Potential Crisis in Nurse Practitioner Preparation in the United States.

The Doctor of Nursing Practice (DNP) degree was established to expand nurse practitioner education by adding new competencies. In 2004, the American Association of Colleges of Nursing released a position statement that redefined practice from only clinical care of patients to include nonclinical care. This policy position likely contributed to the rapid growth of DNP programs. Historical background on the development of the DNP is provided. An analysis was conducted of the programs reported in the American Association of Colleges of Nursing list of accredited DNP programs between 2005 and 2018 to compare whether the programs prepared graduates for advanced clinical practice or administrative or leadership. During this time, 553 DNP programs were established, 15% (n = 83) are clinical, and 85% (n = 470) are nonclinical. The adequate production of nurse practitioners in the future may be in jeopardy with this imbalance in educational resources, especially with the nation's growing need for primary care clinicians.

The ABCs of the doctor of nursing practice: assessing resources, building a culture of clinical scholarship, curricular models.

The Doctor of Nursing Practice (DNP) degree prepares nurses to provide comprehensive care across sites and over time. It is absolutely crucial-for both patient care and the nursing profession-that broadly recognized standards of competency for these new practitioners be established. The Council for the Advancement of Comprehensive Care has met since 2000 to build consensus on competency standards and a process for certifying these graduates. Deans of five nursing schools discuss their experiences and provide guidance for schools interested in developing DNP programs.

Who's who in nursing: bringing clarity to the doctor of nursing practice.

Advanced practice nurses across the country are informally learning expanded skills and are assuming significant autonomy. The growing complexity and acuity of care, the aging of the US population, and the dwindling number of primary care physicians all contribute to the need for increased knowledge and practice competency. A formal and standardized educational process leading to a doctoral degree is essential for quality assurance, to clarify and validate authority/responsibility, and to recognize and identify these practitioners. The Doctor of Nursing Practice (DrNP) degree will formalize the acquisition of the knowledge and skills necessary for fully accountable and broader scope clinical nursing practice.

Context of care or provider training: the impact on preventive screening practices.

BACKGROUND: While MD adherence to U.S. Preventive Services Task Force guidelines has been found to be uneven, nurse practitioners (NPs) and their adherence to guidelines have not been closely examined. METHODS: A retrospective chart review of new patients (n = 1339) in an NP primary health care center, four MD primary health care centers, and one private NP practice. Screening and counseling were compared for NPs and MDs. RESULTS: When patient populations, resources, and administrative policies were similar in the NP and MD primary health care centers, NPs were more likely than MDs to perform primary prevention; however, MDs were more likely to document the delivery of secondary prevention screening. Private practice NPs' performance was more congruent with practice guidelines than either NP or MD primary health care center providers. Private practice NPs were more likely to perform screening, assessment, and counseling. CONCLUSIONS: When context, patient population, and productivity requirements were the same, NPs and MDs differed in their use of preventive measures, and not as expected. When NPs are not constrained by productivity requirements, and when their patient population has more resources and higher expectations, NPs perform better than their primary care center counterparts, particularly in secondary prevention and assessment and counseling.

Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.

This study reports results of the 2-year follow-up phase of a randomized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice. In the sample of 406 adults, no differences were found between the groups in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Physician patients averaged more primary care visits than nurse practitioner patients. The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians.

Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.

PURPOSE: The purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes. METHODS: Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin A1C (A1C) testing were performed to measure patient outcomes. RESULTS: NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and A1C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes. CONCLUSIONS: This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.