The University of Tennessee at Chattanooga PROPOSAL FOR INITIATION OF A NEW DEGREE PROGRAM. Submitted by: The University of Tennessee at Chattanooga

The University of Tennessee at Chattanooga PROPOSAL FOR INITIATION OF A NEW DEGREE PROGRAM Submitted by: The University of Tennessee at Chattanooga October 6, 2009 Date of Submission College of Health, Education and Professional Studies Name of College, School or Division School of Nursing Name of Dept/Academic Unit A NEW PROGRAM LEADING TO THE DEGREE OF: Doctor of Nursing Practice Title of Degree as on Diploma Nursing Title of Major With Sub-Majors (Concentrations, Options, etc.) In: Family Nurse Practitioner Nurse Anesthesia CIP/THEC Code DNP Formal Degree Abbreviation Doctor of Nursing Practice Degree Designation on Student s Transcript (Indicate how degree, major, etc. will be recorded) August 2010 Proposed Starting Date 1

Abstract Degree Program Institution: The University of Tennessee at Chattanooga Division/Department: School of Nursing Program Leading to Degree of: Doctor of Nursing Practice With a Major in: Nursing With Sub-Majors in: Family Nurse Practitioner and Nurse Anesthesia Proposed Start-Up Date: August 2010 Total Credit Hours Required for Major: 34 New Courses Proposed: See Course List on Page 30 of Document Number of New Courses: 10 Number of New Course Credit Hours: 34 Estimated Headcount Enrollment, FTE s, Graduates and Faculty for New Program Year Fall Full-Time Headcount Fall Part-Time Headcount Fall Full-Time Equated Students Graduates Current FTE Faculty 1 (2011) 12 0 12 -- 1 1 2 (2012) 26 0 26 12 2 1 3 (2013) 40 0 40 14 3 -- 4 (2014) 80* 0 80 26 3 -- 5 (2015) 108 0 108 54 3 -- New New Costs Generated by Program: Year 1: $143,778 Year 2: $228,455 Year 3: $219,359 Year 4: $220,291 Year 5: $221,250 Accrediting Organization (if applicable): AACN, COA, SACS Target Date for Accreditation: August 2013 *Enrollment projections increase at Year 4 (2014) because the MSN will no longer be available. Ultimately enrollment will stabilize at approximately 100 students. 2

Abstract The growing length of the master s programs in nursing, which were responding to explosions in scientific knowledge, increasing sophistication in technology and the increased complexity of health care, was the major impetus for the development of the Doctor of Nursing Practice (DNP). On October 25, 2004, the American Association of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing. This pronouncement required changing the current level of preparation necessary for advanced nursing practice from the master s degree to the doctorate-level by the year 2015. The DNP presented in this proposal will meet the demands of students in Tennessee, particularly our community of interest, providing the education and practice competencies for expert advanced practice nursing clinicians needed for certification at the Advanced Practice Nurse (APN) level dictated by the professional accrediting agencies nationwide. The goals and outcomes for the proposed The University of Tennessee at Chattanooga (UTC) DNP program are in compliance with the standards of the AACN eight essential elements as identified in The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2007). The DNP program goals and outcomes are also congruent with the UTC Strategic Initiatives: (a) successful achievement of all goals will require partnerships outside of the University and (b) with diverse collaborators. The DNP is congruent with the THEC Master Plan specifically related to assuring partnerships for access, producing a Knowledge Economy, and engaging in partnerships for educational excellence. The DNP program will complement other programs in the School of Nursing and will fulfill an impending need because nursing accrediting agencies will require the DNP for Advanced Practice Nurses by 2015. The need for clinical nurses prepared at the doctoral level is well documented at the state and national level. No university offers the clinical doctorate program in the Chattanooga catchment area, and UTC is the appropriate place for such a program. UTC and the School of Nursing have a good track record in attracting a diverse student population. The DNP program will complement other programs in nursing and will fulfill a pending mandate. AACN has specified that the DNP should be the degree of choice for Advanced Practice Nurses by 2015. By initially offering the MSN to DNP, sufficient numbers of preceptors will be available. In 2013, students holding baccalaureate degrees in nursing will be eligible for admission to the DNP program. Currently only 1% of the registered nurse population holds a doctoral degree. Most nurses with doctorates are employed in schools of nursing leaving few available for clinical practice positions. Nurse executives of agencies have offered strong support for the program and have made commitments to hire graduates. In addition, it is anticipated that offering the DNP will assist in alleviating the current faculty shortage that is contributing to the nursing shortage. 3

Table of Contents Background 5 Program Description 5 Mission 5 Curriculum 8 Evaluation 14 Accreditation 14 Productivity of Related Programs 15 Demand/Need for Program 17 Diversity and Access 20 Estimate Size of the Program 20 No Unnecessary Duplication 21 Faculty 21 Administration/Organization 23 Library Resources 23 Support Services 25 Cost Benefit 26 Cost/Productivity of Recently-Initiated Programs 29 Consultants 29 Appendix I: MSN Course Descriptions 31 Appendix II: DNP Course Syllabi 35 Appendix III: SON Evaluation Plan 78 Appendix IV: CHEPS Organizational Chart 98 Appendix V: SON Organizational Chart 99 Appendix VI: Faculty Curriculum Vitas 101 Appendix VII: Nursing DNP Program Catalog Copy 157 4

