Msn essentials Conferences achne concerns/Talking Points (V. 3)

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MSN Essentials Conferences

ACHNE concerns/Talking Points (v.3)

(Based on 11-11-09 AACN documents)
The Association of Community Health Nursing Educators (ACHNE) Executive Board, Education Committee, and interested members reviewed the Draft MSN Essentials in October/November. ACHNE supports the development of such a document, especially in light of the recent APRN consensus model; the model has had a tremendous impact on graduate education in nursing. The wide variety of health care needs across the nation and efforts to improve our nation’s health require nurses to be prepared beyond the generalist level; and in roles other than APRN roles. However, there is currently a lack of clarity about the education required for these non-APRN roles of the future. Additionally, by stressing that Advanced Nursing Practice be conducted at the DNP level, the role of MSN prepared nurses now becomes unclear. The current draft MSN Essentials document does not provide the needed clarity, and has several compelling weaknesses, which diminishes the usefulness of these future roles to develop and implement coordinated health care in systems designed to address national health needs. Here are several concerns:
1. 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
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 this level might be prepared to work with individuals within clinical populations, but developing population focused interventions is a specialist level skill.^4,5
3. Leveling of Public Health Content: The level of public health content proposed in the AACN endorsed Clinical Prevention and Population Health Curriculum Framework¹(Framework)is to inform individual/family level clinical preventive efforts and is not at a public health specialist level. The content in the public health sciences, as outlined in Essential 1, should be clarified as a basic – not specialty level - to meet the Framework¹ guidelines. As detailed in the PHN Scope and Standards, public health nurses take specialty level course work in order to apply epidemiology, environmental science, surveillance, and population health analysis and program planning to develop, implement, and evaluation population-focused interventions;²this is not at a microsystem level of care.
4. Role of the MSN Prepared Nurse: This revised document clarifies the roles that the MSN prepared nurse will be prepared to fill to some extent. However, the document continues to vacillate between discussing the MSN prepared nurses 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
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.

Component	Areas of Concern
Introduction	p. 2, para 1, line 3-4: Delete communities & populations. Suggested wording: “individuals, families and groups in the community.” p. 2, para 2, line 3-4: Delete ‘public health nurse’ as it is not a role but a focus
I. Scientific Background for Practice	p. 3-4: Change the use of ‘population’ to ‘clinical population’, as population-focused is at the PHN specialty level p. 4 Objectives, #4: Change wording to ‘community-based clinical populations’ as designing nursing care for a community-based population implies care delivery at the population level, which is specialty level practice. p. 3 Sample Content: Content in the public health sciences would be at a basic level, as programs would not have sufficient time or faculty expertise or need to ensure that students understand and can apply epidemiology, environmental science, surveillance, and population health analysis and program planning. If indeed, possible roles for a MSN prepared nurse include in the public health/community health realm, then the requirements of advanced health assessment, pathophysiology and pharmacology are not necessary for all MSN programs. There may be programs which would find such content useful, but it is not necessary/required for those working in public/community health.
II. Organizational & Systems Leadership	p. 6, para 1, line 6-7: At the MSN level, the focus is on a clinical population or groups within the community but practice to a ‘target population, a set of populations or a broad community” implies population/community-focused care, which is at the specialty PHN practice level. Change wording to “…a panel of clients and clinical populations. “ p.5, para 4, line 6: Delete ‘and communities”, as comprehensive care to communities is at the specialist PHN practice level. This change in wording will then align with the stated Outcomes on p.7-8.
VI. Healthcare Policy for Advocacy in Health Care	p. 20, Outcomes: #1 is at a very high level. The skill of policy analysis is a specialist level skill. Rather, at the MSN level, the nurse needs to be policy competent, and able to assess the impact of health care policy on clinical practice and make recommendations for changes to support practice and improve clinical outcomes.
VII. Interprofessional Collaboration for Improving Pt & Pop Health Outcomes	p. 22, para 1, line 2 & p.23, para 1, line 10: The use of “population health outcomes” implies population-focused practice, rather than the community/population-based care described in the Framework.
VIII. Clinical Prevention & Population Health for Improving Health	p. 25, para 3, line 3: Change wording to population-based care to be consistent with the Framework p. 25, para 3, line 4: Change wording to identified clinical populations p. 25-26: Worded at a PHN specialist level (not micro system); would not be achievable at MSN level programs, as outlined here. p. 26, Objectives 1-5: All of the Outcome objectives need to eliminate the term identified population and replace with Clinical populations. p. 26 Sample Content: Needs to be at a basic level, and applied with Clinical populations and not populations in the public health definition.
X. Master’s Level Practice	p.31-32, list of objectives: #8: Change client population to clinical population #9 Change population to clinical population #17 Delete communities from the list of target populations of care, as this is related to specialist level practice
Glossary	p. 38: Definition of patient – delete community and population level. See Talking Points #2