DNP Tool Kit - Section 1

Template for Negotiating the Process in the Academic Setting

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University of South Alabama

There are many steps to starting a new program, and these steps will be dependent upon the policies and procedures in place within your academic setting and state. Some of the steps that are common across institutions are as follows:

Step 1: Nursing faculty develop and approve a proposal for a DNP program to include the curriculum, admission, progression, and graduation policies, as well as needed resources. A budget for the program is developed and revenues and expenditures are projected. During this phase of the process it maybe helpful to engage a consultant to work with the faculty. In some situations, a consultant may be required as part of the approval process.

Step 2: Institutional approval for the DNP program is obtained. Depending upon the setting, the program may be reviewed by a number of different individuals and bodies. For example, approval will be needed from the graduate school if the DNP program is to be organizationally a part of the graduate school. Some schools may choose not to position the program within the graduate school since the DNP is not a research degree. The chief academic officer of the school and the school's board of trustees must also approve the program.

Step 3: External approvals (as required) are obtained (i.e. state higher education board, board of nursing). Politics, especially in state institutions, can play a large role in the external approval process. Garnering the support of other nursing programs in the state through statewide collaborations and planning will be essential.

Institutional and state (as required) guidelines for starting a new program should be obtained early to facilitate planning. Information that is required for most proposals for a new program include:

1. Statement of Student Learning Outcomes

a.Description of Program Outcomes
b. Description of Competencies for Graduates

2. Local, regional, and national need for the program
3. Evidence of applicant interest in the program
4. Evidence of employment opportunities for graduates
5. Relationship of the new program to existing programs at the parent institution
6. Relationship of the program to other like programs
7. Collaboration with other like programs in the state
8. Accreditation
9. Projected costs and available resources to deliver a quality program

a. Faculty resources
b. Library resources
c. Clinical resources
d. Facility and technology resources

10. Evaluation

a. Graduates are eligible for national certification exam.
b. Practice impact

Your ability to communicate the above information effectively to both internal and external constituents will determine the success of the approval process. The following template will help you get started on the proposal for a new DNP program.

1. Student Learning Outcomes

The Doctor of Nursing Practice degree prepares graduates to provide the most advanced level of nursing care for individuals, families, groups, and communities. This includes the direct care of individual patients, management of care for individuals and populations, administration of nursing systems, and the development and implementation of health policy. Consistent with the American Association of Colleges of Nursing's (AACN's) specifications for practice doctoral programs in nursing, the goals of the program are as follows:

Upon completion of the DNP program, the graduate will be able to:

2. Need for the Program

Similar to other disciplines, doctoral programs in nursing can be categorized into two distinct types: research-focused and practice-focused. The DNP program is a practice-focused program and therefore analogous to professional degrees offered in other disciplines including entry-level degrees [e.g. the Doctor of Medicine (MD), Doctor of Dental Surgery (DDS) and the Doctor of Pharmacy (PharmD)], and those that offer advanced practice degrees (e.g., the Doctor of Psychology or PsyD).

The proposed DNP program fulfills a strong local, regional, and national need for doctorally prepared advanced practice nurses. The proposed program was designed to be in full compliance with professional standards for the practice doctorate as put forth by the American Association of Colleges of Nursing (AACN). The program was developed in direct response to the October 2004 endorsement of the AACN position statement which recognizes the DNP as the appropriate credential for all advanced nursing practice roles by 2015. AACN developed this position after an intensive study of the health care system and the findings and recommendations of many national groups. Based upon the growing complexity of health care compounded by an escalating demand for services, burgeoning growth in scientific knowledge, and the increasing sophistication in technology, the nursing profession's current practice of preparing advanced practice nurses in master's degree programs is no longer adequate.

