NKU- DNP Peers’ Posts Needing Responses
I need help responding to the attached peers’ posts in 220 words each, kindly provide references with each post.
1. Make your initial post by 23:59 EST Thursday.
2. Respond to two other classmates’ posts by 23:59 EST Sunday. 
3. Address 2 of the following discussion questions in your post: 
1. Describe the evolution of the doctor of nursing practice curriculum and its potential impact on the future of nursing.  (CO1)
2. Analyze factors in our current healthcare delivery system that is driving the need for nurses prepared as at the doctoral level (CO1)
3. How do you determine the impact of the DNP degree?  What methods should be used to determine the impact of DNP  graduates? See pg 52 of Pritham & White article.  (CO1)
4. What are your thoughts on having a universal standard for APRN entry? 

Analyze factors in our current healthcare delivery system that is driving the need for nurses prepared as at the doctoral level 
It is common for an individual to hear about the national nursing shortage on the news, or radio. This has become a growing topic since the development of COVID-19. One may also be familiar with the factor of nurse burnout. Schmidt (2020) informs that nearly 62% of nurses working in the United States are affected by some form of burnout. These two factors, including the use of advancing technologies in healthcare drive the need for nurses prepared at the doctoral level.
The doctoral prepared nurse is able to bridge the gap between theory and practice (Rivaz et al., 2021). Throughout this current doctor of nursing practice (DNP) program, students have been taught the ability to conduct research, review its validity and initiate it into practice. The DNP is the terminal degree which thoroughly prepares nurses to make change in the clinical setting. By utilizing the education provided by a DNP program, the nurse is able to understand how to provide effective change or adaptations for nurses affected by staffing shortages, or burnout. They may also be prepared to properly research advancing technologies (charting systems, tools, etc) and prepare nurses for their operation. The DNP prepared nurse displays top leadership, or management qualities based on their education. In times of stress or an ever changing environment, one may seek the expertise of the DNP prepared nurse for their guidance or leadership. Rivas et al. (2021) provide that challenging healthcare systems require nurse leaders that are able to manage unstable environments. This leader is the doctoral prepare nurse. 
What are your thoughts on having a universal standard for APRN entry?
According to McCauley et al. (2020), in 2004 the American Association of Colleges of Nursing (AACN) informed universities to transition to doctoral prepared advanced practice registered nurses (APRNs) programs by the year 2015. It is evident now that the AACN’s wish did not come true. This poses the question if there should be a universal standard for entry into APRN practice. A universal standard would allow equal clinical preparedness for practitioners. If the standard was changed to doctoral prepared nurses only, the education of the practitioner, excluding speciality education, would be similar to that of another APRN. However, one may question if it is wise to require an APRN to spend additional time and money on a degree with the current state of our healthcare system.
McCauley et al. (2020) inform that due to the increase in chronic health conditions and decline in resources, there has been a spike in the need for APRNs. The need for APRNs is crucial as illness and hospital admissions are increasing. This proposes that the APRN standard for entry into practice should remain as timely as possible. One may also argue that APRN candidates may not wish to pursue a doctoral degree or universal standard for entry. Within the last 10 years, doctoral nursing programs for the APRN have increased, however, there has been minimal decrease in the occurrence of master degree prepared APRN entry programs. If a universal standard is set, especially to the AACN’s standards, this may decrease the rate of APRNs into practice, thus minimizing the care provided to the public. This will provide additional strain to the already overwhelmed healthcare population. Although a universal standard for APRN entry seems ideal, the entry of a master degree or doctoral degree prepared APRN will suffice. 
McCauley, L., Broome, M., Fraizer, L., Hayes, R., Kurth, A., Musil, C., Norman, L., Rideout, K., & Villarruel, A. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing Outlook, 68(4). doi: 10.1016/j.outlook.2020.03.008
Rivaz, M., Shkorollahi, P., Setoodegan, E., & Sharif, F. (2021). Exploring the necessity of establishing a doctor of nursing practice program from experts’ views: A qualitative study.  BMC Medical Education, 21(328). doi: 10.1186/s12909-021-02758-w
Schmidt, A. (2020).  We need to talk about burnout the same way we talk about benefits. American Hospital Association.

