Volume 17, Issue 2, July 2006
The Nurse Practitioner SIG Newsletter is underwritten through a grant from Amgen Inc.
     
Coordinator's Message
Make Your Opinion Known About the Doctorate of Nursing Practice


Wendy H. Vogel, MSN, FNP, AOCNP®
Bristol, TN
wvogel@charter.net


Hello, Nurse Practitioner (NP) SIG members!

We had a great Congress in May, and I look forward to seeing all of you again in Pittsburgh in November at the Oncology APN Conference.

This issue of our newsletter is devoted to the doctorate of nursing practice (DNP) issue that is so pertinent to us as NPs. Barbara Gobel, RN, MS, AOCN®, the Clinical Nurse Specialist SIG coordinator ex officio, and I have put together a literature review of the DNP issue that was handed out at our SIG meeting at Congress and also is included in this newsletter. We have solicited some opinions from various members of our SIG for your perusal as well. Numerous names were collected and presented to the ONS Board of Directors at the Town Hall Meeting in opposition of the DNP and requesting support of the Board for the issue by approving a statement against the DNP or a white paper expressing our concerns.

To review our meeting minutes, click here.

We all have busy, stressful, and sometimes overwhelming lives. We are so busy that we forget to take time out to care for ourselves. We assume that someone else in leadership is going to look out for our best interests, but we cannot keep our heads in the sand. If you do not speak out for your profession, someone else will determine your future—someone who may not know what you do and why you do it every day or someone who may not have your best interests at heart. No, I am sure you don't have much time to e-mail the American Association of Colleges of Nursing (AACN), your NP professional group, the American Nurses Association, or the ONS Board of Directors. I don't either. But don't let yourself become one of the "silent majority" who plod along working hard, too busy to look to the future. An important piece is missing from what the AACN has proposed for our profession: input from the most important stakeholders, practicing NPs—you! Whatever your opinion is, let it be known.

 
The Nurse Practitioner SIG Newsletter is produced by members of the
Nurse Practitioner SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  July 2006
 
   

Editor’s Message
Your Comments About the Doctorate Are Welcome

Barbara Biedrzycki, MSN, AOCN®, CRNP
Baltimore, MD
npbiedrzycki@aol.com


ONS has granted us special permission to publish a double-sized issue for this newsletter because of the importance of the doctorate of nursing practice (DNP) issue, including the controversy surrounding its conception and planned implementation. Although we are unable to include everyone's opinions about the DNP, we believe that you will find that authors have provided varied content that stimulates thought, dialogue, and action.

If you would like to share your comments or offer a rebuttal to the opinions expressed by the authors, please do not send it directly to the authors but rather e-mail it to me at NPBiedrzycki@aol.com and Coordinator Wendy H. Vogel, MSN, FNP, AOCNP®, at wvogel@charter.net. The letters will be summarized and shared collectively and anonymously with the authors. If we are considering publishing a letter to the editor for a future newsletter, you will be contacted directly with a request for your permission.

 
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Special Interest Group Newsletter  July 2006
 
   

The Doctorate of Nursing Practice
Synopsis of Literature and Practicing Advanced Practice Nurse Concerns

Wendy H. Vogel, MSN, FNP, AOCNP®
Bristol, TN

Barbara Gobel, RN, MS, AOCN®
Chicago, IL


What Is the Doctorate of Nursing Practice?
The doctorate of nursing practice (DNP) degree has been proposed by the American Association of Colleges of Nursing (AACN) as an alternative to a traditional PhD (Fitzpatrick, 2003; Lenz, Mundinger, Kane, Hopkins, & Lin, 2004) and suggested to be the entry level degree for advanced nursing practice by 2015. The DNP would be the terminal professional degree representing the highest level of clinical competence (Sperhac & Clinton, 2004) and a higher level of overall knowledge and responsibility with the same accountability and scope of practice as other clinical doctorates (Mundinger, 2005). The DNP is considered a clinical or practice-oriented doctorate and involves skills beyond the baccalaureate degree without the necessity of an intermediary master's degree (Clement, 2005). Other examples of this first professional doctoral degree include the doctor of medicine (MD) and the doctor of pharmacy (PharmD). The DNP is intended as entry into practice by the 2015.

Timeline

1979: The first practice-focused doctoral degree originated at Case Western Reserve University (Lenz et al., 2004; Sperhac & Clinton, 2004). Since then, several doctoral programs emerged with a variety of titles, including the nursing doctorate (ND), doctor of nursing practice (DNP and DrNP), doctor of nursing science (DNS and DNSc), and doctor of science in nursing (DSN) (McEwen & Bechtel, 2000). Results from a survey of 78 doctoral programs (McEwen & Bechtel) showed a shift away from clinical doctorates to research doctorates, although few differences exist in the research focus of doctoral nursing programs.

2000: Mary Mundinger (Mundinger & Kane, 2000) published a randomized study in JAMA showing that nurse practitioners (NPs) (prepared at a master's level) provided care that is at least equivalent to that of a physician.

2001: The University of Kentucky founded the first DNP, but a different model than proposed by Mundinger and Kane (2000).

January 2001: Formal discussions among varied organizations regarding the practice doctorate were initiated at the AACN Doctoral Conference (Sperhac & Clinton, 2004).

March 2002: The AACN charged an 11-member task force with examining the status of current clinical or practice nursing doctorate programs in the United States and with making future recommendations. All of the members were in academia, with the exception of one, who was the AACN staff liaison. For two years, in partial collaboration with the National Association of Nurse Practitioner Faculties (NONPF), the task force worked on the issue.

January 2003: Limited discussions at AACN's doctoral education conference

February 2003: A webcast conference with NONPF and AACN was held regarding the practice doctorate (Sperhac & Clinton, 2004).

March 2003: Master's Education Conference open discussion

December 2003: AACN cosponsored with NONPF an open discussion on practice doctorates with representatives from key nursing organizations and schools of nursing with present or planned practice doctoral program.

The National Forum on the Practice Doctorate, an invited event, was held in Washington, DC (AACN, 2004). Representatives from 25 national nursing organizations and 16 academic health centers attended, including American Academy of Nurse Practitioners, American Association of Nurse Anesthetists, American College of Nurse Midwives, American College of Nurse Practitioners, American Nurses Association, American Nurses Credentialing Center, National Association of Clinical Nurse Specialists, National Association of Nurse Practitioners in Women's Health, National Association of Pediatric Nurse Practitioners, National Council of State Boards of Nursing, and National League for Nursing. The minutes from this meeting were not distributed to the attendees or the larger nursing community.

