Education and Educators Joyce Pulcini, PhD, RN, FNP-BC, FAAN, FAANP - - PowerPoint PPT Presentation

Development of APN Nurse Education and Educators

Joyce Pulcini, PhD, RN, FNP-BC, FAAN, FAANP Professor George Washington University School of Nursing October 6, 2016

Purpose

• This presentation will discuss the experience of

APN nurse education and of mentoring APN nurse educators in the U.S. with application to Latin America and the Caribbean

• This will include a history of NP Education and

the successes experienced when nurse educators work together to create common

• goals. It will also discuss strategies for

incorporating existing and new educators into APN education.

Definición: Práctica Avanzada en Enfermería

La Nurse Practitioner/Enfermera de Práctica Avanzada es una enfermera registrada la que ha adquirido conocimiento de experto, habilidades para tomar decisiones complejas y competencias clínicas para una práctica expandida, cuyas características varían según el context y o país en el cual esta autorizada a

• ejercer. Se recomienda tenr un grado de

Magister para desempeñarse en este rol. En los Estados Unidos se exige el grado de Magister.

ICN, 2002: http://icn-apnetwork.org/

Preparación Educacional

• La preparación educacional es a un nivel

avanzado

• Reconocimiento formal de los programas

educacuionales para formar enfermeras de práctica avanzada/ nurse practitioners y sus roles estan aprbados y acreditados

• Sistema formal de licencia, registro,

certificación y credencial

ICN, 2002: http://icn-apnetwork.org/

Naturaleza de la Práctica

• Integra investigación, educación, práctica clínica y

administración

• Alto grado de autonomía profesional y práctica

independiente

• Gestión de casos
• Habilidades avanzadas para la valoración en salud,

habilidades para la toma de decisiones y habilidades para el razonamiento diagnóstico

• Reconocidas competencias clínicas avanzadas
• Servicios de consultoría a proveedores de salud
• Planificación, implementación y evaluación de programas
• Reconocida como primer contacto con clientes

ICN, 2002: http://icn-apnetwork.org/

Mecanismos Regulatorios

• Regulaciones específicas para la práctica de NP/APN acorde a

cada país

• Derecho a diagnosticar
• Autoridad para prescriber medicamentos
• Autoridad para prescriber tratamiento
• Autoridad para referir clients a otros profesionales
• Autoridad para ingresar pacientes al hospital
• Legislación para conferir y proteger el título de Nurse Practitioner/

Advanced Practice Nurse

• Legislación u otro tipo de mecanismo regulatorio específico para

advanced practice nurse

• Títulos oficialmente reconocidos para enfermeras que desempeñan

roles de práctica avanzada

ICN, 2002: http://icn-apnetwork.org/

Primary Health Care WHO (1978)

“essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self- determination.”

History of Nurse Practitioner education in the US: 1965 to 2000

1965:1st NP program at U. of Colorado--PNP, certificate: educated public health nurses to be Pediatric Nurse Practitioners 1971: 1st FNP Program at U. of Washington 1973: over 65 NP programs in place 1974: 1st meeting to discuss NP curriculum at Chapel Hill, Mid1970s: first national certification examinations for NPs, CNSs Nurse Training Act of 1975--federal support for NP programs 1980: NONPF Guidelines for FNP curriculum planning published and revised every 5 years until 1995 (domains and competencies) 1983: 22-24,000 NPs in US By 1987 $100 million spent on NP education via federal grants 1990: 90% of NP programs now master’s granting 1997: National Task Force Criteria for Evaluation of NP Programs 2000: > 60,000 NPs in US/ 323 NP programs 2016: ~200,000 NPs in US (www.aanp.org)

Educating the Educators

• Like Latin America and the Caribbean, the earliest graduate

programs in the U.S. focused on nursing theory and on preparing teachers and administrators

• Doctoral education in nursing was well established in the

1970’s and 1980s.

• Clinical Nurse Specialist roles preceded the NP and these

were mostly in acute care

• As we moved to a primary care and a direct care focus for

NPs, educators needed to understand the new role.

• Many were skeptical in the beginning and were concerned

that we were training mini-doctors

• Faculty also had to practice to maintain their skills and teach
• NONPF advocated for formal faculty practice arrangements

so that faculty would not loose their skills.

Educating the Educators

• From 1976 to 1982, The Robert Wood Johnson

Foundation offered the Nurse Faculty Fellowship so that nurse faculty could be prepared to practice as NPs.

• Goal: to create a core of leaders in nurse practitioner

education who would help establish master’s degree programs at schools of nursing

• This led to a proliferation of NP programs and a

“tipping point” in the mid 1990s when most graduate programs offered these programs

Source: http://www.rwjf.org/en/library/articles-and- news/2012/01/four-decades-of-championing-nursing.html

Educational Expansion: Key Documents

• Masters Programs
• NONPF: National Task Force Criteria for Evaluation of Nurse

Practitioner Programs (1997) revised 2002, 2008, 2012, 2016

• Set standards for programs and in 2003 were integrated

into accreditation standards.

