Research Proposal on "Clinical Residency"

Research Proposal 6 pages (1740 words) Sources: 6 Style: APA

[EXCERPT] . . . .

Clinical Residency for a Family Nurse Practitioner Program

Despite the growing demand for family nurse practitioners today, there is no clinical/practicum component offered as part of that degree. Therefore, the proposed study seeks to identify what is required in order to create a clinical component in the form of a clinical residency with specialty rotation within the clinic setting for a family nurse practitioner. The doctor of nursing practice clinical residency is a key component that would ideally integrate a clinical practicum together with the immersion experience with knowledge at the completion of a program that demonstrates the competencies required by relevant accrediting healthcare organizations. To this end, this study proposes to develop a clinical residence program for family nurse practitioners in the United States in order to facilitate the delivery of care to a panel of patients across a clinical setting that is becoming increasingly multicultural and older in demographic composition.

Background/Rationale for a Clinical Residency

According to McCabe and Burman (2006), "Advanced practice nurses (APNs) have become increasingly visible and important providers in America's changing and often unpredictable healthcare system. Evidence exists establishing both the quality and cost-effectiveness of the APN role in meeting the needs of patients" (p. 3). Despite their growing importance to the healthcare needs of an increasingly aging and multicultural society, there remains a fundamental need to improve the curricular offerings that are required to attain a doctorate of nursing practice today as they pertain to a clinical residency component. As Ebersole and Hess (1998) emphasize, "There seem to be no specialized training programs in schools of nursing that have formal coursework and clinical residency" (p. 1031). In this environment, identifying opportunities for improving the manner in which advanced practice nurses in general and family nurse practitioners in particular are educated and provided with hands-on experience has assumed new importance and relevance today.

Review of the Relevant Literature

Although there remains a paucity of relevant studies concerning the need for a pre-doctoral clinical residency for advanced practice nurses in general and family nurse practitioners in particular, some valuable insights concerning the need for such an initiative can be gained from similar studies conducted for other professions. For example, a survey of 410 members of the American Mental Health Counselors Association conducted by Scovel, Christensen and England (2002) found that 41.5% of the respondents believed that at least 1 year (2,000 hours) of pre-doctoral clinical residency should be completed prior to their members being authorized independent prescription privilege and a similar amount (40%) thought that more than 1 year (3,000 hours) should be required; slightly fewer but still significantly, 9.5% of the respondents believed that less than 1 year (1,000 hours) should be required (9% did not respond). For the purposes of this study, independent prescriptive privileges were defined as a type of privilege in which the healthcare provider (in this case, mental health counselors) were authorized to prescribe psychotropic medications without physician oversight; dependent prescriptive privileges were defined as a type of prescriptive privilege in which the healthcare provider had dependent authority to prescribe psychotropic medications under the oversight of a physician (Scovel et al., 2002).

Likewise, a majority of the respondents in the Scoval et al. study were in favor of requiring 1 or more years of supervised post-doctoral clinical residency for members to attain their dependent prescriptive privileges (Scoval et al., 2002). In addition, Scovel and her associates found that slight more than three-quarters (75.6%) of the respondents felt that more than 2,000 hours of supervised post-doctoral clinical residency was needed in order for their members to be sufficiently prepared to exercise dependent prescriptive privilege; moreover, concerning independent prescriptive privilege, the survey requested that the respondents provide responses to two items concerning post-doctoral training that showed fully 84% of the respondents believed that between 1 and 5 years of training was necessary, and nearly 82% believed that a post-doctoral clinical residency in excess of 2,000 hours was required in order to be sufficiently prepared to exercise independent prescription privilege (Scoval et al., 2002).

American Association of Colleges of Nursing Essentials of a Doctorate Education for Advanced Practice Nurses

Following the publication of AACN's guidelines in the Essentials of Master's Education for Advanced Practice Nursing (1996) and the development of the initial set of monitors used to assess the quality of doctoral nursing education in 1986, a number of changes in healthcare education and delivery have taken place that have required a reevaluation of previous requirements for advanced practice nurses. In fact, the past 20 years or so have witnessed a significant expansion in the number of graduate programs in nursing. For instance, in 1980, just 220 institutions provided 39 doctoral programs and 180 master's programs; by sharp contrast, by 2006, there were 518 institutions offering 101 doctoral programs as well as 417 master's programs (the essentials of master's education, 2006). According to the guidelines published by the AACN, "Increasing numbers of these programs offer preparation for certification in advanced practice specialty roles such as nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists. Specialization is also a trend in other health professional education" (p. 6).

From 1980 to 2006, there has also been an enormous increase in innovations in technology and a growing amount of scientific evidence that is being used to guide nursing practice in ways that have made the course of educational programs in nursing longer and more comprehensive (the essentials of master's education, 2006). The AACN points out that, "In response to these trends, several other health professions such as pharmacy, physical therapy, occupational therapy, and audiology have moved to the professional or practice doctorate for entry into these respective professions" (the essentials of doctoral education for advanced nursing practice, 2006, p. 6).

Clearly, there is an increasing trend toward doctorate-level educational requirements for advanced practice nurses, a trend that will be complete by the next decade when all nurse practitioners will require a doctorate. While the need for additional training and on-hands experience is acute, there remains a lack of a clinical residency component in all of these colleges of nursing, a lack that adversely affects the ability of aspiring family nurse practitioners to enter the field sufficiently prepared for the rigors they will inevitably encounter on a day-to-day-basis. In this regard, the AACN emphasizes that there is growing support for doctoral education for nursing practice based on an analysis of existing master's level nursing programs. The analysis of current curricular offerings by the AACN found that many programs have significantly expanded based on the foregoing issues, developing curricular offerings that are far beyond the typical credit load and length for a typical master's degree (the essential of doctoral education for advanced nursing practice, 2006). According to the AACN:

The expansion of credit requirements in these programs beyond the norm for a master's degree raises additional concerns that professional nurse graduates are not receiving the appropriate degree for a very complex and demanding academic experience. Many of these programs, in reality, require a program of study closer to the curricular expectations for other professional doctoral programs rather than for master's level study. (the essentials of doctoral education for advanced nursing practice, 2006, p. 6)

Taken together, the foregoing trends and issues represent a challenge for colleges of nursing that seek to provide their advanced practice nursing candidates with the quality and level of education and experience they will need to deliver high-quality healthcare services to the wide range of patients they will encounter in their specialized field of practice, and this need remains understudied and unmet.

The Council for Advancement of Comprehensive Care (CACC) has weighed in on the issue as well. According to a recent press release maintained on their organizational Web site, there has been a New Comprehensive Care Certification Examination as of March 6, 2009, developed in collaboration with the CACC at Columbia University. The press release notes that, "AACN recognizes the Doctorate of Nursing Practice (DNP) as an academic degree that prepares nurses for a variety of advanced specialty nursing roles. A variety of specialty and role certification examinations are currently available for nurses who have graduated from an accredited graduate program and are prepared to practice as an APRN" (AACN update on the new comprehensive care certification exam, 2009, p. 2). This certification does not replace, but rather is in addition to, the national certification examinations required to attain recognition for state licensure as an APRN; applicants for the new examination must possess both national certification as an APRN as well as be a graduate of a DNP program (AACN update on the new comprehensive care certification exam, 2009). It is apparent that there is a move towards requiring a higher level of knowledge, training and expertise among APNs that is commensurate with a doctoral-level practice; however, unlike many other doctorate programs, APNs continue to lack the opportunity to participate in a clinical residency program that can provide them with the real-world experience and guidance from experienced healthcare practitioners. The current competencies… READ MORE

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