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Raising the medical bar

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Nursing undergraduate Joyce Jumawan checks to see that there is blood return from the prosthetic arm.

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Kristin Ulstad (right), a nursing grad student, helps undergraduate Erin Bowler check a catheter for functionality. Catheters are plastic tubes used for many things, such as IVs and blood samples.

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Erin Bowler, an undergrad nursing student, ties a tourniquet around a prosthetic arm to increase blood flow.

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Salimah Man, another undergraduate nursing student, uses a butterfly catheter to take a pseudo-blood sample.

When people put their health in the hands of a doctor, there is an underlying sense of confidence in his or her knowledge. What gives doctors their all-knowing reputation is their tremendous amount of training — in short, medical school.

But primary health care providers also include nurse practitioners — advanced practicing nurses with master’s degrees in nursing practice. In the state of Washington, nurse practitioners have the legal authority to prescribe prescription medication.

In the end, patients benefit if nurse practitioners are better trained, which is why the UW School of Nursing has introduced a new degree called the Doctor of Nursing Practice (DNP).

“I think about it as enhancing the health care we can deliver to the public,” said Nancy Woods, dean of the UW School of Nursing.

There are 46 students enrolled in the Doctor of Nursing Practice (DNP) program at the UW School of Nursing; the first cohort started in the winter of 2007. The intensive three-year program is designed to bring even more advanced training for advanced practice nurses.

The UW is part of a new wave that is sweeping the nation. In April 2005, only nine schools of nursing in the nation offered the DNP program. Now the American Association of Colleges of Nursing (AACN) lists 71 DNP programs underway, including the UW’s. An additional 140 schools are considering the program.

The nationwide boom of DNP programs is a response to a push led by the AACN. In October 2004, the AACN endorsed a position that highly recommended that nursing schools implement a doctoral program for advanced practice nurses.

The AACN is asking schools to phase out the current master’s degree and instead require a doctoral degree for advanced practice nurses. The goal is to complete the transition by 2015.

The job of a nurse encompasses all aspects surrounding health care. Nurses in general take a holistic look at a patient through lenses that transcend biology and medicine and delve deeper into a patient’s social health determinants.

“Nurses seem generally more caring. They spend more time with patients,” said Rachel Kehoe, a second year UW undergraduate.

Health care is becoming increasingly complex. Demands range from care of the aging population to understanding cultural implications of clinical practices.

Woods said that the program helps to address these complex needs that health care faces today.

“We need people who understand policy,” Woods said. “We need nurse practitioners who have a better understanding of the whole system, not just thinking about practice from a particular place.”

The bottom line with the DNP program is that it promotes a higher quality of health care.

“But we won’t really know what impact is until probably 2015,” Woods said.

The DNP program helps to bridge the gap between health research and clinical practice.

“Right now, there’s about a 13-year gap from when research gets published and when it turns into practice,” said Christine Noyes, the DNP program coordinator. “The skill we never have had the time to develop is to read the research studies, figure out what they mean, and immediately implement it into practice with leadership tools.”

Other than core courses in leadership, social justice and nursing practice, the DNP program requires 1,000 hours of clinical work over the course of three years. This is compared to the current 500-hour clinical requirement for the master’s in nursing practice. In the DNP program, the learning component is inclusive of experience.

DNP student Meghan Green said her learning in the classroom is 100 percent applicable to what she expects to be doing as a nurse practitioner.

“Education is a big driver helping people remain interested, remain motivated to stay in nursing,” Woods said. “One of the reasons people are walking away from work in health care is that they realize they are not prepared well enough to be a practitioner.”

Concerns voiced by critics of the DNP program claim it will exacerbate nursing shortages by prolonging the education process and taking nurses out of hospitals and into school. A March 2006 article from the Journal of Issues in Nursing asked, “Why would we want to add to that severe shortage of nurse scientists by extending the education of nurses in advanced practice?”

Yet the program may alleviate nursing shortages by providing training for nurse educators. Some say a large part of the nursing shortage is due to a lack of nursing educators.

Lisa Sieberson, a first year DNP student, hopes to help change this.

“I’m interested in teaching nurses,” she said. “The degree would allow me to advance my practice in medicine as well as teaching. Universities are looking for DNP-prepared nurses to be teachers.”

The nursing profession emphasizes that health is largely determined by environmental factors such as socioeconomic status, workplace hierarchy and nationality. In order to accommodate for this new understanding, the DNP program requires students to grasp the complexity of health care and funnel their knowledge into practice.

“I will definitely go back to school in the future,” said Christopher Klein, a junior in the UW’s School of Nursing program. “I’m never going to be done learning.”

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