Nursing Education and
Certification Matters:
What You Do DOES Make A Difference
Susan Reinarz, DNP, RN, NNP-BC Past-President
National Association of Neonatal Nurses
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Disclosures
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Objectives
• Describe the recommendations from the Institute of Medicine report “The Future of Nursing” that pertain to education.
• Discuss the current status of the practice doctorate.
• Identify the certification changes that assist in promoting competency maintenance.
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4/8/2014 Slide courtesy of Debra Sansoucie,
EdD, ARNP, NNP-BC 5
What Are Nurses Being Called To Do?
Why Talk About This Now?
• Health care reform is not going to go away • Nurses are the largest proportion of the workforce • Nurses are the most trusted health care professional
• 2013 Gallup Poll: Nursing is the Most Trustworthy Profession
http://campaignforaction.org/community-post/2013-gallup-poll-nursing-most-trustworthy-profession 4/8/2014 7 4/8 /2 01 4 8 4/8/2014 http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2010/02/who-will-influence-health-reform-in-the-united-states-in-the-nex.html 9 Question Wording: Thinking about the next five to ten years, how much influence do you think each of the following professions or groups of people will have in health reform in the United States?
Who Will Influence Health Reform in the United States in the Next 5-10 Years
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Our Population is Impacted
U.S. lags in global measure of premature births The Dallas Morning News The New York TimesPublished: 02 May 2012
• Fifteen million babies are born prematurely each year, and the United States fared badly in the first country-by-country global comparison of premature births (ranking 131/184 per the World Health Organization
• Although U.S. hospitals excel at saving premature infants, the United States is similar to developing countries in the percentage of mothers who give birth before their child is due, the study's chief author noted. It does worse than any western European country and considerably worse than Japan or the Scandinavian countries.
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Our Population is Impacted
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543,000 babies (1 in 8) are born too soon each year
Texas
4/8/2014 http://nhqrnet.ahrq.gov/snaps06/clinicalarea.jsp?menuId=18&stat
e=TX&level=17 13
What is the Maternal and Child Health Care Quality Performance Compared to All States?
How Has That Performance Changed?
Nebraska
4/8/2014 http://nhqrnet.ahrq.gov/snaps06/clinicalarea.jsp?menuId=18
&state=NE&level=17 14
What is the Maternal and Child Health Care Quality Performance Compared to All States?
How Has That Performance Changed?
We Need To Be Prepared
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Recommendations for an action-oriented blueprint for the future of nursing
The Future of Nursing Report
• Evidence-based• Inter-professional Team of Authors • Provides 8 recommendations
opractice, education, leadership and nursing workforce data
• 4 key messages
o Nurses should practice to the full extent of their education, training and licensure, which requires the removal of scope of practice barriers.
o Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression, including nurse residency programs and lifelong learning.
o Nurses should be full-partners, with physicians and other health professionals, in redesigning health care in the United States. o Nurses should be full-partners, with physicians and other health
professionals, in redesigning health care in the United States.
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Key Message #2
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression, including nurse residency programs and lifelong learning.
oMore BSN-trained nurses (80% by 2020) ***
oDouble the number of nurses with a doctorate by 2020 oADN-to-BSN and ADN-to-MSN programs
• Seamless transition
oIncrease student diversity to create workforce prepared to meet demands of increasingly diverse patient population
Aren’t We Still Arguing About
Entry Into Practice?
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NO!
NO!
NO!
NO!
The chaos of the questionis over.
The pieces are falling into place.
Multiple Ways To Enter
Practice
4/8/2014 http://bhpr.hrsa.gov/healthworkforce1/rnsurveys/rnsurveyfinal.pdf 20 • Diploma • Associate Degree • Baccalaureate Degree 0 10 20 30 40 50 60 % of Current (2008) RN Workforce % of TotalFaculty Shortage
4/8/2014 21 0 20000 40000 60000 80000 100000 120000 2005 2006 2007 2008 2009 BS AACN BS NLN AD NLN Missing NLN Data for 2007Qualified Applicants Not Accepted in Associate (AD) and Baccalaureate (BS) RN Programs
Education Improves
Outcomes
• Growing evidence that education improves outcomes
A 10% increase in the proportion of nurses
holding BSN degrees decreased the risk of
patient death and failure to rescue by 5%.
