Category: Nurse Practitioner Hot Topics

The Doctor of Nursing Practice (DNP) is a terminal degree that serves as an add-on program to the Master's of Science in Nursing (MSN). Currently, nurse practitioners (NPs) obtain an MSN and then return to complete a DNP program. As a rigorous degree with an emphasis on clinical expertise and leadership skills, the DNP program culminates with an evidence-based practice project. DNPs are prepared to translate evidence into practice, lead patient care teams, evaluate patient outcomes, and promote system change. There are currently over 300 DNP programs in the U.S. with more than 8,000 DNPs, which represents approximately 1% of NPs in the country. DNP programs strengthen the MSN by providing additional education around evidence-based practice, quality improvement, and systems leadership.

Why the DNP?

The value of the DNP models other health professions that transition to doctoral degrees such as physical therapy (DPT), pharmacy (PharmD), Psychology (PsyD), and Audiology (AudD). Doctoral education prepares today's health professionals for the complexity of modern healthcare due to:

• The rapid expansion of knowledge underlying practice.

• Increased complexity of patient care.

• National concerns about the quality of care and patient safety.

• Shortages of nursing personnel, which demand a higher level of preparation for leaders who can design and assess care.

• Limitations of doctorally-prepared nursing faculty.

• Enhanced educational expectations of other members of the healthcare team.

Proposing Change

In 2018, The National Organization of Nurse Practitioner Faculties (NONPF) committed to assisting all entry-level nurse practitioner (NP) programs with shifting to the DNP by 2025. In other words, the MSN exit point will dissolve and the DNP will become the common endpoint. NONPF emphasizes that the addition of curriculum around evidence-based practice, quality improvement, and systems leadership is critical for modern healthcare.

Since 2002, NONPF has promoted a seamless path for obtaining the DNP. In 2004, the American Academy of Colleges of Nursing (AACN) proposed that the DNP should be the entry-level degree for NPs. However, transitional challenges prevented the accomplishment of this goal. In 2006, NONPF announced plans for completing the transition by 2025.

Challenges to Change

Although support for eliminating the MSN varies across academia, there are more concerns outside of the educational realm. The AACN identifies the following barriers of removing the MSN step:

• While the MSN continues to be the dominant pathway for APRN entry-into-practice education, there is some limited movement toward replacement with the BSN-to-DNP.

• Two tracks toward the DNP will remain, as defined by schools' planning horizons: a single-step process (BSN-to-DNP) and two-step process (BSN-to-MSN followed by an MSN-to-DNP at a later date).

• Requirement of the DNP for certification and accreditation is an important factor in schools' decisions to eliminate the MSN degree.

• There is no demand for DNP-educated APRNs by employers.

• Elimination of the MSN raises costs and budgetary concerns for many schools—particularly those that are not freestanding or autonomous.

Supporting the DNP Entry-to-Practice

Despite the difficulties involved in eliminating the MSN and promoting the DNP as an entry-level NP degree, the advantages are undeniable. In addition to ensuring the best quality care for patients, this degree offers the following benefits for the nursing profession:

1. Higher income potential. DNP-educated NPs earn approximately $7,000 more per year than MSN-educated NPs. Learn more about NP salaries.

2. More position choices. More education results in an increased amount of choices. DNPs can explore opportunities in nursing education, nurse leadership, and healthcare administration.

3. Opportunity for advancement. As DNP knowledge and capabilities become increasingly mainstream, hospital networks have begun promoting individuals in this role to advanced positions. In fact, nurses must participate in shared governance to qualify for Magnet Hospital status. The DNP is an important part of this initiative.

4. Greater job security. The expansion of nursing in today's healthcare system has led to increased recognition around the importance of DNP knowledge in advanced nursing practice, organizational leadership, and healthcare policy. This creates higher job security for the DNP.

In addition to elevating the position to the doctoral level, the universal DNP helps create an equitable environment among NPs, increase wages across the board, and expand professional opportunities. The DNP is not only an advanced practice provider, but a practice change agent as well. While creative change may be a challenge for academia, support from current DNPs and future NPs will propel professionalism and job satisfaction to new heights.

