The practice doctorate: innovation or disruption?

Advanced practice nurses, particularly nurse practitioners, have been described as a disruptive innovation. The American Association of Colleges of Nursing (AACN) has proposed that by 2015 all advanced practice nurses be prepared with a Doctor of Nursing Practice (DNP). This article uses critical reflection on published literature to examine the potential difficulties that mandating such a change may present to potential students, practicing advanced practice nurses, colleges of nursing, and doctoral education in general. After considering the pressures in the nursing profession to prepare nurse faculty and reviewing the success of current models of education for advanced practice, we explore in depth the unintended consequences of the AACN recommendation. Implications for academic nursing, curriculum, advanced practice nurses, doctoral education, titling and licensure, economic issues, and the lack of evaluation research are addressed. We recommend abandoning the 2015 deadline for implementation of advanced practice nurse preparation with the DNP.     

Widening the entry gate--an excellent research opportunity

Widening the entry gate does not mean lowering the standard of nurse education and nursing practice. The concept has been applied by the Open University for over 10 years based on the 'first come first served' principle irrespective of educational attainment, whilst maintaining its standards as an academic institution. This paper asks, whether the nursing profession wish to introduce the same system? The question of learning and teaching strategies is raised by the author who urges nurse educators to take the opportunity to develop research. The outcome of nurse education is to ensure practitioners possess the necessary knowledge, skills, attitudes, creativity and the ability to apply them in clinical, educational and management practice. Research data is required by the profession to plan and develop nurse education in the 1990's and beyond.     

Processes in the creation and diffusion of nursing knowledge: an examination of the developing concept of family-centred care

The creation of a knowledge base to underpin and direct nursing practice has been the pursuit of nurse academics, educationists and practitioners over recent decades Much of this work has concerned the explication of major theories of nursing, whilst some has sought to elucidate specific areas of knowledge This paper outlines processes of creation and diffusion, considering the influence of factors from both within and without the nursing profession on the epistemology of its knowledge base An examination of the developing concept of family-centred care is utilized to illustrate the convolutionary process of knowledge creation     

Ira P. Gunn: educator, advocate, legend

This column examines the contributions of nurse anesthetist Ira P. Gunn, CRNA, MLN, FAAN (1927-2011), widely recognized as a visionary and tireless advocate for the profession of nurse anesthesia. Her contributions to nurse anesthesia practice, research, education, publication, consultation, credentialing, and government relations have significantly contributed to the preservation and advancement of nursing and nurse anesthesia.     

Licensure and entry into nursing practice. A survey of occupational health nurses' opinions

Since 1965, the controversial question of what level of educational preparation is appropriate and necessary for entry into nursing practice has been discussed. No consensus has been reached by the members of the nursing profession as a whole. The opinions of occupational health nurses toward the requirement for initial registered nurse licensure and entry into occupational health nursing practice was assessed. The study revealed occupational health nurses generally supported their respective basic programs for initial licensure and entry into occupational health nursing.     

Clinical practice/education exchange: bridging the theory-practice gap

Nursing education is directed toward development of nursing practitioners competent to nurse effectively in the reality of our present society. A major challenge to the nursing profession is to find ways of merging theory and practice in the delivery of nursing education and patient care. One option for achieving this goal is for nurse educators to spend time in clinical practice updating their clinical skills and re-experiencing the realities of practice. Joint appointments with practice, intermittent periods of clinical update in practice and work role exchanges have all been utilized by the profession. However clinical practice/education exchange (CPEE) involving two people--one in clinical practice and the other in education--who exchange jobs for a fixed period of time is a relatively new concept. Central to a CPEE is the aim of enhancing student learning and facilitating meaningful links between theory and practice for them. Hence the exchange occurs between the education institute and the service area where students are placed. This article positions the CPEE within nursing literature and presents narrative accounts from a nurse educator and clinician who exchanged jobs for one year.     

Current and future credentialing in respiratory therapy.

Increasing demands by society in the United States for better, more efficient, and readily available health care have led to development of numerous categories of health practitioners. After a decade of vigorous growth, the emergence of new kinds of specialized health personnel raises questions of legal authority and quality of care. The multiplicity of health care professions often results in duplication of effort, fragmentation of services, and overlapping of job responsibilities, which contribute to ineffective regulation of health care personnel. Historically, credentialing has been the hallmark of professional accountability. All forms of credentialing are intended to provide the public with safe and effective care, but unfortunately the current system has led to ineffective regulation of health care personnel. Respect for professionalism has diminished in the public eye as consumers are questioning whether the elaborate, multiple, and costly mechanisms of current credentialing really protect society. Three types of credentialing currently in use are accreditation of institutions and educational programs, licensure of practitioners, and certification or registration of practitioners. These mechanisms of credentialing are not adequately assuring the competency of health practitioners; therefore, proposed alternatives such as institutional licensure, administrative regulation, national certification, and proficiency examinations should be explored.     