Linda H. Aiken, Sean P. Clarke, Robyn B. Cheung, Douglas M. Sloane, Jeffrey H. Silber, "Educational Levels of Hospital Nurses and Surgical Patient Mortality," Journal of the American Medical Association (JAMA), Vol. 290, September 24, 2003, 1617-1623.
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“BSN In 10” by ANA HOD 2008
• WHEREAS, while continuing professional education is encouraged for all registered nurses, only future graduates of diploma or associate degree programs would be required to meet the academic requirement of a baccalaureate degree in nursing within 10 years of initial licensure; therefore be it
• RESOLVED, that the American Nurses Association affirms that increased numbers of registered nurses with a baccalaureate degree are needed to address the ongoing challenges of an increasingly complex health care delivery system and a critical nursing faculty shortage; and be it further
• RESOLVED, further that the American Nurses Association supports initiatives to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within ten years after initial licensure, exempting (grandparenting) those individuals who are licensed or are enrolled as a student in a nursing program at the time legislation is enacted; and be it • RESOLVED, that the American Nurses Association advocates for and
promotes legislative and educational activities that support enhanced advanced degrees in nursing.
http://www.nursingworld.org/MemberCenterCategories/ANAGovernance/ANA-HOD-Resolutions/Educational-Advancement-for-Registered-Nurses.aspx
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NANN’S Position Statement
Educational Preparation for Nursing Practice Roles(Position Statement #3048 )
Approved by NANN Board of Directors Nov 2009
Conclusions
• All neonatal nurses at all levels of practice should give careful consideration to their educational preparation for nursing practice roles. It is the position of NANN that (1) future nurses entering practice as RNs should obtain a BSN within 10 years of receiving their first nursing license, and (2) the APRN who practices in the NICU should be a graduate of an accredited master’s‐ or doctoral‐level NNP or neonatal CNS program and should be nationally certified in the neonatal specialty
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http://www.nann.org/pdf/09educational_prep.pdf
SEAMLESS Transition
Provide for seamless educational transition • ADN-to-BSN
• ADN-to-MSN programs
• Creative connections between schools
• Creative connections with employers
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RN to BSN Programs
• Currently 692 programs nationwide• Of those, ~ 400 all or partially on-line • Enrollment increased 15.8% 2010-2011
• Hundreds of articulation agreements between ADN and diploma programs and four-year institutions exist nationwide, including some statewide agreements, to facilitate students seeking baccalaureate level nursing education.
• Last Update: January 21, 2014 AACN
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Update
• 3.5% entry-level BSN enrollment increase • 22.2% increase in RN-to-BSN programs last year • Statewide articulation agreements in several states,including Texas
• Baccalaureate graduates more than twice as likely to have jobs at the time of graduation
o39.1% of employers require BSN for employment o77.4% strongly prefer BSN prepared nurses
• Increasing evidence that specialty certification associated with better patient outcomes
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What About APRNs?
AACN (2004) - Position Statement on the Practice Doctorate in Nursing
• Endorses graduate level education for practice
Recommends transition to DNP for APRN Target goal of 2015
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http://www.aacn.nche.edu/publications/position/DNPpositionstatement.pdf 28
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48 Endorsing Organizations 29
Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification &
Education
July 7, 2008
Completed through the work of the APRN
Consensus Work Group & the National Council
of State Boards of Nursing APRN Advisory
Committee
http://www.aacn.nche.edu/education-resources/APRNReport.pdf
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Education
• Formal graduate degree or master’s or post-doctorate certificate
• Accredited program
• Clinical and didactic coursework that is comprehensive and sufficient to prepare the graduate to practice in one of the four APRN roles across one of the six population foci
• Three separate comprehensive graduate-level courses
oAdvanced physiology/pathophysiology: Across the Lifespan
oAdvanced physical assessment (health assessment) oAdvanced pharmacology (Broad categories of agents)
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ANA Position Statement
Position Statement prepared by the Congress on Nursing Practice and Economics Released April 2010, Revised April 2011
The Doctor of Nursing Practice: Advancing the Nursing Profession
Summary: The American Nurses Association supports the Doctor of Nursing Practice as a terminal practice-focused degree in nursing offered to educate RNs in advanced levels of clinical judgment, systems thinking, and leadership to the profession of nursing.
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Why The DNP?
