This article originally appeared in the Spring 2016 issue of Columbia Nursing magazine
by Mark Gaige, PhD
A brand-new curriculum will debut this June, ushering in the next chapter of Columbia University School of Nursing’s 125-year history.
The accelerated 15-month Masters Direct Entry (MDE) program for non-nurse college graduates will educate students as master’s-credentialed registered nurses. MDE builds on and replaces the 12-month Entry to Practice (ETP) program, which awarded bachelor of nursing science degrees to non-nurse college graduates. MDE is aimed at both future caregivers and researchers.
“The new MDE program reflects our commitment to expertly prepare students to deliver high-quality, compassionate care, and for taking leadership roles in the nursing field,” said Bobbie Berkowitz, PhD, dean of Columbia Nursing. “By preserving what is best of ETP and adding new offerings that address today’s and tomorrow’s challenges, we are ensuring that our graduates are fully equipped to meet the demands of a fast-evolving profession.”
Masters Direct Entry is a key part of other changes at Columbia Nursing. The school is an early adopter of the American Association of Colleges of Nursing’s recommendation that, beginning in 2015, all new advanced-practice nursing students graduate with a doctor of nursing practice degree. Starting next year, becoming a nurse practitioner or nurse midwife at Columbia Nursing will mean acquiring a doctorate in nursing practice (DNP). Our new nurse anesthesia program culminating in the clinical doctorate will begin in 2019.
At the end of the 15-month program, MDE graduates will sit for the NCLEX (National Council Licensure Examination-the nationwide test for the licensing of nurses) and have the option of becoming advanced practice nurses by moving directly into Columbia Nursing’s 33-month DNP program or obtaining a PhD. Those choosing the DNP track will be able to select from seven advanced-practice nursing specialties: adult-gerontology acute care, adult-gerontology primary care, family medicine, pediatrics, mental health and psychiatry, midwifery, and nurse anesthesia. Those selecting the PhD track will be poised to embark on research and teaching careers and will be mentored by a senior researcher working in the same field of interest. (Postbaccalaureate nurses from other institutions who are accepted into the DNP program will take a semester’s worth of additional courses before they begin their doctoral study.)
“Columbia Nursing has been a leader in clinical education since the school began,” said Judy Honig, DNP, EdD, associate dean of academic affairs and dean of students. “By establishing the MDE program and becoming an early adopter of the AACN’s recommendation that advanced practice nurses possess a doctoral degree, we’re building on that long history of leadership. Education is power, and the more our students know, the better they can care for patients and improve how care is delivered.”
Momentum for the changes began when Dean Berkowitz initiated a strategic planning process. Columbia Nursing leaders, faculty members, and students spent three years re-envisioning program offerings. A task force zeroed in on the details. After extensive schoolwide discussion, the transition from the BS to MS degree for entry into the profession of nursing, and acceptance of the AACN’s doctoral recommendation for advanced practice nurses, were approved by a full faculty affirmative vote.
“As times have changed and the science has advanced, people are living longer,” said Karen Desjardins, DNP, director of the new MDE program. “Nurses require more knowledge to manage these often complex patients. New technology, gene-based treatments, and an impetus to keep costs down also mean that nurses need more education. Masters Direct Entry will ensure that our students hit the ground running while acquiring rigorous preparation if they choose to undertake doctoral training.”
Because Columbia Nursing emphasizes the importance of translating new knowledge into nursing practice, in their first semester MDE students will be exposed to an evidence-based practice course. Topics will include orientation to research methods and limitations, interpretation of data, and applying new findings to practice. “We want our students to think of evidence-based practice as central to their caregiving,” said Desjardins. “Doing something because it’s always been done is simply not good enough for 21st-century nursing. We’re after the bigger picture: Whatever type of care you’re providing, the default assumption must be to learn what the research says. This is a way of thinking, but it’s also a way of professional life.” In addition to the semester-long course, all clinical offerings will have evidence based practice projects.
Another hallmark will be care coordination. Because nurses are increasingly responsible for the coordination and continuity of care as patients move from one healthcare environment to another, a semester-long class will provide a thorough understanding of the various settings and care teams involved in such shifts. “Coordination of care means communicating and sharing information. It is not a new idea and has been a long-recognized strength of the nursing profession,” said Desjardins. “But it’s become more important as specialization and complexity of care have grown. At the patient level, coordination can reduce unnecessary or duplicate tests, medication errors, and hospital admissions. At the system level, experts tell us that inadequate care coordination resulted in $25-$45 billion in avoidable spending in 2011 alone.”