February 2004: Limited discussion took place at AACN's doctoral education conference. An invited external reaction panel, with 10 people representing a wide array of perspectives and disciplines outside of nursing, was convened to draft a position statement about the practice doctorate. The external reaction panel included representatives from the National Quality Forum, National Academy of Sciences, American Organization of Nurse Executives, Association of Academic Health Centers, Department of Veterans Affairs, Yale University Law School, Council of Graduate Schools, and Association of American Medical Colleges.

October 2004: AACN endorsed the position statement on the practice doctorate in nursing (AACN, 2004).

AACN member institutions voted to move the current entry level to advanced nursing practice (master's degree) to the doctorate level by 2015. This passed by a margin of 160 "for" and 106 "against," with only about 53% of eligible schools voting. Only those in attendance were able to vote, despite a membership of more than 500 schools (Fulton & Lyon, 2005; National Association of Clinical Nurse Specialists, 2005). Dean-approved representatives, such as associate deans attending in place of a dean, were not permitted to vote. No proxy voting or absentee voting was permitted (Fulton & Lyon).

March 2004: Limited discussion at AACN's annual spring meeting

January 2005: The AACN Doctoral Education Conference was held.

April 2005: The National Association of Clinical Nurse Specialists (2005) published a white paper on the nursing practice doctorate, describing multiple reasons for their decision to not support the DNP proposal.

June 2005: The American College of Nurse Midwives (2005) Division of Accreditation Governing Board affirmed the DNP as one option for some nurse-midwifery programs but does not support the DNP as a requirement for midwifery education.

The American Association of Nurse Anesthetists (2005) held a summit about the DNP, and it determined that it had no support to move nurse anesthesia education to the doctoral entry level by 2015.

October 2005: The American Academy of Nurse Practitioners (2005) published a discussion paper on the DNP, acknowledging that although transitioning to the clinical doctorate might be worthwhile, present master's-prepared NPs must not be disenfranchised or denigrated in any way. It also affirmed that care given by present master's-prepared NPs is safe and high quality.

November 2005: Eight DNP programs and two DrNP programs are accepting students in the United States.

January 2006: The Pennsylvania State Nurses Association (2006) published position statement against the DNP proposal.

March 2006: Although much controversy exists about the issue and it has no national consensus, AACN has moved forward with its proposal. The Commission on Collegiate Nursing Education has taken a position that it will only accredit DNP programs, not DrNP programs. The National League of Nursing Accreditation Commission's position is that it will accredit practice doctorate programs regardless of title.