Inducted as a Fellow of the American Association of Nurse Practitioners (FAANP) in June 2020, Dr. Carol Gullo Mest, PhD., RN, ANP-BC, FAANP is the chair of graduate education at DeSales University in Center Valley, PA. In addition to 35 years of community NP practice, Dr. Gullo Mest’s career accomplishments include developing all of the MSN and DNP programs at DeSales. Dr. Gullo Mest successfully secured over $2.5 million in grants to support nursing students and faculty by starting a simulation program at the university as well as community health programs. She has served on many healthcare-related boards and is an active member of various nurse and nurse practitioner organizations. Her proactiveness has advanced the nursing profession and positively contributed to nursing education and community health. “I’m really a humble person at heart, but I'm at the age where you look back on what you've done and I thought my contributions are something that they're looking for," said Gullo Mest. "I want to be able to continue to contribute even after I retire. By being a fellow, I'll be able to do that."

Being elected as a Fellow of the American Association of Nurse Practitioners (FAANP) is the highest professional designation for a nurse practitioner. In the year 2000, 21 charter fellows vowed to create and support mentorship and leadership programs for nurse practitioners and NP students. This elite group fosters growth and professionalism for NPs. Less than one percent of NPs within the AANP are designated FAANPs.

FAANP Leaders

FAANP leaders make outstanding contributions to NP education, policy, clinical practice, and research. The fellows work toward furthering the NP profession, developing NP leaders of the future, and enhancing the AANP’s mission. Fellows are chosen on an annual basis after a rigorous application review. Currently, 874 fellows out of about 290,000 nurse practitioners serve coveted leadership roles as FAANPs.

RELATED: Six Nurse Practitioner Visionaries You Should Know About

How Do You Become a Fellow?

The process starts with self-assessment. Reflect on your career and ask yourself the following questions:

Am I an AANP Member?

Membership in the AANP governing body is a given. At least two years of membership is necessary for FAANP eligibility.

In My NP Career, Have I Demonstrated Exceptional Contributions?

Candidates must demonstrate contributions and outcomes in two of the following areas: research, clinical practice, education, and policy. Inducted fellows have started and advanced NP programs or participated in and published original studies. Other fellows opened community clinics or contributed to state and federal NP policy to ultimately advance the profession. Expanding NP leadership through company board positions or nonprofit management is also impressive.

How Do I Find a Sponsor?

FAANP membership is conducted via invitation from a current fellow that agrees to serve as a sponsor. NPs research fellow biographies to find one with a similar background and interests. The fellows are then contacted by the NP, who sends a professional letter of interest that incorporates their resume, previous leadership experience, and NP initiatives. A primary sponsor and a secondary sponsor are then secured. If a fellow agrees that the NP's contributions advance the nursing practice, the primary sponsor invites the NP to apply. Secondary sponsors are selected in the same way, but their role is to mentor the applicant throughout the process. If the NP meets the induction criteria, the next step is acceptance for mentorship and sponsorship.

What Do I Submit to The Sponsors?

Finally, NPs provide evidence of their career contributions and outcomes for the profession as a whole. This involves presenting completed research, policy and community health projects, and NP education successes to the sponsors.

What Do NP Fellows Do?

As part of the AANP, fellows work to advance the profession and set the stage for the next generation of NP leaders. The fellows' focus is to:

• Promote nurse practitioner roles
• Foster NP research
• Positively impact healthcare
• Change NP policy
• Sponsor a mentorship program
• Develop a policy education program
• Share progress with AANP members through a quarterly newsletter, monthly podcasts, and website updates

Reaching New Heights

So when you see "FAANP" as the last NP credentials, you now know that person is a fellow and serves as a leader for nurse practitioners within the AANP. That NP leader positively influenced the practice landscape, educated nurses and NPs, and conducted and disseminated research. Both individually and as a group, the fellows continue to lead and promote NP practice and set an example for those who follow. If you think that you may have made a difference in NP practice, education, or policy, consider reaching out to a sponsor or applying for mentorship. This highest professional designation is worth working towards, as it will simultaneously advance your career and the NP profession.

