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

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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
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

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

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


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


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

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.”

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


Advanced nursing practice

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

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

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

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

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

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 2012-2013

AANA Position on Doctoral Preparation Nurse Anesthetists (2007)

AANA supports doctoral

education for entry into

nurse anesthesia practice

by 2025


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
doctor of nursing practice
Schools of Nursing DNP Consortium

CSU Fullerton, Long Beach and Los Angeles

Doctor of Nursing Practice


  • 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


  • 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


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

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

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

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

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

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