Full implementation of the Doctoral Nursing Practice (DNP) by 2025 is important to best prepare advanced practice registered nurses (APRNs) for the changing demands of the current healthcare system (AACN, 2019). Patient care is becoming more complex which demands higher-level APRNs to ensure patient safety. There have been many efforts to implement DNP education as the standard of APRN education, but they have been unsuccessful. Barriers for DNP implementation for APRNs, including Nurse Anesthetists (CRNA), are current nursing education, opposing healthcare professionals, and scope of practice regulations. Some strategies for full implementation of DNP education are to support baccalaureate education and remove the scope of practice barriers by engaging in strong system leadership as outlined in the DNP Essentials (AACN, 2006).
Background on the Issues
Nursing is a continuously growing field. Advanced Practice Programs were originally recognized at the master’s level in the 1980s, but soon the educational demand of APRNs grew, and the Master’s Essentials Graduate Core Curriculum needed to expand its requirements (AACN, 2004). The American Association of Colleges of Nursing (AACN) supported an alternative research-focused degree, the Doctorate in Nursing Practice, as the most appropriate terminal degree for APRNs (AACN, 2004). In this reform, the AACN recommended educational programs offer doctorate degrees by 2015 (AACN, 2004).
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Many barriers impeded implementation of a doctorate by 2015. The AACN Task Force recognized current issues and clarified recommendations to meet the DNP Essentials (AACN, 2015). Some of the recommendations made distinctions between research and practice-focused scholarship, minimum practice hours, the transition from masters to doctoral practice (AACN, 2015). After these recommendations, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) decided to support “doctoral education for entry into nurse anesthesia by 2025” (COA, 2018).
Review of Current Status of DNP
DNP programs are continuing to grow with 243 established DNP programs and over 70 under development in the US (AACN, 2014). However, barriers still exist for DNP growth. Specifically, CRNAs face barriers involving their ability to practice to the full extent of their education, to be full partners with other healthcare professionals, and expanding their education.
The current scope of practice defines Certified Registered Nurse Anesthetists as independent practitioners across the lifespan (AANA, 2013). However, many nurse anesthetists practice under anesthesiologists or physicians, especially in large city hospitals (AANA, 2013). Differences in hospital and state regulations, as well as anesthesiologists’ opposition to CRNAs independent practice, impede CRNAs’ scope of practice (AANA, 2013; ASA, 2018). Nevertheless, nurse anesthetists are safe, independent primary anesthesia providers in underserved areas like rural communities (AANA, 2013).
Also, many Registered Nurses (RNs) maintain associate rather than bachelor’s degrees impeding their ability to apply for doctoral education in an APRN or Nurse Anesthesia DNP program (AANA, 2019). Nurse Anesthesia Doctoral Programs require a bachelor’s degree to apply, however, there is an inconsistency between educational facility requirements (AANA, 2019). In addition, obtaining a doctoral degree takes an extended amount of time that is undesirable for older RNs with associate degrees.
Strategies for Moving Forward
The scope of practice barriers need to be removed and reformed for CRNAs to successfully practice to the full extent of their DNP education. CRNAs should advocate for change in their state’s regulations and participate in AANA’s movement to ensure independent practice in all circumstances (AANA, n.d.). Support to pass the APRN Compact will help the APRN Consensus Model achieve consistent scope of practices with one multistate license (Van Cleve, 2019). Nurse anesthetists should engage in anticompetitive efforts with the medical community, especially physician anesthesiologists, to encourage full scope policies for CRNAs.
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Increasing baccalaureate degrees among nurses can increase the number of DNP candidates. Leaders in academics should encourage schools to partner with public and private funders to support this transition (Van Cleve, 2019). Many hospitals now provide scholarships for associate employees to pursue their baccalaureate degrees (Stuenkel, Nelson, Malloy, & Cohen, 2011). In addition, more accelerated baccalaureate degrees are available for older nurses so they can achieve their degrees faster (Stuenkel et al., 2011). An increase in baccalaureate degrees will support the goal of doubling doctoral degrees by 2020 (Van Cleve, 2019).
Changes to DNP barriers require more government and business intervention than nurses can achieve alone (Van Cleve, 2019). Involvement in nursing associations and nursing educational programs will encourage nurses to “be at the table” so they can access opportunities for DNP implementation (Van Cleve, 2019). Currently, the American Association of Nurse Anesthetists influences government decisions through their Political Action Committee (AANA, 2019). As leadership roles increase, decisional positions in public, private, and government health care will become more available for nurses to advance DNP implementation.
- American Association of Colleges of Nursing (AACN). (2019). DNP fact sheet [PDF document]. Retrieved from https://www.aacnnursing.org/Portals/42/News/Factsheets/DNP-Factsheet.pdf
- American Association of Colleges of Nursing (AACN). (2015). The doctor of nursing practice: current issues and clarifying recommendations [PDF document]. Retrieved from https://www.pncb.org/sites/default/files/2017-02/AACN_DNP_Recommendations.pdf
- American Association of Colleges of Nursing (AACN). (2014). DNP talking points [PDF document]. Retrieved from https://www.aacnnursing.org/DNP/About/Talking-Points
- American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice [PDF document]. Retrieved from https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
- American Association of Colleges of Nursing (AACN). (2004). AACN Position Statement on the Practice Doctorate in Nursing October 2004 [PDF document]. Retrieved from https://www.aacnnursing.org/Portals/42/News/Position-Statements/DNP.pdf
- American Association of Nurse Anesthetists (AANA). (2019). Education of nurse anesthetists in the united states – at a glance [PDF document]. Retrieved from https://www.aana.com/membership/become-a-crna/education-of-nurse-anesthetists-in-the-u.s
- American Association of Nurse Anesthetists (AANA). (n.d). CRNAs: we are the answer [PDF document]. Retrieved from https://www.aana.com/docs/default-source/marketing-aana-com-web-documents-(all)/crnas-we-are-the-answer.pdf?sfvrsn=b310d913_4
- American Association of Nurse Anesthetists (AANA). (2013). Scope of nurse anesthesia practice [PDF document]. Retrieve from https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/scope-of-nurse-anesthesia-practice.pdf?sfvrsn=250049b1_2
- American Association of Nurse Anesthetists (AANA). (2019). Take action now! [PDF document]. Retrieved from https://crna-pac.com/actionalerts/
- American Society of Anesthesiologists (ASA). (2018). ASA urges revisions to APRN compact. Retrieved from https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2018/05/asa-urges-revisions-to-aprn-compact
- Council on Accreditation (COA). (2018). COA position statements. Retrieved from https://www.coacrna.org/about/Pages/COA-Position-Statements.aspx
- Stuenkel, D., Nelson, D., Malloy, S., & Cohen, J. (2011). Challenges, changes, and collaboration: Evaluation of an accelerated BSN program. Nurse Educator, 36(2), 70-75. doi:10.1097/NNE.0b013e31820c7cf7
- Van Cleve, S. (2019). National recommendations for DNP nursing [Powerpoint slides]. Retrieved from https://uiowa.instructure.com/courses/114589/files/9742868/download?wrap=1
- Van Cleve, S. (2019). APRN consensus model [Powerpoint slides]. Retrieved from https://uiowa.instructure.com/courses/114589/files/9742868/download?wrap=1
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