• Parity with other disciplines • Standardize APRN education • Change in healthcare systems
• Rapid expansion of healthcare knowledge • Protection of the public
• Focus on Evidence-Based Practice
• Terminal degree and advanced educational credential for those who do not want research-focused degree
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DNP vs PhD
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Characteristics
DNP
PhD
Objectives The practice of clinical nursing at the highest level (DNP is to nursing what the
MD is to medicine)
The conduct of research for the advancement of nursing science
Program Outcomes Nurse Practitioner in clinical practice or professional education settings, eligible for national certification examination
Nurse Scientist in an academic or research intensive setting
Final Scholarly Project Evidence-based, population level practice, health or policy improvement project
Original Research
Perceived Benefits of the
DNP
• Enhanced knowledge to improve practice
• Enhanced leadership skills to strengthen practice and health care delivery
• Enhanced status of profession
• May provide higher reimbursement services
• CMS is already moving to base reimbursement on quality indicators
• Improved patient care outcomes
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When Will the DNP Be Required?
• Still lack of agreement• Target date 2015 for entry into practice*
o AANA has identified as 2025 for entry into practice for CRNAs
• NANN does not support for entry into practice at this time
• Already practicing APRNs will be grandfathered
o State-to-state portability hoped for
• Some suggestion of “DNP in 10” • Focus on Post-Master’s right now • Growth in Post-BSN programs also • Remember the issue of portability • Hope to see future outcomes evidence
That being said….
That being said….
That being said….
That being said….
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Growth in Doctoral Programs
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http://www.aacn.nche.edu/media-relations/fact-sheets/DNPFactSheet.pdf#page=2&zoom=auto,0,566 37
DNP Programs
• 241 programs nationwide (59 in planning stage) • Available in 49 states and DC• 2013 – 14,699 students enrolled • 2013 – 2,443 DNP graduates • Competitive student enrollment • Value seen in DNP curriculum
• Some data indicate that DNP prepared NPs earn up to $8,576 more than Master’s prepared NPs
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Why Certification?
IOM Report: To Err is Human (1999)
RECOMMENDATION 7.2:
• Performance standards and expectations for health professionals should focus greater attention on patient safety.
• Health professional licensing bodies should (1) implement periodic reexaminations and relicensing of doctors, nurses, and other key providers, based on both competence and knowledge of safety practices; and
(2) work with certifying and credentialing organizations to develop more effective methods to identify unsafe providers and take action.
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Continued Competence in Nursing
• NCSBN
convened the Continued CompetenceAdvisory Panel with the following charges: • Develop and implement a communication plan on
Continued Competence
• Develop a content outline for Continued Competence Assessments
• Conduct preliminary feasibility studies for assessments of continued competence.
• Continue development of a Continued Competence Regulatory Model to be used by member boards.
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What Is Competence?
Must provide employers and the public a valid measure of assurance regarding the ongoing competencies of providers.
Competence: Competence: Competence: Competence:
• “the effective application of a combination of knowledge, skill and judgment demonstrated by an individual in daily practice or job performance” Competency:
Competency: Competency: Competency:
• “a measurement of skill against outcome standards or role expectations”
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Continued Competency
APRN Joint Dialogue Group
Consensus Model for APRN Regulation
Stated: Certification maintenance must include a review of qualifications and continued competence • Procedures for ensuring a match between
continued competency measures and the APRN specialty
• Procedures for validating information provided by candidates
• Procedure for issuing re-certification
Competency And The
Consensus Model
APRN certification programs will provide a mechanism to ensure ongoing competence and maintenance of certification
APRNs must have a mechanism in place to verify their ongoing competence in
• Knowledge
• Patient management • Procedural skills
This must identify strengths, deficiencies and limits in knowledge and expertise so the APRN can set learning and improvement goals
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Consensus Model
Certification programs will assess specialty competencies separately from APRN core, role and population-focused competencies NCC NCC NCC NCC • APRN CertificationoNeonatal Nurse Practitioners oWomen’s Health Nurse Practitioners
• Core Certification Exams (Specialty competencies)
oInpatient Obstetric Nursing oNeonatal Intensive Care Nursing oMaternal Child Nursing oLow-risk Neonatal Nursing
• Subspecialty Exams
oNeonatal Pediatric Transport oElectronic
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Continued Competence
National Certification Corporation (NCC) response • Assurance of core certification knowledge competencies • Validate knowledge competencies related to thecertification that is consistent with the current educational curriculum, national standards of practice and the current practice
• Parallel the content outline for the original certification examination
• Designed to show you have maintained knowledge competencies over time.
