The Doctorate of Nursing Practice Education Today

The medical field is in a constant state of change, which is particularly true for the nursing profession. Nurses have four levels of degrees that can be earned, allowing for practice: associates, bachelors, masters, and doctorate. There are also many certifications or specialties available for nurses who do not want to be tied to bedside duty or only making home health visits. While the associate and bachelor prepared nurses are those who carry out the provider’s orders in hospitals, home health companies, or even in rehabs, the master's and doctorate prepared nurses are diagnosing, prescribing, and even running their own practices.

As I am currently in the planning stages of opening a practice that will provide office hours, telemedicine, as well as in-office hours, I have chosen to research the nurse practitioner role as an entrepreneur in independent practice with FPA.

Entrepreneur Role and Doctorate Influence for NPs Currently, there are twenty-three states that allow full practice authority (FPA) for nurse practitioners prepared at the master’s level. In these states, countless stories exist of nurse practitioners who have opened successful practices without the aid or oversight of a physician. These nurses have been able to establish practices in underserved populations and reach those who otherwise would not seek out medical treatment due to either financial issues or transportation (Hahn, 2018). I think of these patients as the forgotten masses, as there are approximately only 11% of physicians throughout the United States that practice in rural areas (Sharp & Monsivais, 2014). I feel this is a critical point to mention, as the American Medical Association (AMA) has been the primary and most vocal opponent of nurse practitioners gaining FPA nationwide. It is ironic to think the AMA wants to prevent nurses from usurping their position as the provider of choice, but the majority of physicians open practices in areas that are already well-served.

Metropolitan areas, rather than rural areas, have the greatest need. Nurse practitioners have stepped up to fill this need. The increasing demand for nurse practitioners is in direct relation to the passage of the Affordable Care Act. It is important to note another factor that has led to the increased demand for advanced practice nurses: each year, fewer physicians leaving residency enter into practice in primary care. This trend has created an opening for nurse practitioners to fill this gap in care. This gap in care was recognized by the Institution of Medicine (IOM), who addressed this issue with guidelines for nurse practitioner education and practice in the Future of Nursing Report. The IOM offered four recommendations in their report: increasing nursing education, allowing nurses to practice at the full extent of their training, recommending nurses become full partners with their physician counterparts, and improving continuity of care through sharing information (Shalala & Vladeck, 2011).

The recommendation to allow nurse practitioners to practice at the level of their training, and with FPA, would have a positive impact on the increased number of patients seeking care. The doctorate of nursing practice (DNP) education helps the nurse practitioner to integrate quality improvement strategies while analyzing the cost-effectiveness of their practice (Zaccagnini & White, 2017). As an entrepreneur, the DNP degree will help the nurse practitioner evaluate and revamp policies that are not working within the practice (Zaccagnini & White, 2017). The DNP also prepares the nurse practitioner to bring about change on behalf of nurses and the patient population they serve by lobbying for healthcare change. DNP Essentials: Augmenting Practice The eight DNP essentials are the core competencies that must be met by all DNP students by the end of the program. These core competencies align with every aspect of our practice. On

On a daily basis, we incorporate knowledge of the underlying science of pathophysiology and how it relates to the current health status of our patients. Improving the quality of care we provide to our patients can be accomplished through reviewing policies within the practice to determine their relevance to the patient population. An important aspect of this core competency is to maintain the quality of care, even with a large patient population. I believe one of the most critical core competencies is ensuring the patient is receiving evidence-based care. DNP providers should stay abreast of new research and trends in healthcare, allowing nurse practitioners to remain on the cutting edge of treatment plans for their patient populations. The ultimate goal is to increase patient satisfaction, safety, and access to care. I hold improving access to care close to heart. An objective I have is to secure iPads in the treatment rooms for patient-specific education.

A knowledgeable patient is a prepared patient. Another piece to increasing access to our patients is the addition of telemedicine. Our senior citizens often have difficulty leaving their homes to see a physician. This also brings up the fifth DNP essential, which is promoting change in health care policy through legislative policy. This can be accomplished by drafting policies that will benefit the public as a whole, either to change policy that is not working or helping to get new policy before lawmakers. Another DNP essential is approaching the patient’s care with a team approach. Understanding that a single practitioner does not have the answers to every aspect of the patient's care really helps implement this core competency. The team could include a social worker, a physical therapist, the nurse practitioner, and possibly the home health aide, as well as a dietician. The key is meeting the patient where they are in their disease process and trying to improve their situation as much as possible. This also works in conjunction with the next...

The focus on health prevention and promotion is essential. Benjamin Franklin's famous quote, "an ounce of prevention is worth a pound of cure," has resonated throughout history (Franklin, n.d.). Teaching patients preventive measures early proves more cost-effective than treating a disease that may have been slowly progressing for years. The final essential is incorporating all these competencies into our daily practice to not only improve our patients' health but also assist in overhauling our overwhelmed national healthcare system. DNP Essentials: Project Formulation While not every DNP essential may be applicable, they might contribute significantly to shaping our projects. As I have just outlined how each DNP essential will be beneficial to my future DNP practice, I have also selected those that would align well with my project design. These include the knowledge of science and health patterns, which is DNP essential one.

This would be closely followed by DNP Essential Two, which focuses on improving the quality of care delivery. These two will directly aid my project, helping to identify the lack of knowledge among providers in recognizing peripheral arterial disease in patients at risk. Through the education of nurse practitioners as well as physician assistants, I hope to increase the knowledge base of these practitioners. When arterial disease of the lower extremity is identified earlier, we can not only save the patient’s limb, but also their life. As this project includes interacting with other providers, it would be beneficial to incorporate DNP Essential Six, which pertains to collaboration to improve patient and population outcomes. I’m confident that as I begin the project earnestly, I will start incorporating more of the DNP essentials. DNP: The Basis is Nursing Theory. My DNP project, which I have been planning since I was accepted into my BSN program three years ago, will identify physician assistants as well as nurse practitioners.

Knowledge deficit regarding risk factors and key symptoms for peripheral arterial vascular disease (PAD) is present. To accomplish this goal, I will incorporate Paplau’s Interpersonal Model as the nursing theory in my DNP project. The advantage this nursing theory lends to this project is the collaboration between the practitioner and the patient to develop a plan and mutually strive to reach the goals set together. It is imperative to identify these patients earlier in the disease process to improve their overall outcome, but also to decrease morbidity and mortality due to PAD. This theory will help guide me to make a mutually beneficial plan to ensure the patient’s needs are met and PAD issues can be identified early. Conclusion As I am nearing the end of my first semester of my doctoral journey, I have been pleasantly surprised by the new knowledge I have gained.

I feel I have a new zest for providing the best care to my patients while advocating for increased access to care for all. I have always considered myself to be the least political person among my peers, as I would much rather watch something entertaining than the evening news. However, I realize that the mentality of burying my head in the sand and not taking active participation in the decisions that shape my practice, as well as the delivery of care to my patients, is no longer an option for me. This class has opened my eyes to the core competencies I must achieve to become not only a better practitioner but also a better advocate. I have a better understanding of how the competencies will fit into my final DNP project and also in my current daily practice. My ultimate goal in becoming a DNP-prepared nurse has always been a personal goal, but now it has become so much more.

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