Call to Action – Doctorate Nursing Program at Elms Responds to Workforce Needs

Healthcare is changing rapidly due to reforms in the system, the aging population, and the growing number of patients with more than one condition or disease who often have complex medical needs. As a result, national nursing associations have called for nursing schools to expand their programs.

To that end, Elms College last year became the second school in Western Mass. to offer a Doctorate of Nursing Practice degree, or DNP.

“The development of the program was motivated by the increased complexity of today’s healthcare environment, the national call for improved preparation of nurses in leading advanced nursing practice, and the current and future workforce needs,” said Kathleen Scoble, dean of Elms’ School of Nursing and a professor of Nursing. “We listened hard and well to our community of nursing and healthcare leaders who earnestly told us of an increased need for advanced-practice nurses to provide care and assume future roles in their systems.”

Scoble said that, historically, Elms has developed new programs when it has become apparent there is or will be a gap in the nursing workforce.

She told HCN that the college began meeting with representatives from clinical program teams at Baystate Medical Center and Berkshire Medical Center in 2012, which led to the formation of academic partnerships. The centers helped Elms tailor its new program, and both facilities feel it is important enough that they each agreed to fully fund eight scholarships before it was launched.

“Although it’s possible to become certified and licensed as a nurse practitioner with a master’s degree, the healthcare environment has become so complex that nurse practitioners need a broader range of knowledge and skills in clinical practice as well as in leadership and organizational expertise,” Scoble said, adding that the doctorate degree fulfills those needs.

“Baystate Medical Center and Berkshire Healthcare Systems are looking for nurses educated to the highest level with new skills and competencies to manage diverse populations with different diseases and conditions,” said the co-director of the DNP – Program Operations and associate professor of Nursing, adding that leaders from these organzations cited an aging workforce, a dearth of primary care physicians in Western Mass., and the challenge of attracting and retaining new ones, as well as the changing healthcare landscape as reasons why the need for these professionals will continue to rise.

“They’ve been talking with us about the future of healthcare in our area and how these nurses will be needed to fill the gap in hospitals, clinics and other outpatient settings,” she noted, explaining that the DNP program differs from a traditional Ph.D. nursing degree because it integrates coursework and practical experience that allows graduates to use their knowledge in clinical settings, rather than in research.

Elms College is one of 400 schools of nursing across the nation that has created a DNP or has plans to start one; the only other school in Western Mass. offering the course of study is UMass Amherst.

For this issue and its focus on healthcare employment, HCN talked with officials at Elms about the program and what it means for the school and the region’s healthcare community.

Elms has created other programs in the past to meet the needs of the local community and workforce. It launched a bachelor’s degree in nursing in the ’80s, and in 2011 Scoble created an ‘Accelerated Second Degree in Nursing’ program designed for people who want to change careers and already have an associate’s, bachelor’s or higher degree in a non-nursing major. It takes 20 months to complete, and graduates are eligible to sit for the national Council of State Boards of Nursing Licensure Examination for registered nurses.

“People have enrolled who were working in careers that range from teachers to librarians,” Kuta Reske explained.

The DNP is the school’s latest venture, and it was launched last September with a class of 41 students after a highly competitive admission process. Eligible candidates must have a bachelor’s degree in nursing or a master’s degree in nursing education or leadership, and have worked as a nurse for at least a year. However, Kuta Reske said the candidates who were accepted into the program have five to 15 years of experience.

“Our students are amazingly qualified and have worked in positions that ranged from the emergency room to critical care, community hospitals or home care. They are a diverse group but each of them want to help fill the gap,” Kuta Reske said. “It’s a perfect degree for them because it combines nursing expertise with new knowledge and competencies in specialized areas.”

Candidates with a bachelor’s degree must earn 81 credits, which takes three years, while those with a master’s degree earn 68 credits in 2½ years. The course runs year-round, with scheduled breaks between semesters, and was designed to allow students to continue working while they are in school.

