Some recommendations outlined in a joint report published by the Institute of Medicine and the Robert Wood Johnson Foundation (RWJF) advocating for doubling the number of nurses with a doctorate by 2020 are being implemented in Maine. The Maine Nursing Action Coalition applied for a grant from the RWJF as a way to help implement the recommendations in this report.
In 2015, the RWJF announced that the Maine Action Coalition would be included as part of the Future of Nursing State Implementation Program. This initiative seeks to help states improve access to quality health care with a greater number of doctorate-prepared nurse practitioners and other advanced practice registered nurses. This two-year grant provides up to $150,000 depending on matching funds from a number of Maine’s healthcare advocacy groups and nursing associations:
- Betterment Fund
- Eastern Maine Health Care
- Maine General Health Care
- Organization of the Nurse Executives in Maine (OMNE) Nursing Leaders of Maine
The State of Maine Nursing Workforce Strategic Plan 2012-2020 called for advancing the education of at least 10% of the state’s BSNs to the master’s or doctoral level. Maine’s nursing schools wasted no time, launching the first DNP program in January 2012, which had 5 students enrolled as of fall 2015 according to the American Association of Colleges of Nursing.
Maine’s Strategic Plan reported that 30% of faculty in the state’s nursing schools had a doctorate degree as of the fall of 2011, representing an increase from 23% in 2009.
Positions for experienced nurses with residency experience have been among the most difficult positions to fill according to Paul Bolin, the VP of Human Resources for the East region of Eastern Maine Healthcare Systems who was quoted in a 2014 article in the Press Herald.
The recruitment of qualified nurses in Maine is made even more challenging by the rural nature of the state. The fact that 41% of Maine’s residents live in rural areas has only added to the challenge of providing high-quality healthcare amid a shortage of primary care providers.
DNP-educated nurses are helping to fill a void in advanced healthcare in Maine, and many are doing so as influential leaders:
- Marjorie S. Wiggins, DNP, MBA, RN, NEA-BC – Senior Vice President, Patient Services & Chief Nursing Officer, Maine Medical Center
- Lisa J. Hogan DNP, CRNA – Adjunct Faculty at the University of New England
- Ellie Milo, DNP – Chief Nursing Officer, York Hospital
Earning a Doctor of Nursing Practice (DNP) in Maine
Maine’s DNP programs are available to both BSN and MSN-prepared RNs and APRNs:
- BSN-DNP (post-bachelor’s for BSN-educated RNs) programs generally offer their students the chance to earn an MSN before transitioning into the DNP program. This enables RNs in an APRN track to obtain national certification and initial APRN licensure in their chosen role (nurse practitioner, nurse midwife, clinical nurse specialist, nurse anesthetist). Programs are also available in tracks like executive leadership, informatics and health policy that don’t involve direct patient care. BSN-to-DNP programs typically involve at least 3 years of full-time study and approximately 90 credits. The number of credits varies somewhat depending on the specialty.
- MSN-DNP (post-master’s for MSN-educated RNs and APRNs) programs are designed for nurses that already possess an MSN, offering APRNs the option to advance to leadership roles in clinical practice, add an additional specialty or patient population focus, or choose a track outside of direct patient care in such areas as executive leadership or informatics. MSN-DNP programs typically involve at least 1.5 years of study to earn 30-36 credits.
Maine’s nurses are increasingly seeking out the flexibility of accredited online programs as an alternative to the state’s one campus-based program. While courses will be online, DNP students complete their practicum requirements at local partner sites. Thus, they will have to work with school advisors to identify local partners that have established arrangements with their school. Flexible formats that are frequently offered by both online and campus-based programs include:
- Traditional DNP programs: 1.5-2 years
- Accelerated programs: 1 year
- Part-time study: 2.5 years
DNP programs have these three main components:
- DNP core – The core courses of DNP programs include topics such as methods for epidemiology and social determinants of population health, evidence-based practice, transforming the healthcare organization, and scientific underpinnings for practice.