Public health and healthcare agendas can seem to run parallel to each other rather than together. Some clinicians lament that public health agencies don't understand the difficulties of primary care services. On the other hand, providers often discuss how overwhelmed they can get by 15-minute appointments, as it prevents them from spending quality time with their patients.

Public health agencies and nurse practitioners have the same overall agenda — improving people's health. Despite maintaining similar goals, they work on separate tracks. Public health and nursing — specifically nurse practitioners — can work together to improve the health of their patients and communities through clinical-community linkages (CCL).

Why Nurse Practitioners and Public Health Go Together

Nursing focuses on the health of all people. Florence Nightingale, a renowned nurse who was known as the Mother of Nursing, paved the way for professional nursing in the mid-19th century by utilizing scientific approaches and health education across the community. Nursing has since evolved, with opportunities ranging from working inpatient in hospitals to outpatient in research and a variety of other careers. Nurse practitioners take this one step further, gaining additional education to reach specific patient populations. According to the American Public Health Association, public health promotes and protects the health of people and the communities where they live, learn, work, and play. Based on both descriptions, advanced-practice nursing and public health can join forces to improve the health of individuals and communities.

RELATED: 6 Nurse Practitioner Visionaries You Should Know About

What Are Clinical-Community Linkages?

Clinical-community linkages are one of the many ways that nurses, nurse practitioners, and public health agencies can work together. This extends beyond working in a government agency, such as Health and Human Services. Instead, clinical-community linkages are connections that community organizations and clinics form and utilize to better serve individuals within the local community.

According to the Agency for Healthcare Research and Quality, CCL offers the following benefits:

• Patients receive more help with changing unhealthy behaviors
• Clinicians are supported in offering services to patients that they cannot provide themselves
• Community programs are connected with clients who their services were designed for

Here's an example of how clinical-community linkages can work. A patient who is at risk for diabetes visits a community clinic for a follow up. A nurse practitioner has approximately 15 minutes to talk to the patient about what it means to be at risk for diabetes and how to prevent it, and then sends them on their way. Through CCL, a nurse practitioner can network with organizations in the community that may provide free diabetes education classes, such as the National Diabetes Prevention Program, community walking groups, and more. This type of linkage provides opportunities for healthcare clinicians to help patients connect with community organizations to improve their health. As a bonus, some of these programs are free.

How Nurses and NPs Can Get Involved

Healthcare doesn't have to be secularized to only a provider or a clinic. As healthcare moves toward an interprofessional model, clinicians can look outward and determine which community organizations can serve their patients' needs. It can be remarkable to see so many organizations involved in community-clinical linkages. However, they often lack a key player — healthcare providers. Public health agencies are often reluctant to receive feedback from clinicians on their programs and associated implementations. While these groups need to be more accessible to clinicians (i.e. scheduling times when clinicians aren't seeing patients or charting), it’s surprising that many clinicians who want their voices heard on improving others' health do not attend these work groups.

Nurse practitioners and clinicians can play an active role in supporting individuals' health within a community. It can be as simple as emailing local public health agencies about opportunities to be involved in public health initiatives, attending public health webinars or conferences, and networking with community organizations.

A Personal Connection

Working in public health, I have been able to learn about all of the excellent resources that are available on a local scale. While studying to be a family nurse practitioner, I was told about how important it is to educate older patients about falls. However, we were never provided with resources or available classes where patients could learn more about fall prevention Through public health networks, I eventually learned about the National Council on Aging and where I could access fall prevention resources. However, it's likely that not all clinicians know about these resources. That is why clinical community linkages are so important.

Public health and healthcare don't have to work on separate tracks towards the same goal. With the help of clinical-community linkages, both groups can network together and build strong links within the community to effectively serve patients.

