Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicine's “Future of nursing” report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change. 1. Introduction National and international reports, including one published recently by the Institute of Medicine [1], describe the potential for advanced practice registered nurses (APRNs) to contribute to the provision of high-quality healthcare as part of comprehensive healthcare reform [2, 3]. Preparing APRNs for practice and fostering the role of APRNs in a variety of educational, clinical, and research settings are necessary steps toward achieving this vision. Given the current economic and political climate in the United States, however, success may be elusive. At present, a shrinking number of nurse educators carry an increasingly large responsibility for educating a declining number of APRNs [4, 5]. In many settings, outdated regulations, policies, and biases prevent APRNs from practicing to the fullest extent of their education, skills, and competencies [6–8]. Some US-based physician organizations have mounted campaigns aimed at discrediting APRN education and practice and decrying the potential of APRNs to provide cost-effective and clinically efficient care [9, 10]. While barriers to practice are significant, innovative approaches to clinical education and curricular transformation offer promise to nursing administrators, nursing educators, and practicing APRNs who are committed to preparing a highly qualified APRN workforce that will serve future generations of Americans. The rapid development and establishment of the practice doctorate has generated cautious enthusiasm among many nurse educators who are eager to help APRNs achieve their fullest potential in clinical practice. The purpose of this paper is to describe challenges in providing APRN clinical education
References
[1]
Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, The National Academies Press, Washington, DC, USA, 2011.
[2]
M. Sargen, R. S. Hooker, and R. A. Cooper, “Gaps in the supply of physicians, advance practice nurses, and physician assistants,” Journal of the American College of Surgeons, vol. 212, no. 6, pp. 991–999, 2011.
[3]
J. F. Wilson, “Primary care delivery changes as nonphysician clinicians gain independence,” Annals of Internal Medicine, vol. 149, no. 8, pp. 597–600, 2008.
[4]
L. H. Aiken, R. B. Cheung, and D. M. Olds, “Education policy initiatives to address the nurse shortage in the United States,” Health Affairs, vol. 28, no. 4, pp. w646–w656, 2009.
[5]
P. I. Buerhaus, D. O. Staiger, and D. I. Auerbach, The Future of the Nursing Workforce in the United States: Data, Trends, and Implications, Jones and Bartlett, Boston, Mass, USA, 2009.
[6]
T. Hansen-Turton, A. Ritter, and B. Valdez, “Developing alliances: how advanced practice nurses became part of the prescription for Pennsylvania,” Policy, Politics, and Nursing Practice, vol. 10, no. 1, pp. 7–15, 2009.
[7]
A. Ritter and T. Hansen-Turton, “The primary care paradigm shift: an overview of the state-level legal framework governing nurse practitioner practice,” Health Lawyer: National Nursing Centers Consortium, Chicago, Ill, USA, American Medical Association, 2008, http://www.policyarchive.org/handle/10207/bitstreams/11855.pdf.
[8]
B. Safriet, State Legislative Requirements for Prescriptive Authority for Nurses, Specialty Nursing Forum, Park Ridge, Ill, USA, 1991.
[9]
American Medical Association, The AMA Scope of Practice Data Series: Nurse Practitioners, American Medical Association, Chicago, Ill, USA, 2009.
[10]
American Academy of Family Practitioners, Primary health care professionals: a comparison, 2011, http://www.aafp.org/online/en/home/media/kits/fp-np.html.
[11]
U.S. Department of Health and Human Services HRSA, The Registered Nurse population: Findings from the 2008 National Sample Survey of Registered Nurses, Washington, DC, USA, 2010, http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf.
[12]
M. Gray, C. Ratliff, and R. Mawyer, “A brief history of advanced practice nursing and its implications for WOC advanced nursing practice,” Journal of Wound, Ostomy and Continence Nursing, vol. 27, no. 1, pp. 48–54, 2000.
[13]
American Association of Nurse Practitioners, Quality of Nurse Practitioner Practice, Washington, DC, USA, 2010, http://www.aanp.org/NR/rdonlyres/34E7FF57-E071-4014-B554-FF02B82FF2F2/0/QualityofNPPractice4pages.pdf.
[14]
American Academy of Nurse Practitioners, Nurse practitioner cost-effectiveness, 2010, http://www.aanp.org/NR/rdonlyres/34E7FF57-E071-4014-B554-FF02B82FF2F2/0/QualityofNPPractice4pages.pdf.
[15]
K. D. Yordy, The Nursing Faculty Shortage: A Crisis for Health Care, Robert Wood Johnson Foundation, Washington, DC, USA, 2006.