Table 1. American Association of Colleges of Nursing's Proposal Rationale and Concerns of Practicing Advanced Practice Nurses
American Association of Colleges of Nursing’s Rationale
Concerns
Parity of status with medicine, pharmacy, psychology, and academicians in other fields by raising the level of academic preparation for clinical teaching and expert clinical practice to doctorate level (Dracup et al., 2005; Fitzpatrick, 2003; O’Sullivan et al., 2005). Nurses holding the doctorate of nursing practice (DNP) would be prepared and credentialed as independent practitioners like other professional disciplines such as pharmacy, psychology, and medicine, which would blur traditional titles such as doctor and nurse (Marion et al., 2003).
  1. Medical backlash may occur as economic competition among providers is perceived or actually occurs (American Association of Nurse Anesthetists, 2005; Marion et al., 2003).
  2. The legal use of the title “doctor” varies from state to state (National Organization for Nurse Practitioners [NONPF], 2003).
  3. The DNP would not change regulations at the onset. As noted previously, state nurse practice acts would have to be opened and changed (Fulton & Lyon, 2005; Sperhac & Clinton, 2004).
  4. Hospital admitting privileges would still have to be reviewed and approved by hospital medical boards (Mundinger, 2005).
  5. Independent prescribing privileges would be the prerogative of the state and payers (Mundinger).
  6. Multiple degree models exist for other disciplines, even medicine, dentistry, and veterinarians (Dreher et el., 2005; Tumolo, 2003).
  7. It is important to examine whether the movement to the practice doctorate in other disciplines has improved patient outcomes. Parity should not be important if the result is not an improvement in healthcare outcomes (Fulton & Lyon).
Development of nurse scientists and researchers, with research originating from practice (Ellis & Lee, 2005)
  1. The DNP may threaten the meager supply of PhD-trained active researchers, leading to decreased evidence for which to base nursing practice and, thus, defeating one of the premises for creating the DNP (Dreher et al.; Fulton & Lyon; Meleis & Dracup, 2005).
  2. Fewer than 500 nursing PhD students graduate yearly (Dracup & Bryan-Brown, 2005).
  3. Nursing traditionally has sought graduate degrees at later ages than in other disciplines (Dracup & Bryan-Brown).
  4. Investigating whether the movement to a practice doctorate in other disciplines has recruited potential PhD students away from research careers in that discipline is important (Fulton & Lyon).
Acquisition of practice doctorate as entry level into advanced practice by 2015 (American Association of Colleges of Nursing, [AACN] 2004)
  1. Entry level into nursing practice has not yet been established (Dracup & Bryan-Brown).
  2. The master's degree has become increasingly recognized as the degree for all advanced practice and faculty roles and is the one degree that most (including state boards of nursing) are able to agree on (Dracup & Bryan-Brown).
  3. More than 106,000 NPs are practicing currently in the United States (American Academy of Nurse Practitioners [AANP], 2004). Eighty-eight percent have graduate degrees, and only 4% have doctorate degrees (Sperhac & Clinton). Ninety-five percent are female, and the average age is 48 (AANP). More than 69,017 CNSs are practicing currently in the United States, and 14,643 individuals are qualified to work as CNSs or an NPs. Expecting that a sufficient number of clinical doctorate programs to accommodate all of these APNs is unfeasible (Sperhac & Clinton).
  4. Current master's-prepared APNs may be disenfranchised (Carlson, 2003; Dracup & Bryan-Brown; Marion et al.) and grandfathering is imperative, although grandfathering may be applicable only as long as practitioners remain in the state where they are licensed currently (Carlson).
  5. APNs who choose not to pursue the DNP potentially may lose their employment (Fulton & Lyon).
  6. Ultimately, individual state boards of nursing will mandate the degree for licensure eligibility (Sperhac & Clinton). This requires opening up each state's nurse practice act, inviting the attention of stakeholders who wish to limit or diminish existing scopes of practice (Fulton & Lyon).
  7. The cost of further education is unlikely to be rewarded with a commensurate higher salary (Carlson; Fulton & Lyon). DNP graduates also may not be affordable to employers and third-party payers (Carlson).
  8. The timeline is not even supported by the NONPF (2005). A suggested 25-year timeline was viewed as more realistic by the American Association of Nurse Anesthetists (2005).
  9. Some may assume that all DNP graduates will be prepared as NPs. NP and CNS title must remain protected and all APN roles must be recognized (O'Sullivan).
  10. The proposal is for a single practice doctorate that would include many roles of advanced practice such as CNSs, NPs, nurse anesthetists, and nurse midwives (Fulton & Lyon).
A terminal practice degree (the doctorate) is required to prepare nurses for the complexities of clinical advanced nursing practice today, and the DNP would provide NPs with a higher level of knowledge that could advance clinical practice, enhance leadership skills, and provide greater career goals and flexibility (Dracup & Bryan-Brown; Lenz, 2005; Mundinger et al., 2000; O’Sullivan). Patients need more advanced care than graduates with current APN education can provide (Mundinger) because of the complexity of patients and continuous advances in care.
  1. No evidence-based research has shown that doctorally prepared APNs will provide safer, better, or equal care to master's-prepared APNs (Ellis & Lee).
  2. The implication is that master's-prepared APNs are unsafe, contrary to the growing body of evidence that master's-prepared APNs provide cost-effective and quality care (Ellis & Lee; Fulton & Lyon; Lenz).
  3. No harm data about care provided by master's-prepared APNs have been filed with the American Nurses Association malpractice data bank (Fulton & Lyon).
  4. The nature of additional knowledge in the DNP curricula versus the knowledge in the present master's-level curricula is not known (Fulton & Lyon).
  5. No essential empirical and theoretical underpinnings exist to argue in favor of the DNP (Fulton & Lyon). Just as practitioners are required to provide evidence-based practice, so should academia provide an empirical basis for decisions about doctoral provision (Ellis & Lee).
  6. The DNP should be researched over time and outcomes examined longitudinally (Fulton & Lyon).
  7. The debate has taken place primarily within association and academic meetings, not with practicing clinicians and specialty organizations such as ONS (Dracup & Bryan-Brown).
Nurses with the DNP as a terminal practice degree could address the current and projected shortage of nursing faculty (Dracup et al.; Fitzpatrick; Lenz; NONPF, 2003).
  1. The widespread initiation of DNP programs could drain faculty and budgetary resources (Dreher et al.; NONPF).
  2. The cost of moving to the proposed DNP is not known (Fulton & Lyon).
  3. The definition of the DNP suggests that more will be required of students than in PhD programs, potentially devaluing the PhD (Clement, 2005; Ellis & Lee).
  4. On the contrary, the DNP may not have the academic equivalence, status, and currency of the PhD (Clement; Ellis & Lee).
  5. DNP graduates who practice in academia may be marginalized (Cartwright & Reed; Dreher et al.; Fulton & Lyon; Gennaro, 2004; National Association of Clinical Nurse Specialists, 2005). Some question whether DNP graduates who leave clinical practice for academia would be eligible for tenure-tract faculty positions, thus excluding them from academic Senates and having a voice in decision making regarding educational and faculty policies (Dreher et al.; Fulton & Lyon).
  6. Currently, the AACN annual report shows that only 49.7% of nursing professors in baccalaureate or higher nursing education currently are prepared at the doctoral level (AACN).
  7. Nationally approved standards mandate that preceptors must have a degree greater than that of their students (Clement; Fulton & Lyon). This raises concern over who will teach and precept in DNP programs, given the lack of existing professionals with the credentials.
  8. The DNP may not adequately prepare graduates to teach, as the proposal for the DNP is not to ground students in the philosophy of science (or metatheoretical) issues that define the nature of nursing practice and research (Fulton & Lyon).
  9. The need for preceptors for DNP students will pull doctorally prepared nurses in yet another direction (Fulton & Lyon).
An opportunity for shared learning results from interprofessional focus, collaboration, and communication across disciplines (Ellis & Lee; NONPF, 2003).
  1. The DNP may enlarge the gap between academia and clinical nursing and increase the discord already present in the profession (Dracup & Bryan-Brown).
  2. The title of the terminal degree is already being debated: AACN is recommending the DNP, whereas NONPF is recommending the DPN (Fulton & Lyon; O'Sullivan).
The availability of a practice-oriented doctorate will attract “highly capable” individuals to the field, thus increasing the workforce (Lenz). At present, prospective graduate students from other fields may shy away from nursing because it does not offer a comparable credential after four years of professional preparation like pharmacy or medicine (Marion et al., 2003). The high number of credits needed for a master’s degree in the advanced nursing curricula exceeds the amount required for master’s degrees in other disciplines (Dracup et al.,; Lenz; O’Sullivan; Sperhac & Clinton).
  1. When nursing programs adopt the DNP, it will unnecessarily extend the length of time it takes to become an APN (Dracup & Bryan-Brown).
  2. None of the suggested models are less than two years, full time, in length (from master's in nursing to DNP), and models from high school graduate through DNP are eight to nine years long (Marion et al., 2005).
  3. Course requirements for DNP programs suggest duplication of content already found in existing CNS programs. Most CNS curriculum is such that as many as 30 master's credits may be counted toward a PhD in nursing (Fulton & Lyon).
The DNP should provide ideal preparation and credentialing for clinical teaching. Currently, most undergraduate faculty are master’s-prepared individuals who do not qualify for full faculty status because they have not earned a terminal degree in the discipline.
  1. The very definition of the DNP is not clear because even existing programs are vastly different (Ellis & Lee; Fulton & Lyon). Already some are debating that the DNP should not be the only practice doctorate degree model offered (American Association of Nurse Anesthesists, 2005; Dreher et al.).
  2. Great potential exists for more confusion (collegial and public) regarding the merits, equivalences, and differences among the different forms of doctoral qualifications (Dracup & Bryan-Brown; Ellis & Lee; Gennaro).
  3. The DNP is not universally endorsed by colleges and universities with graduate nursing education programs (Dreher et al., 2005).
  4. Some fear that many master's nursing programs will close (Dreher et al.).
  5. Few college faculties may be willing to amend their charters to permit nursing to offer its first doctoral degree, especially a professional doctorate (Dreher et al.).
  6. The number of educational institutions preparing APNs may decrease because many existing programs will close if not permitted by state statute to offer doctoral education or lack the fiscal or faculty resources to do so (Fulton & Lyon; Lenz; NONPF, 2003; O'Sullivan). This would result in a decrease number of APNs providing much needed care.
Improvement in healthcare delivery by addressing the complexity of health care today (Dracup et al.; Lenz; Marion et al., 2005; Mundinger; Sperhac & Clinton)
  1. No evidence exists that the DNP will improve access to care, cost of care, diversity of providers, or quality of care (Dracup & Bryan-Brown).
  2. The debate is ill timed because nursing currently has a critical shortage of nurses, difficulty with retention, and threats to quality and safe care (Meleis & Dracup).

