THE ROYAL FLUSHLEVERAGING DNP STUDENTS TO CHANGE HEALTH POLICY

SHANNON IDZIK, DNP, ANP-BC, FAANP, FAANAssociate Dean, Doctor of Nursing Practice

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The Essentials of Doctoral Education for

Advanced Nursing Practice

Essential V• “Health care policy--whether it is created through governmental actions,

institutional decision making, or organizational standards--creates a framework that can facilitate or impede the delivery of health care services or the ability of the provider to engage in practice to address health care needs.”

AACN, 2006

The Essentials of Doctoral Education for Advanced Nursing Practice: Essential V

The DNP program prepares the graduate to: 1. Critically analyze health policy proposals, health policies, and related issues from the perspective of consumers, nursing, other health professions, and other stakeholders in policy and public forums. 2. Demonstrate leadership in the development and implementation of institutional, local, state, federal, and/or international health policy. 3. Influence policy makers through active participation on committees, boards, or task forces at the institutional, local, state, regional, national, and/or international levels to improve health care delivery and outcomes.

4. Educate others, including policy makers at all levels, regarding nursing, health policy, and patient care outcomes. 5. Advocate for the nursing profession within the policy and healthcare communities.

6. Develop, evaluate, and provide leadership for health care policy that shapes health care financing, regulation, and delivery.

7. Advocate for social justice, equity, and ethical policies within all healthcare arenas

AACN, 2006

Common Advanced Practice Registered Nurse Doctoral-Level Competencies

Competency: • An observable ability of a

health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition. (Frank JR, Snell LS, Cate OT, et al, 2010)

AACN, 2017

Common Advanced Practice Registered Nurse Doctoral-Level Competencies

The competencies are designed to be observable, realistic, and measurable.

• First progression indicator (Time One): expected level of achievement when the student begins the first meaningful clinical experience

• Second progression indicator (Time Two): expected level of performance at completion of the student’s APRN doctoral program

AACN, 2017

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NP Core Competencies1. Demonstrates an understanding of the

interdependence of policy and practice.2. Advocates for ethical policies that promote

access, equity, quality, and cost.3. Analyzes ethical, legal, and social factors

influencing policy development.4. Contributes in the development of health

policy.5. Analyzes the implications of health policy across

disciplines.6. Evaluates the impact of globalization on

healthcare policy development.7. Advocates for policies for safe and healthy

practice environments.

7. Participates in professional organizations and activities that influence advanced practice nursingand/or health outcomes of a population focus.

Policy Competencies

Leadership Competencies

AONL, 2015

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Community/Public Health Nursing [C/PHN] Competencies

Quad Council, 2019

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For Educators:Start with the problem

Ask the students- what in health related thing do they want to work on• Identify an issue then identify the organizations who would

be involved• See if it is on their policy docket, if not ask

• Example: Overuse of Antibiotics in Animals• Maryland Public Health Association• Maryland Sierra Club• Maryland Nurses Association• United Health Care Workers• Society of Infectious Disease Pharmacists• Fair Farms• Waterkeepers Chesapeake• Maryland Conservation Council• Maryland Votes for Animals• Natural Resources Defense Council• Clean Water Action

For Educators:Start with the problem

Ask the students- what in health related thing do they want to work on

• Identify an issue then identify the organizations who would be involved

• See if it is on their policy docket, if not ask• Example: Prior Authorizations

• Maryland Public Health Association• Maryland Nurses Association• Nurse Practitioner Association of Maryland• Maryland Pharmacist Association• Maryland Insurance Administration• Health Services Cost Review Commission• AARP• Healthcare Information and Management Systems Society• Insurance Companies

For Clinician:Start with the

problem

Contact the school-what impacts your ability to provide patient care• What “ticks” you off everyday?• What would you use your magic

wand for?• Find a school• Find a student

Different ways DNP students should be doing policy

Projects-Every student has to do a project, why not policy?

Practicum-Every DNP student has to complete 1000 hours, why not policy?

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Changing Healthcare One Student at a Time

Karen Doyle Katherine Fornili Joan Ejiofor-Okoli Nicole Grass

In the State of Maryland, the Maryland Institute of Emergency Medical Systems has approved a MIH framework for the state jurisdictions to implement. The overarching issue is that there is no sustainable mechanism for EMS to be reimbursed via Medicare, Medicaid or private payers. Reimbursement thus far has been through state grants or partnerships with hospitals. Thus, the brokenness is the lack of reimbursement.

Additionally, there is no formal mechanism to capture data to determine whether or not patient outcomes improve or cost savings are realized.

Create uncontested market space

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Complexity of

stakeholders

Karen Doyle

Changing Healthcare One Student at a Time

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• Collaborate with local organizations to develop a toolkit and presentation to prepare NPs in the state to order home health (starting Jan 2020)

• Collaborate with many groups (including but not limited to MDAC, GAPNA, NPAM, MNCHA, VNA, MHA).

NPs ordering home health in Maryland

Joan Ejiofor-Okoli

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The winning hand!

Karen Doyle Katherine Fornili Joan Ejiofor-Okoli Nicole Grass Shannon Idzik

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REFERENCES

American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing. Washington, DC, AACN.

American Association of Colleges of Nursing (2006a). DNP Roadmap Task Force Report. Retrieved from: www.aacn.nche.edu/dnp/roadmapreport.pdf

American Association of Colleges of Nursing (2006b). The essentials of Doctoral education for advanced nursing practice. Retrieved from: http://www.aacn.nche.edu/education-resources/essential-series

American Association of Colleges of Nursing (2015). The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations. Washington, DC, AACN.

Commission on Collegiate Nursing Education, (2013) Standards for Accreditation of Baccalaureate and Graduate Nursing Programs. Retrieved at http://www.aacn.nche.edu/ccne-accreditation/Standards-Amended-2013.pdfInstitute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.

Crowder SJ, Ironside PM, Cangany M, Roddy WS. Implementation of a state legislative fellowship for doctor of nursing practice students. Nurs Educ. 2016;41(3):156-159.

Gallup. Honesty/ethics in professions. Gallup Web site. Avail- able at http://www.gallup.com/poll/1654/Honesty-Ethics- Professions.aspx. Accessed June 11, 2019.

Hahn J. Integrating professionalism and political awareness into the curriculum. Nurs Educ. 2010;35(3):110-113.

Institute of Medicine. (2010). The future of nursing: Focus on education. Washington, DC: National Academies Press.

Kostas-Polston EA, Thanavaro J, Arvidson C, Taub L-FM. Advanced practice nursing: shaping health through policy. J Am Assoc Nurse Pract. 2015;27(1):11-20.

Manning ML, Grosso D. Doctor of nursing practice students advocating for health care access, quality, and reform: from the virtual classroom to capitol hill. J Nurs Educ. 2011;50(1):14-20.

Moran, K. , Burson, R. & Conrad, D. 2020. The doctor of nursing practice scholarly project: A framework for success. In Press. Sudbury, MA: Jones and Bartlett Learning.

National Organization of Nurse Practitioner Faculties (NONPF) (2012). Domains and competencies of nurse practitioner practice. Washington, D.C.: Author.

National Organization of Nurse Practitioner Faculties (NONPF) (2013b). DNP Competency Toolkit: Process and approach to DNP competency based evaluation. Washington, D.C.: Author.

National Organization of Nurse Practitioner Faculties (NONPF) (2013c). Sample curriculum templates for doctorate of nursing practice (DNP) NP education. Washington, D.C.: Author.