The nursing licensure process and the NCLEX-RN

Each profession is obligated to ensure society's safety. Licensure examinations must be valid and reliable measures of the knowledge necessary to practice safely in the profession. Nursing has an obligation to society for safe care and licensure is one way to guarantee this. Many changes have occurred in nursing licensure and many nurses are unfamiliar with them. The author traces these changes, describing and analyzing the current licensure examination.     

Alternative treatment modalities: the need for a rational response by the nursing profession

During the last 2 decades, interest in and use of alternative modalities of health care has proliferated. As the public demand for such therapies increased, nursing has been among a few of the health professions to fill this need. Some of these therapies may prove to be valuable, others may be shown to be ineffective, and others may be harmful. Presently, many alternative methods have not been tested by using rigorous scientific methods. In addition, standardization in education and credentialing of practitioners of these modalities is lacking. As health care professionals, nurses have a responsibility to their patients and to their profession to validate the safety and efficacy of their practice. It is incumbent on the recognized bodies of the nursing profession to address these serious issues. The safety of patients and the reputation of the profession of nursing may depend on it.     

Nursing regulation, the nurse licensure compact, and nurse administrators: working together for patient safety

Maintaining the concept of states rights, boards of nursing responded to the need for removal of barriers in meeting nursing manpower needs. One mechanism to accomplish this end was the development of the Nurse Licensure Compact, a multistate nurse license structured in much the same way as driver's license compacts. Representatives of State Boards of Nursing developed model compact structure and rules which allow nurses licensed in their state of residence to practice in other participating states without having to obtain additional licenses. Monitoring of nurse licensure and disciplinary information is facilitated through Nursys (nurse system). Nurses, nurse administrators, and the public benefit from the experiences of the 23 states that have implemented the Nurse Licensure Compact.     

From scientific discovery to health outcomes: A synergistic model of doctoral nursing education

Across the globe, health system leaders and stakeholder are calling for system-level reforms in education, research, and practice to accelerate the uptake and application of new knowledge in practice and to improve health care delivery and health outcomes. An evolving bi-dimensional research-practice focused model of doctoral nursing education in the U.S. is creating unprecedented opportunities for collaborative translational and investigative efforts for nurse researchers and practitioners. The nursing academy must commit to a shared goal of preparing future generations of nurse scientists and practitioners with the capacity and motivation to work together to accelerate the translation of evidence into practice in order to place nursing at the forefront of health system improvement efforts and advance the profession.     

The story of nurse licensure

The evolution of nurse licensure is representative of the heroic efforts of nurses to enhance the value and impact of the nursing profession. This literature review presents a historical account of the advancement of nursing through the nurse licensure process.     

The certified psychiatric nurse practitioner: advanced practice psychiatric nursing reclaimed

During the decade of the 1990s, health care reform, market forces, population needs, new knowledge in neuroscience and changes in advanced practice regulation provided the impetus for the development of the role of the psychiatric nurse practitioner. Debate about issues of role, scope of practice, educational preparation, titling, and credentialing for the advanced practice psychiatric nurse (APPN) of the future intensified as the American Nurses Credentialing Center (ANCC) proceeded with its controversial decision to develop a certification examination for the psychiatric nurse practitioner-in advance of consensus among advanced practice psychiatric nurses about those widely debated issues. Ironically, now that the ANCC adult and family psychiatric nurse practitioner (PMHNP) examinations exist, with test content outlines that clearly identify the professional standards and scope of practice relevant to the role of the certified psychiatric nurse practitioner, those contentious issues of role, scope of practice, educational preparation and credentialing (if not titling) seem considerably less thorny. In fact, by credentialing the role of the psychiatric nurse practitioner sooner rather than later, ANCC may have saved advanced practice psychiatric nursing for psychiatric nurses. This article proposes to (1). explain that assertion, (2). clarify what the scope of practice relevant to the newly certified role means in terms of credentialing requirements for existing types of psychiatric nurse practitioner, and (3). identify some of the controversies that linger with the debut of the PMHNP certification examination(s).     

