The Doctor of Nursing Practice: a national workforce perspective.

In 2004, the American Association of Colleges of Nursing (AACN) adopted a position statement concerning the future of advanced practice nursing education. A target date of 2015 was articulated as the point by which master's preparation for advanced practice nurses would be replaced by doctoral level education. Seismic shifts in the realities surrounding nursing education and practice have occurred since the proposal to require a Doctor of Nursing Practice (DNP) degree for entry into advanced practice nursing was proposed. Unprecedented economic challenges have resulted in significant budget downturns for all sectors, including higher education. The consequent cutbacks, furloughs, and restructuring in educational operations of all types have placed enormous demands on faculty, staff, and students across the country. In addition, the growing incidence and earlier onset of chronic disease, a rapidly aging population, health care reform agendas, a shortage of primary care practitioners, and projected severe shortages of nursing faculty have raised fundamental questions about the capacity of nursing education to produce the numbers of advanced practice nurses needed. This article addresses the changing realities and growing concerns associated with the future of advanced practice nursing. Recommendations to ensure continuing development of advanced nursing practice that serves the interests and needs of the public now and in the future are presented within the context of a national workforce perspective.

Improving quality and safety education: The QSEN Learning Collaborative.

As part of a national initiative to improve quality and safety education in prelicensure nursing programs, 15 schools participated in a 15-month learning collaborative sponsored by Quality and Safety Education for Nurses, funded by the Robert Wood Johnson Foundation. This article presents the rationale, design, activities, and outcomes of the collaborative. Collaborative members revised curricula, developed new teaching strategies, and established the foundation for future faculty development efforts to advance teaching of quality and safety concepts in nursing education.

Assessing quality and safety competencies of graduating prelicensure nursing students.

The Quality and Safety Education for Nurses (QSEN) project is focused on enhancing nursing curricula and fostering faculty development to support student achievement of quality and safety competencies. The purpose of this descriptive study was to assess student perspectives of quality and safety content in their nursing programs along with self-reported levels of preparedness and perceived importance of the 6 QSEN competencies. Graduating students (n = 565) from 17 US schools of nursing completed an electronic student evaluation survey. Students reported exposure to QSEN knowledge areas, more often in classroom and clinical learning settings than in skills lab/simulation settings. Clinical experience outside of formal education was associated with perceptions of a higher level of preparedness for QSEN skills in several competencies. In general, students reported relatively high levels of preparedness in all types of prelicensure nursing programs and endorsed the importance of quality and safety competencies to professional practice.

Quality and safety education for advanced nursing practice.

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

The ethics of using quality improvement methods in health care.

Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings and concluded that QI is an intrinsic part of normal health care operations. Both clinicians and patients have an ethical responsibility to participate in QI, provided that it complies with specified ethical requirements. Most QI activities are not human subjects research and should not undergo review by an institutional review board; rather, appropriately calibrated supervision of QI activities should be part of professional supervision of clinical practice. The group formulated a framework that would use key characteristics of a project and its context to categorize it as QI, human subjects research, or both, with the potential of a customized institutional review board process for the overlap category. The group recommended a period of innovation and evaluation to refine the framework for ethical conduct of QI and to integrate that framework into clinical practice.

A present-day academic perspective on the Carolina nursing experience: building on the past, shaping the future.

Past, present, and future models of academic-service collaboration are described and projected from an academic perspective. The features that characterize academic-service partnerships during the history of nursing education in America, the goals that drove faculty and academic leaders to engage or disengage in earlier partnerships, and new forms of emerging partnerships are presented, along with a discussion of their importance in the context of environmental change. The foundation for building the Carolina Model between the University of North Carolina-Chapel Hill and the University of North Carolina Hospitals is a prototype for extending future academic-service initiatives.

Analysis & commentary. Unleashing nurse practitioners' potential to deliver primary care and lead teams.

Highly skilled primary care is a hallmark of high-performing health care systems. We examine nurse practitioners' role in delivering primary care and the effects of current restrictions on their ability to practice. By resolving differences between states' individual scope-of-practice regulations, we can fully benefit from the skills of advanced-practice nurses in all fifty states. We recommend substantive changes in the way health care professionals in all disciplines are trained, and in their roles, so that patients can receive appropriate and cost-effective care from skilled and fully functional health care teams.

Current assessments of quality and safety education in nursing.

Concerns about the quality and safety of health care have changed practice expectations and created a mandate for change in the preparation of health care professionals. The Quality and Safety Education for Nurses project team conducted a survey to assess current levels of integration of quality and safety content in pre-licensure nursing curricula. Views of 195 nursing program leaders are presented, including information about satisfaction with faculty expertise and student competency development related to 6 domains that define quality and safety content: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. With competency definitions as the sole reference point, survey respondents indicated that quality and safety content was embedded in current curricula, and they were generally satisfied that students were developing the desired competencies. These data are contrasted with work reported elsewhere in this issue of Nursing Outlook and readers are invited to consider a variety of interpretations of the differences.

Quality and Safety Education for Nurses.

Quality and Safety Education for Nurses (QSEN) addresses the challenge of preparing nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work. The QSEN faculty members adapted the Institute of Medicine(1) competencies for nursing (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), proposing definitions that could describe essential features of what it means to be a competent and respected nurse. Using the competency definitions, the authors propose statements of the knowledge, skills, and attitudes (KSAs) for each competency that should be developed during pre-licensure nursing education. Quality and Safety Education for Nurses (QSEN) faculty and advisory board members invite the profession to comment on the competencies and their definitions and on whether the KSAs for pre-licensure education are appropriate goals for students preparing for basic practice as a registered nurse.

Reflections on the doctorate of nursing practice.

A debate is currently raging in many academic nursing circles about a new degree, the Doctor of Nursing Practice (DNP). The degree is envisioned as the terminal degree in the discipline that focuses on clinical practice, and it is proposed to supplant the master's degree by 2015. There are a number of driving forces fueling the proposed change, including the hoped-for parity it will create with other health care disciplines and the potential for addressing the complexity of today's health care system. However, we believe that a substantive debate is required prior to a full-scale adoption of this new degree. In this article, we pose the potential unintended consequences of adopting a practice doctorate within our profession-the ones that might be negative for the nursing profession, for health care, and for society as a whole. We discuss these 3 dimensions and suggest that the DNP may erode the major progress nursing as a scientific discipline has made in universities over the past 3 decades. We suggest that the adoption of a DNP will threaten the generation of theory-based science in our discipline, either by decreasing the number of PhD-prepared nurses that will enter the field in the future or by lengthening the course of study to a PhD, thereby significantly shortening productive scientific careers. We question whether the creation of 2 doctoral tracks will further widen the chasm between nurse scientists and clinicians and result in many nurse clinicians feeling disenfranchised. We also pose questions about the impact of the DNP on health care and society. We are concerned that the number of nurses prepared at an advanced practice level will decrease and that the DNP will, thus, have negative impacts on quality, cost, and access to care. Finally, we question whether the DNP will create confusion among colleagues and consumers. We recommend that the adoption of the DNP only occur after thoughtful discussion both within and outside the profession.