The Doctor of Nursing Practice Degree: A Look at the Evolution and Potential Impact on Nursing
The Doctor of Nursing Practice (DNP) is a terminal degree in nursing that prepares nurses for advanced practice roles, such as primary care providers, consultants, and nursing leaders. The DNP curriculum typically includes advanced nursing practice, healthcare policy, leadership, and population health coursework. The DNP degree was developed in response to the growing demand for highly qualified nurses in advanced practice roles. The American Association of Colleges of Nursing (AACN) recognized the need for a practice-focused doctoral degree in nursing. It established the DNP as the terminal degree for advanced practice nursing in 2004 (The American Association of Colleges of Nursing (AACN), 2022). Prior to this, the highest degree in nursing was the Master of Science in Nursing (MSN), which was primarily focused on preparing nurses for research and academia (The American Association of Colleges of Nursing (AACN), 2022). The DNP curriculum has evolved to reflect the healthcare industry’s changing needs and the healthcare system’s increasing complexity (McCauley et al., 2020). The AACN has published guidelines for DNP programs, including coursework in healthcare policy, leadership, and population health, in addition to advanced nursing practice (McCauley et al., 2020). The potential impact of the DNP on the future of nursing is significant. As more nurses earn their DNP, they will be able to take on more advanced roles within the healthcare system and significantly impact patient care (American Association of Nurse Practitioners, 2022. The DNP degree also prepares nurses to be leaders in their field, which can help to shape the future direction of nursing and healthcare.
Factors Driving the Need for Nurses Prepared at the Doctoral Level
Several factors in the current healthcare delivery system drive the need for nurses prepared at the doctoral level. One factor is the increased complexity of healthcare. The healthcare system has become increasingly complex, with advanced technologies, specialized treatments, and complex patient cases (Hajizadeh et al., 2021). This has led to the need for highly trained nurses who can provide advanced levels of care and handle complex situations. Another factor is the shortage of primary care providers. There is a shortage of primary care providers in the United States, which has led to an increased demand for advanced practice nurses who can provide primary care services. The aging population also contributes to the need for nurses prepared at the doctoral level (Hajizadeh et al., 2021). As the population ages, there is an increased demand for healthcare services. Nurses prepared at the doctoral level can provide advanced care to older patients with complex health needs. The prevalence of chronic diseases, such as diabetes and hypertension, is also increasing. Nurses prepared at the doctoral level can provide advanced care and management for patients with chronic conditions. Finally, healthcare reform initiatives, such as the Affordable Care Act, have increased the focus on preventive and primary care services (Rivaz et al., 2021). Nurses prepared at the doctoral level can provide these types of care, which can help to reduce healthcare costs and improve patient outcomes.
Determining the Impact of the Doctor of Nursing Practice Degree
Several methods can be used to determine the impact of DNP graduates. One method is the use of outcome measures. This involves assessing the outcomes of DNP graduates’ practice, such as patient satisfaction, clinical outcomes, and cost savings. Surveys of DNP graduates and their employers can also provide valuable insights into the impact of the DNP degree (Pritham & White, 2016). These surveys can ask about the roles DNP graduates are taking on, their level of responsibility, and their impact on patient care and the healthcare system. Case studies of DNP graduates and their practices can provide a more in-depth understanding of the impact of the DNP degree. These case studies can look at specific projects or initiatives DNP graduates have undertaken and their impact on patient care and the healthcare system (Pritham & White, 2016). Data analysis can also be used to examine trends and patterns in the practice of DNP graduates over time. This could include analysis of administrative data, such as billing records, to assess the types of services DNP graduates are providing and their impact on healthcare utilization and costs. Finally, DNP graduates can contribute to the evidence base through peer-reviewed publications, which can help demonstrate the DNP degree’s impact on nursing practice and healthcare.
The Potential Benefits and Challenges of a Universal Standard for APRN Entry
Having a universal standard for APRN entry could have several benefits. One benefit is that it could increase the consistency and quality of care provided by APRNs (McCauley et al., 2020). A universal standard would ensure that all APRNs have met specific minimum requirements for education, training, and competency, which could improve patient safety and outcomes. Another benefit of a universal standard is that it could help to remove barriers to practice for APRNs. Currently, APRN practice is regulated by each state, and there can be significant variability in the requirements for APRN licensure and certification from one state to another (McCauley et al., 2020). A universal standard would provide a consistent set of requirements for APRN practice across the country, making it easier for APRNs to practice in multiple states and reduce patient care barriers. However, it is essential to consider that a universal standard would also require significant coordination and resources to implement. There would need to be agreement on the specific requirements for APRN practice and a mechanism for enforcing the standard. There could also be challenges in addressing the unique needs and circumstances of different states and regions.
The American Association of Colleges of Nursing (AACN). (2022).  DNP position statement.
The American Association of Colleges of Nursing (AACN). (2022).  AACN fact sheet – DNP.
American Association of Nurse Practitioners. (2022).  Discussion paper: Doctor of nursing practice.
