The passage of the Affordable Care Act, which extends coverage to millions of uninsured Americans, is increasing demand for nurse practitioners in primary care. In recognition of the broader role nurses are filling in the health care system, Clinical Scholars Review, the journal of doctoral nursing practice published by Columbia University School of Nursing, is debuting a special section devoted to public policy.
Mary O'Neil Mundinger, DrPH, RN, Edward M. Kennedy Professor of Health Policy and dean emeritus at Columbia University School of Nursing, stresses the importance of the doctor of nursing practice (DNP) degree in her essay in the inaugural section, "Why are Standards for DNPs Who Practice Comprehensive Care so Crucial? And What Are We Doing About it?"
As the DNP degree has become more common, some clinical doctorate programs have shifted more training resources to management skills and other areas. That has made the Diplomate in Comprehensive Care (DCC) exam an essential credential to distinguish those DNPs with the advanced clinical skills necessary to provide evidence-based primary care, Mundinger argues.
"The DCC can become the most sought-after and competent professional to fill the positions in comprehensive care," Mundinger says. "It will set those DNPs apart from their colleagues who choose a DNP preparing them for an administrative career."
In his essay, "Certifying Competency in Comprehensive Care," Michael Carter, DNSc, DNP, University Distinguished Professor at the University of Tennessee Health Science Center, also advocates for the DCC exam as a way to ensure that advanced practice nurses are trained in the full range of clinical experiences they may encounter in the field.
The DCC credential helps to differentiate nurse practitioners with advanced clinical skills from those who are from DNP programs focused only on administration, leadership and health policy, Patricia Stark, DSN, RN, dean of the University of Texas Health Science Center at Houston School of Nursing, says in her essay, "Restructuring Healthcare: The GNE Initiative for Increasing the Supply of Advanced Practice Registered Nurses."
The effectiveness of advanced practice nurses also depends on how well health systems are organized within a community, Richard Cooper, MD, director of the Center for the Future of the Healthcare Workforce at New York Institute of Technology, argues in his essay, "The Three Ps of Primary Care: Professional, Pragmatic and Patient-Centered."
Services should be population-based, with medical practices centered around providing all services needed in a community rather than tethered to facilities that focus on specific treatments. States also need to permit nurse practitioners to practice to the full extent of their education and licensure, he says.
"In some circumstances, care teams will be physician-led and in others they will be led by nurse-clinicians," Cooper writes. "Ultimately, it is competence and collegiality within comprehensive treatment centers that will make primary care work for patients and providers."
Columbia University School of Nursing