​Norton Healthcare Partners With UK's DNP Program

10/31/2014 – It’s no secret the health care industry is under pressure. Baby boomers, which represent a disproportionate segment of the population, are reaching retirement age and facing many of the health challenges and chronic diseases that go with today’s longer life spans. And most recently, sweeping changes in the U.S. health care system mean millions of previously uninsured patients are seeking care.

Those in the industry have not been standing idly by. Rather, they are responding to the 2004 American Association of Colleges of Nursing (AACN) paper for Advanced Practice Registered Nurses (APRN) to be prepared at the practice-doctorate level of education. The AACN call was reinforced by the two-year Robert Wood Johnson Foundation and Institute of Medicine (IOM) study that resulted in the landmark 2010 IOM report titled “The Future of Nursing: Leading Change, Advancing Health.”

The IOM report took an in-depth look at the reality of the health care climate and made recommendations for systemic changes. Primary recommendations for nursing included higher levels of education, practice at the full extent of licensure and full partnership in redesigning health care in the U.S.

“Because we had established the Doctor of Nursing Practice (DNP) Program in 2001, our faculty members were well-grounded in the curriculum for the practice-doctorate option. It was timely for us to advance AACN and IOM recommendations related to actual practice and the redesign of health care systems,” says Patricia B. Howard, PhD, RN, NEA-BC, FAAN, and director of the academic partnership between the UK College of Nursing and the Norton Healthcare (NHC) Institute for Nursing. 

Norton Healthcare also heeded the call to action. As a giant in regional health care, Norton includes five hospitals, more than 1,800 beds and 140 patient care locations throughout Louisville and southern Indiana. With the large number of patients receiving services now and the even higher numbers predicted for the future, the officials at Norton were determined to take on the challenge of advancing the education levels of their nurses.

What developed was Norton’s Nursing 2020 Plan, which creates a vision for how care must change by 2020, and it became increasingly clear that more people with advanced degrees would be required. The IOM report showed that just three percent of nurses hold a master’s degree and less than one percent hold a doctoral degree. Recognizing this gap, officials at Norton decided to focus on helping nurses with bachelor’s degrees achieve doctorates.

The next step was the search for an education partner.

“After a nationwide request for proposals, officials at Norton determined that the University of Kentucky’s College of Nursing was the most appropriate for our needs,” says Tracy Williams, DNP, RN, senior vice president and system chief nursing officer of Norton. “As the first Doctor of Nursing Practice Program in the U.S., the UK College of Nursing is known as a model for innovation.”

What developed is a true partnership between an academic institution and a health care system. “We are excited to have been selected for the partnership,” says Dr. Howard. “Our faculty members were ready to accept the challenge of helping Norton achieve the goals of its 2020 Nursing Plan and we were equally excited about their commitment to the College’s teaching, research and service goals.”

“We had to come together to see what each would bring to the table, creating the right product for our needs, while being mindful of the academic standards of UK,” Norton’s Dr. Williams says.

"We value their experience and engagement with us to create a unique program. Their expectations for the future of the nursing profession and for nursing professionals align with Norton Healthcare’s vision."

The program is a seven-year commitment to transition approximately 150 of Norton’s BSN staff nurses into advanced practice nurses with doctoral-level education. According to Norton's Dr. Williams, some basics of the program are:

• Norton will pay 100 percent of the tuition.
• The nurses will continue to be employed while they are in the program, transitioning into new positions as they advance.
• Norton will help students coordinate work and class schedules, as well as support scheduling needs for class and clinical commitments.
• All classes will be held in Louisville supplemented with online and independent study.
• This academically rigorous program will take approximately three years to complete.
• Each nurse will make a work commitment to Norton, which will vary based on years of prior service and the amount of education required.

Norton will invest $7.5 million to launch the program, Dr. Williams says. Since 2005, the health care system has invested more than $13.5 million to educate approximately 1,200 individuals, enabling them to earn their primary licensure as registered nurses or advance their education levels.

“Norton is an extremely forward-thinking organization,” says Dr. Howard. “Their vision is to transform nursing and prepare the type of workforce that is needed in health care systems today. Fundamentally, that means evidence-based nursing care that promotes quality and safety.”

Rooted in Nursing Practices

Carolyn Williams, PhD, RN, FAAN, who was dean of the College from 1984 to 2006 and is still a faculty member, was president of AACN during the formative years of the practice-doctorate movement.

“The idea of a practice doctorate had been on my mind for many years,” she says. “Most nurses who earned their PhDs had an emphasis in research, which prepared them to be researchers, not practitioners.”

So as the program took shape, UK’s Dr. Williams and the faculty assured that key components of UK’s DNP Program would be practice with an emphasis on organizational systems, leadership skills and scientific underpinnings for practice.

“We need more nurses who can teach nursing,” UK’s Dr. Williams explains. “By obtaining the skills at the doctorate level, it opens the door to higher-level teaching, as well as practicing.”

UK leaders see the Norton program as a natural extension of the on-campus program.

“Being chosen to partner with Norton is a tribute to the strength of UK’s DNP Program,” says Colleen Swartz, DNP, MBA, RN, NEA-BC, chief nurse executive at UK HealthCare. “This partnership allows integration of the advanced-practice nursing care model with both ambulatory and inpatient care models and enhances the program already in place.”

The UK DNP curriculum encompasses many facets of the nursing profession. Students are exposed to courses in evidence-based practice, quality improvement, finance, economics and technology, says Sharon Lock, PhD, RN, APRN, codirector of the Norton-UK program. These classes are not in the typical curriculum for bachelor’s programs. Similarly, they are either not included or are focused at a higher level than those of most master’s programs. “We will have so many nurses who all understand the opportunities for the future and they will have the education to take them there,” says Dr. Lock. 

