In November, I had the opportunity to engage in a lovely afternoon discussion with Dean Janie Heath of the University of Kentucky, College of Nursing. She took time from her busy schedule to meet with me, and she was accompanied by Elizabeth Adams, Senior Information Specialist with the UK Public Relations and Marketing Department. The goal of our meeting was for me to obtain information, of interest to physicians, regarding the new terminal degree in nursing, the Doctor of Nursing Practice (DNP).
Dean Heath, who came to UK from the University of Virginia, College of Nursing, pointed to the UK College of Nursing’s leadership role in developing advanced degrees for nurses. An APRN, is a nurse who completes a masters, post-masters, or doctoral degree in a nursing specialty. In 1987, UK became the first university in Kentucky to develop a PhD in nursing. Its purpose was to advance nursing science and “discover knowledge for improving health and wellness.” It is a terminal degree and has a research focus. Moreover, in 2001, UK introduced the first Doctor of Nursing Practice degree in the country. This degree has the purpose of advancing nursing practice to “translate evidence for improving health and wellness.” It is a terminal degree with a clinical focus.
The Doctor of Nursing Practice degree requires significant preparation. First, an undergraduate applicant to the program must possess a Bachelor of Science in Nursing degree (BSN). Subsequently, this will require completing 80 credit hours of study, containing about 1200 clinical practice hours, to achieve the DNP degree. If the nurse has a Master of Science degree in Nursing (such as with the Advanced Practice RN), generally the DNP completion will require 30 more credit hours plus a number of additional clinical practice hours. Dean Heath stresses that the DNP degree is designed to provide a nurse with enhanced skills above the Advanced Practice RN diploma, but with the same core set of skills achieved while obtaining the MSN degree. The prerequisites to study for theD.NP. degree are as noted above, and additionally these require a 3.3 GPA, a personal/professional statement, and a personal interview.
The doctoral curricula contains Nurse Practitioner core courses in the sciences, clinical practice, plus the following DNP. courses to meet American Association of College of Nursing standards:
- Scientific Underpinnings for Practice
- Organizational & Systems Leadership for Quality Improvement and Systems Thinking
- Analytical Methods for Evidence-Based Practice
- Information Systems/Technology
- Healthcare Policy for Advocacy in Healthcare
- Inter-professional Collaboration for Improving Patient and Population Health Outcomes
- Clinical Prevention and Population Health for Improving the Nation’s Health
- Advanced Nursing Practice
I asked Dean Heath to describe what value is added to medical care by acquiring the DNP degree. She pointed out, “Parity at the table,” since this is the first program of its kind in the United States, it has been successful focusing on the development of advanced competencies for complex practice and for utilization to improve clinical care delivery, patient outcomes, and systems management. The graduates of the DNP program at UK will be expert at designing, implementing, managing, and evaluating healthcare delivery systems and will be prepared to lead at the highest clinical and executive ranks.
The Dean described how doctoral-level nurses would practice vis-à-vis physicians. She stated that they will complement the team approach in medical practice and they are prepared to lead and provide value added by being accessible to deliver quality and cost effective care. There are far too many healthcare needs in the United States for a physician-only mode. She stressed that previous practice models have demonstrated that Nurse Practitioners who have a physician partner, who can be trusted and counted on to be there when they need them, will allow AP nurses to perform their jobs within their scope of practice.
Dean Heath explained that out of the current three million registered nurses in the United States, over 190,000 are Nurse Practitioners, and almost 50% practice in primary care settings. Within the prior year, there have been 900 million visits to primary care nurse practitioners in the United States. However, such as with the physician shortage within the United States, currently over 25 states do not have a full complement of Nurse Practitioners to practice to the fullest extent of their education, training, and license. She noted that there is a need for APRNs and DNPs to be allowed to order home healthcare, to certify Medicare patients for Hospice, and to perform monthly examinations for patients in skilled nursing facilities. If these privliges can be added to the scope of practice by legislators, the overall health of the country, and the needs of underserved patients, can be more fully met.
Dean Heath, who calls herself an “Oklahoma girl,” is highly qualified to meet the needs of the College of Nursing, and she came to Kentucky from the Commonwealth of Virginia’s flagship nursing program. She has a long and distinguished scholarly record at the University of Virginia and other notable institutions of higher learning in Georgia, South Carolina, and Washington D.C. during her nearly 40-year career in nursing. She is a recognized national leader in nursing education, tobacco control, and healthcare outreach. Not only is she the Dean of the UK College of Nursing, but she also holds the Warwick Professorship in Nursing at the University of Kentucky.
By Robert P. Granacher, Jr., M.D., M.B.A.