2015 DNP

[BabyLady]

I am wondering if anyone has heard any updates.

Everything I keep seeing online from the AACN is "recommendation", "strongly encouraged", "highly suggested".

I have yet to see anything, that says, "Look, either you graduate and pass your boards by January 1, 2015 or you can put the MSN you have in back of the closet and start working on your DNP, because the MSN isn't good enough anymore to sit for national certification."

There are many of us, including myself, that will be finishing probably in 2013 or 2014...now, we would all like to think that we would pass our certification the first go-round, but we all know that may or may not happen for some of us.

Example: You graduate in June 2014 with your MSN and it is January, 2015, you still cannot pass your certification exam...does that mean you have to go back to school or you cannot practice?

I have seen some colleges that have completely phased out MSN programs but I have seen MANY that have not...that makes me wonder if it is not going to be a "go" like they are claiming that it is.

I would love to hear from those that keep up with this sort of thing...that may have more insight.

[PMFB-RN, RN]

There are two problems: 1. The credit hours do not match the degree, and 2. the MSN isn't doing enough to address utilization of EBP.

Bringing research into practice is huge in academia and the government right now. There are even degrees that focus on this particular phenomenon. What is Translational Science? | Tufts Clinical and Translational Science Institute National Center for Advancing Translational Sciences (NCATS)

The DNP is one way nursing is addressing this problem.

*** If, as you say, it takes 17 years for EBP to reach clinical practice currently, how long would it take if all APRNs had DNPs? Has anyone estimated this? Is there any evidence that the time would be less? Is it required that every single APRN hold a doctorate in order for us to inprove untilization of EBP?

My obervation is that the bottle neck for faster EBP utilization is mostly administration related, not clinical practitioner related.

[wtbcrna, MSN, DNP, CRNA]

*** If, as you say, it takes 17 years for EBP to reach clinical practice currently, how long would it take if all APRNs had DNPs? Has anyone estimated this? Is there any evidence that the time would be less? Is it required that every single APRN hold a doctorate in order for us to inprove untilization of EBP?

My obervation is that the bottle neck for faster EBP utilization is mostly administration related, not clinical practitioner related.

There are administrative bottle necks especially at the bedside nursing level, but at the APN level it is mostly provider driven that determines the use of EBP. As a CRNA I determine the drugs and techniques,usually based on EBP, that I think will benefit my patients the best with their anesthetic.

It is funny how nurses in general are the only professional group that seems to balk at advancing their education whether it be ADN/BSN or MSN/DNP. Advanced nursing education has been shown to improve patient outcomes.

[elkpark]

As a CRNA I determine the drugs and techniques,usually based on EBP, that I think will benefit my patients the best with their anesthetic.

It is funny how nurses in general are the only professional group that seems to balk at advancing their education whether it be ADN/BSN or MSN/DNP. Advanced nursing education has been shown to improve patient outcomes.

As a staff nurse 20 years ago, I used to base my individual practice on the most current information and evidence I could find. I didn't need an artificially inflated degree to do that, and I don't need one now. The problem isn't the education -- the problem is the individual choices people make about their own practices once they're out of school. As the old saw goes, you can lead a horse to water, but you can't make it drink. And while there have been some studies suggesting a connection between higher levels of BSN-prepared RNs and better client outcomes (putting aside for the moment the questions about the validity of those studies), I'm not aware of any studies that suggest that DNP-prepared advanced practice nurses are doing any better a job, clinically or otherwise, than the existing MSN-prepared population. (Or maybe I'm just not aware of them, since I don't have a DNP and I'm too dumb to understand research. :) )

[prairienp]

As astaff nurse 30 years ago I also used the most current information. Additionaleducation (biostats and EBP) allowed me to understand the difference between avalid EBP study and those that were not.

There are a plethora of studies supporting the BSN with improved incomes(magnet hospitals). The DNP is relatively new and the studies will be coming. Isuspect as with most other professional, when you increase the level ofeducation you get a better product. I do agree garbage in will often result ingarbage out as in any educational pursuit. I do not agree that when you take acapable motivated nurse that the educational level makes no difference, the greaterthe exposure the greater the potential.