Most nurse practitioners can recall the reason that they decided to advance their nursing practice and pursue advanced practice degrees. Whether it's experiencing the individual care of a gifted NP or witnessing a talented NP interact with a team of healthcare professionals, the impact that an NP leaves behind is truly magical and career-changing. In this current healthcare environment, it's especially important to remind ourselves of the talent surrounding us. Keep reading about these six nurse practitioner visionaries to boost your inspiration!

1. The Original Visionary

Loretta Ford, EdD, PNP, FAAN was the first nurse practitioner and founder of the nurse practitioner model and training program. In the 1960s, Dr. Ford recognized how a shortage of primary care physicians was affecting the care of families and children. Partnering with pediatrician Dr. Barry Silver, she began a nurse training program to extend care to these populations. Inducted into the List of Living Legends by the American Academy of Nursing and the National Women's Hall of Fame, Dr. Ford successfully transformed the nursing profession and made healthcare more accessible to the general public. Dr. Ford educated a variety of nurses and nurse practitioners, authored over 100 publications, and lectured and consulted across the country.

2. The Health Care Visionary

Courtney Vose, DNP, MBA, RN, APRN, NEA-BC is the Vice President and Chief Nursing Officer of Nursing and Patient Care Services at New York-Presbyterian (NYP)/Columbia University Medical Center, NYP/Allen and the NYP/Ambulatory Care Network. She is also a clinical instructor at the Columbia University School of Nursing. As a result of her transformational leadership, NYP/Columbia University Irving Medical Center achieved Magnet recognition from the American Nurses Credentialing Center. Magnet achievement honors the highest levels of nursing excellence and professionalism. Dr. Vose has co-authored many research studies related to nursing care and processes. She recently conducted research on the emotional toll of COVID-19 on health care workers and is advocating for frontline worker loan forgiveness. Serving as an ongoing champion for nurses and patients, Dr. Vose is an exemplary leader.

RELATED: Is Full Practitioner Authority Here to Stay? How COVID-19 is Advancing the Future of Nurse Practitioner Practice

3. The Nursing Informatics Visionary

Christopher Caulfield RN, NP-C, MSN is a nurse practitioner and the co-founder of IntelyCare, an on-demand mobile healthcare staffing company for post-acute facilities across the U.S. While working as a nurse administrator, he identified sources of nursing burnout and staffing challenges. He co-founded Intelycare to address these issues while highlighting the importance of nursing informatics in modern health care. Based in Massachusetts, IntelyCare helps facilities reduce nurse burnout, streamline administration, and improve overall care. It also provides nurses and nursing assistants with flexible shift scheduling, in-app education, and support to optimize patient care.

4. The Holistic Care Visionary

Herline Raphael, MSN, AG-NPC, CPCA is a holistic care nurse practitioner in Pennsylvania. Herline began her work in global care by founding Helping Hands and Beyond, a volunteer organization that offers aid to impoverished world populations. The organization has completed over 30 mission trips, supporting thousands of people in Haiti, Grenada, and the hurricane-struck Bahamas islands. Helping Hands and Beyond has built several clinics, as well as a girls’ orphanage in Haiti. As a nurse practitioner, Herline continues to serve her mission of providing healing and holistic care in her practice. BIX Homes and Wellness is a family-centered medical health and wellness center that combines east and west treatment modalities for all life stages. The center also offers disease management and coping and transition support programs that guide patients and families through illnesses, home care transitions, and health education. Herline's view of holistic care includes all aspects of patient life—physical and spiritual health, and family and social life.

5. The NP Education Visionary

Michael E. Zychowicz, DNP, ANP, ONP, FAAN, FAANP is an award-winning NP professor at the Duke University School of Nursing and the Director of the Duke-Durham VA Academic Partnership. Dual-certified in acute care and orthopedics, he leads the only Orthopedic NP specialty program in the U.S. Dr. Zychowicz is an active board member and the current treasurer of the National Organization of Nurse Practitioner Faculties, an organization driving nurse practitioner education. He was selected as a Fellow of the American Academy of Nursing in 2013 and the American Academy of Nurse Practitioners in 2007. He has edited several books, remains active in research, and frequently lectures at conferences. Dr. Zychowicz serves as a progressive educator for NPs on the cusp of change in the current U.S. healthcare climate.

