleges of Nursing. DNP Roadmap Taskforce Report. http://www.aacn.nche.edu/dnp/pdf/DNProadmapreport.pd
The National Council of State Boards of Nursing: Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education http://www.nonpf.com/associations/10789/files/APRNConsensusModelFinal09.pdf
IOM: The Future Of Nursing Report http://thefutureofnursing.org/recommendations
The National Sample Survey of Registered Nurses (2008) http://bhpr.hrsa.gov/healthworkforce/rnsurvey/2008/nssrn2008.pdf