[16]
National League for Nursing, Percentage of Programs that Turned Away Qualified Applicants by Program Type, Fall 2009, National League for Nursing, New York, NY, USA, 2011.
[17]
American Association of Colleges of Nursing, “Nursing faculty shortage fact sheet,” American Association of Colleges of Nursing, 2011, http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf.
[18]
National League for Nursing, Tenure Status of Nurse Educators, by Nursing Education Program Type, 2009, National League for Nursing, New York, NY, USA, 2011.
[19]
Bureau of Labor Statistics, May 2010 National Occupational Employment and Wage Estimates, United States, Occupational employment statistics, United States Department of Labor, Washington, DC, USA, 2010, http://www.bls.gov/oes/current/oes_nat.htm#25-0000.
[20]
American Association of Colleges of Nursing, DNP Roadmap Task Force Report, Washington, DC, USA, 2006.
[21]
L. Cronenwett, K. Dracup, M. Grey, L. McCauley, A. Meleis, and M. Salmon, “The doctor of nursing practice: a national workforce perspective,” Nursing Outlook, vol. 59, no. 1, pp. 9–17, 2011.
[22]
National League for Nursing, Main Obstacle to Expanding Admissions by Program Type, Fall 2010, National League for Nursing, New York, NY, USA, 2011.
[23]
S. M. Skillman, L. Palazzo, D. Keepnews, and L. G. Hart, Characteristics of Registered Nurses in Rural vs. Urban Areas: Implications for Strategies to Alleviate Nursing Shortages in the United States, WWAMI Center for Health Workforce Studies, University of Washington, Seattle, Wash, USA, 2005.
[24]
National League for Nursing, Executive Summary: Findings from the Annual Survey of Schools of Nursing, Academic Year 2009-2010, National League for Nursing, New York, NY, USA, 2011.
[25]
Accreditation Commission for Midwifery Education, Criteria for Programmatic Accreditation of Midwifery Education Programs with Instructions for Elaboration and Documentation, American College of Nurse Midwives, Silver Spring, MD, USA, 2010.
[26]
J. B. Feinland and H. Z. Sankey, “The obstetrics team: midwives teaching residents and medical students on the labor and delivery unit,” Journal of Midwifery and Women's Health, vol. 53, no. 4, pp. 376–380, 2008.
[27]
National Task Force on Quality Nurse Practitioner Education, Criteria for Evaluation of Nurse Practitioner Programs, National Task Force on Quality Nurse Practitioner Education, Washington, DC, USA, 2008.
[28]
American Medical Association, AMA responds to the IOM Report on Future of Nursing: Physician-led team approach to care helps ensure high quality patient care and value for health care spending, 2010, http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.page.
[29]
Robert Wood Johnson Foundation, Expanding America's Capacity to Educate Nurses: Diverse, State-Level Partnerships are Creating Promising Models and Results, Robert Wood Johnson Foundation, Washington, DC, USA, 2010.
[30]
R. C. Siewert, L. B. Rasmussen, M. A. Lofgren, and P. Clinton, “Innovative university partnership meets neonatal nurse practitioner program need amid faculty shortage,” Journal of Nursing Education, vol. 50, no. 3, pp. 159–162, 2011.
[31]
T. A. Murray, C. Crain, G. A. Meyer, M. E. McDonough, and D. M. Schweiss, “Building bridges: an innovative academic-service partnership,” Nursing Outlook, vol. 58, no. 5, pp. 252–260, 2010.
[32]
P. Benner, M. Sutphen, V. Leonard, L. Day, and L. S. Shulman, Educating Nurses: A Call for Radical Transformation, Jossey-Bass, Philadelphia, Pa, USA, 2010.
[33]
E. LeCuyer, J. DeSocio, M. Brody, R. Schlick, and R. Menkens, “From objectives to competencies: operationalizing the NONPF PMHNP competencies for use in a graduate curriculum,” Archives of Psychiatric Nursing, vol. 23, no. 3, pp. 185–199, 2009.
[34]
G. H. Rassool, “Professional education in co-occurring disorders: some considerations towards practice development,” Journal of Addictions Nursing, vol. 17, no. 3, pp. 187–191, 2006.
[35]
C. S. Clark, “Transforming nursing education: a partnership social system for alignment with philosophies of care,” International Journal of Nursing Education Scholarship, vol. 2, no. 1, 2005.
[36]
J. W. Distler, “Critical thinking and clinical competence: results of the implementation of student-centered teaching strategies in an advanced practice nurse curriculum,” Nurse Education in Practice, vol. 7, no. 1, pp. 53–59, 2007.
