DNP Questions and Answers

Q: ...the second paragraph under Response #1 dealing with the Fitch Ratings report is a misquote in regards to the statement that "lesser skilled (nursing) staff will negatively affect quality, especially with the greater acuteness anticipated in future populations" The Fitch Ratings report was discussing quality, shortage of nursing staff, staffing mix, expanding job responsibilities for lesser trained care givers, such as licensed practical nurses to compensate for vacancies and concluded in saying "While it may be too early to determine what effect staffing mix adjustments will have  on outcomes, it is very possible that lesser skilled staff will negatively affect quality, especially with the greater acuteness anticipated in future hospital populations."

So I think the way the white paper reads in this paragraph is not reflective of the source's intent. See what you think. It may "ruffle feathers" more than is necessary, depending on how it is interpreted.
A: thanks for the feedback on the Fitch Rating.  I  will adjust according to Judy’s insights….I had hoped we could have final feedback/ response from TOADN by this week….since THECB sub task force meets next week (March 27th)…..thanks alexia
 

Q: Doesn't the Nursing Doctorate (ND) already prepare nurses for practice? http://www.aacn.nche.edu/Publications/positions/qualityindicators.htm
 
Q: Section 4 and Section 5 seem to be contradictory.  How can there be a "Clear Distinction in Skills and Scope of Practice between Masters and Doctoral Levels" and "...no impact on the current Masters in Nursing programs..."?
 

DNP Comments
 

I have a couple of comments concerning the "white paper" and the proposed DNP degree.

First, I believe TOADN should support the issue. To not do so just creates professional chasms that are not conducive to a collaborative environment. To not do so also might jeopardize our opportunity as an organization to continue to provide needed input as this degree completes development.

My second comment is that I would like to ask that a track for nursing educators be strongly considered within the degree plan for a DNP. My rationale for this is the recognition that of course teaching nursing is a specialized track in nursing. The nursing shortage is not going away-in part because nurses are still leaving the profession way before retirement age. I believe it is up to those of us teaching nursing then to develop graduates with a passion for nursing--not just a competent individual with a desire for a steady job and decent pay, in the hopes that the passion continues despite the frustrations that occur while working the shifts and dealing with the complex issues of healthcare. I also believe that mentors in the roles of nursing educators can instill that sense of passion when they demonstrate application of a passion for teaching and molding nurses. I believe continuing to further our skills IN TEACHING--helps us keep that passion for teaching in tip-top shape. An education track then in a DNP would be a way for nurse educators to further enhance their knowledge of TEACHING NURSING. The task force could look at curriculum for a doctorate in education for assistance in developing this track, along with using some courses designed for clinical practice track and leadership track.
 
Overall, I can certainly endorse this white paper for the future direction in nursing education opportunities it proposes. Suggested edits.
 
I can see that the DNP will probably be a positive step for the profession of nursing as a whole, providing an avenue for clinical nurses to achieve the doctoral degree. However, I do not see it as benefiting ADN education at this time.  I am concerned it will take funding away from addressing the nursing shortage, which is a higher priority. If there is funding available for both initiatives, then I would support it.
 
I feel TOADN needs to support the DNP and work with our nursing colleagues on this issue. Otherwise we are asking to remove ourselves and not be represented on the decisions which will impact the future of nursing. TOADN has become very well respected due to our proactive participation and involvement in nursing education and scholarship issues.  I would like for TOADN to help shape this new role, and work on our concerns with our university colleagues.
 
It is so important to be at the table and not on the outside looking in.  Sue Oschner was always anxious to be at the table so we could speak for ourselves and not let others do so. I would encourage us to have the vote as soon as possible and get the letter written so it will be ready to mail.  I hope we get some feedback by the vote. I would vote for a very carefully written letter that supports the concept and the right to have a some voice in this matter.
 
If I were you, I would be very concerned about the move to the DNP.  I hope the directors are doing their research and thinking about it carefully before they vote.
 

Dracup, K. & Bryan-Brown, C.W. (2005). Doctor of nursing practice - MRI or total body scan? American Journal of Critical Care, 14, 278-281.

Proposed advantages of the DNP :

  1. Parity with other healthcare professionals - medicine, dentistry, pharmacy, etc
  2. "Credit creep" in MSN programs compared to other graduate programs in the same university
  3. Complexities of clinical practice

Questions for debate:

  1. Will another degree add to public confusion? (diploma, AD, BSN, MSN [CNS, APN], DNS, ND, DSN, or PhD)
  2. Will the DNP threaten the supply of nurses who pursue a PhD?
  3. Will the DNP increase the "gap" and "discord" between academia and clinical practice?
  4. Will the DNP "unnecessarily extend the length of time it takes a nurse to be prepared for advanced practice"?


Burman, M.E. & Hart, A.M. (2005). Doctor of nursing practice: Opportunity amidst choas. American Journal of Critical Care, 14, 463-464.

"...the competencies required for the DNP, which are a combination of skills in advanced practice and skills in evidence-based practice and clinical leadership, may provide a heretofore unavailable mechanism to bridge the practice-research chasm that has haunted nurses professionally."

"...a recent study of nurse practitioners revealed that many think that they were inadequately prepared by their educational programs..."

"DNP programs that are 3 to 4 years long are really not all that much longer than the existing master’s programs."

"The core of advanced practice nursing is...not significantly different from what is found in traditional medical education...APNs are not being prepared to assume high-level roles in health promotion and disease management...The DNP gives nursing the opportunity to reconceptualize what advanced
practice is and should be and to develop the core sciences of true advanced nursing practice."
 
The DNP made sense at first when I thought it's focus was on advanced practice.  At our recent meeting, we were led to believe that there would also be tracks for future nursing educators and nurse administrators. Now, it doesn't make sense.
 

DNP TF Update

 

As per our last conference call the following has occurred in relation to our work:

1)  Nursing education leadership groups met last week in Austin with presentations from various TF members to these subgroups.  Requested that TOADN and TOBGNE endorse the white paper:

a)  TOADN – Alexia Green and Marla Cottenoir rep. TF -  decision postponed by TOADN members to provide feedback by March 15th to TOADN board with potential endorsement soon to follow.  Many questions raised…see attached powerpoint presentation.  They were of course also provided white paper.

b)  TOBGNE – Pat Starck and Carolyn Harvey presenting for TF – endorsed white paper – letter of support provided (attached above)

c)  Deans and Directors – report by Carolyn Harvey – but no request to endorse white paper since membership is composed of TOADN and TOBGNE members collectively.

2)  Contacted Chris Fowler at THECB re: potential to present white paper via sub-taskforce (same group which previously met with THECB staff) to THECB committee meeting on March 29th whom will be considering clinical doctorates.  No confirmation from Chris if it will be possible for us to address the committee – will keep you posted as this is worked out.

3)  Attempting to educate key stakeholders around the state re: the value, importance, role of the DNP for the future workforce.  Please join us in doing same.

4)  Invited three new advanced practice persons to join the TF (via recommendation from Linda Rounds).  Two have accepted and planning orientation conference call (by Alexia and Carolyn) within next two weeks.

5)  Reordered white paper that will be sent to THECB by March 29th to move the nursing shortage issue (item 2) to the top just under issue of patient safety (item 1). 

Will keep you all posted as this progresses.  Let me know if you have questions. Thanks alexia