PHILADELPHIA — The primary care doctor of nursing practice (DNP) program at Johns Hopkins University is being revamped to integrate clinical practice experience into the curriculum with a view to improve learning, ease the burden on preceptors, and better prepare students for the workforce.
With clinical experience incorporated throughout the course of study, “students have time to process what they’re learning. They have more time to learn more theory to apply and refine their experience,” said JoAnne Silbert-Flagg, DNP, assistant professor and clinical coordinator of the MSN program at Johns Hopkins in Baltimore.
When all the clinical experience is gained at the beginning of the program, students can “lose their skills if they don’t have to apply them over the next 2 years,” she explained.
The revamped approach will start this fall.
All nurse practitioners must complete a master’s or doctoral degree and advanced clinical training, but the way that training is timed and administered varies widely among programs. And practitioners and educators generally agree that the 500-hour requirement for precepted clinical practice is not enough.
Dr Silbert-Flagg and her colleagues formed a task force to develop a postbaccalaureate DNP curriculum and conducted a market analysis of other academic nurse practitioner programs and healthcare organizations.
Clinical Practicums
The revamped DNP curriculum distributes precepted clinical practicums over five semesters instead of the more typical two or three semesters, Dr Silbert-Flagg reported during a poster session here at the American Association of Nurse Practitioners 2017 National Conference.
The clinical experience begins with a second-semester health assessment, which is followed by a competency-based simulation course that applies the tenets of health assessment. The remaining clinical hours include 1 day a week of precepted clinical practice in semesters four, five, and six, increasing in intensity and complexity to 2 days a week in semesters seven and eight.
At other universities, clinical practicums are “either front-loaded or back-loaded,” she explained. “We didn’t find another program that resembles what we did.”
There are some gaps before students graduate, so I like how this approach allocates clinical hours throughout the entire program.
In addition to giving students time to process information, the new approach also greatly eases the burden on preceptors — who are often in demand — and better accommodates the outside work commitments of students.
“It’s very challenging for every school to get preceptors to work one-on-one with students,” she said. “There are a lot of clinical sites to find and clinical hours needed. If we spread them out, it’s easier to find a site.”
The curriculum redesign also offers students more time to explore specialties, which could make them more marketable after graduation and could benefit patients.
Dr Silbert-Flagg’s poster received a steady stream of attention from conference attendees.
This approach reminds Barbara Siebert, DNP, director of student health services at University of the Sciences in Philadelphia, of the way her own nurse practitioner curriculum was designed in the 1980s.
“The challenge is preparing someone to be a nurse practitioner in 3 years, as well as give them all the research courses for the DNP,” she told Medscape Medical News.
With this new approach, it appears that all the research courses and clinical practice can be integrated “in 2 full years plus two more semesters in the third year. We have come full circle,” Dr Siebert said.
“We struggle with DNP students and their clinical experience,” Susan Copp, EdD, a clinical instructor at the University of Illinois College of Nursing in Peoria.
“There are some gaps before students graduate, so I like how this approach allocates clinical hours throughout the entire program,” Dr Copp told Medscape Medical News. “This makes it more doable and relevant to students.”
Dr Silbert-Flagg, Dr Siebert, and Dr Copp have disclosed no relevant financial relationships.
American Association of Nurse Practitioners (AANP) 2017 National Conference. Presented June 24, 2017.
Follow Medscape Nurses on Twitter @MedscapeNurses and Maureen Salamon @maureensalamon
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