Background A New Program Leading to the Doctor of Nursing Practice (DNP) The United States health care environment is radically changing. Ever increasing changes in health care delivery have required different approaches to how the nation delivers, pays for and sustains health requirements. Universities preparing health professionals must produce practitioners who are prepared for practice today and in the future. The professional doctorate is the model for the practice of medicine (MD), dentistry (DDS), pharmacy (PharmD), physical therapy (DPT) and psychology (PsyD). In all of these professions, the doctorate builds on a liberal undergraduate education. The Doctor of Nursing Practice (DNP) joins the others as the model of advanced practice nursing. The growing length of the master s programs in nursing, which were responding to explosions in scientific knowledge, increasing sophistication in technology and the increased complexity of health care, is a major impetus for the development of the DNP. On October 25, 2004, the American Association of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing (available at http://www.aacn.nche.edu/dnp/dnppositionstatement.htm). This pronouncement required changing the current level of preparation necessary for advanced nursing practice from the master s degree to the doctorate level by the year 2015. Endorsement of this decision resulted from three years of research and consensus building by a task force charged with exploring the need for the practice doctorate with a variety of stakeholder groups. By 2005, AACN published The Essentials of Doctoral Education for Advanced Nursing Practice (available from: http://www.aacn.nche.edu ). The National Council of State Boards of Nursing (NCSBN) has now developed criteria for state approval for DNP programs. Currently, DNP graduates across the nation are and will continue to practice as advanced practice nurses at the highest professional level of nursing practice and will advance the application of nursing knowledge to improve health care for diverse populations. The DNP presented in this proposal will meet the demands of students in Tennessee, particularly our community of interest, providing the education and practice competencies for expert advanced practice nursing clinicians needed for certification at the APN level as dictated by the professional accrediting agencies nationwide. Program Description A. Mission: The DNP program is consistent with the approved Mission of The University of Tennessee at Chattanooga (UTC): The University of Tennessee at Chattanooga is an engaged, metropolitan university committed to excellence in teaching, research, and service, and dedicated to meeting the diverse needs of the region through strategic partnerships and community involvement. The Core Values of the School of Nursing are consistent with those of UTC. 5

1. The Goals and Outcomes of the DNP Program The goals and outcomes for the UTC DNP program are in compliance with the standards of the AACN eight essential elements as identified in The Essentials of Doctoral Education for Advanced Nursing Practice. (AACN, 2007). The DNP program goals and outcomes are also congruent with the UTC Strategic Initiatives. Successful achievement of all goals will require partnerships outside of the University and with diverse collaborators; these are two of the Strategic Initiatives of the university. Program goals of the DNP require that the graduate will: 1. Practice in a specialized advanced nursing role through comprehensive assessment, ethically and culturally sensitive planning, therapeutic intervention and evidence-based evaluation. (Essentials 8) 2. Apply evidence-based prevention by integrating epidemiological, biostatistical, environmental and other scientific data in providing health services to individuals, aggregates and/or populations. (Essentials 7) 3. Employ organizational and systems leadership competencies to address current and future health, safety and other quality improvement issues for health services. (Essentials 2) 4. Analyze, select and evaluate information systems and advanced technical resources to support and improve health care. (Essentials 4) 5. Critically seek and appraise new knowledge from nursing and other sciences and translate this knowledge in developing, implementing and evaluating new practice approaches to meet goals for improving health care. (Essentials 1, 3) 6. Initiate, analyze and/or influence proposals for health policy, respecting the perspectives of the consumer, other health care providers and the affected communities or public entities, while incorporating principles of business, finance and economics. (Essentials 5) 7. Stimulate effective system change as a leader or a member of a collaborative and/or inter-professional team. (Essentials 6) 2. Relationship of the UTC Strategic Initiatives and the Goals of the DNP Program The DNP program is aligned with the Strategic Initiatives of UTC: 1. Partnerships for Students - The DNP Program will create teaching and learning experiences both on and beyond campus. 2. Partnerships for Education and Research The DNP will create external educational and research partnerships. 3. Partnerships for Diversity The DNP will require engagement in diversity in all forms - people, ideas and cultures related to health care outcomes essential for a healthy community and productive society. 4. Enabling Partnerships The DNP will efficiently use human, fiscal, physical and communication resources through partnerships in the community. 3. Relationship of the DNP to the THEC Master Plan The DNP is congruent with the THEC Master Plan specifically related to assuring partnerships for access, producing a Knowledge Economy, and engaging in partnerships for educational excellence. The DNP students and faculty will engage with clinical partners in the community. New models of care practice determined to be 6