Male nurse: A concept analysis

Use of the term male nurse is common in nursing wherever the practice setting may be, but no formal analysis has been done to illuminate the meaning of the concept. The term male nurse is often problematic to those referred to, as the label carries stereotypes that further marginalize this extreme minority in the nursing profession. The Nurse Registration Act of 1919 (UK) banned men from nursing de jure, whilst Nightingale's reform of nursing education established the same de facto years before. This potent mix of tradition and law served as the basis for sex‐segregation and feminization of nursing. Fast forward to today—in the centennial of the Nurse Registration Act—women still dominate nursing, and attempts to recruit and retain men into the profession remains to be a very challenging task. Walker and Avant's methodology was utilized in this concept analysis. Seven defining attributes of the male nurse were identified: perceived as a male, credentialed as a nurse, increased visibility, nonconformist as to career choice, cautious caregivers, stereotyped/stigmatized, and increased role strain. Antecedents, consequences, and illustrative cases were also discussed. Gender‐based labels such as male nurse are injurious to nursing, as it preserves sex‐segregation as well as stereotypes that affect both men and women in the profession. This concept analysis corroborates the need to degender nursing and caring, which is a recurrent theme in nursing literature. Ultimately, degendering nursing should translate to measures to increase the proportion of men in the nursing workforce. A gender‐balanced workforce, coupled with degendered notions of caring will strengthen the nursing profession and optimize our ability to serve our clientele.     

Reciprocal Enforcement and Other Collateral Issues With Licensure Discipline

While the fear of liability is generally related to malpractice lawsuits, for nurses, including nurse practitioners (NPs), the greater risk is in licensure discipline. Unlike physicians, NPs are more likely to be disciplined by their board of nursing than they are to be sued in malpractice.¹ In addition, licensure discipline can be more consequential than malpractice lawsuits, because licensing boards have the authority to temporarily, or even permanently, separate an NP from practice. Because punitive action by a nursing board can create other problems, it is important to understand the potential effects of having one’s license disciplined.     

The case for graduate entry to the United Kingdom nursing register

ALI P.A. & WATSON R. (2011) The case for graduate entry to the United Kingdom nursing register. International Nursing Review 58 , 312–318 Aim: The recent decision of the United Kingdom Nursing and Midwifery Council to make nursing a degree profession is contentious and has generated debate among nurses and other stakeholders. We argue why nurses need a degree to nurse and what the implications of making a degree in nursing obligatory at the point of registration will be. Background: Nurses work at the forefront of any healthcare system. The complexity of their role and demands on them are increasing. To fulfil demands and expectations of employers, the public and the profession, and to be able to work collaboratively with other healthcare professions, nurses need critical thinking, problem‐solving and decision‐making skills, which can help them to work as independent practitioners. We argue that this can only be assured if the level of education for nurses is raised from diploma to degree, making this a prerequisite for registration as a nurse. Conclusions: The increasingly complex role of nurses, the changing landscape of the healthcare needs and a need to improve the image and status of nursing as a profession to make it an attractive career choice are some of the important reasons that justify nursing in becoming a degree‐only profession.     

Reflections on the continuing evolution of advanced practice nursing

While the concept of advanced practice nursing (APN) is still relatively new, distinct patterns of evolution from specialty practice to advanced practice nursing are evident over the last 100 years. The purpose of this article is to describe 3 stages in this evolutionary process, as well as discuss several internal and external issues that represent challenges facing APN educators and clinicians who seek to strengthen advanced practice in the current healthcare system. We clarify our definition of advanced practice nursing, and note the critical need for cohesion within the profession regarding the definition and core competencies of advanced practice. Our aim is to suggest a preferred vision for advanced credentialing. We encourage dialogue among our nursing colleagues to move this agenda forward.     

The Multi-State Nursing Licensure Compact: Making Nurses Mobile

Licensure compacts are not new, but they are new to nursing licensure and even newer to the regulation of advanced practice nurses (APRN). State laws govern professional practice. Boards of Nursing represent the public and are responsible for the health, safety, and welfare of patients in their states. The Multi-state Nursing Licensure Compact is a coordinated effort by the regulatory boards and their state legislatures to protect the public and simultaneously minimize unnecessary barriers to access to care for their citizens. Nurses also benefit when legislators and regulators remove barriers to enhancing delivery of care through evolving technologies and to reaching patients who are remotely located and in the most need. Concerns about licensure discipline and the lack of uniformity have been addressed for the basic nursing licensure compact, but they continue to be examined for APRNs.