[PMFB-RN, RN]

I do not agree that when you take acapable motivated nurse that the educational level makes no difference, the greaterthe exposure the greater the potential.

*** I am not sure who you are disagreeing with. However there are more paths to education than formal (expensive) for credit at a university

[PMFB-RN, RN]

It is funny how nurses in general are the only professional group that seems to balk at advancing their education whether it be ADN/BSN or MSN/DNP.

*** OF COURSE WE DO! Every other profession would have balked at it too if it was done the way nursing is doing it. When pharmacists when to a doctorate the grandfathered in all the pharmacists that did not have a doctorate. They did not insist that EVERY pharmacists go back to school and earn a doctorate or face unemployment. THAT is what nursing is doing. Nursing isn't satisfied with simply requiring a BSN for entry to practice and grandfather in all the existing ADN and diploma RNs, oh no. The powers that be won't be happy until all nurses have at least a BSN and the ADNs are pushed out into the unemployment wasteland. We see it all over the place with "BSN preferred" and "BSN required" job postings.

I feel very strongly that if nursing would handle the increased education requirements the way that PT, pharmacy and others did we would be is a very, very different situation right now.

How you can expect people who are being pushed out of employment not to balk is amazing to me.

Advanced nursing education has been shown to improve patient outcomes.

*** Hmm, people selling a product (nursing degrees), have found that there is a benefit to more people buying their product. Amazing how that works.

[wtbcrna, MSN, DNP, CRNA]

As a staff nurse 20 years ago, I used to base my individual practice on the most current information and evidence I could find. I didn't need an artificially inflated degree to do that, and I don't need one now. The problem isn't the education -- the problem is the individual choices people make about their own practices once they're out of school. As the old saw goes, you can lead a horse to water, but you can't make it drink. And while there have been some studies suggesting a connection between higher levels of BSN-prepared RNs and better client outcomes (putting aside for the moment the questions about the validity of those studies), I'm not aware of any studies that suggest that DNP-prepared advanced practice nurses are doing any better a job, clinically or otherwise, than the existing MSN-prepared population. (Or maybe I'm just not aware of them, since I don't have a DNP and I'm too dumb to understand research. :) )

I disagree that a normal bedside nurse would be able to implement many EBP guidelines. Nursing care is often directed by administrative policies and provider orders. Also, undergraduate nurses are exposed to research utilization, but do not have the formal education to perform proper literature reviews that are needed to implement EBP changes. There are studies that suggest higher nursing educational levels lead to better patient outcomes.

I went to a research intensive MSN program, but I still learned quite a bit more about research utilization and EBP going through my DNAP program.

http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education

"There is a growing body of evidence that shows that BSN graduates bring unique skills to their work as nursing clinicians and play an important role in the delivery of safe patient care.

• In the October 2012 issue of Medical Care, researchers from the University of Pennsylvania found that surgical patients in Magnet hospitals had 14% lower odds of inpatient death within 30 days and 12% lower odds of failure-to-rescue compared with patients cared for in non-Magnet hospitals. The study authors conclude that these better outcomes were attributed in large part to investments in highly qualified and educated nurses, including a higher proportion of baccalaureate prepared nurses.
  
• In a January 2011 article published in the Journal of Nursing Scholarship, Drs. Deborah Kendall-Gallagher, Linda Aiken, and colleagues released the findings of an extensive study of the impact nurse specialty certification has on lowering patient mortality and failure to rescue rates in hospital settings. The researchers found that certification was associated with better patient outcomes, but only when care was provided by nurses with baccalaureate level education. The authors concluded that “no effect of specialization was seen in the absence of baccalaureate education.”
  
• In an article published in Health Services Research in August 2008 that examined the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient outcomes. Nurses prepared at the baccalaureate-level were linked with lower mortality and failure-to-rescue rates. The authors conclude that “moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients.”
  