necessary to improve the economics of health care organizations or health of a community may evolve from students translational research projects. The US Department of Health and Human Resources (DHHR) and Health Resources and Service Administration (HRSA) identified the tremendous need for health professionals who can lead and engage in translational research. The School of Nursing has been very successful in obtaining HRSA grants. In addition, as a sought-after entity by the nature of their academic preparation, the DNP graduate will provide assurance to constituents and community stakeholders of the School of Nursing commitment to quality improvement and excellence in health care outcomes. The DNP will more than fulfill the aspirations of Tennessee to provide a Knowledge Economy through its education system. Expansion of Tennessee s Knowledge Economy through creation of something new or identification of a more efficient way of doing things provides the recipient and the state a competitive advantage (Drummond, 2003). DNP students will collaborate and share knowledge with hospitals, clinics, public health agencies, community planners, elected officials and others who are interested in adopting innovative strategies across systems that will improve effective health care delivery and health care outcomes. In addition, UTC DNP graduates who elect to teach in academic settings will further provide an additional source of nursing faculty, a commodity that is becoming scarcer in a time of greater need. This would begin to satisfy a critical workforce demand, not only in Tennessee but also in the Southeastern region. Because the DNP program will be delivered via distance learning technology in conjunction with minimum face-to-face meetings, it will reach a number of students who normally would not contemplate the notion of returning to obtain an advanced practice nursing degree because of work and family commitments. This professional group is working in areas where their salaries are above the state average, even though many originally came from lower income backgrounds. Traditionally, most desire increased knowledge and an advanced degree. It is anticipated that they will be able to attain this through the use of technology because the program will offer its courses primarily online, but with intense interaction between faculty and students and among students themselves. Survey results showed that 51.8% of the respondents strongly agreed or somewhat agreed they would enroll in the DNP if it was online only, and 70.3% would enroll if the program was a hybrid format. The School of Nursing has designed programs to accommodate distance-based learners as well as working nurses. The School of Nursing has been very successful in offering the RN to BSN track using a predominantly online delivery that includes streaming video and other virtual learning activities combined with occasional face-to-face classroom activities for the working RN. The MSN Family Nurse Practitioner (FNP) Concentration is designed for the working professional nurse using a variety of distance-based technology and face-to-face classroom sessions. In fact, the School of Nursing undergraduate and graduate programs make use of innovative teaching methodologies using state-of-the-art technology in a variety of courses across the curriculum. The DNP program will also be designed to accommodate distance-based learners in rural areas of Tennessee as well as working advanced practice nurses. 7

B. Curriculum: The UTC DNP curriculum is based on the American Association of Colleges of Nursing (AACN) Essentials of Doctoral Education for Advanced Nursing Practice. The DNP will incorporate the content currently included in the School of Nursing MSN program and required for APN certification for advanced practice nurses as specified by the AACN Essentials of Master s Nursing Education. Regardless of the entry point, DNP curricula are designed so that all students attain DNP end-of-program competencies. Because different entry points may exist, the curricula will be individualized for candidates based on their prior education and experience. For example, early in the transition period, most students entering the DNP will have a master s degree based on the AACN Essentials of Master s Nursing Education. Graduates of such programs would already have attained many of the competencies defined in the DNP Essentials. Therefore, their program will be designed to provide those DNP competencies not previously attained. Additional courses were developed to reflect the AACN content in the Essentials of Doctoral Education for Advanced Nursing Practice. Thus, the DNP curriculum will comply with accreditation standards specified by the Commission on Collegiate Nursing Education (CCNE). CCNE is officially recognized by the U.S. Secretary of Education as a national accreditation agency and is an autonomous accrediting agency contributing to the improvement of the public's health. CCNE ensures the quality and integrity of baccalaureate and graduate programs in nursing. 1. General Description for the Degree Admission to the Doctor of Nursing Practice Program The first candidates for the degree will be post MSN students who are certified nurse midwives, nurse practitioners, nurse anesthetists, nurse administrators, clinical nurse specialists or other nursing specialists. 1. Admission to the program is accomplished in two steps: admission to the UTC Graduate School and admission to the DNP program. 2. Applicants to the DNP must meet the general UTC Graduate School requirements of graduation from a regionally accredited college or university. 3. Applicants must complete a Graduate School Application. 4. Official transcripts from all schools attended, both undergraduate and graduate, must be sent directly to the Graduate School. 5. Applicants holding the MSN degree must present a minimum cumulative GPA of 3.00 on a 4.0-point scale from their highest degree earned or they may present an acceptable MAT or GRE score for consideration if their GPA is below 3.00. 6. Applicants holding the BSN degree but not the MSN degree must send Miller Analogies Test (MAT) scores or Graduate Record Examination (GRE) scores to the Graduate School and have a minimum cumulative GPA of 3.00. 7. A non-refundable application fee, a resume and a completed DNP application, along with three letters of reference, must be sent to the Graduate School. One of the letters must be from a person familiar with the applicant s professional nursing practice. 8

8. Upon completion and submission of the Graduate School s requirements, and after admission to the Graduate School, the Graduate School Office will forward all required items to the School of Nursing. 9. Applicants will participate in the interview process with the DNP Admissions Committee. The School of Nursing DNP Admissions Committee will make a decision for acceptance into the program based upon the overall potential for the applicant s success in the program. This recommendation will be forwarded to the Director of the School of Nursing and the Dean of the Graduate School for official action. 10. Applicants must provide evidence of current RN licensure. 11. For applicants holding the MSN degree, evidence of certification in an advanced practice specialty must be provided. Retention/Progression Policies 1. Conform to the Continuation Standards as stated in the UTC Graduate Catalog. 2. Successful achievement of a cumulative GPA of 3.00 or above in the doctoral program with no more than two grades below a B. 3. Maintain clinical requirements and other policies as published in the School of Nursing Graduate Handbook. Dismissal Policies Students who violate professional or academic policy will be subject to dismissal from the nursing program. 1. Students found guilty of unprofessional conduct, negligent habits or other causes as specified in the Board of Nursing Rules and Regulations of Registered Nurses will be dismissed from the program. 2. Students who violate the ANA code of ethics policy will be dismissed from the program. 3. Students who have a cumulative GPA that falls below 3.00 will be subject to the UTC Graduate Catalog Continuation Standards. 4. A graduate student will be dismissed from the program if they receive a No Credit grade in a clinical course in more than one grading period. A grading period is defined as either Fall, Spring, Summer I or Summer II. Program of Study Curricular essentials for the DNP include: competencies in advanced nursing practice, organization and system leadership, clinical scholarship and analytical methods, information systems for patient care, health care policy, inter-professional collaboration, clinical prevention and population health plus specific clinical courses required for APN certification, 1,000 hours of supervised practice and a final translational research project. Nationwide, the average DNP programs for post-bsn degree nurses are three calendar years, 36 months or four academic years in length and include: 84 credit hours post-bsn degree, 34 credit hours post-msn and a minimum of 1,000 hours of supervised practice, some of which must be included in the residency portion of the DNP. To earn the MSN degree at UTC, the student must complete 48 to 59 credit hours of post-bsn course work; the FNP student completes 650 hours of supervised practice; the Nurse Anesthesia (NA) student completes well over 1,000 hours of supervised practice. The UTC post-masters candidates (MSN to DNP) can complete the DNP in five semesters of full time study. The baccalaureate-prepared nurse will complete the DNP program 9