Transforming health care delivery recognizes the critical need for clinicians to design, evaluate, and continually improve the context within which care is delivered. The need for this change is supported by several national studies including the November 1999 report by the Institute of Medicine (IOM) on medication errors; To Err is Human: Building a Safer Health System. This report, extrapolating data from two previous studies, estimates that somewhere between 44,000 and 98,000 Americans die each year as a result of errors in health care. These numbers, even at the lower levels, exceed the number of people that die each year from motor vehicle accidents, breast cancer, or AIDS. The national costs of preventable adverse healthcare events (injury and errors) were estimated to be between $17 billion and $29 billion, of which health care costs represented over one-half. The IOM report focused on the fragmented nature of the healthcare system and the context in which health care is provided as being major contributors to the high and inexcusable error rate that compromises patient safety. To combat this problem, a focus of DNP programs is to educate nurses who are able to effect systems level change to improve patient care outcomes.

Two other IOM reports also support the need for the DNP. The report, Crossing the Quality Chasm (2001), stresses that our health care system as it is currently structured does not make the best use of resources. Changing demographics in our country including the increase in the numbers of elderly and development of new services and technologies have contributed to increasing costs. Waste of resources, however, is a significant problem. One of the recommendations in the report calls for all health care organizations and professional groups to promote health care that is safe, effective, client-centered, timely, efficient, and equitable (p.6). In a follow-up report, Health Professions Education: A Bridge to Quality (2003a), the IOM Committee on the Health Professions Education stated that "All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics" (p.3). DNP programs are a direct outcome of nursing's plan to address the IOM challenges. Nurses prepared in practice doctoral programs have a blend of clinical, organizational, economic, and leadership skills to enable them to critique nursing and other clinical scientific findings and design programs of care delivery that are locally acceptable, economically feasible, and have significant impact on health care outcomes.

During the past three decades, the doctorate has become firmly established as the terminal degree in nursing. As doctoral programs developed, priority was placed on research-focused education that would lay the groundwork for knowledge development in the nursing profession. Tremendous strides have been made in the development of nursing science because of PhD programs. Unfortunately, according to the Agency on Healthcare Research and Quality (2005) it can take up to 20 years for new knowledge to be integrated into practice. This agency calls for the preparation of a nursing professional that has the capacity to evaluate new knowledge and apply this new knowledge to improve health care outcomes and develop new systems of care.

The nurse prepared in a DNP program is a valuable counterpart to the nurse prepared in a PhD program in nursing. While the PhD prepared nurse conducts research to provide new knowledge, the DNP prepared nurse focuses on developing systems of care based on research utilization. DNP graduates are experts in designing, implementing, managing, and evaluating health care delivery systems and patient populations. DNP graduates are prepared to lead at the highest practice and executive ranks in nursing.

At the national level there is a severe shortage of all types of registered nurses including an acute shortage of doctorally prepared nurses. Of the 3 million nurses in the U.S., fewer than one percent have a doctoral degree, and just over ten percent hold a master's degree in nursing. The DNP program will facilitate the preparation of more doctorally prepared nurses and thereby increase the numbers of well prepared professional nurses to assume leadership positions in health care and nursing education.

3. Applicant Interest

Interest in the DNP program is expected to be significant. A needs assessment to determine applicant demand for the degree was conducted in ___. Surveys were mailed to alumni and ___ questionnaires were returned. The alumni were asked "if a Doctoral Program in nursing were offered at ___, how likely is it that you would enroll?" Approximately ___ (__%) stated that they were very likely or likely to enroll. When asked what type of degree they would be most interested in, ___% indicated an interest in a professional doctorate. In addition, the college has an extensive list of names and addresses of individuals who want to be notified regarding approval to offer a program. There are currently __names on the list.

In ___, the college conducted a survey of students enrolled in the Master of Science in Nursing (MSN) program. ____ students responded, and ____ stated that they were interested in enrolling in a DNP program within the next 5 years if such a program were offered at___.

At the national level, interest in the post-master's DNP degree is supported by reports of a strong applicant pool from the schools offering the program (personal communication with nursing deans at Rush University, the University of Kentucky, and the University of Tennessee at Memphis). These deans report that they have many more qualified applicants than can be accepted to their programs. The following table displays a historical account of robust growth in enrollments in the doctoral programs at both the University of Kentucky and the University of Tennessee Health Sciences Center. Both institutions have experienced enrollment growth in both the DNP and PhD programs over time (Table 1).