• In a study released in the May 2008 issue of the Journal of Nursing Administration, Dr. Linda Aiken and her colleagues confirmed the findings from her landmark 2003 study (see below) which show a strong link between RN education level and patient outcomes. Titled “Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes,” these leading nurse researchers found that every 10% increase in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of death.
  
• In the January 2007 Journal of Advanced Nursing, a study on the “Impact of Hospital Nursing Care on 30-day Mortality for Acute Medical Patients” found that BSN-prepared nurses have a positive impact on lowering mortality rates. Led by Dr. Ann E. Tourangeau, researchers from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario studied 46,993 patients admitted to the hospital with heart attacks, strokes, pneumonia and blood poisoning. The authors found that: "Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."
  
• In a study published in the March/April 2005 issue of Nursing Research, Dr. Carole Estabrooks and her colleagues at the University of Alberta found that baccalaureate prepared nurses have a positive impact on mortality rates following an examination of more than 18,000 patient outcomes at 49 Canadian hospitals. This study, titled The Impact of Hospital Nursing Characteristics on 30-Day Mortality, confirms the findings from Dr. Linda Aiken’s landmark study in September 2003.
  
• In a study published in the September 24, 2003 issue of the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10 percent increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5 percent. The study authors further recommend that public financing of nursing education should aim at shaping a workforce best prepared to meet the needs of the population. They also call for renewed support and incentives from nurse employers to encourage registered nurses to pursue education at the baccalaureate and higher degree levels.
  
• Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the reportWhen Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 – one by the state of New York and one by the state of Texas – clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level. These findings are consistent with findings published in the July/August 2002 issue of Nurse Educator magazine that references studies conducted in Arizona, Colorado, Louisiana, Ohio and Tennessee that also found that nurses prepared at the associate degree and diploma levels make the majority of practice-related violations.
  
• Chief nurse officers (CNO) in university hospitals prefer to hire nurses who have baccalaureate degrees, and nurse administrators recognize distinct differences in competencies based on education. In a 2001 survey published in theJournal of Nursing Administration, 72% of these directors identified differences in practice between BSN-prepared nurses and those who have an associate degree or hospital diploma, citing stronger critical thinking and leadership skills.
  
• Studies have also found that nurses prepared at the baccalaureate level have stronger communication and problem solving skills (Johnson, 1988) and a higher proficiency in their ability to make nursing diagnoses and evaluate nursing interventions (Giger & Davidhizar, 1990).
  
• Research shows that RNs prepared at the associate degree and diploma levels develop stronger professional-level skills after completing a BSN program. In a study of RN-to-BSN graduates from 1995 to 1998 (Phillips, et al., 2002), these students demonstrated higher competency in nursing practice, communication, leadership, professional integration, and research/evaluation.
  
• Data show that health care facilities with higher percentages of BSN nurses enjoy better patient outcomes and significantly lower mortality rates. Magnet hospitals are model patient care facilities that typically employ a higher proportion of baccalaureate prepared nurses, 59% BSN as compared to 34% BSN at other hospitals. In several research studies, Marlene Kramer, Linda Aiken and others have found a strong relationship between organizational characteristics and patient outcomes.
  
• The fact that passing rates for the NCLEX-RN©, the national licensing exam for RNs, are essentially the same for all three types of graduates is not proof that there are no differences among graduates. The NCLEX-RN© is a multiple-choice test that measures the minimum technical competency for safe entry into basic nursing practice. Passing rates should be high across all programs preparing new nurses. This exam does not test for differences between graduates of different entry-level programs. The NCLEX-RN© is only one indicator of competency, and it does not measure performance over time or test for all of the knowledge and skills developed through a BSN program."
  