requirements (FNP or Nurse Anesthesia) by successfully completing a minimum of 84 hours. Based on full approval of the DNP Program, a cohort of full time MSN to DNP students will be admitted August 2010 and August 2011. It is expected that by 2012, that UTC will begin to admit students holding the BSN degree into the cohort. All students admitted to the UTC post Masters DNP program of study, irrespective of advanced practice specialty, must have completed standard competency courses in advanced health/physical assessment, advanced physiology/pathophysiology, and advanced pharmacology. The UTC MSN Program for Advanced Practice Nursing is fully approved by the CCNE. The students holding the BSN will enter the DNP program and their program of study will include 84 to 93 credit hours of study depending on the area of concentration for advanced practice that the student selects (FNP or Nurse Anesthesia). This groups program of study will consist of the current MSN courses and the proposed DNP courses. Each doctoral student must file a Program of Study form upon completion of nine (9) semester hours of approved graduate courses and before completion of 18 hours. A list of all core courses, grades and electives must be included on the Program of Study form that is routed to the DNP Coordinator. The Program of Study form must be approved by the doctoral advisor, DNP Coordinator, the Director of the School of Nursing and the Dean of the Graduate School. If a student fails to file a Program of Study form, he/she may receive a registration hold and timely program progress may be suspended. Admission to Candidacy Application to candidacy should be made after the student has completed in residence 28 semester hours of approved graduate courses (excluding transfer credit and any specified prerequisites). The Candidacy Form may be found in the Graduate School Office (also available at: http://www.utc.edu/administration/graduateschool/currentstudentforms.php). Graduation Requirement 1. Students enrolled in the post Masters DNP program will complete core doctoral courses. 2. Completion of minimum 84 hours required for the post bachelor s student. 3. A cumulative GPA of 3.0 in the doctoral program with no more than two courses below a grade of B. 4. Successful completion of the translational evidence-based residency courses. 5. Successful completion and defense of the translational project. Completion of Program All doctoral students shall complete all degree requirements for the DNP within a ten-year limit. All doctoral course work and the successful defense of the translational project must be completed within ten years. Translational Project The translational project in the DNP program demonstrates synthesis of the student s work and relates to a specialized area in advance practice. The final translational research project must benefit a group, population or community rather than an individual patient. The translational proposal must be reviewed and approved by committee members. The culminating project reflects scholarly work that translates 10

evidence into improved practice or health outcomes that affect aggregates. Each doctoral student will defend his or her final translational project in a public presentation. 2. Proposed DNP Courses NURS 7000 Philosophic Underpinnings for Nursing Practice NURS 7010 Evidence-Based Practice and Nursing Systems NURS 7020 Epidemiology and Health Requisites of Populations NURS 7030 Meeting Population Demands through Biostatistics NURS 7040 Technology and Transformation of Health Care NURS 7050 Leadership in Complex Health Care Systems NURS 7060 Health Care Policy & Economics NURS 7070 Translational Evidence-Based Residency I NURS 7080 Translational Evidence-Based Residency II NURS 7090 Translational Project 3 hrs 3 hrs 3 hrs 3 hrs 3 hrs 3 hrs 3 hrs 3 hrs 3-6 hrs 6 hrs The program of study for students who enter the DNP program holding the BSN degree is found below and combines the current MSN courses with the proposed DNP courses. Current Core MSN Courses NURS 5000 - Conceptual and Theoretical Foundations of Nursing NURS 5010 - Nursing Research Methods NURS 5120 - Health Policy, Finance, and Economics NURS 5160 - Diversity and Ethical Issues in Advanced Practice NURS 5830 - Advanced Health Assessment NURS 5840 - Advanced Health Assessment Lab Current Concentration Courses for the MSN FNP NURS 5040 - Advanced Pathophysiology NURS 5510 - Health Promotion & Disease Prevention in Primary Care NURS 5520 - Primary Care of Children NURS 5530 - Primary Care of Children Practicum NURS 5540 - Primary Care of Adults NURS 5550 - Primary Care of Adults Practicum NURS 5560 - Primary Care or Women NURS 5570 - Primary Care of Women Practicum NURS 5590r -Family Nurse Practitioner Practicum 3hrs NURS 5800 Advanced Pharmacology 3hrs 4hrs 3hrs 3hrs 2hrs 1hr 3hrs 3hrs 3hrs 2hrs 3hrs 2hrs 3hrs 2hrs 3hrs Current Concentration Course for the MSN Nurse Anesthesia NURS 5040 - Advanced Pathophysiology 3hrs NURS 5410 - Professional Aspects of Nurse Anesthesia Practice 2hrs NURS 5420 - Advanced Anatomy & Physiology Nurse Anesthesiology I 3hrs NURS 5430 - Advanced Anatomy & Physiology Nurse Anesthesia II 3hrs NURS 5440 - Integrated Health Science for Nurse Anesthesia 3hrs NURS 5450 - Principles of Nurse Anesthesia- Basics 3hrs NURS 5460 - Principles of Advanced Anesthesia I 2hrs 11