Table 1

Enrollment Projections

The following table presents enrollment projections at the time of implementation and over a five-year period. For the purposes of the projection, __ or more hours is considered full-time study and ___or less is considered part-time study. ___full-time students will be admitted each ___. Full-time students will be able to complete the program in ___ semesters. Ten part-time students will also be admitted each ___. Part-time students will be able to complete the program in ___ semesters.

Projected Program Completion Rates

4. Employment for DNP Practice Graduates

The DNP program is intended to meet the market demands for highly skilled professional nurses in local, state, regional, and national markets. It is especially important to offer the DNP program to ensure adequate numbers of advanced practice nurses for the future as the profession transitions to the DNP degree by 2015.

Many different types of employment opportunities exist for graduates of DNP programs. Nationally there are 20 existing practice doctoral programs in nursing, however, a recent survey conducted in February 2006 by AACN revealed that 190 institutions are developing DNP programs.

Graduates of DNP programs are assuming positions with the following job titles: Vice President for Nursing and Clinical Services, Program Director, Vice President for Patient Care, Chief Executive Officer, Health Officer, Commissioner of Health, Quality Improvement Director, Clinical Information Technology Specialist, Direct Care Clinician, and Faculty Member. It is expected that graduates of the ___'s DNP program will assume a variety of high level responsible positions in health care as well. A recent survey revealed the following projected job openings for DNP graduates.

Example Projected Job Openings

Methodology to determine projected job openings:
A number of different methods have been used by policy makers to estimate supply and demand for nurses. Although there is consensus that a shortage of all types of registered nurses, including advanced practice nurses, exists and that the shortage is continuing to escalate each year, there is little specific data about advanced practice nurses as a whole. Therefore, the ability to make predictions about the number of job openings in the future for advanced practice nurses is hindered by the limitations and lack of available data.

National Job Openings- The methodology for determining future job openings for DNP graduates is based on the nursing shortage data from the Bureau of Health Professions, and on data from AACN on graduations from MSN degree programs. Graduations from MSN programs were used since most advanced practice nurses are currently prepared in these programs.

In 2004, master's programs in nursing reported graduating 10,686 students (AACN, 2005). Due to the nursing shortage, job openings existed for all these individuals, and jobs are projected to be available for all advanced practice nurses graduating during the years projected in the above table (2008-2012). The national rate of growth in graduations in master's degree programs is approximately 5% per year. This growth rate was used to calculate the number of new graduates from advanced practice nursing programs beginning in 2008, the first year that the ___will have DNP graduates, through 2012. To determine job openings each year, the total number of graduates for the year was increased by the projected percent of shortage for that year.

The projected shortage was determined by using data from the Bureau of Health Professions. These data provide projections for the demand for nurses (based on the growth and composition of the population); the supply of nurses; and the proportion that the supply will fall short of the demand. The projected percent shortage for 2008 through 2012 is as follows:

2008 11%
2009 12%
2010 13%
2011 15%
2012 17%

The job opening projection assumes that the need for APNs is responsive to the same population trends that influence the demand for all registered nurses. Thus, the percent short each year for all RNs will be the same as the percent of shortage for APNs. This is a conservative estimate because the percent of shortage of APNs is higher than for the general nursing population. The Pew Commission supports doubling the number of advanced practice nurses to meet the needs of underserved populations particularly in rural areas.

SREB- Job openings for the Southern Regional Education Board (SREB) region were calculated using the methodology described for national job openings. Data on graduations from MSN programs was obtained from the SREB (2005). The number of graduates per year was increased by 6 percent to reflect actual yearly increases in MSN graduates in the SREB region.

Alabama Job Openings- Job openings in Alabama were calculated using the methodology and data sources as described for SREB job openings except that the projected nurse shortage percentages for Alabama19 have been used. These projections show the nursing shortage increasing from 6% in 2008 to 8% by 2012.