• Continuing Competency Specialty Assessment • Assess knowledge gaps
• Develop a learning plan
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Knowledge Competencies
Continuing Competency Specialty Assessment (NCC)
• Used to identify areas of specialty knowledge strengths and gaps
• Does not affect your certification but the nature and amount of continuing education that will be required for certification maintenance
• Available on demand at any computer
• Must be taken in the first two years of each 3 year maintenance cycle leaving one year to earn the CE (take it as early as possible!)
• No cost to you to take the Continuing Competency Specialty Assessment
• Only CE earned after taking the continuing competency specialty assessment can be used for maintenance
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Although all nurses meet competencies for their RN license. Certified Nurses and Certified Advanced Practice Nurses. . . • Have gone beyond licensure by validating their specialty
knowledge and skills through a rigorous national examination • Are clinical experts - dedicated to providing the most
up-to-date, evidenced-based care
• Maintain their commitment to excellence in patient care through specialized continuing education
• Are unique professionals that have made the commitment to life-long learning, patient advocacy and professional practice
• Reassess their specialty knowledge throughout their career as part of their commitment to continuing competency • Are an asset to the field of nursing - their certification
documents their dedication to quality, evidenced-based, clinical care
• Meet and exceed the nationally recognized standards of proficiency and professionalism
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Certification Organizations
American Academy of Nurse Practitioners Certification Program American Association of Critical-Care
Nurses
American Midwifery Certification Board American Nurses Credentialing Center Commission on Nurse Certification Infusion Nurses Certification Corporation
Medical-Surgical Nursing Certification Board
National Certification Board for Diabetes Educators
National League for Nursing Wound, Ostomy, and Continence Nursing
Certification Board 4/8/2014 50
The National Certification Corporation American Board of Perianesthesia
Nursing Certification, Inc. CCI – Operating Room Nurse Certification
Board National Board of Certification and
Recertification for Nurse Anesthetists Oncology Nursing Certification
Corporation Orthopaedic Nurses Certification Board
Pediatric Nursing Certification Board American Board of Certification
for Gastroenterology Nurses National Board for Certification of
Hospice and Palliative Nurses
http://www.youtube.com/watch?v=Saj3Il-d7Vw
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Plan Your Journey…
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How Can Each One Of Us Be Involved
We Can:We Can: We Can: We Can:
• Think where you want to be in a few (2-10) years. Set career goals and identify how to get there. • Commit yourself to lifelong learning.
• Stay informed.
• Be a member of your professional association! • Participate actively in your association(s). • Get involved in the design and implementation at
your facility, in your organization, in your state. • Participate in workforce surveys and data
collection.
• Share this information with colleagues. • Mentor others or seek mentoring.
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References
• Institute of Medicine. (2010). The future of nursing; leading change, advancing health. Washington, DC: National Academies Press.
www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
(downloadable free PDF of report)
• Robert Wood Johnson Foundation. (2011). Future of nursing: Campaign for action.
http://www.thefutureofnursing.org/
• Future of nursing: Campaign for action.
http://campaignforaction.org/ 4/8/2014 Footer Text 56
Program Information
• AACN CCNE • http://directory.ccnecommunity.org/reports/accprog.asp Accredited Baccalaureate & Graduate Nursing Programs Search By: Institution StatesState: Degree:
• ACEN (formerly NLNAC)
http://www.acenursing.us/accreditedprograms/programsearch.htm Search by state, country or name of governing organization (enter any part of the name of the governing organization).
Narrow your search by program type by selecting from the drop down list available.
Search by State or Country: and/or Search by Name of Governing Organization:
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DNP Information
o http://www.aacn.nche.edu/dnp/program-schools owww.dnpprogramsonline.com/ o http://www.nannp.org/Content/nnp-programs.html 4/8/2014 Footer Text 58Healthcare News Resources
• ANA/NNAo http://nursingworld.org/ o http://nebraskanurses.org/
• Commonwealth Fund
o http://www.commonwealthfund.org/
• NANN and NANNP
o http://www.nann.org
• Kaiser Family Foundation
o http://www.kff.org/
• Medscape
o http://www.medscape.com/nurses o http://www.medscape.com/medscapetoday
• Robert Wood Johnson Foundation
o http://www.rwjf.org/
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