NURS 5470r - Clinical Practicum for Nurse Anesthesia NURS 5480 - Principles of Advanced Anesthesia II NURS 5800 - Advanced Pharmacology NURS 5810 - Advanced Pharmacology for Nurse Anesthesia 16hrs 2hrs 3hrs 3hrs Table 1. Curriculum for One Cycle of the Post-MSN DNP Courses Year 1 Fall Year 1 Spring Year 1 Summer Year 2 Fall Year 2 Spring NURS 7000 3 hrs NURS 7010 3 hrs NURS 7020 3 hrs NURS 7030 3 hrs NURS 7040 3 hrs NURS 7050 3 hrs NURS 7060 3 hrs (PM I) NURS 7070 3 hrs (PM II) NURS 7080 3-6 hrs NURS 7090 6 hrs Semester Credits = 9 Semester Credits = 9 Semester Credits = 6 Semester Credits = 3-6 Semester Credits = 6 On campus on campus for orientation Initial meeting with possible preceptor Synchronous meeting with professor Student s presentation of proposed translational project Synchronous meeting with professor On campus at end of semester Defense of project and graduation DNP Course Descriptions NURS 7000 Philosophic Underpinnings for Nursing Practice (3) Exploration of philosophical and historical issues that create a context for the integration of the natural and social sciences with nursing science to develop a translational philosophy that will support initiation and evaluation of improved practice approaches. Prerequisite: admission to the DNP program, or approval by the Director. NURS 7010 Evidenced Based Practice and Nursing Systems (3) Examines the foundational and philosophical aspects of evidence-based practice for the advanced practice nurse. Research provides the basis of this course through the application of knowledge in the translational project. The student will examine and use applied research methods with a focus on protection of human subjects. Critiques of evidence-based research such as reliability, validity, trustworthiness and relevance to practice of research designs and findings will be emphasized. Prerequisite: admission to the DNP program, or approval by the Director. NURS 7020 Epidemiology and Health Requisites of Population (3) Examines the distribution and determinants of health related states and events in specified populations. Emphasis will be placed on the integration of applied epidemiology, study design, public health surveillance, methods of control and prevention and evaluation of health conditions, diseases, injuries and outcomes. This course will analyze specific epidemiologic methods for describing patterns of disease and developing innovative approaches involved in health planning, health policy and health care delivery systems. Prerequisite: admission to the DNP program, or approval by the Director. NURS 7030 Meeting Population Demands through Biostatistics (3) Examines methods used to generate and analyze biostatistical data as a foundation for developing, implementing, and evaluating policies and programs integral for the health 12

care of identified populations. Prerequisite: admission to the DNP program, undergraduate and graduate statistics, or approval by the Director. NURS 7040 Technology and Transformation of Health Care (3) Provides the advanced practice nurse with the ability to use information systems/technology to support and improve patient care and transform health care systems. Prerequisite: admission to the DNP program, or approval by the Director. NURS 7050 Leadership in Complex Health Care Systems (3) Examines evidence-based concepts and theories to be an effective leader in complex health care systems. Prerequisite: admission to the DNP program, or approval by the Director. NURS 7060 Health Care Policy & Economics (3) Critically examines governmental, nongovernmental and geopolitical issues that influence advanced nursing practice. Provides a critical analysis of the economics of health care, focusing on financing and delivery of care within the US. Prerequisite: admission to the DNP program, or approval by the Director. NURS 7070 Translational Evidence-Based Residency I (3) Provides the Doctor of Nursing Practice student with individualized opportunities to apply advanced leadership and clinical knowledge in healthcare systems; identification of needs and/or interests to further define their clinical practice; allow the student to gain experience in selected clinical or agency sites to increase competencies in areas such as clinical acumen, case management, leadership, and/or business practices. Practice setting and focus is individualized to students specific areas of interest. Student will be precepted by an expert in the field. This course meets full time equivalency requirements. Prerequisite or Corequisite: NURS 7000, NURS 7010, NURS 7020, NURS 7030, NURS 7040, NURS 7050, NURS 7060. Graded SP/NP. NURS 7080 Translational Evidence-Based Residency II (3-6) Continues to build on the work done in NURS 7070. Students will continue to apply advanced leadership skills and clinical knowledge within their designated practicum site and will continue to enhance his/her competencies in areas such as clinical acumen, case management, leadership, and/or business practices. The student will develop, submit, and defend a proposal for the Translational Project. This course meets full time equivalency requirements. Prerequisite or Corequisite: NURS 7000, NURS 7010, NURS 7020, NURS 7030, NURS 7040, NURS 7050, NURS 7060, NURS 7070. Graded SP/NP. NURS 7090 Translational Project (6) The Doctor of Nursing Practice program culminates in a capstone translational project course that will merge the practice and scholarship components of the degree. It is designed to address a practice issue affecting groups of patients, health care organizations or health care systems. Students will work with community groups, clinics, hospitals or health care systems to assess, plan, implement, and evaluate a proposal that is mutually agreed upon by the practice setting, the student, and the student s advisory committee. The successful completion of this scholarly project will contribute to an aspect of advanced nursing practice. This course meets full time equivalency requirements. Prerequisite or Corequisite: NURS 7000, NURS 7010, NURS 7020, NURS 7030, NURS 7040, NURS 7050, NURS 7060, NURS 7070, NURS 7080. Graded SP/NP. NURS 7970r Individual Studies (1-6) 13