• American Association of Colleges of Nursing: Revised in

2011: AACN Essentials for Master’s Education

• 2008: Consensus Model for APRN Regulation: Licensure,

Accreditation, Certification & Education (LACE) Model

• Set standards for population foci and roles for APNs
• Identified curricular components for APN education

APRN REGULATORY MODEL

APRN SPECIALTIES

Focus of practice beyond role and population focus linked to health care needs Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care



Licensure occurs at Levels of Role & Population Foci

Family/Individual Across Lifespan Adult- Gerontology* Neonatal Pediatrics

      

POPULATION FOCI APRN ROLES

Nurse Anesthetist Nurse- Midwife Clinical Nurse Specialist Nurse Practitioner * Women’s Health/Gender

• Related

Psychiatric- Mental Health**

AACN, 2011

APRN Modelo Regulatorio

APRN Especiaidades

Foco de la practica más allá del rol y foco poblacional Vinculado a las necesidades de atencion de salud Ejemplos: : Oncología, Adulto Mayor, Ortopedia, nefrología, Cuidados Paliativos



Licensure occurs at Levels of Role & Population Foci

Familia/Individuo Ciclo Vital Adulto- Gerontologia* Neonatal Pediatrico

      

Foco Poblacional Roles de Enfermeras de práctica Avanzada

Enfermera Anestesista Enfermera- Matrona Enfermera Especialista Clínica Nurse Practitioner * Salud de la Mujer/ Enfoque Género Psiquiatría Salud Mental**

AACN, 2011

Building a Curricula: LACE Model

(AACN, 2011)

APRN Role Population foci Specialty Regulation

Competencies

3 Ps (Advanced Pathophys, Pharmacology, Health Assessment) NP, CRNA, CNM CNS Core competencies in Population context Professional Organizations (e.g. oncology, palliative care, nephrology) Professional Certification Graduate Core Master’s or DNP Essentials

Construyendo un Curriculum: Modelo LACE (AACN, 2011)

Enfermería de Practica Avanzada Rol Foco población Especialidad Regulación

Competencias

3 Ps (patofisiología Avanzada, Farmacología, Valoración de la SAlud NP, CRNA, CNM CNS Competencias esenciales en el contexto poblacional Organizaciones profesinales (ej. oncología, cuidados paliativos, nefrología) Certificación Profesional Cuerpo de Graduados Esenciales para Magister y DNP

Graduate Programs

Offer additional routes to advancing the expertise of registered nurses:

• Master’s Degree (MSN) programs offer a number of

tracks designed to prepare Advanced Practice Nurses, nurse administrators, and nurse educators.

• Doctor of Philosophy (PhD) programs are research-

focused whose graduates typically teach and/or conduct research

• Doctor of Nursing Practice (DNP) programs focus on

clinical practice or leadership roles

Educational Expansion: Key Documents- Doctoral Programs

• 2001: Work began on the Doctor of Nursing Practice
• 2006: Practice Doctorate NP Entry Level

Competencies

• 2006: AACN Essentials of Doctoral Education for

Advanced Nursing Practice

• 2010: The Future of Nursing Report (IOM, RWJF)
• 2012: NONPF- Nurse Practitioner Core

Competencies

• 2014: NONPF- Nurse Practitioner Core

Competencies (revised)

National Organization of Nurse Practitioner Faculties (NONPF)

• Educational/Curricular Resources
• Faculty/student supports
• Practice competencies
• Research
• Networking
• See: http://www.nonpf.org

NONPF History & Competencies

• First competencies introduced in 1990.
• Competencies tied to domains (Brykczynski, K.A, 1989)
• Core competencies revised in 1995, 2002, 2006 for

Master’s level.

• 2006 core introduced for doctoral level – tied to

competency areas and not domains.

Source: www.nonpf.org

Population Focused Competencies Primary Care set completed in 2002: –Adult –Family –Gerontological –Pediatric –Women’s Health Psych Mental Health completed in 2003 Acute Care completed in 2004

Source: www.nonpf.org

Population Focused Competencies

Consensus Model for APRN Regulation (2008) led to new competencies: 2013 – Family/Across Lifespan, – Neonatal Pediatric AC, Pediatric AC, – Psychiatric-Mental Health Across Lifespan, & – Women’s Health/Gender-Related 2016

• AGNP- PC and AGNP- AC

(Source: www.nonpf.org)

DNP Competencies

2011 core competencies reflects merger of doctoral and master’s level into 1 set of NP core competencies. 2012 core competencies updated – current set of NP core competencies for all NP graduates.

(Source: www.nonpf.org)

Nine NP Core Competencies

Scientific Foundation Leadership Quality Practice Inquiry Technology and Information Literacy Policy Health Delivery System Ethics Independent Practice

(Source: www.nonpf.org)

Selected References

American Association of Colleges of Nursing. (2011). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Washington, DC: AACN. Available at: http://www.aacn.nche.edu/education-resources/aprn-consensus-process. American Association of Colleges of Nursing. (2006). Essentials of doctoral education for advanced nursing practice. Washington, DC: Author. Available at: http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf American Association of Colleges of Nursing (2011). Essentials of masters education for advanced practice nursing. Washington, DC: Author. Available at: http://www.aacn.nche.edu/education- resources/essential-series INP/APN Network, ICN. (2009).Nurse Practitioner/Advanced Practice Nurse: Definition and

• Characteristics. Nursing Matters. Available at:

https://acnp.org.au/sites/default/files/33/definition_of_apnnp.pdf. National Organization of Nurse Practitioner Faculties. (2016). National Task Force Criteria for Evaluation

• f Nurse Practitioner Programs. Available at: www.nonpf.org

U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. (2014). Highlights from the 2012 National Sample Survey

• f Nurse Practitioners. Rockville, Maryland: U.S. Department of Health and Human Services. Available

at: http://bhpr.hrsa.gov/healthworkforce/supplydemand/nursing/nursepractitionersurvey/npsurveyhighlights. pdf U.S. Department of Health and Human Services, Health Resources and Services Administration. (2013). The U.S. nursing workforce: Trends in supply and education. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/