- Specialty courses in the student’s chosen focus – Advanced practice or an aggregate/systems/organizational focus
- DNP Project – The finale of a student’s DNP studies offers the chance to showcase their training by analyzing an aspect of advanced practice to produce original research on their topic. These DNP Projects end up being either papers published in a research journal or formal presentations at a conference.
Nurses in Maine who seek a Commission on Collegiate Nursing Education (CCNE)-accredited DNP-level education at a campus site currently have the following option:
- University of Southern Maine, Portland
- BSN-DNP program will become available in the future
- Post-MSN program currently available
In the future, Saint Joseph’s College of Maine in Standish will offer a DNP program to the residents of the state.
Other DNP programs in the state may be regionally accredited or hold specialty accreditation through the Council on Accreditation of Nurse Anesthesia Educational Programs or the Accreditation Commission for Midwifery Education.
A larger selection of CCNE and ACEN (American Commission for Education in Nursing)- accredited DNP programs are available online to students in Maine.
Post Bachelor’s BSN-to-DNP Programs for BSN-Prepared Nurses
Virtually all of the country’s BSN-to-DNP programs enable students to earn both an MSN and a DNP in the same accelerated program. Nurses seamlessly transition to their DNP program after completing their MSN. Typically, such combined programs entail about 4 years of study.
BSN-DNP programs that are specific to one of the four APRN roles (nurse practitioner, nurse-midwife, nurse anesthetist, or clinical nurse specialists) require their students to earn an MSN in the student’s chosen advanced practice nursing specialty. Doing so entails obtaining about 500 hours of clinical training and qualifies the nurses to obtain national certification and state licensure in their role.
Although the MSN component of these programs varies based on the track, these programs typically have the same core courses:
- Interprofessional collaboration
- Evidence-based practice
- Policy and advocacy
- Quality and safety
- Program evaluation for improving patient and population outcomes
- Organizational and systems leadership
- Clinical prevention/population health
MSN programs for students seeking to become APRNs also include core courses in:
- Advanced health assessment, including the assessment of all human systems, advanced assessment techniques , and concepts and approaches
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Advanced pharmacology, including:
- Pharmacotherapeutics of all broad categories of agents
Opportunities Available to DNP-Prepared Nurses in Maine
The State of Maine Nursing Workforce Strategic Plan 2012-2020 reported “steep competition” in the state from nurses who have a doctorate. This speaks to the wealth of opportunities available to DNP-prepared nurses, ranging from practicing at an advanced level to serving in executive leadership positions.
The residents of Maine will need highly trained practitioners particularly as its population ages. Predictions indicate that Maine will have the second oldest population in the country by 2020. Thus its residents will require an even higher level of advanced medical care.
While a large population of practicing nurses and nurse faculty are nearing retirement age throughout the country, Maine’s Strategic Plan reported that the state’s nursing faculty and nursing workforce are “aging out” at a faster rate than the national average. The American Association of Colleges of Nursing reported that Maine’s nurse faculty averaged 56 years of age in 2015, many of them preparing to retire soon.
Maine already has a shortage of doctoral-prepared nursing faculty to teach at the five nursing schools in the state. The aging of its nurse faculty will make this situation even worse. In addition, the advent of a new DNP program at Saint Joseph’s College of Maine will increase the demand for DNP-educated faculty.
A survey of job listings performed in April 2016 identified the following vacancy, which should not be interpreted as a job offer or assurance of employment:
Program Director of Graduate Nursing at Saint Joseph’s College of Maine
- Candidate will oversee the development and implementation of a DNP program
- DNP, PhD, or EdD required
- Must be eligible for an unencumbered RN license in Maine
- Must have at least 5 years of experience in an academic faculty position
- Family Nurse Practitioner experience preferred
Once this position is filled, the Program Director will be seeking additional faculty for this program. While an MSN used to suffice for a nurse to become a faculty member, nursing schools increasingly choose faculty candidates with doctorate degrees. It is extremely likely that more positions for DNP-educated nurses will become available at this new nursing program.