Individual studies designed to enable students to study a selected topic in depth. Requires and individual studies contract describing the specific responsibilities and/or learning objectives of the student, and the criteria to be used in evaluation and grading. Prerequisite: admission to the DNP program, or approval by the Director. Course syllabi for the above courses are found in Appendix II. C. Evaluation: Ongoing evaluation of the DNP program will occur as outlined in the detailed School of Nursing Program Evaluation Plan, which is based on the AACN Essentials Documents for the BSN, MSN and DNP programs. In addition, the Nurse Anesthesia Concentration is evaluated in respect to the Council on Accreditation of Nurse Anesthesia Educational Program (COA) standards, and this evaluative data is reported to the COA annually. The School of Nursing Evaluation Plan is included in Appendix III. The School of Nursing Graduate Committee is responsible for continuous evaluation and quality improvement of the graduate program. Aggregate data are reviewed and recommendations for improvement, if appropriate, are reported to the School of Nursing Faculty Organization Committee, the Director and ultimately to the Dean of the College of Health, Education and Professional Studies and the Academic Provost. The CCNE has reviewed the School of Nursing Program Evaluation Plan and found it to be fully operationalized and compliant with standards. The School of Nursing annual reports are submitted to the Dean of the College of Health, Education and Professional Studies (CHEPS), AACN, COA and the Tennessee Board of Nursing. In addition, our community of interest is integral to the evaluation and implementation of the DNP program. Our community of interest includes students in the Undergraduate and Graduate Programs, pre-nursing students, prospective students in the community, the RN seeking the BSN, the BSN RN seeking the MSN, ADN programs in the area, advanced practice nurses holding the MSN who desire to obtain the DNP, clinical agencies hiring our graduates and other selected healthcare organizations. Annual surveys at the School of Nursing Advisory Committee meetings, employer surveys, student advisement evaluations, needs assessments, recruitment fair surveys and clinical agency data are all part of the evaluation plan to solicit feedback and evaluation of the DNP program from the School of Nursing community of interest. D. Accreditation: The School of Nursing has been a member of the AACN since 1998. The School of Nursing was accredited for 10 years in 2000 by the CCNE. In addition, the MSN Nurse Anesthesia Concentration has been fully accredited by the COA since 1996. The MSN Nurse Anesthesia Concentration is scheduled for re-accreditation by COA in 2012. The School of Nursing completed successful re-accreditation of all its programs by CCNE in September 2009. The CCNE accreditation surveyors gave a verbal report of their findings to faculty, the Director of the School of Nursing and the Dean of CHEPS. All programs were fully compliant with the AACN/CCNE Standards. The official written report will be received in 2010. It is anticipated that CCNE will make an accreditation visit for the DNP in Fall 2013. 14

The Commission on Colleges of the Southern Association of Colleges and Schools (SACS) was notified of the impending change and replied positively, requesting a copy of this full proposal before classes begin in August 2010. The Council of State Boards of Nursing has a draft proposal of criteria for individual states to use to grant approval for DNP programs. If and when these criteria become law in Tennessee, the DNP program will meet the criteria laid out in the draft. All of the above evaluation measures will meet Tennessee s Performance Funding review process. E. Related Productivity of Related Programs: As of the fall of 2008, the UTC School of Nursing had an enrollment of approximately 127 traditional BSN students and 398 pre-nursing major students. Eighty-two percent of the undergraduate students were female, 18% male and 8% minority. The enrollment in the BSN Gateway Track for May 2008 was 27 students: 74% female, 26% male and 3% minority. For May 2009, enrollment included 40 students: 89% female, 14% male and 14% minority. In the Graduate Program there are 43 family nurse practitioner (FNP) students and 54 nurse anesthesia (NA) students including 77% females and 23% males for both concentrations by the 14 th day of Fall 2008. To serve its entire student body of pre-nursing students (500 students), undergraduate (167 students), and graduate students (98 students) as of Fall 2009, the School of Nursing has eleven (11) full-time tenured or tenure-track faculty and eight (8) full-time faculty in nontenure-track positions (two of the faculty have joint appointments with a healthcare organization and are allocated to teach 50%). All eleven full-time tenured or tenure-track faculty are doctorally prepared. Funding for five (5) faculty positions occurs through partnerships created with healthcare systems in the Chattanooga area. The School of Nursing admits students into the MSN FNP and NA concentrations each May. Aggregate evaluative data are collected continuously and reported to the Dean of the College of Health, Education and Professional Studies and the Provost. One hundred percent (100%) of the graduates of the MSN program reported employment in their specialty area. In addition, the overall graduation rate for the MSN Program is excellent. Enrollment in the School of Nursing Graduate Program for the 14 th day of Fall Semester 2009 was 98 graduate students. All students admitted to the MSN FNP concentration in the last five years have graduated or will graduate from the program. In addition, 100% of graduates passed the national certification exam on the first attempt. As of Fall 2009, 46 students are enrolled in the MSN FNP Concentration. All students graduating in the BSN program have written the NCLEX-RN exam for 2009 except for one student, who is scheduled to take that exam in November. All students who have taken the exam thus far have passed on the first attempt. The 2008 first time pass rate on the NCLEX-RN for the BSN program was 100%. Table 2. MSN FNP Concentration Graduation Rate Year Graduated Graduation rate 2006 100% (9) 2007 100% (12) 15