Recommendations
  • Carefully examine why change is needed (Cartwright & Reed, 2005; Clement, 2005).
  • Move slowly.
  • Encourage input from public.
  • Encourage input from other types of healthcare professionals.
  • Encourage input from state boards of nursing.
  • Bring academians and practitioners together and listen to one another (Olshansky, 2004).
  • Examine other fields that have moved to clinical doctorates, such as audiology, physical therapy, and pharmacology for the impact on improved patient outcomes, increases in salary, and enhanced enrollments in these programs (Fulton & Lyon, 2005). Also examine whether the clinical doctorate recruited potential PhD students away from research careers in these disciplines.
  • Systematically evaluate the outcomes of the DNP (Olshansky, 2004).
  • If universities decide that the DNP is important for nursing, build the DNP as a post-master's degree. This will allow APNs the flexibility to select a doctoral program that meets their career goals (Dracup & Bryan-Brown, 2005). It also would allow states with regulatory language mandating the master's of science in nursing for advanced practice to consider the issues, particularly in relationship to the issue of "grandfathering" the already thousands of nurses certified in advanced practice (Fulton & Lyon, 2005).

References

American Academy of Nurse Practitioners. (2004). U.S. nurse practitioner workforce 2004. Retrieved February 9, 2006, from http://www.aanp.org/Practice+Policy+and+Legislation/Practice/NP+Workforce+Data+Survey+2004.htm

American Academy of Nurse Practitioners. (2005). Discussion paper: Doctor of nursing practice. Retrieved February 10, 2006, from http://www.aanp.org/NR/rdonlyres/eohypbva5ab2yefiszlbl3nttmi3czv2lojklfechu5w3le
cyuy6gmnn6ykpzv6xhjmropsmeo2wou3ebo6qhdsafgf/Doctor+of+Nursing+Practice+_
DNP_+Discussion+Paper.pdf

American Association of Colleges of Nursing. (2003). National forum on the practice doctorate. Retrieved February 10, 2006, from http://www.aacn.nche.edu/Education/pdf/ExecutiveSummary.pdf

American Association of Colleges of Nursing. (2004). AACN Position statement on the practice doctorate in nursing. Retrieved February 6, 2006, from http://www.aacn.nche.edu/DNP/DNPPositionStatement.htm

American Association of Nurse Anesthetists. (2005). Report of the American Association of Nurse Anesthetists' Summit on Doctoral Preparation for nurse anesthetists. Retrieved February 2006, from http://www.aana.com/professionaldevelopment.aspx?ucNavMenu_TSMenuTargetID=131&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1734

American College of Nurse Midwives. (2005). Midwifery education [Position statement]. Retrieved February 10, 2006, from http://www.midwife.org/siteFiles/position/Midwifery_Education_05.pdf

Carlson, L. (2003). The clinical doctorate—Asset or albatross? Journal of Pediatric Health Care, 17, 216-218.

Cartwright, C., & Reed, C. (2005). Policy and planning perspectives for the doctorate in nursing practice: An educational perspective. Online Journal of Issues in Nursing, 10(3). Retrieved February 6, 2006, from http://www.nursingworld.org/ojin/topic28/tpc28_6.htm

Clement, D. (2005). Impact of the clinical doctorate from an allied health perspective. AANA Journal, 73(1), 24-28.

Dracup, K., & Bryan-Brown, C. (2005). Doctor of nursing practice-MRI or total body scan? American Journal of Critical Care, 14, 278-281.

Dracup, K., Cronenewettt, L., Meleis, A., & Benner, P. (2005). Reflections on the doctorate of nursing practice. Nursing Outlook, 53, 177-182.

Dreher, H., Donnelly, G., & Naremore, R. (2005). Reflections on the DNP and an alternate practice doctorate model: The Drexel DrNP. Online Journal of Issues in Nursing, 11(1). Retrieved February 6, 2006, from http://www.nursingworld.org/ojin/topic28/tpc28_7.htm

Ellis, L., & Lee, N. (2005). The changing landscape of doctoral education: Introducing the professional doctorate for nurses. Nurse Education Today, 25, 222-229.

Fitzpatrick, J. (2003). The case for the clinical doctorate in nursing. Reflections on Nursing Leadership, First Quarter, 8-9, 37.

Fulton, J., & Lyon, B. (2005). The need for some sense making: Doctor of nursing practice. Online Journal of Issues in Nursing, 10(3). Retrieved June 23, 2006, from http://www.nursingworld.org/ojin/topic28/tpc28_3.htm

Gennaro, S. (2004). A rose by any other name? Journal of Professional Nursing, 20, 277-278.

Lenz, E., Mundinger, M., Kane, R., Hopkins, S., & Lin, S. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review, 61, 332-351.

