The Doctorate of Nursing Practice and
Advanced Community/Public Health Nursing
Christine L. Savage, RN, PhD, CARN University of Cincinnati Derryl E. Block, RN, PhD, APHN-BC
Public health nursing has a rich tradition in the field of nursing that extends back to the work of Florence Nightingale.
The Medical Industrial Complex
After World War II, in conjunction with the growth in the medical industrial
complex, the majority of nursing graduate programs provided students with
education for highly specialized
individualized direct care rather than population-focused care.
PHN in Masters Essentials
The AACN (1996) Essentials of Masters Education For APN document included
◦ Graduate nursing core for all masters degree students
◦ Three tracks with separate courses needed Administration
APN clinical
Community health track
The APN clinical was defined as direct
PHN in DNP Essentials
Document
The AACN (2006) The Essentials of
Doctoral Education for Advanced Nursing Practice document included two tracks:
◦ Advanced Practice Nursing (APN)
◦ Aggregate/systems/organization (ASO)
The ASO track includes Community/Public Health
nursing (C/PHN) as well as nursing
administration, informatics and other non APN specialty areas.
PHN in DNP Essentials
Document
Lack of AACN guidance re curriculum
for the Aggregate/Systems/
Position paper on APHN Graduate
Education
Graduate Education for Advanced Public Health
Nursing: At the Crossroads (2007) The Association of Community Health Nurse Educators (ACHNE)
◦ Supports the national movement towards the practice doctorate as a terminal degree for advanced nursing practice
◦ Confirms that doctoral education for specialty practice is defined by the specialty nursing organization
Implementation of DNP programs in PHN is an evolutionary process that may follow multiple pathways:
◦ Collaboration with schools of public health
◦ Collaboration between schools of nursing to create centers of excellence
Blurring of Terms
Terms as defined by AACN
◦ Advanced Practice Nursing - involving the care and management of individuals and
families
◦ Advanced Nursing Practice - ―…any form of nursing intervention that influences health care outcomes for individuals or populations…‖
◦ Aggregate/systems/organizations—focusing practice on aggregates
Challenges for PHN DNPs
Implementation of Doctorate of Nursing Practice (DNP) programs in C/PHN faces numerous challenges including the ability of the institution to support doctoral
programs and the lack of definition of the ASO specialty track.
Challenges for PHN DNPs
If the DNP becomes the desired degree will there be enough programs to meet increasing workforce demand for
advanced public health nurses?
Are nursing schools instituting DNP programs that include an
aggregate/systems/organization or C/PHN track?
What are the characteristics of current C/PHN graduate programs?
Survey
To answer these questions we conducted a
survey of nursing schools. ◦ Cross sectional survey
◦ Unit of analysis – nursing academic institutions
Convenience sample
Distribution of the survey through the ACHNE lit serve
The purpose:
◦ Identify and count the institutions having or
planning to have a DNP in Community/Public Health Nursing
◦ Identify potential barriers to implementing DNP programs
The Research Questions
Questions:
◦ Are nursing schools instituting DNP programs?
If so, do they include a PHN track?
What is the rationale for instituting a DNP
program or not instituting one?
◦ What are the characteristics of graduate program in PHN related to title and clinical hours?
Methods
Online survey using Survey Monkey
Email invitation to ACHNE electronic mailing
list members:
◦ ―This survey is for CPHN educators working at an institution that offers graduate programs in nursing. If your institution only offers Baccalaureate or
Associate degrees, please do not complete the survey.‖
Data reviewed for outliers or multiple
answers from the same institution
Data analysis via SPSS frequency
Respondents
Respondents
◦ 86 completed surveys (all reported graduate programs in nursing)
◦ 44 reported graduate program in public health nursing
Response Rate Unknown
◦ Unknown number of programs with graduate
nursing degrees represented on ACHNE electronic mailing list
Findings: Are you instituting a
DNP program?
46 (54%) have a DNP program in place or by
fall of 2010
Reasons for implementing the DNP at the
institution level (n=22)
◦ Requirements for NP certification (27%)
◦ AACN directives (27%)
◦ Increase number of doctorally prepared nurses (10%)
◦ Future of nursing (18%)
◦ Institution part of original initiators of DNP (ND) (18%)
Findings
Institutions with a graduate C/PHN program (n = 40)
◦ 29 current DNP or by fall 2010 (73%)
◦ 13 have ASO or C/PHN track (33%)
Institutions without a graduate C/PHN program (n = 39)
Findings: At what level will
students enter the DNP program
For programs with a DNP currently or by Fall 2010 (n=48), entrance to DNP
program is:
◦ 38% post masters only
◦ 4% post BSN only
Findings: ASO and C/PHN Tracks
Tracks in DNP Programs (n = 46)
◦ 37% Aggregate/Systems/Organization (ASO)
◦ 41% C/PHN
Findings: Reasons for not having
DNP?
Reasons (n=17)
◦ Institution does not support doctoral programs (29%)
◦ No market for DNPs (12%)
◦ Lack of qualified faculty (23.5%)
◦ Other (35.5%)
Other comments
◦ Budget problems
Findings: Characteristics of C/PHN
graduate programs
Names for C/PHN graduate programs varied (n =39)
◦ Community/public health 33.3%
◦ Public health nursing 23%
◦ Community health nursing 12.8%
◦ CNS 7.6%
Findings: Characteristics of C/PHN
Graduate Programs
Clinically supervised hours (n = 27)
◦ Mean 512 hours
◦ Range 100 to 1000
◦ 18.5% less than 500 hours
Require the three P’s (n = 43)
19%
Include an MPH option (n = 36)
Conclusions
Respondents reported:
Over half of their institutions will have a DNP program in
place by the fall of 2010
The main reasons given for developing a DNP program
were:
◦ AACN directive that all advanced nursing practice degrees require a DNP by 2015
◦ NP certification requirements
4 out of 10 DNP programs have a specific C/PHN track Over one third of the DNP programs include APN only
Conclusions: C/PHN Graduate
Programs
For the C/PHN graduate programs varied in:
◦ Titles of programs
CNS designation is being used by some
institutions
Almost one quarter of programs did not include
CH or PH
◦ The number of clinical hours required.
20% of the C/PHN MSN programs required less
Limitations
Convenience sample
Some missing data regarding institution name
Respondents may have had limited information about institutional plans and/or types of programs
Challenges
Rationale for the DNP is driven by
direct care/micro level specialties.
Potential redundancy and blurring of
population-focused care with
individual care is present in the DNP
Essentials.
Challenges
No clear reference to the C/PHN advanced nursing practice in the DNP Essentials.
Students may flock to MPH or APN tracks, causing nursing to loose its voice in Public Health and public health to lose its voice in nursing.
DNP as Terminal Degree
Some graduate nursing programs are in institutions that lack authorization to
provide doctoral degrees.
Will this make it difficult for those seeking an advanced degree in C/PHN to find