2008 100% (18) Table 3. MSN FNP Concentration Graduate Employment Rate Year Graduated Employment 2006 100% 2007 100% 2008 100% Table 4. MSN FNP Concentration National Certification First Time Pass Rate Year Graduated Pass Rate 2006 100% (9) 2007 100% (12) 2008 100% (18) The MSN Nurse Anesthesia Concentration is a 27 month, full-time program. Employment rates for this group are 100% post graduation. Graduation rates are excellent, and the first time pass rate on the national certification exam meets or exceeds the national averages. There are currently 52 students enrolled in the concentration. Table 5. Number of Students Entering and Exiting the MSN Nurse Anesthesia (NA) Concentration by Year of Graduation COHORT ENROLLED COMPLETED # NOT COMPLETED/REASON 2006 30 27 3 academic failures (10%) 2007 31 28 3 academic failures (10%) 2008 31 22 5 academic failures, 4 voluntary withdrawals (2 personal/family/medical reasons; 2 transferred to FNP Concentration) (29%) 2009 28 26 2 academic failure (7%) Table 6. MSN Nurse Anesthesia Graduate Employment Rate Year Graduated Employed 2006 100% (27) 2007 100% (28) 16

2008 100% (22) 2009 100% (26) F. Demand/Need for the Program: 1. Academic or institutional need: The DNP program will complement other programs in the School of Nursing and will fulfill an impending need; nursing accrediting agencies will require the DNP for Advanced Practice Nurses by 2015. The need for clinical nurses prepared at the doctoral level is well documented at the state and national level. No university offers the clinical doctorate program in the Chattanooga catchment area, and UTC is the appropriate place for such a program. UTC and the School of Nursing have a good track record in attracting a diverse student population. By initially offering the MSN to DNP, sufficient numbers of preceptors for future students will be available. Currently only 1% of the registered nurse population holds a doctoral degree. Most nurses with doctorates are employed in schools/colleges of nursing, leaving few available for clinical practice positions. Nurse executives of agencies have offered strong support for the program and have made commitments to hire graduates. In addition, it is anticipated that offering the DNP will assist in alleviating the current faculty shortage that is contributing to the nursing shortage. 2. Student Demand: Nurse practitioners who are members of the Chattanooga Area Nurses in Advanced Practice Organization were surveyed. Since that time, the School of Nursing has received numerous inquires related to when will you start the DNP? In addition, faculty at area community colleges, including Northeast Alabama and Northwest Georgia, have actively sought information about UTC possibly offering the DNP (20 inquiries) although no marketing or advertising has taken place. Of the current graduate students enrolled in the School of Nursing, over 50% have indicated that they would have chosen a clinical doctorate over the MSN. Some faculty in our area who hold an academic doctorate and are MSN prepared also desire to enter the DNP program. A majority of students responded that the do not prefer on line classes only. The survey finds that 70% of respondents would appear to prefer a hybrid model of delivery. When questioned about this, the group s preference was for some face to face (synchronous time) with professors but not on a regular set schedule. In addition, they further stated that if a distance learning format was only offered, they would enroll Thus, the UTC DNP program will use distant learning approaches using synchronous and asynchronous learning to facilitate student achievement of desired outcomes. The charts below outline the initial responses to the survey. Valid Table 7. Current level of nursing education Cumulative Frequency Percent Valid Percent Percent Masters 19 70.4 79.2 79.2 Doctorate 5 18.5 20.8 100.0 Total 24 88.9 100.0 Missing System 3 11.1 Total 27 100.0 17

Valid Table 8. Area of specialty Cumulative Frequency Percent Valid Percent Percent CNS - Adult Health 1 3.7 3.7 3.7 Family Nurse Practitioner 20 74.1 74.1 77.8 Adult Nurse Practitioner 2 7.4 7.4 85.2 Pediatric Nurse Practitioner 3 11.1 11.1 96.3 Psychiatric Nurse Practitioner 1 3.7 3.7 100.0 Total 27 100.0 100.0 Valid Valid Table 9. County of residence Cumulative Frequency Percent Valid Percent Percent Hamilton 17 63.0 70.8 70.8 Bradley 1 3.7 4.2 75.0 Catoosa 3 11.1 12.5 87.5 Franklin 1 3.7 4.2 91.7 Walker 1 3.7 4.2 95.8 Grundy 1 3.7 4.2 100.0 Total 24 88.9 100.0 Missing System 3 11.1 Total 27 100.0 Valid Table 10. Interest in DNP at UTC Cumulative Frequency Percent Valid Percent Percent yes 22 81.5 84.6 84.6 no 4 14.8 15.4 100.0 Total 26 96.3 100.0 Missing System 1 3.7 Total 27 100.0 Table 11. Time likely to begin DNP at UTC Cumulative Frequency Percent Valid Percent Percent 6 months to 1 year 2 7.4 9.1 9.1 1 to 2 years 11 40.7 50.0 59.1 more than 2 years in the future 9 33.3 40.9 100.0 Total 22 81.5 100.0 Missing System 5 18.5 Total 27 100.0 Table 12. Prefer online classes only 18