Lenz, L. (2005). The practice doctorate: An idea whose time has come. Online Journal of Issues in Nursing 10(3). Retrieved June 23, 2006, from http://www.nursingworld.org/ojin/topic28/tpc28_1.htm

Marion, L., O'Sullivan, A., Crabtree, K., Price, M., & Fontana, S. (2005). Curriculum models for the practice doctorate in nursing. Topics in Advanced Practice Nursing eJournal, 5(1). Retrieved June 23, 2006, from http://www.medscape.com/viewarticle/500742

Marion, L., Viens, D., O'Sullivan, A., Crabtree, K., Fontana, S., & Price, M. (2003). The practice doctorate in nursing: Future or fringe? Topics in Advanced Practice Nursing eJournal, 3(2). Retrieved June 23, 2006, from hhttp://www.medscape.com/viewarticle/453247

McEwen, M., & Bechtel, G. (2000). Characteristics of nursing doctoral programs in the United States. Journal of Professional Nursing, 16, 282-292.

Meleis, A., & Dracup, K. (2005). The case against the DNP: History, timing, substance, and marginalization. Retrieved September 16, 2005, from http://www.nursingworld.org/ojin/topic28/tpc28_2.htm

Mundinger, M. (2005). Who's who in nursing: Bringing clarity to the doctor of nursing practice. Nursing Outlook, 53, 173-176.

Mundinger, M., Cook, S., Lenz, E., Piacentini, K., Auerhahn, C., & Smith, J. (2000). Assuring quality and access in advanced practice nursing: A challenge to nurse educators. Journal of Professional Nursing, 16, 323-329.

Mundinger, M., & Kane, R. (2000). Health outcomes among patients treated by nurse practitioners or physicians. JAMA, 283, 2521-2524.

National Association of Clinical Nurse Specialists. (2005). White paper on the nursing practice doctorate. Clinical Nurse Specialist, 19, 215-217.

National Organization of Nurse Practitioner Faculties. (2003). National Forum on the Practice Doctorate: Executive summary. Retrieved February 10, 2006, from http://www.nonpf.org/ExecSummary120803.pdf

National Organization of Nurse Practitioner Faculties. (2005). Practice doctorate resource center: Frequently asked questions. Retrieved February 6, 2006, from http://www.nonpf.com/cdfaqs.htm

Olshansky, E. (2004). Are nurses at the table? A new nursing degree could help. Journal of Professional Nursing, 20, 211-212.

O'Sullivan, A. (2005). The practice doctorate in nursing. The Mentor: The NONPF newsletter, 16(1), 1-2, 12.

O'Sullivan, A., Carter, M., Marion, L., Pohl, J., & Werner, K. (2005). Moving forward together: The practice doctorate in nursing. Online Journal of Issues in Nursing, 10(3). Retrieved June 23, 2006, from http://www.nursingworld.org/ojin/topic28/tpc28_4.htm

Pennsylvania State Nurses Association. (2006). The position statement of the Pennsylvania State Nurses Association on the doctorate of nursing practice. Retrieved February 10, 2006, from http://www.panurses.org/site/resources/Position/positions.cfm?filename=position6.htm

Sperhac, A., & Clinton, P. (2004). Facts and fallacies: The practice doctorate. Journal of Pediatric Health Care, 18, 292-296. Tumolo, J. (2003). Clarifying the clinical doctorate. Advance for Nurse Practitioners, 11(7), 83-84.

 
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Special Interest Group Newsletter  July 2006
 
   

Unity Is Needed Regarding Doctorate of Nursing

Kathy Sharp, MSN, APRN-BC, AOCNP®
Bristol, TN


Pure motive is captivating, inspirational, and idealistic; however, at times it is short sighted. Such is the case of the proposal by the American Association of Colleges of Nursing, the National Organization of Nurse Practitioner Faculties, and others. Their goal is to mandate a doctorate of nursing practice (DNP) as the entry level for nurse practitioners. The motive is touted to engender improved healthcare delivery; create parity of status with medicine, pharmacy, and academicians in other fields; promote the development of nurse scientists and researchers; and, ultimately, lead to the acquisition of improved recognition and respect as healthcare providers.

A dichotomy exists even in the ranks of some of the key leaders in nursing. Some promote the doctorate but acknowledge the difficulty with implementation. Others have stated it is a good idea but should not be mandatory. Still others have implied that those who do not support the mandatory doctorate simply are resistant to change. The truth is, change is a part of life, but it should not be one group's idea or dictated to others by the group with a vested interest in the change.

Although the American College of Nurse Practitioners and the American Association of Nurse Practitioners attended the December 2003 National Forum on the Practice Doctorate, the key players, advanced practice nurses (APNs), have not had an equal voice in this proposal. Even the American Nurses Association declined to comment or make a statement until their questions have been adequately answered. In all fairness, it is noted that Laura Pearson, editor-in-chief of Nurse Practitioner, invited commentary on the issue in her editorial in 2002. Were all of us asleep, or did we ignore it like the boy who cried wolf?

Multiple problems have been identified with implementation. Writers have acknowledged the current shortage of nursing faculty to teach doctoral students, the money and time associated with obtaining a doctorate, whether grandfathering in some form is feasible, and the confusion that having a DNP will create with our patients and the general public. This proposal, slated for implementation by 2015, has caused many APNs to suddenly realize that in only 10 years, they will be facing monumental changes. Many who are rapidly approaching retirement age say they will simply quit. We could be facing a mass exodus from advanced practice unless APNs are grandfathered in or some accommodation is made to facilitate inexpensive attainment of a doctorate degree. With the severe nursing shortage, the lack of nursing faculty at undergraduate and graduate levels, and the primary care provider shortage, how can this goal be attained?

Some have suggested that the medical profession will support a DNP. The fact is, the medical profession has not recognized nursing science and the American Medical Association (AMA) has fought advanced practice and independent practice by APNs at every turn. The AMA's argument will be, as it has been in the past, that APNs are just trying to become doctors. Opening up the Nurse Practice Act in every state will also endanger the legal status, authority, and privileges many nurse practitioners have worked years to attain.

Some leaders claim that the DNP improves preparedness for advanced clinical practice, but disagreement about this proposal still exists in the nursing ranks. Idealism is wonderful, but in this case it is misguided. Some of the nursing leaders are in dire need of a reality check, and nursing is in dire need of unity as a profession!

 
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Special Interest Group Newsletter  July 2006
 
   

Doctorate of Nursing Practice Should Be Optional, Not Mandatory

Edith Sielsch, MSN, AOCN®, CRNP
York, PA


The doctorate of nursing practice (DNP) should be an option for nurse practitioners (NPs) in clinical practice. It provides an opportunity for advanced professionalism in a specialized area of practice.