“The classes are held on campus in the late afternoon or evening one week, then switch to online sessions the next week, said Kuta Reske. “The continual rotation helps students to balance their lives.”

When they enter the program, students choose to enter one of two tracks: they can get a doctorate degree as an adult-gerontology acute-care nurse practitioner or as a family nurse practitioner.

Each track requires 900 hours of clinical work in their field, as well as countless classroom hours, but before they work with actual patients, they spend 100 hours practicing their newly learned skills in a simulation center.

The semesters vary in length and run for eight to 15 weeks, and Scoble said part of what makes the program exceptional is the fact that it has two directors who complement each other by combining administration, teaching, and advanced clinical practice.

They include Kuta Reske and Jean Pelski, who oversees the coursework and helps place nurses in clinical settings. In addition to being director of the DNP – Advanced Clinical Practice, she works as a neonatal nurse practitioner at Baystate Medical Center and is an associate professor at the college.

Graduates must pass a certification and licensing exam, but once they achieve that goal, they can expect to earn $85,000 to $130,000, depending on their place of employment and level of experience.

But Kuta Reske told HCN the main reasons many nurses want the degree is because it gives them the credentials needed to fully utilize their experience and skills.

“It levels the playing field with other healthcare professionals who have doctorate degrees, such as pharmacists and physical therapists,” she explained. “Plus, these students are well-versed in how to introduce change, whether they are working in a hospital or physician’s office.

“Organizations are trying to find new ways to run healthcare businesses in a more cost-efficient manner, and doctors of nursing can help with that,” she went on as she spoke about business courses included in the curriculum that pertain to financial management. “Students learn how revenue is generated in healthcare and are able to translate their knowledge into practice and put cost-effective methods into place.”

Scoble concurred, and said the curriculum includes classes in leadership, finance, quality, and other areas identified as essential for nurses in these roles, who could lead teams of healthcare professionals in an ambulatory care environment or become a director or manager of clinical service.

In addition to business skills, students are also schooled in the college’s tradition of caring. To that end, the doctoral candidates are required to take classes in ethics, religion, and social justice and spend time providing free healthcare to the homeless via the Elms College Care Van which goes into the community two days a week.

“We teach students how to work with technology while giving patients the attention they need,” Kuta Reske added, noting that they need to focus on the person they are treating while they work on a computer or retrieve data.

“It’s a skill set that requires balance,” she continued, explaining that it’s important for graduates to establish trust with patients so they follow directions and take an interest in their own health care. And since teamwork is involved in many settings, students are given group projects and assignments that simulate the environment they will encounter in the workforce.

“We listened to local leaders in the healthcare field when we created this program and asked what type of employees they will need and what type of delivery system they are using,” Kuta Reske said, adding that Scoble was appointed to the board of trustees at Baystate Medical Center after the DNP program began and is the first nurse to hold a seat.

The positions people with DNP degrees will hold in the future could range from a hospitalist to running a specialty clinic.

“It’s an emerging field that allows nurses to practice to the full extent of their knowledge and training,” Kuta Reske said. “As the political environment changes and healthcare reform takes place we are preparing students to manage diverse populations. When this class graduates in 2017 they will lead the way for other nurses to go back to school and become educated at the highest level.”

Scoble agreed, and said Baystate and Berkshire medical centers will continue to work with Elms on the curriculum, capstone projects, and other areas.

“The academic partnerships were designed to include many elements that justify the program’s need and will enhance it so students can help advance goals for quality practice and health care delivery,” she said. “We believe our new program will significantly contribute to the current and future need for advanced practice providers, specifically the growing gap in primary care and adult acute gerontology. Our approach was intentional: we wanted to make sure our program would be of the highest quality, enhanced through collaboration with practice partners. We’re proud to have partnered with Baystate Health System and Berkshire Health System, who both provide scholarships for selected nurses within their systems.”

Which speaks well to relationships being formed in Western Mass. to ensure the workforce of the future will be well-educated and able to accommodate the changing face of healthcare.