Valid Cumulative Frequency Percent Valid Percent Percent yes 4 14.8 16.7 16.7 no 20 74.1 83.3 100.0 Total 24 88.9 100.0 Missing System 3 11.1 Total 27 100.0 Valid Table 13. Prefer online classes with one week per semester on campus Valid Cumulative Frequency Percent Valid Percent Percent yes 5 18.5 20.8 20.8 no 19 70.4 79.2 100.0 Total 24 88.9 100.0 Missing System 3 11.1 Total 27 100.0 Table 14. Prefer hybrid classes - meet 3 times on campus per semester Valid Cumulative Frequency Percent Valid Percent Percent yes 9 33.3 39.1 39.1 No 14 51.9 60.9 100.0 Total 23 85.2 100.0 Missing System 4 14.8 Total 27 100.0 Table 15. More likely to enroll if DNP online only Cumulative Frequency Percent Valid Percent Percent strongly agree 6 22.2 24.0 24.0 somewhat agree 8 29.6 32.0 56.0 neither agree or disagree 2 7.4 8.0 64.0 disagree 5 18.5 20.0 84.0 strongly disagree 4 14.8 16.0 100.0 Total 25 92.6 100.0 Missing System 2 7.4 Total 27 100.0 Valid Table 16. More likely to enroll if DNP is hybrid Cumulative Frequency Percent Valid Percent Percent strongly agree 7 25.9 29.2 29.2 somewhat agree 12 44.4 50.0 79.2 neither agree or disagree 3 11.1 12.5 91.7 disagree 1 3.7 4.2 95.8 strongly disagree 1 3.7 4.2 100.0 Total 24 88.9 100.0 19

Missing System 3 11.1 Total 27 100.0 3. Societal Need Evidence for the DNP: The DNP curriculum is built on traditional master's programs by providing education in evidence-based practice, quality improvement and systems leadership among other key areas. The Institute of Medicine (IOM, 2003) has stated that future graduates from advanced practice nursing programs must be prepared to design, influence, and implement health care policies that frame health care financing, practice regulation, access, safety, quality, and efficacy. The changing demands of this nation's complex healthcare environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. The Institute of Medicine, Joint Commission, Robert Wood Johnson Foundation, and other authorities have called for re-conceptualizing educational programs that prepare today s health professionals. In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. Recognizing society s need, the AACN has mandated changing from the MSN degree to the DNP degree for the practice of advanced practice nursing. Thus, there is a societal call for the DNP. 4. Employee Need: Graduates of the MSN program are 100% employed. Community stakeholders have expressed interest in the DNP program, recognizing the need for innovative health care strategies, advanced clinical leadership, advanced knowledge of systems and organizational workings. The DNP graduate offers advanced clinical knowledge and the ability to engage in translational practice to improve health care delivery and health care outcomes within and across systems, and actively working with these advanced practice nurses is appealing to potential employers. In addition, the DNP graduates are needed to serve as faculty to help alleviate the recognized critical shortage of BSN prepared nurses. G. Diversity and Access: The DNP program will not impede the state s commitment to diversity and access. The School of Nursing has been fortunate in their effort to address health disparities and diversity as evident by its HRSA grants and other scholarship efforts in promoting diversity in its programs and community service activities. H. Estimate Size of the Program: Estimates of Headcount and full-time equated enrollment and number of graduates: The anticipated size of the first cohort is 12 students. Student enrollment is expected to increase as an additional faculty member is obtained. Table 17 shows the enrollment and graduation estimates for five years of program operation. Program Year Full-Time Major Head Count Fall Table 17. Size of Program Part-Time Major Headcount Fall Total FTE Enrollment Fall Total Graduates 20

2010 12 0 12-2011 26 0 26 12 2012 40 0 40 14 2013 80 0 80 26 2014 80 0 80 26 Basic Assumptions: The estimated size of the program is based on several assumptions. First, the program will initially admit post MSN applicants. Applicants will be placed in the curriculum based on each individual s previous educational attainment and their advanced practice specialty interest. Second, the DNP Program has been devised based on a rigorous review of the School of Nursing s MSN Program to avoid duplication of content and to meet the requirements of the AACN and the national certification groups. The third assumption is that the DNP will be available only on a fulltime basis to facilitate consistent planning of course offerings and appropriate utilization of faculty and resources to achieve effective outcomes. Admission figures are based on the assumption that in the first year 12 post-msn students would enter the DNP. The second year admission cohort would include 14 post-msn students. By the third year, post-masters and post-bsn students will be admitted. Each year it is expected that the number of MSN-to-DNP applicants will decrease, and conversely, baccalaureate prepared nurse-to-dnp applicants will increase. By 2015, the baccalaureate prepared nurse-to-dnp program will be fully operational. Increasing class size beyond the number anticipated each year would be evaluated by the faculty and administration once the DNP is fully implemented and evaluated. I. No Unnecessary Duplication: 1. List of comparable programs (public and private) by institution: According to the AACN web site (http://www.aacn.nche.edu/dnp/dnpprogramlist.htm) there are only two programs in Tennessee offering the DNP: the University of Tennessee Health Science Center in Memphis and Vanderbilt University in Nashville. Applicants to the DNP are more likely to enroll in a program near their work area. 100% of the MSN FNP students live in the Chattanooga area, and the majority of students in the MSN Nurse Anesthesia Concentration are also from the Chattanooga area. J. Faculty: 1. Faculty Currently Employed in the School of Nursing: The School of Nursing has a number of doctoral-prepared tenured and tenure-track faculty who teach in its programs. Several faculty hold the MSN as the highest degree but are expert clinicians. These faculty will teach in the MSN advanced practice clinical courses and serve as clinical mentors for students. Only doctoral-prepared faculty would be responsible for the expert practice of the curriculum. Several faculty holding the MSN are currently enrolled in an academic doctoral program. Others plan to complete the DNP degree. The SON currently has two faculty members who hold the DNP. Table 3 below identifies current faculty who will teach one or more courses in the major. Name of Faculty Highest Degree Table 18. Current Faculty Total Years Teaching Total Years Teaching in Area of Degree Specialty Full-Time or Part-Time 21