Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.

BACKGROUND: In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. PURPOSE: The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. METHODS: Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. FINDINGS: This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. DISCUSSION: This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

Promoting Faculty Scholarship: A Clinical Faculty Scholars Program.

BACKGROUND: The importance of supporting and promoting faculty scholarship in nursing is acknowledged, but the reality of scholarship for faculty engaged in clinical teaching can be challenging. METHOD: The article describes the development and initial results of the scholarly practice program. Mentorship, time, and limited funding are essentials for the program. RESULTS: After submitting detailed proposals, 15 faculty were chosen to be project leaders in the first 2 years of the program, resulting in 15 presentations, three posters, 19 publications, and a webinar, to date. External continuing funding has been secured by three projects. Additional dissemination efforts are awaiting peer review. CONCLUSION: The program has successfully increased the level of scholarship among clinical teaching faculty and contributed to the faculty's professional satisfaction. Faculty have increased experience and ability to conduct clinical quality improvement. Experience supports targeted, substantial support for projects, rather than a general average faculty allocation strategy to promote scholarship. [J Nurs Educ. 2018;57(2):121-125.].

Junior research track faculty in U.S. schools of nursing: Resources and expectations.

BACKGROUND: Concerns about U.S. nursing research workforce preparation and success in the research arena require information about support mechanisms and readiness because the first research position is key to researcher retention and success. PURPOSE: The purpose was to describe the state of junior nursing research faculty recruitment terms, nursing programs' support during the first 2 years of employment, and administrators' views about strengths and weaknesses of the junior nursing research faculty pool and adequacy of the support provided. METHODS: Survey administrators in all U.S. nursing programs offering research doctorates (n = 125; response rate: 52%). DISCUSSION: Resource availability varied widely across institutions. Most respondents reported resources were adequate regardless of the actual level provided. Administrators' teaching and research expectations of these faculty also varied widely. Administrators identified readiness to perform as an issue of concern. CONCLUSION: As consumers of nursing research program graduates and as administrators responsible for the nursing research enterprise, deans need to take collective as well as individual actions.

A description of U.S. post-graduation nurse residency programs.

BACKGROUND: Concern regarding newly licensed registered nurses' abilities to cope with the increasing complexity of care has led to the development of a variety of nurse residency program (NRP) initiatives. The unknowns are the extent to which and how various program elements are implemented across NRPs. Without understanding the extent to which NRPs deliver the same program, determination of their impact on care is limited. The purpose of this study was to describe U.S. NRPs and thereby identify the extent of treatment fidelity across programs. METHODS: Program attributes were measured using a 24-item survey based on the outcomes production conceptual framework. The survey was sent to known NRP directors or chief nursing officers at the 1,011 U.S. hospitals having 250 or more inpatient beds; 203 surveys (a 20% response rate) were returned. RESULTS: Almost half (48%) of hospitals reported operating an NRP. NRP models included University HealthSystems Consortium (22%), facility based (54%), and "other" (24%). Significant (p < .01) differences were noted among and within program model types in terms of career planning, project requirements and types, and mentoring. CONCLUSIONS: The extent of differences within and across program types indicates a lack of treatment fidelity needed to detect objectively the impact of the NRP as a discrete intervention on patient outcomes. NRP expansion may be limited by the number of hospitals of a size most likely able to support such programs.

Defining and describing capacity issues in U.S. Doctor of Nursing Practice programs.

Recent calls to expand the number of U.S. Doctors of Nursing Practice (DNPs) raises questions about programs' capacities, content and requirements, and their ability to expand. This paper aims to describe (1) key aspects of DNP program capacities that may provide direction for DNP program expansion plans, the timing of such expansion and program QI efforts; and (2) the impact of the DNP on faculty resources for research doctoral programs. A survey of all U.S. DNP programs (n = 130; response rate 72%) was conducted in 2011 based on previously tested items. Reviews of Web sites of nonresponding schools provided some data from all programs. Ratios of students to faculty active in advanced practice (AP) and in QI (QI) were high (AP 11.0:1, SD 10.1; QI 20.2:1, SD 17.0 respectively). There was wide variation in scholarly requirements (0-4: 50% of program had none) and program committee composition (1-5; mode=2). Almost all responding schools that offered PhD and DNP programs reported assigning research-active or potentially research-active faculty in both programs. The ability to expand programs while maintaining quality may be compromised by capacity issues. Addressing demand issues through the alignment of program requirements with societal and employment requirements may provide directions for addressing current DNP capacity issues.

Are nurses ready for health care reform? A decade of survey research.

As health care delivery organizations react to the changes brought about by public and private sector reform initiatives, RNs can anticipate that, in addition to intended outcomes, there will be unpredictable pressures and unintended consequences arising from reform. Biennial national surveys of RNs conducted over the past decade have explored various changes in the nursing workforce, quality of the workplace environment, staffing and payment policies, and RNs' views of health policy, including their expectations of health reform. The latest survey results offer a picture of RNs' capacity to practice successfully in a care delivery environment that, over the current decade, is expected to emphasize teams, care coordination, and become driven increasingly by payment incentives that reward quality, safety, and efficiency. If RNs are provided with strong clinical leadership, participate in developing an achievable vision of the future, and if supported to take risks and innovate to improve the quality and efficiency of care delivery, then the profession is likely to thrive rather than struggle during the health reform years that lie ahead. Increasing the education and preparation of nursing leaders, and particularly unit-level managers, will be increasingly vital for nursing to prosper in the future.

Advanced practice nursing for enduring health needs management: a global perspective.

Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.

Leadership in doctoral nursing research programs.

The expansion of U.S. doctoral nursing research programs and transitions based on demographic distribution of the nursing academic workforce raises questions about the preparation for leadership transition planning. The purpose of this study was to describe the program leaders, job conditions, and status of transition efforts. A survey of U.S. nursing research doctoral programs (N = 105) was conducted in 2008. The response rate was 84.8%. A Web search of nonresponding schools provided some data from all programs. Most research doctoral program leaders hold additional responsibilities (mean = 4.2). The mean budgeted leadership time was 32.9% (SD = 21.4). Among programs in which the director's age was at least 60 years, 59% had no succession plan. Continuing improvement of the quality of doctoral nursing research programs could be compromised by leadership transition issues. To produce research-competitive graduates, continued support and attention to leadership of these programs is essential.

Defining and describing capacity issues in US doctoral nursing research programs.

The expansion of US doctoral research programs raises questions about mentorship capacity, program quality, and decisions about future expansion. To describe capacity issues and, when possible, compare findings to those of an earlier study, a survey of US nursing research doctoral programs (n = 105) was conducted in 2008. The response rate was 84.8%. The Web sites of non-responding schools were reviewed providing some data from all programs. The mean ratio of students per current externally funded grant was 6.9 (SD 7.5) to 1. The mean ratio of student to ever-funded faculty was 8.3 (SD 8.3) to 1. The mean number of research activities required (out of 5 possible) was 1.8 (SD 1.4), and the most common was a research practica (77%), followed by attendance at a research meeting external to the school (37%), and submitting an article for publication (32%). The quality of many programs may be compromised by capacity issues. Attention to existing programs' requirements and capacities and determination of the roles of these variables in producing research competitive graduates is needed.

The older nurse in the workplace: does age matter?

Between 2010 and 2020, over 40% of the RN workforce will be over 50 years of age, and many RNs are expected to retire and withdraw from the workforce. Given that older nurses are the fastest growing cohort of the workforce, the important findings presented in this article deserve careful consideration by policymakers, health care leaders, and managers.