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review.  BMC Nursing,  20(1).
McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing Outlook,  68(4), 494–503.
Pritham, U. A., & White, P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change.  The Nurse Practitioner,  41(4), 44–53.
Rivaz, M., Shokrollahi, P., Setoodegan, E., & Sharif, F. (2021). Exploring the necessity of establishing a doctor of nursing practice program from experts’ views: A qualitative study.  BMC Medical Education,  21(1).

2. Analyze factors in our current healthcare delivery system that is driving the need for nurses prepared at the doctoral level
We live in complicated times. Healthcare is at a precipice where change must occur if we are to survive. Healthcare will never “die out” or fade away, but healthcare as we currently know it isn’t sustainable. I believe most of us at least toyed with this idea before the pandemic, but COVID has highlighted many of the cracks within the healthcare system and nursing specifically. Nurses are being asked to do more than ever, and not just at the bedside. Over the course of my career I have seen nursing leadership evolve to a place where an entry level bedside nursing degree is no longer sufficient. 
The American Association of Colleges of Nursing (AACN) (2006) reports one of the benefits of doctoral preparation in nursing as being enhanced leadership that fosters strengthened practice and healthcare delivery. Historically nurses have risen to power primarily based on tenure and tenacity. There is no academic preparation at the bachelor (BSN) level or below for a nursing leadership position. It has been my experience that my bachelors degree prepared me to be a clinically competent bedside nurse who could evaluate evidence as it relates to practice at a very basic level. My masters (MSN) degree in nursing executive leadership scratched the surface of the knowledge necessary to lead nursing in today’s healthcare systems and greatly enhanced my ability to translate knowledge into practice. However, I am pursuing my Doctorate of Nursing Practice (DNP) because I know that there is more to be learned before I am truly prepared to tackle an executive leadership role. Through experience and observation it has never been more clear to me that our nursing leaders must be better prepared to fully expand into their roles. The pandemic has acted as a highlighter to the issues of inadequate nursing leadership. An excellent clinical bedside nurse does not always make a great leader and a well educated nurse does not always have what it takes either. My hope for the future of nursing is that the DNP can provide a foundation on which nurse leaders can build more sustainable nursing environments that, undoubtedly, will lead to better patient and nurse outcomes.   
4. What are your thoughts on having a universal standard for APRN entry? 
I very distinctly remember hearing about the push to DNP prepared advanced practice registered nurses (APRN) early in my career. My initial thought was something along the lines of “that is ludicrous.” Now, 18 years into my nursing career and 2 years living in a pandemic my thoughts are far more complex. Early in the pandemic I transitioned into a clinical education role and left the bedside. I moved from a large teaching institution that held Magnet nursing status to a much smaller hospital where a majority of the bedside nurses were educated at the associate’s degree (ADN) level. It was a jarring shift in organizational priorities for me to observe. My ADN nurses provide excellent clinical care and I couldn’t differentiate between those with a BSN or ADN on any given day. It was simply very different from the push for BSN and higher education at my previous organization. As the pandemic worsened and nursing saw mass exits into travel assignments or out of the profession altogether, the already invisible line between ADN, BSN, even MSN prepared nurses completely vanished. I saw a resurgence in the hiring of licensed practical nurses. Numerous nurse researchers and nursing organizations have long said that there is a need to better define the clinical proficiencies between nursing degrees (McCauley et al., 2020; Boswell et al., 2021). My experience has made that need very apparent to me. Nursing has fought for autonomy and gained it in many rights, but without role clarification based on education I fear we have come as far as we can. 
One glaring example of the need for clarification lies within my field of interest, perinatal services. Fullerton et al. (2019) pinpointed some key issues to consider regarding the DNP as the preferred degree for entry to practice amongst midwives. Currently, there are certified nurse midwives who are educated in both nursing and midwifery and certified midwives who lack the nursing education component that are able to obtain the same midwife certification and practice at the same level (Fullerton et al., 2019). The American College of Nurse Midwives (ACNM) is of the opinion that DNP is an option for the practice of midwifery, but should not be required for entry into the field due to a lack of data that suggests that practice quality is improved by the DNP degree (Fullerton et al., 2019). While I wholeheartedly believe that there is a need and a place for the DNP prepared nurse, I’m not entirely convinced that it is necessary for entry into advanced clinical practice. Boswell et al. (2021) looked at the impact of the DNP degree in their geographical area and found both benefits and challenges. DNP prepared nurses displayed improved communication, leadership and influence (Boswell et al., 2021). Unfortunately, they also noted a lack of understanding regarding the role and a lack of recognition for the rigor of their education (Boswell et al., 2021). What can we do to help normalize DNP recognition amongst our peers and colleagues? What is the best and most efficient way to inform others about the benefits of a DNP prepared nurse? If the APRN remains at the clinical level, treating patients, is it imperative that they obtain a DNP?
American Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. Author.
Boswell, C., Mintz-Binder, R., Batcheller, J., Allen, P., & Baker, K. A. (2021). Capturing the impact of the doctor of nursing practice degree on west texas health care.  The Journal of Continuing Education in Nursing,  52(4), 192–197.
Fullerton, J. T., Schuiling, K. D., & Sipe, T. A. (2019). The Doctorate of Nursing Practice and entry into midwifery practice: Issues for consideration and debate.  Nurse Education in Practice,  36, 97–100.
McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing Outlook,  68(4), 494–503.

               The push to require a Doctor of Nursing Practice (DNP) degree as the entry-level to practice as a nurse practitioner has been the subject in the medical community for many years. Similar to the drive for registered nurse programs to become a BSN entry-level and to phase out the two-year associate program, there has also been a push to suspend the Master of Science in Nursing (MSN) nurse practitioner program and make the DNP the entry-level for nurse practitioners. The American Association of Colleges of Nursing first pushed for the phase-out of Advanced Practice Registered Nurses (APRN) MSN programs in 2004 and wanted all MSN programs to be transitioned to DNP programs by 2015 (McCauley et al., 2020). Although the 2015 deadline was not met, many organizations are still pushing for the transition to the DNP as the entry-level. Furthermore, the National Organization for Nurse Practitioner Faculties pledged to transition to a DNP entry-level education for all nurse practitioners by 2025 (Idzik et al., 2021). The organizations proposing the shift to the entry-level degree often detail the everchanging role and requirement of the nurse practitioner and suggest that obtaining a DNP would help better prepare the nurse practitioners for these roles. The aging population is often referenced as one of the driving forces behind the proposal for changing the degree requirements. The idea is that the DNP program will help prepare students for the complex needs of patients and the evolving healthcare environment (Idzik et al., 2021).
              The push for higher education in healthcare is always a great goal in theory, but I fear that this is in direct conflict with the national shortage in nursing concerning registered nurses. Approximately, 275,000 additional nurses will be needed by 2030 to meet the needs of the aging population according to the Bureau of Labor Statistics (Haddad et al., 2022). Registered nurses can complete a program in two years and begin working after the two-year program. The transition to a four-year program would increase the time spent in school and place a strain on the already critical nursing shortage in the United States. The barriers in rural healthcare areas are often a challenge for registered nurses to obtain advanced degrees including distance to programs and lack of financial support from employers (Odahowski et al., 2021).  Although I do not fully agree with the push for the BSN degree as the entry-level for registered nurses, I could more easily adopt the idea of the DNP being the entry-level degree requirement for APRNs.
              In my practice region, the market is inundated with nurse practitioners and nurse practitioner students. Students often have to pay for their clinical rotations so they can secure a site and new nurse practitioners find it difficult to secure a job. I do not feel as though the requirement for the entry-level DNP for APRN practice will have the same impact that the BSN requirement for registered nurses will have on the field of nursing in this area. I do believe that this DNP requirement may make the APRN role less desirable. There are not any current studies, that could be found, regarding the view potential students have regarding the switch from MSN entry-level to a DNP entry-level APRN. The research should focus on the perceptions of potential nurse practitioner students and how this may affect the enrollment of new students into APRN programs.
              Although some areas are inundated with nurse practitioners, some areas have a great need for advanced practice providers. An example of an area with great need is the rural healthcare market. Rural healthcare facilities and primary care practices in rural America continue to have shortages of providers and the academic transition could place greater strain on these regions (Ortiz et al., 2018). One example of an area flooded with students is the Philadelphia, Pennsylvania region. In the Philadelphia area, there are 6 medical schools and 10 nurse practitioner schools that create a strain on the pool of preceptors which makes it difficult for student placement (Todd et al., 2019). Extensive research would need to be completed to fully understand the future healthcare needs and the impact of switching to the DNP as the entry-level for APRNs. First, it is important to understand the future growth of the healthcare field in the next 10 to 20 years and how many nurse practitioner roles will be needed. Additionally, the impact on the future nursing interest in the APRN role should be evaluated regarding the impact of requiring a DNP.