[37]
J. W. Distler, “Problem-based leaed learning: an innovative approach to teaching physical assessment in advanced practice nursing curriculum,” International Journal of Nursing Education Scholarship, vol. 5, no. 1, article no. 23, 2008.
[38]
C. Hayes, “Deconstructing the 'ivory tower': building strategic curricula for health,” British Journal of Nursing, vol. 18, no. 17, pp. 1068–1074, 2009.
[39]
N. E. Chikotas, “Theoretical links: supporting the use of problem-based learning in the education of the nurse practitioner,” Nursing Education Perspectives, vol. 29, no. 6, pp. 359–362, 2008.
[40]
A. Nielsen, “Concept-based learning activities using the clinical judgment model as a foundation for clinical learning,” Journal of Nursing Education, vol. 48, no. 6, pp. 350–354, 2009.
[41]
M. T. Hovancsek, “Using simulation in nursing education,” in Simulation in Nursing Education: From Conceptualization to Evaluation, P. R. Jeffries, Ed., National League for Nursing, New York, NY, USA, 2007.
[42]
Y. K. Scherer, S. A. Bruce, and V. Runkawatt, “A comparison of clinical simulation and case study presentation on nurse practitioner students' knowledge and confidence in managing a cardiac event,” International Journal of Nursing Education Scholarship, vol. 4, no. 1, article 22, 2007.
[43]
C. Kenaszchuk, K. MacMillan, M. van Soeren, and S. Reeves, “Interprofessional simulated learning: short-term associations between simulation and interprofessional collaboration,” BMC Medicine, vol. 9, article 29, 2011.
[44]
J. Mitchell, J. B. Brown, and C. Smith, “Interprofessional education: a nurse practitioner impacts family medicine residents' smoking cessation counselling experiences,” Journal of Interprofessional Care, vol. 23, no. 4, pp. 401–409, 2009.
[45]
K. T. Roberts, K. M. Robinson, C. Stewart, and F. Smith, “An integrated mental health clinical rotation,” The Journal of Nursing Education, vol. 48, no. 8, pp. 454–459, 2009.
[46]
M. C. Pharez, N. D. Walls, L. A. Roussel, and B. A. Broome, “Combining creativity and community partnership in mental health clinical experiences,” Nursing Education Perspectives, vol. 29, no. 2, pp. 100–104, 2008.
[47]
J. B. Edwards, S. Oppewal, and C. L. Logan, “Nurse-managed primary care: outcomes of a faculty practice network,” Journal of the American Academy of Nurse Practitioners, vol. 15, no. 12, pp. 563–569, 2003.
[48]
C. Sadler, M. Huff, and A. Harrigan, “Faculty practice and health promotion in a community correctional facility,” Holistic Nursing Practice, vol. 14, no. 2, pp. 38–47, 2000.
[49]
D. M. Geary, D. A. Nardi, J. Smith, and M. Kremer, “Community need for university-based mental health services: identifying the top 5,” Journal of Psychosocial Nursing and Mental Health Services, vol. 43, no. 11, pp. 38–45, 2005.
[50]
S. Weber, “Specialized advanced clinical placements for nurse practitioner students,” Journal of the American Academy of Nurse Practitioners, vol. 17, no. 8, p. 291, 2005.
[51]
T. A. Kessler, “Solutions to finding graduate clinical sites for advanced health assessment,” Journal of Nursing Education, vol. 42, no. 9, pp. 421–422, 2003.
[52]
C. Connolly, D. Wilson, R. Missett, W. C. Dooley, P. A. Avent, and R. Wright, “Associate degree nursing in a community-based health center network: lessons in collaboration,” Journal of Nursing Education, vol. 43, no. 2, pp. 78–80, 2004.
[53]
B. R. Heller and M. R. Goldwater, “The Governor's Wellmobile: Maryland's mobile primary care clinic,” Journal of Nursing Education, vol. 43, no. 2, pp. 92–94, 2004.
[54]
Medicare Payment Advisory Commission, “Graduate medical education financing: focusing on educational priorities,” in Report to the Congress: Aligning incentives in Medicare, pp. 101–125, MedPAC, Washington, DC, USA, 2010.
[55]
M. Flinter, “Residency programs for primary care nurse practitioners in federally qualified health centers: a service perspective,” Online Journal of Issues in Nursing, vol. 10, no. 3, 2005.
[56]
K. M. Thies and D. Harper, “Medicare funding for nursing education: proposal for a coherent policy agenda,” Nursing Outlook, vol. 52, no. 6, pp. 297–303, 2004.
