Nursing Education and Regulations of APRN for Curriculum Design
Regulation of the APRN Role In Nursing Education for Curriculum Design
As graduate programs preparing advanced practice nurses continued to grow with expanding enrollments and producing corresponding growth in the APRN workforce, it became apparent that there was a need to achieve some uniformity in the preparation and credentialing of advanced practice nurses.
Drawing on collaboration from professional nursing organizations, regulatory agencies, and accrediting bodies, the APRN Consensus Model was developed to describe regulatory requirements in four areas: licensure, accreditation, certification, and education (LACE).
Several important outcomes related to APRN education resulted from these collaborations that are still influencing the ongoing development of graduate programs.
National Organization of Nurse Practitioner Faculties In Nursing Education for Curriculum Design
The National Organization of Nurse Practitioner Faculties (NONPF) is an organization formed by NP faculty to promote quality NP education, influence policy to advance NP education, foster diversity, promote scholarship of NP educators, and strengthen resources to sustain NONPF.
NONPF has been instrumental, along with the National Council of State Boards of Nursing (NCSBN) and other professional organizations, in leading the development of the APRN Consensus Model. In 1990 NONPF developed core competencies for NPs. These competencies have been updated (National Organization of Nurse Practitioner Faculty [NONPF], 2012) and now apply to all NPs as they complete either an MSN or DNP program and are ready to enter practice.
The competencies are population focused and cover the following areas: scientific foundations, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery system, ethics, and independent practice.
NONPF also brings NP educators together to discuss curriculum issues about NP education and develops national recommendations designed to promote excellence and maintain quality in NP programs.
Examples of issues that
concern NONPF members include faculty/student ratios, number of clinical hours
to ensure competencies are met prior to graduation, and use of technology to
supervise clinical experiences of students from a distance (National
Organization of Nurse Practitioner Faculty, 2012)
The APRN Consensus Model In Nursing Education for Curriculum Design
In 2003 work began to develop the APRN Consensus Model (American Association of Colleges of Nursing, 2008) to regulate the practice of APRNs. Individuals working on this project represented a broad spectrum of stakeholders and included the APRN Consensus Work Group and the NCSBN APRN Advisory Committee.
APRNs were defined as certified registered nurse anesthetists, certified nurse midwives, certified CNSs, and certified NPs. The report on the consensus model was published in 2008 and by 2010, 48 organizations had endorsed the report, which recommended alignment of LACE factors of APRNs across states to ensure the safety of patients as well as expand patient access to APRNs.
Each state determines the APRN legal scope of practice, roles, criteria for entry into advanced practice, and acceptable certification exams. Because there is no uniform model regulating APRNs across all states, a barrier exists for APRNs to move readily from state to state and may limit access of care to patients.
The Consensus Model was designed to diminish this barrier and allow APRNs to move readily from state to state. The goal was to implement this model fully by 2015, a goal which has not yet been achieved. The LACE mechanism was designed to implement the APRN Consensus Model and operate as a communication mechanism among regulatory organizations.
LACE includes the four essential regulatory
elements of LACE. The APRN regulatory model has outlined expectations for all
four elements of LACE, which will enable the Consensus Model to be implemented.
Implementing the LACE mechanism in all states will allow APRNs to more easily
move between states, improve the regulation of APRNs, and ultimately improve
access to care.
Institute of Medicine In Nursing Education for Curriculum Design
Several landmark reports examining the state of health care in the United States and making recommendations for changes in the health care system and education of professionals working in these systems were published by the IOM beginning in the late 1990s. These reports have stimulated many changes within graduate programs to meet the needs of society (Institute of Medicine [IOM], 2010).
Crossing the Quality Chasm (2001) identified the need for restructuring the health care system to promote safe, effective, timely, efficient, and equitable health care. In 2003 the IOM recommended that all health professionals be educated to deliver evidence based, patient centered care and that all professionals work in interdisciplinary teams using quality improvement strategies and informatics.
In 2010 the IOM made recommendations regarding nurses practicing to the full
scope of their authority and achieving greater numbers of nurses prepared at
the doctoral level.
Curriculum Designs for Graduate Programs In Nursing Education for Curriculum Design
Curriculum design for graduate nursing
education has become varied, with a number of program models designed to
facilitate academic progression to graduate-level preparation. The quality of
graduate nursing education programs is maintained in part through the admission
of well-qualified students. This section describes various graduate curriculum
models, as well as student qualifications.
Student Qualifications In Nursing Education for Curriculum Design
A variety of factors influence a student’s admission to graduate study. Overall, students are evaluated for their potential for success in their chosen program. In research-focused doctoral programs, it is also important that a student’s research interest have a match with faculty expertise and scholarship.
Students admitted to a master’s program should demonstrate the potential for academic success as indicated by previous academic achievements (grade point average [GPA]), performance on standardized tests such as the Graduate Record Exam (GRE), admission interviews, and professional references. Some master’s programs do not require standardized tests for admission.
Other common requirements for admission to a master’s
program as a post licensure student include graduation from an undergraduate
program that is accredited by a national nursing accreditation body and a
current, unencumbered licensure as a registered nurse (RN).