Care coordination will be the topic of a stand-alone course as well as a recurrent theme throughout MDE clinical offerings. Aspects include communication and care transitions, patient-centered care planning, teamwork and collaboration, and education and engagement of patients and families. “Nurses bring a comprehensive perspective to outpatient and clinical settings,” said Desjardins. “In the past, students learned this aspect of nursing through daily exposure to how things were done, becoming part of what’s been called ‘tacit knowledge.’ The new curriculum will make it overt.”
A third thread will address matters of religion and culture. Multicultural Issues in Nursing is the stand-alone course, and again, the issue will permeate virtually all clinical courses. The Tanenbaum Foundation, a nonsectarian organization addressing religious prejudice and mutual respect, is providing training for faculty members and learning materials for use in the MDE program. “Religious beliefs and practices are an essential part of many people’s lives, and can become particularly meaningful when facing illness, suffering, or death,” said Desjardins. “In a country where 84 percent of people identify themselves as religious, addressing this vital element in the patient-provider relationship is crucial for ensuring effective, empathetic care.”
Tanenbaum, in partnership with Columbia Nursing faculty members, has developed curricular materials in the form of lectures, formatted discussions, role-playing, and discussion questions that will be employed and reinforced throughout the MDE program.
Masters Direct Entry will carry over a popular course on health policy, examining the legislative and regulatory frameworks that play a central role in the delivery and financing of healthcare today. “The nursing profession has always had a stake in policy development in terms of such issues as smoking,” said the course’s professor, Jacqueline Merrill, PhD. “But in the past few years, the Affordable Care Act and state regulation of nurse practitioners have reinforced the need for students to learn about a process that significantly affects their professional lives as well as those of their patients. My aim is to generate an understanding of policy by doing it. For example, I might ask them to consult such sources as the National Healthcare Quality and Disparities Reports, which could show that a state is underperforming in the ‘Nutrition, Physical Activity, and Obesity’ category. Students would then develop policy recommendations on this issue, targeting individuals, community organizations, and healthcare practitioners.”
Other new course additions include health promotion and disease prevention, population health, advanced normal physiology and pathology, advanced pharmacology (in addition to a basic course in pharmacology), and advanced assessment (in addition to a basic course in physical assessment).
Susan Doyle-Lindrud, DNP, director of the doctor of nursing practice program, is excited about the changes that are coming. “With the fall 2017 curriculum change, the number of students entering the DNP program may increase, but the type of student will remain the same. Students come to Columbia Nursing because of its strong academic reputation and because they expect to be academically challenged.”
She agrees with the movement toward doctorally trained advanced practice nurses. “Today’s healthcare system is increasingly complex, and advanced practice nursing education should include a higher level of academic rigor. The DNP degree, which includes a full-time clinical practice immersion during residency, better prepares advanced practice nurses to manage their patients’ health problems and evaluate their own practice settings. Our DNP courses are taught by faculty members who maintain clinical practice positions, which means that they are able to bring extensive clinical expertise into the classroom. In addition to improving patient care, doctoral studies prepare nurses to become leaders and make system changes on behalf of patients.”
Arlene Smaldone, PhD, who directs the PhD program, is equally sanguine. “The need for high-quality nursing research has never been greater. There are many potentially fruitful areas for nurse scientists. For example, precision medicine is rapidly growing in importance and serious clinical problems such as multi-resistant organisms remain unsolved. The Affordable Care Act offers many research opportunities, such as the role of the primary care workforce in population health, revamped payment structures, and new access to care for those who previously lacked health insurance.”
She notes that incoming PhD nursing students are increasingly younger. “Until recently, they might have practiced for an extended period of time before considering doctoral study. But today, prior clinical time is often cut in half. Clinical practice is certainly important. However, studies show that those entering PhD programs earlier in their careers can conduct high-quality research without long years or an extended period of time for such experience.”
In addition, today’s researchers regularly partner with clinicians and others, such as psychologists, bioinformaticians, and health economists, to help inform their research. “Our PhD program takes these factors fully into account and we look forward to many newly minted MDE graduates joining our ranks,” said Smaldone.
Columbia Nursing has recruited a group of alumni ambassadors to welcome the June MDE arrivals and help them adjust to their newsettings. One ambassador, Amy Rose Taylor ’14 ’16, earned her BS in nursing through ETP, recently completed her MSN in the adult-gerontology primary care program, and is now a DNP student at Columbia. “Columbia Nursing has provided me with so many opportunities,” she said. “I was a single mother of four when I started the program, transitioning into a new career. I received a phenomenal education, met amazing people, was a health policy fellow, and published a book— all because of the experiences and support I received from Columbia Nursing. This was the perfect school for me. I’ll tell the MDE students that they will be able to achieve their dreams here as well.”