Association of Community Health Nursing Educators
Board of Directors Kathy McGuinn, MSN, RN, CPHQ Director, Special Projects President American Association of Colleges of Nursing Joyce Splann Krothe, DNS, RN Indiana University One Dupont Circle, NW, Suite 530 Washingon, DC 20036 President-Elect Susan Swider, PhD, APHN-BC April 23, 2010 Rush University Medical Center
Vice President Dear Ms McGuinn: Connie Roush, PhD, RN University of North Florida On behalf of the Association of Community Health Nursing Educators, we would like to share our response to the February 2010 draft of the MSN Essentials. The Association of Community Health Secretary Nursing Educators (ACHNE) Executive Board, Education Committee, and interested members Rosemary, Chaudry, PhD, MPH, PHCNS The Ohio State University reviewed the Draft MSN Essentials in October/November, 2009 and then the revised version in February, 2010. ACHNE supports the development of such a document, especially in light of the Treasurer recent APRN consensus model; the model has had a tremendous impact on graduate education in Diane McNaughton, PhD, APHN-BC nursing. The wide variety of health care needs across the nation and efforts to improve our Rush University Medical Center nation’s health require nurses to be prepared beyond the generalist level; and in roles other than Chair Membership APRN roles. However, there is currently a lack of clarity about the education required for these Kristine Warner, PhD, MPH, RN non-APRN roles of the future, and by stressing that Advanced Nursing Practice be conducted at California State University – Chico the DNP level, the role of MSN prepared nurses now becomes unclear. The February 2010 draft MSN Essentials document is a step towards providing such clarity, but it has several compelling Members-at-Large Midwest Member weaknesses, which diminishes the usefulness of these future roles to develop and implement Mary Kay Anderson PhD, FNP-BC coordinated health care in systems designed to address national health needs. Here are several Creighton University concerns:
Northern Member Joan Kub, PhD, APHN- BC On p. 3 the definition of advanced practice nursing eliminates APHN practice (per the Johns Hopkins University APRN consensus document). This wording needs to be changed to reflect Advanced Nursing Practice; appropriate wording is found later in the document where the phrase Southern Member used is “mastery in nursing practice”, if this phrase is defined to refer to nursing practice Judith L. Wold, PhD, RN in specialty areas, such as public health. Lillian Carter Center for International Nursing Emory University P. 3 para. 3 states that Master’s degree programs in nursing build on the competencies of Western Member the generalist nurse and prepares the graduate for mastery in nursing practice and may Charlotte Armbruster, DNS Arizona State University include a functional area of nursing practice. The document does not provide definitions of role versus functional area of practice, so it is not clear where PHN at the generalist International Member level fits in this paradigm. Bonnie Callen, RN, PhD CPHCNS-BC University of Tennessee On p. 4 in the discussion of the DNP essentials as they relate to direct and indirect care, Public Health Nursing is omitted entirely. The DNP Essentials characterize Advanced Public Health Nursing as an indirect care advanced specialty. APHNs may provide some limited direct care to families and individuals, but the bulk of their practice is at the population level, which has been defined as “indirect care”.
ACHNE 10200 W 44th Ave #304 Wheat Ridge CO 80033
Office: (303) 422-1809 Fax: (303) 422-8894 E-mail: [email protected] www.achne.org Definition of Patient: The definition of patient includes recipients of interventions at the community and population level; this usage is far too broad for this level of education. We strongly recommend removing population and community from this definition, allowing alignment with The “Community Aspects of Practice” outlined in Allan et al, as well as the Public Health Nursing (PHN): Scope and Standards.1,2 Community/population as client requires specialty level skills in public health nursing.2
Use of the term “Population”: ACHNE has concerns with the use of the term Population instead of Clinical Population throughout the document. We strongly object to the use of the term Population and would urge AACN to use the term Clinical Population instead as used in the DNP Essentials (people with a common characteristic such as a disease, condition, or demographic attribute).3 The well accepted public health use of the term population means the public in general and interventions designed for population-level health. In addition, nurses at the MSN level might be prepared to work with individuals within clinical populations, but developing population focused interventions is a specialist level skill.4,5 While this has been addressed in some places in the document, there are still several areas where it is unclear (p. 8, the last line; p. 39 line 2, p. 6 lines 10, 16 and 17, p.7 line 2, p.8 line 30, p. 27 Essential VII, p. 28 line 4, p. 39 line 2.)
Role of the MSN Prepared Nurse: The document vacillates between discussing the MSN prepared nurse as a manager of care at the micro-system level (p. 1, para 4, line 5) and care management at the mezzo and macro system level. Community and population-focused care management (e.g., community/population–focused care) is provided by public health nurse specialists (p. 2, para 1, line 3-4) and requires specialty content and skills.2 It is not clear from this document what roles MSN prepared nurses will assume.
Required coursework for MSN prepared nurse. If, as stated on p.1, MSN graduates can pursue either direct or indirect care roles, then requiring advanced health assessment, pathophysiology, and pharmacology for all graduates is inappropriate. Those in indirect care roles would not need these courses-indeed such content is more appropriate for APRN practice. All generalist RNs would have had content in these areas at the RN practice level, and such additional content would not be required for the types of roles described here. This is particularly true for those who choose to practice in public health or nursing administration. For those nurses, content in epidemiology, population health issues, or health promotion frameworks and models might be more appropriate.
In short, this important document needs further revision to be consistent with other nursing documents and standards and clarify the role of the advanced generalist nurse at the MSN level. We are particularly concerned with the lack of attention to the roles that PHNs can play, both at the generalist and advanced nursing practice levels. PHN is the backbone of nursing historically and recent health care reform efforts herald a much needed return to a focus on prevention and care in communities. PHNs at all levels will be an important component of these efforts and can assume leadership in moving our nation towards better health. Thank you for consideration of our comments.
Sincerely,
Joyce Splann Krothe, PhD RN, President Association of Community Health Nursing Educators (ACHNE)
References 1. Allan, J., Barwick, T., Cashman, S., Crawley, J.F., Day, C., Douglas, C.W., et al.(2004). Clinical prevention and population health: Curriculum framework for health professions. American Journal of Preventive Medicine, 27(5), 471-476. 2. American Nurses Association. (2007). Public health nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org 3. American Association of Colleges of Nursing (AACN) (2006). The essentials of doctoral education for advanced nursing practice. Washington DC: AACN. 4. Quad Council of Public Health Nursing Organizations. (2004). Public health nursing competencies. Public Health Nursing, 21(5), 443-452. 5. Levin, P.F., Cary, A.H., Kulbok, P., Leffers, J., Molle, M., & Polivka, B.J. (2008). Graduate education for advanced practice public health nursing: At the crossroads. Public Health Nursing, 25, 176-193.