By Jacqueline Dunbar-Jacob, PhD, FAAN
When the Patient Protection and Affordable Care Act is fully implemented in 2014, 33 million more Americans will become eligible to get affordable health care coverage. But access to coverage will not necessarily translate into care. Experts doubt there will be enough doctors to meet needs. There are not enough now.
The Association of American Medical Colleges estimates that in 2015, the country will have 63,000 fewer doctors than needed, and that number will more than double by 2025 as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. It typically takes a decade to train a doctor, so there is little the government or the medical profession can do to close the gap before the law takes full effect in 2014.
Advanced practice nurses are helping to fill the gap. Hundreds of walk-in clinics run by nurses are already operating across the country. While they most commonly treat routine ailments, the nurses in these clinics are increasingly helping people suffering from chronic illnesses. Nurse-managed clinics offer checkups and help patients to manage their high blood pressure, heart disease, and diabetes. Studies by the RAND Corporation found that these clinics provide care at costs that are 30–40 percent less than similar care provided at a physician’s office and that the care for routine illnesses was of similar quality.
For many people, nurse practitioners are now the main source of primary care—the experts who diagnose those aches and pains and then write the prescriptions that relieve them. But as medicine has grown more complex and sophisticated, so have the skills needed to practice it. Given the ballooning of their clinical duties, it’s no surprise that the education required of many health professionals is expanding as well.
Recognizing that the changing demands of this nation’s complex health care environment require the highest level of scientific knowledge and practice expertise to ensure quality patient outcomes, the American Association of Colleges of Nursing (AACN) advocates the baccalaureate “as the minimum educational requirement for professional nursing practice.” The Robert Wood Johnson Foundation and Institute of Medicine’s report “The Future of Nursing: Leading Change, Advancing Health” support this initiative, calling for 80% of nurses to hold baccalaureate degrees by 2020. In addition, the AACN voted in 2004 to move the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctoral level by the year 2015. This decision followed almost three years of research and consensus building with a variety of stakeholder groups.
According to AACN, some of the factors building momentum for change in nursing education at the graduate level include the rapid expansion of knowledge underlying practice; increased complexity of patient care; national concerns about the quality of care and patient safety; the shortage of nursing personnel, which demands a higher level of preparation for leaders who can design and assess care; shortages of doctorally prepared nursing faculty; and increasing educational expectations for the preparation of other members of the health care team.
Transitioning advanced practice nurses to the Doctor of Nursing Practice (DNP) degree reflects the complex clinical skills and sophisticated knowledge of the evidence base necessary for advanced practice nurses practicing in today’s health care environment. Unlike Doctor of Philosophy (PhD) programs that emphasize academic research, the clinical Doctor of Nursing Practice (DNP) program emphasizes the skills and knowledge students will need to practice their profession at its highest level.
The DNP moves nursing in the direction of other health professions that offer practice/clinical doctorates, such as: medicine (MD), dentistry (DDS), pharmacy (PharmD), psychology (PsyD), physical therapy (DPT), and audiology (AudD). DNP graduates are prepared to affect the health care delivery system not only by delivering primary care and serving as hospitalists but also by evaluating the evidence base for nursing practice, becoming leaders in clinical arenas, establishing standards and policies, and partnering with other members of the health care team to meet the needs of today’s diverse health care systems.
Jacqueline Dunbar-Jacob is dean of the University of Pittsburgh School of Nursing. The National Institutes of Health (NIH) places the school third in the total dollars received – the sixth consecutive year it has ranked in the NIH’s top five list and the fourteenth consecutive year in the top ten. In addition, U.S. News & World Reports ranks the school 9th overall in their 2013 edition of Best Online Programs and seventh overall in the 2011 America’s Best Graduate Schools, the most recent issue ranking schools of nursing. For more information about the University of Pittsburgh School of Nursing, visit www.nursing.pitt.edu or call 412-624-4586 or toll free 888-747-0794.
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