[wtbcrna, MSN, DNP, CRNA]

*** OF COURSE WE DO! Every other profession would have balked at it too if it was done the way nursing is doing it. When pharmacists when to a doctorate the grandfathered in all the pharmacists that did not have a doctorate. They did not insist that EVERY pharmacists go back to school and earn a doctorate or face unemployment. THAT is what nursing is doing. Nursing isn't satisfied with simply requiring a BSN for entry to practice and grandfather in all the existing ADN and diploma RNs, oh no. The powers that be won't be happy until all nurses have at least a BSN and the ADNs are pushed out into the unemployment wasteland. We see it all over the place with "BSN preferred" and "BSN required" job postings.

I feel very strongly that if nursing would handle the increased education requirements the way that PT, pharmacy and others did we would be is a very, very different situation right now.

How you can expect people who are being pushed out of employment not to balk is amazing to me.

*** Hmm, people selling a product (nursing degrees), have found that there is a benefit to more people buying their product. Amazing how that works.

Nursing organizations have been stating for years that a BSN should be the entry level degree for RNs, but nothing has changed. The studies are out there that BSN prepared nurses provide better patient outcomes, so if I was a hospital administrator why would I not hire BSN/RNs only as long as the market would sustain the demand.

Here is what hospitals are facing: Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions - Kaiser Health News

Hospitals are under pressure to cut down HAI and readmission rates as much as possible, and nursing as the largest workforce in the hospital we will always be looked at critically.

It is easy to go from ADN to BSN. There isn't a reason that all nurses could not get their BSNs.

Now back to the original topic...There isn't any professional organization that has suggested non doctoral prepared APNs would not be grandfathered in.

[SandyRN1122]

I have a friend who is a certified women's health NP; she has been one for over 20 years. She told me that she only has a ADN along with the certification. She added that if she were to let her license laps then she would have to return to get her MSN prior to getting recertified so losing her license would be essentially losing her job because she is almost to retirement age anyway.

Why wouldn't it be the same if DNP becomes mandatory? If DNP becomes a requirement for certification then MSN's would be able to recertify unless their license lapses THEN they would have to return to meet current qualifications for the certification. Obviously there would have to be some kind of coordination with NP programs, but this scenario seems logical.

[Ellen NP, MSN, NP]

I would suggest more clinical hours rather than more theory and 'practice' hours. I do believe that the research content in the MSN is sufficient for EBP. If clinicians also want to be making policies and changing curricula then the added research may be helpful. For those of us who are 100% engaged in clinical practice the DNP curriculum adds little.

[Ellen NP, MSN, NP]

I agree that the evidence supports the BSN for RN practice. I teach in an ADN program. Almost all of my students have degrees in other fields. Many are masters prepared. Our students consistently outperform the BSN students on the NCLEX. Their clinical skills as students are recognized by staff RN's as superior to those of the BSN students. I do feel that they are well prepared for entry into practice but that development in the RN role is enhanced when they complete the small amount of additional work for the BSN. They typically need to take a research course and community health. There is clear evidence that patients have better outcomes when nurses have BSNs. hospitals in my area are requiring that new hires have BSN or matriculate in a BSN program within one year of hire.

The data indicate that the MSN prepared NPs provide appropriate, high quality care. Where are the data to support the need for additional theory and policy coursework required for the DNP? We are seeing increasingly complex patients. We could benefit from additional clinical training....what clinician wouldn't? Add a residency to the MSN curriculum and award the DNP after that.

[elkpark]

Now back to the original topic...There isn't any professional organization that has suggested non doctoral prepared APNs would not be grandfathered in.

Of course they are saying the existing APNs will be "grandfathered" in, because there is no way they would even be able to get a conversation going about the proposal if they weren't. However, no one knows how this would work out in "real life." What we do know is how it worked when nurse practitioners went from the certificate programs to MSN as a minimum requirement. The existing certificate-prepared NPs were "grandfathered" in -- however, those individuals found that they could continue to practice in their current state of licensure but could not get licensed in another state because the minimum requirement for licensure was now an MSN, which they did not have. So those individuals were basically stuck in their current state for the rest of their careers, without any ability to relocate if they chose or needed to and continue practicing at the advanced practice level.