兰德-The-DNP-by-2015_-A-Study-of-the-Institutional,-Political,-and-Professional-Issues-that-Facilitate-or-Impede-Establishing-a-Post_95页_644kb

Summary of "The DNP by 2015"

Core Content

This report, commissioned by the American Association of Colleges of Nursing (AACN), examines the progress of nursing schools in transitioning from master's-level programs to the Doctor of Nursing Practice (DNP) degree for advanced-practice registered nurses (APRNs). It analyzes both the structural and contextual factors influencing this transition, as well as the challenges and opportunities faced by schools in adopting the DNP as the entry-level degree for APRNs.

Main Purpose

The primary goal of the study was to understand the reasons behind schools' program offerings, the barriers and facilitators to the full adoption of the DNP, and to provide actionable recommendations to support AACN's objective of transitioning all APRN master's programs to the DNP by 2015.

Key Findings

Schools' Program Offerings

• Growth of DNP Programs: The number of schools offering DNP programs has increased significantly, with a tenfold growth in the past seven years.
• Current Status (2013):
  • 98 schools (25%) had active BSN-to-DNP programs.
  • 229 schools (57%) had MSN-to-DNP programs.
  • Only one school had fully transitioned to BSN-to-DNP by 2010.
• Future Plans (2016):
  • 63 schools planned to offer BSN-to-DNP programs.
  • 33 schools planned to expand their DNP programs to include additional APRN roles.
  • 8 schools without current APRN programs planned to introduce BSN-to-DNP programs.
• Continuation of MSN Programs:
  • 70% of schools that offer APRN education still provide MSN programs.
  • 65% of schools that adopted the BSN-to-DNP also retained MSN programs.
  • MSN programs enroll about three times as many students as BSN-to-DNP programs.

Facilitators and Barriers

• Structural Facilitators:
  • Autonomous or freestanding schools, especially in the West and Midwest, are more likely to offer BSN-to-DNP programs.
  • Schools with a high density of nurse practitioners (NPs) are also more likely to offer BSN-to-DNP programs.
• Contextual Facilitators:
  • Strong support from key faculty, administration, and decision-makers is a major facilitator.
  • Endorsement of the AACN's position on the DNP plays a significant role in schools' decisions.
• Barriers:
  • Institutional constraints, such as approval from multiple leadership levels, are common.
  • Clinical site availability and faculty resources are major challenges.
  • Cost and budgetary concerns are key barriers, particularly for schools not autonomous.
  • Employer awareness and demand for DNP-educated APRNs are limited.
  • Some schools retain MSN programs due to student demand and concerns about losing students.

Conclusions

• The DNP continues to expand, but the MSN remains the dominant entry-level pathway for APRN education.
• Two tracks toward the DNP are expected: a single-step (BSN-to-DNP) and a two-step (BSN-to-MSN to DNP) process.
• The value of DNP education is widely recognized, especially in preparing APRNs for future health care needs and improving clinical outcomes.
• Employer demand for DNP-educated APRNs is generally not differentiated from MSN-educated ones, though there are some exceptions.
• Freestanding or autonomous schools are more likely to offer BSN-to-DNP programs due to fewer institutional barriers.
• Faculty and administrative support is a strong facilitator for the adoption of BSN-to-DNP programs.
• Clinical site availability and resource constraints (especially faculty) are significant challenges.
• Cost and budgetary concerns are a major barrier to the full adoption of the DNP.

Recommendations

1. Conduct Outcome Studies: AACN should support outcome studies to better understand the impact of DNP graduates on patient care.
2. Outreach and Education: Provide outreach and data to employers and health care organizations to highlight the added competencies of DNP-educated APRNs.
3. Document Successful Strategies: Focus on understanding and documenting strategies used by departments in larger universities to overcome barriers in offering BSN-to-DNP programs.
4. Showcase Collaborative Partnerships: Document and promote collaborative partnerships between schools and hospitals to secure clinical practice sites.
5. Clarify Capstone Requirements: Provide greater clarity and guidance on the requirements for capstone projects in DNP programs.
6. Continue Support Efforts: Maintain ongoing efforts to assist schools in addressing challenges related to the adoption of BSN-to-DNP programs.

Key Information

• The DNP is seen as a terminal degree for APRNs, not limited to the four APRN roles.
• The DNP emphasizes practice-based scholarship, innovation in care delivery, and quality improvement.
• The IOM report of 2010 called for an increase in the number of doctoral-prepared nurses to meet future health care demands.
• The transition to the DNP is not yet complete, with many schools still offering or planning to offer MSN programs.

Structure of the Report

• Chapter 2: Describes the methods used, including data analysis from the AACN Annual Survey, the RAND/AACN Online Survey, and qualitative interviews.
• Chapter 3: Provides an overview of the current and expected status of DNP program offerings.
• Chapter 4: Discusses the determinants, barriers, and facilitators of DNP adoption.
• Chapter 5: Summarizes conclusions and recommendations.
• Chapter 6: Includes case studies of five schools that successfully implemented DNP programs.

Appendices

• Appendix A: Lists MSN-to-DNP programs.
• Appendix B: Contains the online survey instrument used in the study.
• Appendix C: Provides a list of schools interviewed for the study.