However, I have grave concerns about the DNP as entry level for NPs. First, I strongly believe that the added time and expense will discourage nurses from pursuing an NP role. The added expense for a marginal increase in compensation will not motivate nurses to pursue advanced credentialing. Numerous studies indicate that NPs currently are providing care comparable to physicians. No evidence suggests that the DNP will improve patient care, safety, or efficiency.

Second, we already have a shortage of nurses and nursing faculty. Currently, not enough nursing faculty exist for the numbers of nursing applicants. Who will serve as faculty for DNP programs? Faculty pay scales are so low that NPs will not be enticed to teach. Will it decrease the number of NPs who graduate each year? Will it impact the number of RNs graduating each year?

Third, I believe that the DNP as an entry-level requirement for NPs has not been researched sufficiently. Many questions need to be addressed. The ONS NP Conference had a session about the DNP on November 12, 2005. The questions and feedback at the session were overwhelmingly negative. NPs working in clinical practice must be included in the discussion.

Overall, I think that requiring the DNP as entry level for NPs will decrease the numbers of NPs providing care, which ultimately will affect the quality of care for our patients in a negative manner.

 
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Special Interest Group Newsletter  July 2006
 
   

Doctorate of Nursing Practice Will Make Me a Better Nurse

Karen Gilbert, MN, GNP, ANP, AOCNP®
Lopez Island, WA


I am interested in the doctorate of nursing practice (DNP) because I want to learn more about how to better serve my patients and community as a nurse practitioner (NP). I want to develop expertise in caring for the physical, emotional, and spiritual needs of patients with cancer as they travel down the path of treatment and post-treatment life.

When I graduated from my NP program, I did not feel a comfortable level of competence even though I believed that my education was as good as it could have been in a two-year program. And I must admit that I had chosen a broad focus to my education because I did not know what job I would be getting after graduation. I rightly assumed that my 19 years of hospice and home health nursing would sufficiently augment my education to allow me to function as an entry level NP with a good mentor. However, I would like to be bringing more real expertise to this job. I must admit I am embarrassed at times by my knowledge deficits.

I'll share with you the scenario I would have liked for my education. I would have graduated from my master's program, secured my employment, and started the job. Concurrently, I would have entered the optional DNP program to further my education in the areas I identified (I knew them at the time), and I would have used my job to fulfill the clinical practicum requirements of the program.

The course work would be part-time and online so I could work from home after hours, going in to school periodically to meet with my advisor, other students, etc. I would have been able to start work after the two-year program so I could afford the additional education I wanted.

I would like to be better at patient assessment, pharmacologic and nonpharmacologic disease management, discussions about genetic testing, evidence-based practice (especially how to rapidly lay my hands on information and evidence), and critical thinking. I'm willing to admit that these deficits may be unique to me, so I am reluctant to say that everyone must have a DNP to practice as a nurse practitioner. All I can say is that I would like the opportunity to develop the expertise I want through a formal program of education that allows me to keep my focus on my practice.

 
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Special Interest Group Newsletter  July 2006
 
   

Nursing Degrees Should Be Studied Across the Board

Carla Daniels, MSN, CNP, OCN®
Springfield, IL


Doctorate of nursing practice (DNP)—the words cause my blood pressure to increase and my respiratory rate to speed up. What are they thinking? Have they gone nuts? I don't want to go back to school again! But before I have that pending anxiety attack, maybe I should take a closer look at what they propose.

Four hours later, I am a little calmer but still not convinced that the DNP is the best route. Throughout the literature I reviewed, the DNP is referred to as a "terminal degree" for nurses. Personally, I have no particular problem with promoting a DNP as an advanced degree that should be considered by advanced practice nurses (APNs). And, actually, I would prefer that nurse educators responsible for teaching APNs possess DNP degrees.

For decades, nursing has struggled with the concept of entry-level degrees. Years prior to my entry into the nursing profession, I heard heated arguments over the bachelor of science versus diploma versus associate degree in nursing as entry level for basic nursing practice. The argument has yet to be resolved and, indeed, appears to have been shelved. Then came the struggle to have all NPs master's prepared in specific NP programs. Resolution came much easier in that situation. Most nurses and other healthcare professionals agree that NPs and other APNs should have a higher degree than that required for basic nursing practice.

Conversely, we now see universities offering expedited programs leading to the basic RN degree. Some of the programs allow minimal nursing exposure before the degree is granted. The nursing shortage is considered enough rationale to support this type of program.

The argument for the DNP degree as entry level for APNs is that nursing is becoming a highly technical and specialized field. However, the argument can be applied to all levels and areas of the nursing profession. Nurses just entering the field now need a higher level of expertise than ever before. They are caring for individuals who are more acutely ill with more complex problems and who are being treated with numerous medications that have complicated interactive patterns. I believe we are focusing our attentions and limited resources in the wrong area. We need to investigate the ability of some of the basic nursing programs to prepare students for their role in providing competent patient care. We need to set an entry-level degree for RNs. It is time to revisit this concept.

I believe that requiring APNs to have a DNP would cause too much disparity within the nursing profession. Entry-level nursing requires a two-year degree, whereas the next level requires a doctorate. Nursing needs many levels of expertise to provide quality health care at affordable prices to as many patients as possible. Before we jump at another set of "terminal degree" credentials, we should look at the requirements for nursing degrees across the board and take a practical approach to our educational requirement changes.

 
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Special Interest Group Newsletter  July 2006
 
   

Doctorate of Nursing Practice Raises Issues in Mandatory Terminal Education

Debi Selm-Orr, MS, CRNP, AOCN®
Florence, NJ


As I ponder the issue of the doctorate of nursing practice (DNP), I am reminded of a time when the American Association of Colleges of Nursing (AACN) was determining the entry level of practice to be the bachelor of science in nursing. This never happened because of resistance from nurses who had acquired their nursing degree from hospital programs or associate degree programs. State boards of nursing never agreed to the concept of one entry level. Now the AACN has turned to terminal degrees instead of entry level.

As I see this issue, I have four areas of concern: (a) the issue of defining the programs, (b) the issue of giving credit for previous programs, (c) who is to be the determining body of what is advanced practice and (d) last, but not least, why were we not asked about this?