RELATED: Guide to Enrolling in an Online Nurse Practitioner Program

6. The Political Visionary

Congresswoman Lauren Underwood (D), RN, MSN/MPH serves Illinois' 14th district, which encompasses the north and west suburbs of Chicago. Congresswoman Underwood is the first woman, a person of color, and a millennial to represent her community in Congress. She is also the youngest black woman to serve in the United States House of Representatives. President Obama appointed this health care and political champion as the disaster preparedness Senior Advisor for the US Department of Health and Human Services (HHA). Through her work with the HHS, she helped implement the Affordable Care Act and contributed to the new focus on quality and value in U.S. healthcare. She also educated nurse practitioners through Georgetown's online NP program.

RELATED: A 7 Step Health Policy Toolkit to Flex Your Political Muscle as a Nurse Practitioner

These non-conformist advanced practice nurses demonstrate strength, innovative action, and growth. We should continue to look to them as a source of inspiration for leading healthcare in a positive direction. Consistently included as a part of the most trusted profession, NPs have successfully advanced education, professionalism, and public support to implement change. Do you know an NP who inspires you?

"Health happens outside of a medical office."

This is a common saying in healthcare. It means that beyond a standard 15-30 minute clinical appointment, a person's health occurs in their daily lives. This includes where they live, work, and play, as well as what they eat, their transportation, and more. We may think that we understand these factors, but do we truly understand how it all works?

In nursing school (pre-licensure and beyond), simulations provide an insightful experience that helps students prepare for both inpatient and outpatient situations in the clinical setting. Simulations can range from a medical emergency in a primary care office to a pregnant woman with undiagnosed eclampsia. Simulations have personally taught me how to function in a team setting, work under pressure, and learn from my mistakes without harming anyone. These lessons are all highly valuable.

The public health simulation that I participated in during my baccalaureate pre-licensure program was my favorite. This simulation showed me that I didn't understand what Americans struggle with as much as I thought I did. If there is one critical simulation for nurse practitioner (NP) students to experience, it's a public health simulation.

What Is a Public Health Simulation?

A public or community health simulation is a non-threatening activity that nursing students participate in. The activities involved in this simulation vary from school to school. While these simulations are not as popular as a traditional simulation in an acute care setting, they are critical in helping students understand disease prevention, population health, and social determinants of health. In the article "Preparing Today's Nurses: Social Determinants of Health and Nursing Education," Thornton and Persaud discuss how simulations can help students understand the health inequities that exist today. Such simulations offer incredible insight into why health disparities exist, as well as provide reflective and thought-provoking moments for nursing students that can help improve their practice as a nurse or advanced practice provider.

At my baccalaureate program, I participated in an activity with a group of student colleagues where we each played a community member with very limited resources. This particular group was a family unit, and mine included a single parent, a child under 5, a teenager, and a live-in grandparent. Our family had no car and the single parent worked two jobs. Scenarios ranged from needing to visit the county building to renew services to taking the children or grandparent to see a doctor. Our family even had our "money" stolen during one event. The experience was incredibly eye-opening. I experienced stress, despair, anger, and hopelessness throughout the simulation. I also felt frustrated with the system. How can somebody who works two jobs make it to the county office to sign for continued services for food or other resources? While I understood that life was difficult for many families in America, I did not fully grasp the extent of it until participating in this four-hour simulation. It truly humbled me. I recognized where I've placed judgment and identified implicit biases that I hadn't previously noticed. That experience made an impression that lasted all the way through my NP program, in both didactic and clinical settings.

Incorporating Community Simulation Programs for NP Students

As I look back on my time as a graduate student, the one simulation that I believe every NP program should invest in is a community/public health simulation. As NPs, we provide disease prevention and management. Therefore, we must go beyond understanding our patients and see the perspective of patients who may not have access to necessary resources. A community or public health simulation provides students with a realistic example of the challenges that many Americans face today. From learning empathy to understanding humility, this type of simulation is critical for future nurses and nurse practitioners to care for patients to the best of their abilities.