UK’s Dr. Williams adds, “There will be a critical mass of nurses who have this higher level of education and it will be effective in leading change in an evolving health care situation.”

An Evolving Program

As a national pioneer and the first to offer the DNP Program, UK’s College of Nursing has made continuous improvements since the first class graduated more than a decade ago. “Early graduates entered the program with master’s degrees but the faculty recognized the importance of BSN nurses prepared as APRNs at the doctoral level,” explains Dr. Howard.

After extensive curriculum work, the program was opened in 2009 to BSN-prepared nurses who wanted to become nurse practitioners, clinical nurse specialists or system leaders.

Today, in addition to management and public health, the UK DNP offers program tracks in Adult-Gerontology Acute Care, Primary Care, Pediatric, and Psychiatric Mental Health specialties. “In an ever-changing world of health care, there is a shortage of providers to deliver care to patients,” says Kim Tharp-Barrie, DNP, RN, SANE, system vice president, Institute for Nursing and Workforce Outreach at Norton. “Providers with an NP or DNP will be able to support our physicians and provide extended care to patients.”

“The delivery model is a hybrid. We use web-based technology and telecommunications so we are able to maintain the same curriculum we use for the students on our Lexington campus,” says Dr. Howard. “It also has a stringent admission process, as the students must first meet Norton’s requirements before they can apply to UK for admittance.”

While educators at UK arranged innovative ways to deliver curriculum to their new students in Louisville, the planners at Norton made sure the curriculum matched their goals.

“We always stress convergent validity, making sure the College of Nursing is teaching the same skill set that we as employers need,” says Dr. Tharp-Barrie. “When these goals are met, they can best serve the providers in whatever area they work, be it a physician’s office, outpatient program or long-term care facility.” 

Dr. Howard agrees. “One advantage of the partnership that benefits both the faculty and students at Norton is the faculty’s ability to use contemporary teaching-learning methods to promote student learning outcomes that stand to enhance the institution’s needs and goals as well as the College’s DNP Program outcome goals.”

Another positive is that nurses and staff at Norton who meet the College’s criteria can also function as professors and mentors—a bonus for everyone involved.

“Working with a clinical system like Norton makes so much sense,” says UK’s Dr. Williams. “By intertwining the academic program with the practice world, I anticipate that our faculty will be exposed to what happens there. We are all going to learn from this.”

First Students Begin Their Studies

The first students from Norton were accepted in fall 2013 and classes began January 2014. This initial group is set to graduate in December 2016.

Students meet for class at the Institute for Nursing at Norton’s Audubon Campus in Louisville, where they are connected through telecommunications to a live class in Lexington. The classes are fully interactive through the use of microphones and cameras. 

“It is so much better than watching a recorded class, like a webinar,” says Laura Nevitt, MBA, BSN, RNC, NE-BC, who is a student in the program and a nurse manager at Norton. “The instructors are so dynamic; they really keep you energized.”

Danielle Bundrent, BSN, RN, a nurse of four years, always assumed she would pursue further education, but she was waiting to pay down some of her student loan debt. When she heard about this program, she knew it was the time to act.

“I love knowing that the people I work for are invested in me, so I am invested in them,” says Bundrent. “This is lining me up to change my entire life, which is something I did not expect to be able to do for at least 10 years. I am so thankful.”

Nevitt and Bundrent say the coursework is challenging, but the convenience of attending class in Louisville greatly helps them manage all their responsibilities.

“It is a juggling act to work full time and take classes,” says Nevitt, who never anticipated she would pursue a doctorate. “You really need to have all your ducks in a row, but in the end, it will definitely be worth it.”

Fellow student and Norton nurse Emmanuel Nwaogu, BSN, RN, had been looking into doctoral programs when he heard about the availability of the Norton-UK program. A native of Nigeria, Nwaogu had been a practicing attorney before immigrating to the United States in 1995.

“I had to reinvent myself here, obtaining my LPN in 2001 and my BSN in 2009,” he says. “I was looking for a new adventure, one that would present all kinds of opportunities. This is it.”

“It is probably a novel idea to find an employer who has the trust to spend a tremendous amount of money to help a health care employee advance,” he says. “This will open many doors for many people.” 

The significance of the new program is not lost on codirector Dr. Lock. “The fact that we will be infusing all of these DNP graduates into the Norton system is somewhat amazing,” she says. “No one else in the country is doing this right now, so we hope to be a model for all colleges and health care organizations in the future. We can only imagine the impact it will make.”

Dr. Terry Lennie, associate dean for the college’s PhD Program agrees that the impact is limitless. Drs. Tracy and Tharp-Barrie are also helping researchers develop the evidence for practice. “It is hard to put into words how incredibly kind and helpful the staff and nurses at Norton Healthcare Institute for Nursing have been in assisting us with our current study of a nutrition intervention to decrease symptoms in patients with heart failure,” Dr. Lennie says. “Everyone has gone well beyond the call of duty. I am delighted that they are also on board to help with a new grant we recently submitted to the National Institute of Nursing Research to test an iPad intervention to increase patient self-management of heart failure.”  

How Norton DNP Applicants are Selected

Effective Fall 2015 candidates must meet the following criteria: They have to have been employed by Norton for at least three years, have a bachelor’s degree in nursing from an accredited university, and meet the grade point average requirement of at least a 3.3 on a 4.0 scale. They must also hold an unencumbered RN license in Kentucky, and provide a goal statement, an example of scholarly written work, three letters of recommendation and pass a faculty interview.

During the interview process, faculty members look for candidates who know how to express themselves verbally and convey both their career and personal interests.

“We basically want to make sure they know what they are getting into,” says codirector Sharon Lock, PhD, RN, APRN. “If they are looking at the primary care track for example, they need to show us that they understand what primary care is all about.”