Those of us who have spent as many as three years in master's and post-master's programs have much to lose. We have been told that the DNP will not be mandatory, but it will be the only program. Then, when I evaluate all of the programs that exist at this time, I find totally different programs. For example, the DNP at Drexel University in Philadelphia, PA, is a combined clinical and research program. The program at Rush University in Chicago, IL, is for nurse leaders. Academia can't decide on its definition of the DNP program.

Whether any credit will be given to us from our master's programs is not yet clear. When my husband went from a Master of Arts in Religion to a Master in Divinity, he was given credit for all of his passing classes. It meant that he was able to complete his degree in less time. Will nursing be as flexible? My cousin graduated from the last class at the Hospital of the University of Pennsylvania in Philadelphia. When she returned to the University of Pennsylvania to complete her bachelor's degree, she had to retake many of the same classes with the same professors. Nursing academia has not been kind with many of the transition programs that are developed.

The next issue is who will determine what credentials are necessary to practice? The last time I checked, it was the state boards. I haven't heard any thing from them yet. I know we are concerned about opening up nurse practice acts. This would have to occur in all states, and because none of the existing DNP programs are the same, who will determine the major competencies? It simply raises more issues than it resolves.

The last issue I have is, why were we not asked? Where were our specialty organizations when this topic was discussed, and why do I feel like this was crammed down our throats? We need more dialogue and more opportunity to operationalize the plan. Is it real? I think not.

I applaud those who wish to further their education. I have thought of entering a PhD or DNP program myself, but not when it is mandated.

 
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Special Interest Group Newsletter  July 2006
 
   

Can We Talk?
A Candid Conversation on the Doctorate of Nursing Practice

Wendy J. Smith, MSN, ACNP, AOCN®
Ripley, MS


I will not call this an "article." It is not based on nursing research or outcomes but rather on experience and passion for oncology nursing. I'd like to take a moment to have a candid conversation with you, my fellow SIG members. Will you grab a cup of coffee or tea and sit with me as we talk?

It seems as though it was just a few years ago when a handful of Nurse Practitioner (NP) SIG members developed a pamphlet to give to patients and third-party payers to define the role of the NP. The public didn't seem to fully understand what or who an NP was, nor did many oncologists. We'd hear comments like, "Does that mean you are practicing nursing?" But times are changing. I had the opportunity to attend a meeting of the Community Oncology Alliance in February, and I was so pleased to see a session on the role and value of NPs in oncology practices. The audience was, in large part, physicians! Just two years ago my own group had only two NPs. Now, we have seven and are feverishly looking for more. The role of the NP has come of age. This is so exciting for me because I have seen and experienced the transition first hand. In fact, in many ways, those of us who helped start and grow the NP SIG were the groundbreakers for NPs in oncology, which makes the current trend very rewarding. But, as exciting as this transition has been, many obstacles and barriers to our practices still exist—some are old, but many are new. The reason I wanted to take this opportunity to talk with all of you is to implore each of you to be more vocal, visible, and involved.

For most of us, our days are hectic and our schedules are crazy. We have families, patients, and stressors vying for our attention. As a result, we have to choose our battles selectively and, in many instances, have allowed others (e.g., American Nurses Association, American Association of Nurse Practitioners, ONS) to fight the battles for us, to represent us, to be our voices. And these organizations have done a great deal on our behalf. However, "the times, they are a-changing." With changes in Medicare reimbursement and the threat that third-party payers will follow suit, we cannot afford to be silent. We know the effect that changes are having on our patients and practice and the barriers to access to cancer care that are being erected. We are on the front line, in the trenches. How can we sit back and wait for forces in the Beltway to drive change when they don't fully appreciate the impact of these changes or decisions? In addition, many of us have fought long and hard to demonstrate that the care provided by NPs is of highest quality and comparable to physician care. Can we afford to sit back and allow a handful of individuals behind the walls of academia to say we need a doctorate of nursing practice, almost negating what we have proven (Mundinger, et. al., 2000)? Isn't it time we take action into our hands? I am not criticizing organizations or institutions as much as I am asking each of you to work with these organizations and speak up yourself. At times, we may disagree, but that's okay. The point is, if what the generals do in directing the war plan is not what works on the battlefield, someone has to tell them or we will lose the battle. I am calling in the reinforcements—that's you! Please educate yourself on the issues and make your position known. Call, write, e-mail, or visit your legislators, both state and national. Attend ONS SIG meetings and ONS town hall meetings whenever possible. If you are running into problems in your practice, network in the SIG, band together, and help each other out. Get involved with other organizations that are working on NP issues to help keep things on track. Please, be advocates not only for your patients, but also for your practice and your profession. Far too much is at stake to sit back and let others drive or decide our future!

Reference

Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., Cleary, P.D. et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. JAMA, 283, 59-68.

 
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Special Interest Group Newsletter  July 2006
 
   

Doctorate of Nursing Practice Enables Us to Look Forward

Barbara Biedrzycki, MSN, AOCN®, CRNP
Baltimore, MD


The concept of a doctorate of nursing practice (DNP), on first review, may sound misguided. Don't RNs currently have too many options? The diversity of educational options to become nurses is incomparable. What other discipline offers so many optional acronyms to place after our professional names? Have you heard the jokes about the nurses' alphabet soup of credentials? Most nurses don't even know what all of the credentials mean. Do NP, ARNP, CRNP, and APN-C really have the same meaning?

What determines whether I am a nurse practitioner (NP) and what I can do as an NP depends on my state's nurse practice act. I may or may not need a master's degree. I may or may not need to pass a national examination to be recognized by my state. Am I allowed to practice dependently, collaboratively, or independently? Our roles and our scopes of practice as NPs are determined geographically.

During debates with legislators or opposing lobbyists as to why NPs should have a certain "right," the issue of our varied educational preparation always seems to surface. We find ourselves on the defensive. For example, in Maryland, we have struggled for NPs to have the privilege of being listed as primary care providers (PCPs) on healthcare provider panels. Although we have served as "ghost" PCPs for years, the visible legal recognition was very difficult to achieve because the opposition argued that some of us are not educationally qualified.

Having the DNP become the terminal entry degree for advanced practice nursing will solidify our educational backgrounds and give us the credibility we need to transform health care. Remember that the DNP is an academic degree. You cannot be "grandfathered" into an academic degree. Although our state boards of nursing or national credentialing bodies may consider provisions so that established NPs may not need to return to school to comply with the 2015 DNP educational requirement so they can continue their practice, they cannot negate or bestow an academic degree.

