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  POPULATION FOCI Licensure occurs at Levels of Women’s Family/Individual Adult- Psychiatric- Role & Population Foci Neonatal Pediatrics Across Lifespan Gerontology* Health/Gender Mental Health** - Related        APRN ROLES Nurse Nurse- Clinical Nurse Nurse Anesthetist Midwife Specialist Practitioner * 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  Foco Poblacional Licensure occurs at Levels of Familia/Individuo Adulto- Salud de la Psiquiatría Role & Population Foci Neonatal Pediatrico Ciclo Vital Gerontologia* Mujer/ Enfoque Salud Mental** Género        Roles de Enfermeras de práctica Avanzada Enfermera Enfermera- Enfermera Nurse Anestesista Matrona Especialista Practitioner * Clínica AACN, 2011

Building a Curricula: LACE Model (AACN, 2011) Competencies Professional Certification Professional Organizations (e.g. oncology, palliative Specialty care, nephrology) Population NP, CRNA, CNM CNS foci Core competencies in Role Regulation Population context 3 Ps (Advanced Pathophys, APRN Pharmacology, Health Assessment) Master’s or Graduate Core DNP Essentials

Construyendo un Curriculum: Modelo LACE (AACN, 2011) Competencias Certificación Profesional Organizaciones profesinales (ej. oncología, cuidados Especialidad paliativos, nefrología) Foco población NP, CRNA, CNM CNS Competencias esenciales en Rol Regulación el contexto poblacional 3 Ps (patofisiología Enfermería de Practica Avanzada, Farmacología, Avanzada Valoración de la SAlud Cuerpo de Esenciales para Graduados 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