Role of DNP nurses in levels of care

Introduction: Emergence of the DNP Degree

The American Association of Colleges of Nursing (AACN), in 2004, pinpointed a necessity for nurses possessing advanced educational qualifications to offer superior clinical care, assume leadership roles, and address the acute faculty shortage in the nursing education sphere. Although a handful of Doctor of Nursing Practice (DNP) programs existed before the AACN’s pivotal document (with the University of Tennessee Health Science Center initiating one in 1999 as an illustration), this critical paper accentuated the imperative for escalating the educational attainment of advanced practice nurses from Master’s to the doctoral echelon. Consequently, a surge in the establishment and conferral of the DNP degree - the ultimate clinical qualification for nursing practitioners - was observed. Starting from a modest 20 programs in 2006, the count escalated to 303 by 2017, per AACN’s 2018 data. Furthermore, the period post-2010 witnessed the enrolment in DNP initiatives soaring from 7,034 to 18,352 students, marking a substantial 161% augmentation, with the enrolment figures for 2016 being estimated at around 29,000 (AACN, 2018). The DNP is acknowledged as a clinical doctoral credential analogous to those in various other disciplines, including pharmacy, audiology, speech, and physical therapy, where the doctorate is recognized as the ultimate practice degree. For aspiring nurses, the journey to securing a DNP is versatile, presenting options like post-Bachelor of Science in Nursing (BSN) to DNP or post-Master of Science in Nursing (MSN) to DNP routes (Edwards et al., 2018).

Healthcare Care Strata

Primary Care forms the foundational healthcare layer within a community, providing direct access for its members. This level is staffed by general practitioners (GPs), practice nurses, and community health specialists like dentists, podiatrists, and optometrists. Accident and emergency (A&E) Departments also contribute to this layer by extending specific primary care elements.

GPs, stationed in surgeries alongside other professionals, play a pivotal role in overseeing community health. They deliver health services to nurses, healthcare assistants, and health visitors collaboratively. Every community member, including children through their parents, can enroll in a GP surgery for holistic health services.

In this essential framework, health visitors actively engage in health education and promotion, providing crucial support to individuals and families. Specialized health visitors offer their expertise to families with members suffering from unique conditions or disabilities (Beeber et al., 2019).

Every school is affiliated with a designated nurse responsible for health education and promotion among students within educational institutions. Special schools have access to dedicated nurses who administer medication and deliver necessary care during school hours.

The A&E departments within hospitals are specialized units that address urgent health crises. These departments are accessible through walk-ins or ambulance services and play a crucial role in community health (Beeber et al., 2019).

Secondary care, or Intermediate Healthcare, offers a more specialized healthcare form accessible through referrals primarily from GPs. In community health settings or hospitals, secondary care professionals, including community pediatricians, work collaboratively to address family needs at the community level. They provide outpatient and various therapeutic services, with specialists like occupational therapists, physiotherapists, and speech and language therapists engaging patients to facilitate their daily functioning and education (Beeber et al., 2019).

Child and Adolescent Mental Health Services (CAMHS) naturally operate within secondary care, offering psychiatric and psychological support through teams composed of psychiatrists, community psychiatric nurses, psychotherapists, psychologists, and occasionally, social workers and other therapists.

At the pinnacle of healthcare services is Tertiary Care, a highly specialized echelon that necessitates referrals from either primary or secondary professionals. Often dispensed at distant hospitals or significant regional centers, tertiary care offers expert treatments for low-incidence but high-cost conditions through specialized practitioners like consultant pediatricians and expert nursing teams, who are highly trained in specific care areas (Beeber et al., 2019). These specialized services range from diagnostics, acute clinical, and emergency services to treatment for severe and complex mental health cases.

Doctor of Nursing Practice (DNP)-prepared nurses play indispensable roles at each healthcare level. They work closely with GPs and other professionals in primary care, offering education, preventive care, and addressing urgent health needs. DNP-prepared nurses in secondary care often specialize, providing expert guidance in various therapies and treatments. At the tertiary level, their role is even more critical. These highly trained and educated professionals deliver specialized care for complex and severe health conditions, taking on leadership roles and actively contributing to patient assessment, diagnosis, treatment, and evaluation, ensuring a seamless healthcare experience for all patients.

DNP’s Multifaceted Impact:

From the inception of the inaugural DNP program, its alums have made noteworthy contributions to nursing practice and played a pivotal role in the evolution of healthcare structures within the United States. These highly-trained individuals are equipped to conceptualize and critically assess innovative patient care models, scrutinize the economic aspects of various patient care tactics, and wield influence over health policies on multiple fronts. With Evidence-Based Practice (EBP) being a fundamental aspect woven through the entirety of DNP education, it reinforces using intervention strategies grounded in research to enhance patient care outcomes. DNP graduates extend their influence beyond just health systems and clinical practice; they also make significant inroads in health policy, academia, and diverse sectors like health economics, health insurance, administration, and information technology (Edwards et al., 2018).

Furthermore, individuals with DNP qualifications have begun to leave their mark in health economics, health insurance, administrative roles, and information technology within the healthcare domain. For instance, many DNP holders are now seen in administrative capacities within the health insurance sector, having a say in healthcare financing matters. They are adept at employing Electronic Health Records (EHRs) for data compilation and extraction, which aids in refining patient care processes, positively influencing patient outcomes, and facilitating the enhancement of EHR systems. The potential impact of DNP professionals on the healthcare sector is immense, with many more areas awaiting their valuable contribution and influence (Edwards et al., 2018).