Some of us may be anxious to obtain that new academic degree and pursue a post-master's DNP. Many educational programs are open already for your consideration. (Visit the American Association of Colleges of Nursing Web site for more information.) In the future, you may find that the actual number of academic credits you completed for your master's degree may be comparable to the 2015 DNP academic requirements.

Now is the time to completely abandon any remaining real or imagined ties to the historical subservient role of nursing. We are excellent healthcare providers and have worked very hard to get the recognition we now have among our patients and the public. We should applaud the action plan for the DNP that will offer us the opportunity to gain more respect through an academic title befitting our educational accomplishments.

Don't feel frustrated that you were not part of the groundbreaking work that provided the DNP as our future academic entry into NP practice. We need to realize that we are not alone in nursing. An old political adage says, "If you don't speak up, others will speak for you." This is true but, on occasion, it also works out for the best.

We cannot do everything. We are providing quality care to people with cancer. We are making strides to make cancer history.

Rest assured that powerful nursing leaders are looking out for the best interest of our profession. The decision was not made in a vacuum. The American Association of Colleges of Nursing is our national voice for nursing education, and is it represented by 592 nursing schools across the nation. The deans of schools of nursing across the nation developed the DNP action plan. Believe that they have the vision to see a brighter future for nursing. Share the vision—look forward.

 
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Special Interest Group Newsletter  July 2006
 
   

Important Announcements and Opportunities

Nurse Practitioner SIG Opportunities
The SIG is seeking volunteers for
  • Poster coordinator
  • Archivist
  • Newsletter writers
  • Mentors and mentees
  • Meeting planning committee
  • Membership committee
  • Nominating committee
  • Education committee.

Contact Coordinator Wendy Vogel, RN, MSN, FNP, AOCN®, at wvogel@charter.net for details.

Order your copy of the second edition of the Clinical Manual for the Oncology Advanced Practice Nurse.
This resource is essential for oncology APNs. The book is available in late June, and you can take advantage of a special introductory offer with ONS member savings of more than 20%! Place your order on the ONS E-Source.

New Radiation Therapy Educational Program Is Now Available
The newest educational program for nurses in radiation therapy is now available. Radiation Oncology Nurses Enhancing Excellence is an eight-module CD-ROM teaching tool for nurses working in radiation therapy. Order your set on the ONS E-Source today.

Learn About the ONS CEO Search
Visit the ONS Web site for the latest information on the search for the successor to long-time ONS CEO Pearl Moore, RN, MN, FAAN, who will retire from her position in January 2007 after leading the organization for three decades.

Visit the New Outcomes Resource Area
Learn more about oncology nursing-sensitive patient outcomes. In the new resource area, you'll find evidence tables, resource cards, references, and more. To get started, visit www.ons.org/outcomes.

Submit Your Research Conference Abstracts Today
Abstracts are now being accepted for the ONS Ninth National Conference on Cancer Nursing Research, which will be held February 8-10, 2007, in Hollywood, CA. For more information, visit www.ons.org/meetings/research07.

 
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Special Interest Group Newsletter  July 2006
 
   

Membership Information

SIG Membership Benefits
  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG's newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc.
  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://sig.ons.wego.net, including
    • Educational opportunities for your subspecialty
    • Education material on practice
    • Calls to action
    • News impacting or affecting your specific SIG
    • Newsletters
    • Communiqués
    • Meeting minutes.

Join a Virtual Community
A great way to stay connected to your SIG is to join its Virtual Community. It's easy to do so. All you will need to do is

  • Log on to the ONS Web site (www.ons.org).
  • Select "Membership" from the tabs above.
  • Then, click on "Chapters, SIGs & Virtual Communities."
  • Scroll down to "Special Interest Groups (SIG) Virtual Community" and click.
  • Now, select "Find a SIG."
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once the front page of your SIG's Virtual Community appears on screen, select "New User" from the top left. (This allows you to create log-in credentials.)
  • Type the required information into the text fields as prompted.
  • Click "Join Group" (at the bottom right of the text fields) when done.
Special Notices
  • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
  • If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.

Subscribe to Your SIG's Virtual Community Discussion Forum
All members are encouraged to participate in their SIG's discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG's Virtual Community discussion forum. To do so,

  • Select "Log In," located next to "New User," and enter your information.
  • Next, click on the "Discussion" tab on the top right of the title bar.
  • Now, select "Featured Discussion" from the left drop-down menu.
  • Locate and select "Subscribe to Discussion" inside the "Featured Discussion" section.
  • Go to "Subscription Options" and select "Options."
  • When you have selected and entered all required criteria, you will receive a confirmation message.
  • Click "Finish."
  • You are now ready to begin participating in your SIG's discussion forum.
Participate in Your SIG's Virtual Community Discussion Forum
  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on "Discussion" from the top title bar.
  • Select "Featured Discussion" from the left drop-down menu.
  • Click on any posted topic to view contents and post responses.

Sign Up to Receive Your SIG's Virtual Community Announcements
As an added feature, members also are able to register to receive their SIG's announcements by e-mail.

  • From your SIG's Virtual Community page, locate the "Sign Up Here to Receive Your SIG's Announcements" section. This appears above the posted announcements section.
  • Select the "Click Here" feature, which will take you to a link to subscribe.
  • Once the "For Announcement Subscription Only" page appears on screen, select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG's Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on "Next Page."
  • Because you have already joined your SIG's Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click "Finish."
  • This will bring up a listing of your SIG's posted announcements. Click on "My SIG's Page" to view all postings in their entirety or to conclude the registration process and begin browsing.
 
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Special Interest Group Newsletter  July 2006
 
   

Nurse Practitioner SIG Officers

Coordinator (2005-2007)
Wendy Vogel, RN, MSN, FNP, AOCN®
Kingsport, TN
wvogel@charter.net

Coordinator-Elect/Coeditor (2006-2007)
Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
Abingdon, MD
npbiedrzycki@aol.com

 

ONS Publishing Division Staff
Elisa Becze, BA
Copy Editor
ebecze@ons.org

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Administrative Assistant Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, MS, CAE, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diane Scheuring, MBA, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org

 
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