             I would also propose the importance of clear research associating improved patient outcomes with DNP-prepared nurse practitioners. The Institute of Medicine proposed that 80% of working nurses should obtain a BSN by 2020 due to reports of improved patient outcomes in hospitals with a higher proportion of BSN-prepared nurses (Harrison et al., 2019). One study found that hospitals with higher percentages of BSN-prepared nurses along with lower nurse-to-patient ratios were associated with improved patient outcomes after cardiac arrest (Harrison et al., 2019). The push for BSN-prepared nurses is supported by studies that have shown a correlation with improved patient outcomes. The research is quite limited when searching for patient outcomes comparing MSN-prepared nurse practitioners and DNP-prepared nurse practitioners. It is important to understand the impact of the DNP degree and how to measure those impacts. The change is more likely to be accepted when it is supported by improved patient outcomes. One critical area to study is patient outcomes and if the DNP degree has a positive impact, a negative impact, or an overall neutral impact on the outcomes of patients.  
            The impact of the DNP degree is an important area of focus when considering the push to require this degree. It is important to consider how to evaluate the outcomes of the DNP degree and how it affects the delivery of healthcare, the health of individuals, and the overall care of patients (Pritham & White, 2016). We should consider if the requirement of the DNP entry-level for an APRN would negatively or positively impact the care of patients and the delivery of healthcare. It is critical to gauge all the potential outcomes from a transition to the DNP degree as the entry-level for the APRN. Could the requirement negatively impact the access to healthcare for the public? Would this reduce interest in the APRN field as a whole? The overall costs of the programs should also be taken into consideration. The overall benefits of the transition should outweigh the potential detractors. One potential evaluation technique would be to complete outcome studies to better gauge patient-based outcomes (Pritham & White, 2016). If there is a correlation regarding improved patient outcomes when comparing MSN to DNP graduates then this could be the push needed for the transition an entry-level DNP for the APRN role.
            Another consideration is the delivery of healthcare and how it is affected by the proposal. The nurse practitioner role has been able to assist in reducing the healthcare strain in primary care that has been caused by an aging population and high prevalence of chronic health conditions in the United States (Poghosyan et al, 2021). A thorough evaluation would need to be completed regarding the impact this may have on the long-term impact on the APRN field. In the extended outlook, could this reduce the enrollment and graduation of APRNs? The overall strain on healthcare could be detrimental if this reduced the number of registered nurses who return to school for their APRN. Many colleges detail the growing need for advanced practice providers as well as financial constraints as reasons they have not yet transitioned to solely DNP-level programs for APRNs (Martsolf et al., 2015). The current interests and discussions regarding a universal standard will help to drive the necessary research to better understand and gauge the impact this will have on the healthcare field.
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In  StatPearls. StatPearls Publishing.
Harrison, J. M., Aiken, L. H., Sloane, D. M., Brooks Carthon, J. M., Merchant, R. M., Berg, R. A., McHugh, M. D., & American Heart Association’s Get With the Guidelines–Resuscitation Investigators (2019). In hospitals with more nurses who have baccalaureate degrees, better outcomes for patients after cardiac arrest.  Health affairs (Project Hope),  38(7), 1087–1094.
Idzik, S., Buchholz, S. W., Kelly-Weeder, S., Finnegan, L., & Bigley, M. B. (2021). Strategies to move entry-level nurse practitioner education to the doctor of nursing practice degree by 2025.  Nurse educator,  46(6), 336–341.
Martsolf, G. R., Auerbach, D. I., Spetz, J., Pearson, M. L., & Muchow, A. N. (2015). Doctor of nursing practice by 2015: An examination of nursing schools’ decisions to offer a doctor of nursing practice degree.  Nursing outlook,  63(2), 219–226.
McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing outlook,  68(4), 494–503.
Odahowski, C. L., Crouch, E. L., Zahnd, W. E., Probst, J. C., McKinney, S. H., & Abshire, D. A. (2021). Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce.  Journal of professional nursing, 37(2), 404–410.
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes.  Healthcare,  6(2), 65.
Poghosyan, L., Norful, A. A., & Martsolf, G. R. (2017). Primary care nurse practitioner practice characteristics: Barriers and opportunities for interprofessional teamwork.  The Journal of ambulatory care management,  40(1), 77–86.
Pritham, U. A., & White, P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change.  The Nurse practitioner,  41(4), 44–53.
Todd, B. A., Brom, H., Blunt, E., Dillon, P., Doherty, C., Drayton-Brooks, S., Hung, I., Montgomery, K., Peoples, L., Powell, M., Vanacore, D., Whalen, D., & Aiken, L. (2019). Precepting nurse practitioner students in the graduate nurse education demonstration: A cross-sectional analysis of the preceptor experience.  Journal of the American Association of Nurse Practitioners,  31(11), 648–656.
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