Moving Toward Equity and Transparency in NP Faculty Workload: It's More Than Just Credits.

BACKGROUND: Nurse practitioner (NP) programs rely on a highly educated and experienced faculty to deliver the curriculum. Full-time NP faculty are expected to be doctorally prepared, with responsibilities for instruction, an active clinical practice, scholarship, and service. PROBLEM: Although the majority of faculty workload comes from effort in instruction, there is significant variability in how faculty workload is assigned. Absent a national model, schools of nursing are challenged to develop workload models for NP faculty to allocate effort for the full scope of work that NP faculty are expected to perform to meet requirements for academic credentialing bodies, licensure, and academic promotion. APPROACH: This article examines current practices in NP workload allocation and explores ways to allocate effort to the domains of work integral to NP education. CONCLUSION: NP faculty workload models should align with academic promotion expectations to encourage equity and transparency.

Exploring Clinical Practice Hours in Postbaccalaureate-to-Doctor of Nursing Practice Nurse Practitioner Programs.

BACKGROUND: Advanced practice nursing education is evolving to the doctor of nursing practice (DNP) degree. The American Association of Colleges of Nursing (AACN) DNP Essentials required 1000 hours of direct patient care, whereas the Report of the National Task Force on Quality Nurse Practitioner Education (NTF) Criteria for Evaluation of Nurse Practitioner Programs required 500 direct patient care hours. Indirect hours were unclear and undefined. The AACN Essentials changed the 1000-hour requirement to 500 practice hours, and the NTF increased the direct patient care hours to 750. PURPOSE: The study sought to describe the distribution of direct and indirect hours that the National Organization of Nurse Practitioner Faculties member schools offer in their seamless postbaccalaureate-to-DNP nurse practitioner (NP) program. METHOD: A quantitative survey was distributed to schools of nursing. RESULTS: Eighty-six surveys represented 86 distinct schools and 112 NP programs. Supervised direct patient care hours were an average of 791.31 hours. Indirect hours averaged 170.08 hours. The DNP project hours served as an indirect hour activity. CONCLUSION: Many schools have more than 750 direct hours adhering to the 2022 NTF Standards. The indirect hour allocation varies and weighs heavily on the DNP project.

U.S. Primary Care Provider Needs: An Analysis of Workforce Projections and Policy Implications.

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce.

Development of the Doctor of Nursing Practice Nurse Practitioner Minimum Data Set (DNP NP MDS).

BACKGROUND: While the number of Doctor of Nursing Practice (DNP) programs has grown steadily, there is limited data on how national organizations are collecting data on DNP-prepared nurse practitioners (NPs) and no standard instrument exists to collect data on DNP-prepared NPs. PURPOSE: The purpose of this study was to develop a universal minimum data set (MDS) for the DNP-prepared NP population. METHOD: Instrument development consisted of several sequential stages, including conceptualization and item generation, preliminary evaluation of items, field testing the survey, and analysis of scale development data. FINDINGS: A set of 16 core variables and 19 additional variables were developed to collect standardized data on the demographics, education, and practice patterns of DNP-prepared NPs. Pilot testing revealed high correlations between the activities DNP-prepared NPs are prepared for and typically participate in a typical workweek and in their career. The MDS demonstrated high reliability in our sample. DISCUSSION: The DNP NP MDS can be used for data collection by various stakeholders, including national organizations, to facilitate improved tracking of outcome data for the DNP-prepared NP workforce. It can also provide data-driven support for the need and significance of the DNP degree for NPs.

Strategies to Move Entry-Level Nurse Practitioner Education to the Doctor of Nursing Practice Degree by 2025.

BACKGROUND: The National Organization of Nurse Practitioner Faculties (NONPF) has made the commitment to move all entry-level nurse practitioner (NP) education to the Doctor of Nursing Practice (DNP) degree by 2025. PROBLEM: Although there are more than 250 DNP NP programs throughout the United States, many other NP programs have yet to transition to the doctoral level. APPROACH: Leaders representing licensure, accreditation, certification, education, and practice organizations attended a NONPF 2017 Summit to discuss the DNP degree as entry into NP practice. Summit participants strategized on building collective strengths and addressed barriers to implementation. A solution-oriented discussion with action items has been operationalized for the last 4 years. OUTCOMES: Four workgroups were created to address education, outcomes, capacity, and messaging related to moving all entry-level NP education to the DNP degree. CONCLUSION: Ongoing collaborative efforts are critical to facilitate advancing all NP education programs to the DNP degree by 2025.

Nurse practitioner student clinical placement processes: A national survey of nurse practitioner programs.

BACKGROUND: Providing quality clinical sites and preceptors is one of the greatest challenges for nurse practitioner programs. PURPOSE: To conduct a national survey of nurse practitioner (NP) program directors to better understand the complex process for clinical site placement in the United States. METHODS: In 2018, a web-based survey was sent to program directors to ascertain the faculty and staff effort allocation and processes related to NP student placements, the number of required clinical rotations, the total hour requirement, and preceptor incentives and barriers. FINDINGS: There was a 47% survey response rate. Variation in processes was found across NP programs. Almost 14% of respondents said that students were required to find sites entirely on their own. Ten percent of faculty reported devoting 90% to 100% of their effort to finding preceptors. Preceptors and sites were rarely paid, but other incentives were common. DISCUSSION: It is vital for NP programs to streamline clinical placement processes, to foster academic-practice partnerships, and to advocate for federal funding to train the future NP workforce.

A call to action: Building evidence for use of simulation in nurse practitioner education.

Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.

Nursing leadership and health policy: a dialogue with nurse leaders.

National public health policy influencing the entire population is particularly exciting when nurses serve as key players informing the process. The leaders in this dialogue participated in the process by sharing their disciplinary knowledge and experience. They were selected to work with bureaucrats to design healthcare for the future. This dialogue among two nurse leaders demonstrates a path to top leadership in the United States. Swider and Bigley here share their stories of how they moved beyond clinical practice to involvement in their communities and the nation. Through public health and policy initiatives, both nurse leaders have helped shape healthcare to provide better patient-centered care at all levels. This dialogue not only shares their successes, but also sets the stage for others in nursing to use policy to transform healthcare for the future.

Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change.

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.

The roles of healthcare professionals in implementing clinical prevention and population health.

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.

New standards and enhanced utility for family health history information in the electronic health record: an update from the American Health Information Community's Family Health History Multi-Stakeholder Workgroup.

Family health history is a complex, multifaceted tool for assessing disease risk that can offer insight into the interplay between inherited and social factors relevant to patient care. Family health history tools in electronic health records can enable the user to collect, represent, and interpret structured data that properly supports clinical decisions. If these data can be made interoperable, important health information can be shared with minimal duplication of effort among entities involved in the continuum of patient care. This paper reviews the efforts by the American Health Information Community's Family Health History Multi-Stakeholder Workgroup to create a core data set for family health history information and to determine requirements to promote incorporation of such information in electronic health records. The Workgroup is a component of the U.S. Department of Health and Human Services' Personalized Health Care Initiative.