Patient needs and care environments have become increasingly complex. Nurses must acquire the requisite competencies to deliver high-quality care including leadership, health policy, system improvement, research and evidence-based practice, as well as teamwork and collaboration. In response to increasing demands, nurses must achieve higher levels of education and training. In May 2010, The Tri-Council for Nursing issued a statement encouraging “all nurses, regardless of entry-point into the profession, to continue their education in programs that grant baccalaureate, master’s, and doctoral degrees.” Doctoral-level education prepares nurse practitioners to deliver the next level of nursing care and help shape the future of nursing.
Fulfilling a Need
There is an increasing need for doctorally prepared nurse practitioners. The American Association of Medical Colleges predicts a shortage of 46,000 to 90,000 primary care doctors by 2025. Increased demand for healthcare services is expected due to an increased emphasis on preventive care, the aging baby boomer population and large numbers of newly insured patients under the Affordable Care Act. APRNs will be needed to provide preventive and primary care in team-based models of care in hospitals, physician offices, clinics and other ambulatory care settings.
In 2003, the Institute of Medicine’s (IOM) “Health Professions Education: A Bridge to Quality” encouraged nurses to continue their education in order to improve and provide high-quality patient-centered care. In 2004, the American Association of Colleges of Nursing (AACN) recommended that the standard for advanced nursing practice education be moved to the doctoral level. Other educational and institutional nursing bodies have adopted or promoted this position. For example, the IOM’s 2011 report, “The Future of Nursing: Leading Change, Advancing Health,” called for doubling the number of doctorate-prepared nurses in the workforce by 2020.
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Autonomy and a Greater Scope of Practice
Autonomy has always been central to the concept of an NP as a primary care provider. The Institute of Medicine (IOM) and the National Governors Association recommend that APRNs be permitted to practice to the full extent of their education and training while the AANP advocates for "full scope of practice" for NPs, which it defines as the ability to evaluate patients, diagnose conditions, order and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing.
The regulations regarding scope of practice vary from state to state. Each year, nursing is moving closer to the day when all 50 states grant NPs full autonomy to treat their patients. In 21 states and the District of Columbia, NPs are legally sanctioned to work without doctor supervision. They are able to assess and diagnose; prescribe medications; interpret diagnostic tests; establish and operate their own independent practices. NPs hold prescriptive privileges in all 50 states, with the authority to prescribe controlled substances in 48 of them.
New laws continue to increase the autonomy of NPs. With the advent of the Affordable Care Act, patients now have the option of seeking treatment at nurse-managed health clinics. The Medicare Access and CHIP Reauthorization Act (MACRA) authorizes NPs to document face-to-face encounters to obtain durable medical equipment. The law also reiterates that NPs can provide care to patients under the new chronic care management code.
An increase in the number of doctorally prepared FNPs strengthens the argument for greater autonomy for nurse practitioners. Data continues to accumulate that supports the positive patient outcomes derived from APRN care. Removing barriers to care reduces costs, increases consumer choice and improves healthcare quality. States with broader nursing scopes of practice have experienced no deterioration of patient care. No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective and efficient or that care is better in states with more restrictive scope-of-practice regulations for APRNs.
Cost-Effective, Quality Care
A 2009 study by the RAND Corporation found that FNPs provide the same quality of care at lower costs when compared to primary care physicians. A study published in the journal Annals of Internal Medicine examined the treatment of upper respiratory infections, back pain and headaches, and found that FNPs deliver comparable care to physicians when it comes to antibiotic prescriptions, ordering scans and lab tests, and referring to other healthcare providers. Continuity of care is improved when FNPs who care for patients in primary care settings can follow their patients and their families when they are admitted to the hospital. Hospital privileges may decrease readmission rates and errors, speed recovery and improve health for consumers.
According to research presented at the American Academy of Nurse Practitioners 26th Annual NP meeting, patient satisfaction was higher among low-income primary care patients treated by NPs than among those treated by physicians. The trust between patient and provider is critical for ensuring patients are engaged in their own healthcare. It encourages adherence to treatment plans and scheduled follow-up and wellness visits—appointments that are critical for cost efficiency and healthcare quality.
A DNP-prepared nurse practitioner possesses heightened competence in the areas of assessment, pathophysiology, pharmacology and epidemiology. In addition to technical practice skills, DNP-prepared nurses have a deep understanding of the business of nursing, policy, ethics, scientific inquiry and research. As a result, DNP nurse practitioners possess the interpersonal, interprofessional and organizational communication and relationship-building skills to create and lead high-functioning, reliable and healthy teams.
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Baylor University Online DNP Program – Meeting the Challenges of Today’s Healthcare Environment
The health challenges facing the country have shifted dramatically in the 21st century. DNP-prepared nurses are poised to meet these healthcare needs, but only if they acquire the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. Baylor University’s online DNP program prepares nurses in a uniquely Christian environment to use interpersonal, interprofessional and organizational communication and relationship-building skills to create and lead highly functioning, reliable and healthy teams. In addition, the online DNP program offers three tracks: DNP – Family Nurse Practitioner, DNP – Neonatal Nurse Practitioner, and DNP – Nurse-Midwifery, which allow RNs to attain the highest nursing education credential and gain advanced knowledge in their specialty area. DNP-prepared Baylor nurses can drive change, innovate and become exemplary nursing leaders.
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