Local Job Openings- The ____is located in Alabama's 1st congressional district which comprises approximately 14% of the state's population. The local job opening forecast is for jobs located in this district. The local estimate for job openings is calculated to be 14% of the state's demand for advanced practice nurses.

5. Relationship of program to existing programs at the parent institution (example is for a postmaster's DNP program)

The DNP program will not replace any existing program at this time. However, AACN has adopted a position statement that by 2015, the DNP, not the MSN, will be the required credential for all advanced-practice nurses. By that time, it is anticipated that all tracks within the Master of Science in Nursing program that prepare nurses for advanced nursing practice will become part of the Doctor of Nursing Practice curriculum.

6. Relationship of proposed DNP program to other programs

Over the last several years, interest has grown within nursing to develop a viable alternative to research-focused degrees (Doctor of Philosophy and the Doctor of Nursing Science). Currently there are 20 programs in the nation that offer the DNP. However, since the AACN released its position paper supporting the DNP degree in October 2004, over 190 institutions in the nation are now working toward establishing a DNP program at their school. Despite this increased interest in the DNP, practice focused doctoral degree programs in nursing are not a new development. The first practice focused doctoral program was established in 1979 and since then, several practice-focused doctoral programs and degree titles have emerged.

For a complete list of the institutions offering DNP programs, visit the AACN Web site at dnp/dnp-program-schools.

7. Academic Collaborations

Discussions are underway among the nursing deans and directors in the state to determine feasible approaches to facilitating access to the DNP for all advanced practice nurses. For example, articulation agreements that would streamline the admission of ___ students to the DNP program once the students have finished their MSN program at ___ are under discussion. Discussions are also underway regarding the sharing of faculty resources by offering joint courses through web based technologies. Such arrangements will be important to ensure adequate production of advanced practice nurses and to accomplish the goal that by the year 2015, all new advanced practice nurses will be prepared in DNP programs.

8. Accreditation

The program is designed to be in compliance with standards for DNP programs developed by by the American Association of Colleges of Nursing. Professional accreditation for the program will be sought as soon as it is available. The Commission on Collegiate Nursing Education (CCNE) is developing an accreditation process for DNP programs. The baccalaureate and master's programs in nursing are fully accredited by CCNE through ___.

9. Projected Cost and Available Resources

Estimated New Funds Required to Support the Program

Sources and Amounts of Funds Available for Program Support

10. Program Review and Assessment

The DNP program will be evaluated through the college's Evaluation Plan. Continuous quality improvement strategies are the basis of the evaluation system. Formative evaluation (monitoring) and summative evaluation (outcomes) are linked to assure that potential problems are identified and resolved early and that data-based reports of program successes and issues are readily available for dissemination to faculty, administrators, the college's Evaluation Committee, and Curriculum Committee. Objectives are measurable and are linked to appropriate activities and evaluation criteria.

The Evaluation Plan provides an infrastructure for identifying, analyzing, and reporting data for program decision-making. The plan assesses program inputs, monitors program processes, and measures the achievement of program outcomes. The plan provides a multidimensional, multivariate framework for evaluation of college programs. Students, faculty, program graduates, accrediting agencies, employers, administrators, licensing agencies, and others as appropriate provide program evaluation data. The plan's goals are to: (a) provide formative evaluation (ongoing feedback) to administrators, faculty, students, advisory groups, and others concerned with the strengths and weaknesses of the program; (b) identify specific areas for future development in curriculum, instruction, faculty expertise, resources and facilities, organization and administration, and alumni affairs; (c) identify the relationship between the program and the current and emerging needs of society; (d) determine the extent to which the program meets the needs of students, faculty, and employers; and (e) provide evidence of program effectiveness in accordance with accreditation and other pertinent criteria.

Internal academic assessment processes require that the College assess its effectiveness in achieving its goals and objectives; assess student attainment of learning outcomes; document use of assessment data; and establish goals and objectives for the next academic year. These assessment activities along with external evaluation from the CCNE when available will ensure that the Doctor of Nursing Practice program fulfills its mission, goals, and objectives to produce nurses for the highest level of nursing practice. In addition, DNP graduates will be eligible for national certification exams.