A number of master’s programs have traditionally stipulated a specified amount of work experience prior to admission, but such requirements are increasingly being questioned within the profession as being unduly restrictive to promoting academic progression.
In addition, depending on the type of master’s program, there may be prerequisite course requirements in selected courses, such as statistics or health assessment. Admission to doctoral nursing programs tends to be competitive, in part because of the smaller numbers of students admitted and the rigorous qualifications.
Requirements vary somewhat depending on the nature of the doctoral program. Successful candidates for admission to either the research-focused doctorate (PhD) or the clinical doctorate (DNP) will demonstrate high levels of academic achievement (GPA) in previous programs and will be expected to submit standardized test scores (GRE).
Graduation from an accredited nursing program and a current unencumbered RN license are also common requirements. Graduate level prerequisite course work in selected areas may also be required depending on the focus of the graduate program.
Students seeking enrollment in a postmaster’s DNP program focused on an advanced practice role will also be asked to provide evidence of the number of clinical hours performed in their master’s program. Interviews and written essays are often key elements to the admission process to doctoral study.
It is important for faculty to determine that the student’s career goals and research interests are a good fit for the program to which the student is applying. In research focused doctoral programs, it is important for the research interests of the student to be consistent with the research strengths and interests of the faculty.
Program Designs for Master’s Education for Curriculum Design
Master’s degree programs prepare nurses with practice expertise that builds on baccalaureate or entry-level nursing practice. Graduates from master’s degree programs have a deeper understanding of the discipline of nursing and are able to engage in higher level practice and leadership in a variety of settings.
Graduates of master’s degree programs are prepared to enter a research or practice-focused doctoral program (American Association of Colleges of Nursing [AACN], 2011). The curricular design for a master’s degree program builds on a base of sciences and humanities and prepares graduates for practice in a clinical or indirect care nursing specialty.
The essentials of the curriculum design include a foundation from the sciences and humanities; organizational systems and leadership; quality improvement and patient safety, translating and integrating scholarship into practice; health policy and advocacy; inter professional collaboration for improving population health and patient outcomes; clinical prevention and population health for improving health; and an area of master’s level nursing practice (American Association of Colleges of Nursing, 2011).
Nursing specialty organizations also provide competencies and clinical expectations for a master’s degree in their given area of practice. Master’s programs vary in length and focus, and the credit hour allocation for the program may range from 30 credits to 45 depending on the program design and clinical hour requirements. Some areas of focus for master’s programs include administration, education, CNL, and informatics.
Even with the introduction of the DNP degree, a wide range of master’s level advanced practice programs continue to exist. Most master’s programs require 2 years of full-time study, but can range from 12 to 18 months.
The length of the program is determined by a variety of factors, including the entry level of the student, curriculum design, credit hours and clinical hours required. Many students do enroll in part-time study, which lengthens their time in the program.
Many MSN programs offer their courses fully or partially online, thus making the program accessible to underserved areas of the country and allowing students to remain in their area during the program and upon graduation.
Although many master’s programs require an earned baccalaureate in nursing for admission, increasing numbers of academic progression models facilitate student achievement of the master’s degree (RN to MSN).
There are also entry-level master’s programs for
non nurses who have undergraduate degrees in another field. Postmaster’s
certificates (PMCs) are program options that allow students with a previous
master’s degree in nursing to obtain credentials in another specialty.
Program Designs for Doctoral Education for Curriculum Design
There
are two types of doctoral programs in nursing, the DNP and the PhD. DNP
programs are practice focused and PhD programs are research focused. Doctoral
curricula tend to be unique to each institution. Because these two doctoral
degrees have different purposes and goals, their program design is
significantly different.
PhD Program Design and Curriculum Design
Doctoral programs that award the PhD are research focused with a program outcome of preparing graduates to engage in knowledge generation and dissemination. Curricula typically consist of coursework related to philosophy and theory construction; statistics and research methodology; state of the science nursing knowledge; social, political, and ethical issues; and teaching and mentoring (American Association of Colleges of Nursing, 2010a, 2010b).
Students may also select a minor that complements their major area of study. Although the majority of PhD nursing programs require a master’s degree, a growing number of programs admit baccalaureate nursing students, referred to as BSN to PhD programs. Students who enter the PhD program with a master’s degree will usually engage in full-time study for approximately 3 years and complete a dissertation.
Students who enter a PhD program with a baccalaureate nursing degree usually study full time for 5 years and complete a dissertation. These timelines are extended for many students as they choose to pursue part time study.
On completion of coursework and prior to writing the dissertation, students typically must complete a qualifying examination to demonstrate their ability to conduct research and to be eligible to enter into the final stage of the program. The process used for the qualifying examination varies depending on the institution, but it is common to have a written or oral component, frequently both.
Graduates of PhD programs are required to conduct independent research and prepare a document communicating the process and results of the research. This document historically has been a dissertation.
Currently, faculty in PhD programs are reconsidering the value of a lengthy dissertation, and are allowing options for presenting the results of the student’s research. These may include writing one or more manuscripts to submit for publication, or even digital products that could include motion, sound, and graphics (Morton, 2015).
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