The Atlanta Journal-Constitution
Advanced degree how-to,
Nurses everywhere are responding to changes in the field and reaping major rewards
Nursing schools in Georgia and across the nation are turning out more graduates with Master’s and doctoral degrees and the potential for six-figure starting salaries.
They’re responding, at least in part, to a transfor- mational move in medicine that’s been embraced by 22 states, Georgia not included.
Following a recommendation from the Institute of Medicine, these states are allowing nurse practitioners – nurses with a master’s or doctorate degree – to evaluate, diagnose, treat and prescribe medications to patients without a doctor’s oversight.
Nationwide, the American Association of College of Nurses reports that nursing enrollment has increased by nearly 7 percent in master’s programs, by 3 percent in research-focused doctoral programs and by 26 percent in practice-focused doctoral programs.
Applications at the nursing schools at Atlanta’ s Emory University and Georgia Southern University in Statesboro reflect those trends.
Applications for Emory’s Doctorate of Nursing Practice program have jumped a whopping 856 percent since 2015, said Dr. Linda McCauley, dean and professor of the university’s Nell Hodgson Woodruff School of Nursing.
Applications also are up in that same period by 366 percent for Emory’s Accelerated Bachelor of Science in nursing program and by 370 percent for its Accelerated Master of Science in nursing program, she said.
Georgia Southern had 146 applicants for advanced degree programs this year, compared to about 40 a year in each of the last 10 years, Dr. Sharon G. Radzyminski, chair of the university’s nursing program, said.
“We can’t take that many students,” she said, “but that’s how many qualified students we had apply.”
Georgia Southern turned
away all but 40 of this year’s 146 applicants because it didn’t have the faculty to support more students, Radzyminski said.
The university’s program for psychiatric mental health practitioners also is at capacity this year, she said.
“Strengthening the pipeline of highly educated nurses has always been a priority within the nursing profession - even before health care reform—to meet the nation’s growing need for nurse scientists, faculty, expert clinicians, leaders and innovators,” Emory’s McCauley said. “With the growing complexity of health care, the need for nurses with the highest level of scientific knowledge and practice expertise has only intensified.”
Andi Smith, a 34-year-old single mother of three from Austell, is a doctoral student at Emory.
“It’s all about personal knowledge,” said Smith, who is an assistant nurse manager in the new mother/baby unit at WellStar Cobb Hospital. “I want to become a better leader.”
Her employer is contributing $5,000 a year to her tuition costs, and that’s been a huge help.
“WellStar made it possible to do it now while I’m young instead of down the road when I could afford it,” said Smith, who started her doctoral program in August 2016 and hopes to complete it in 2018.
2010: A turning point
The push for more nurse practitioners began in the early 2000s, but dramatically escalated around 2010. That was the year that the Institute of Medicine released a report, “The Future of Nursing: Leading Change, Advancing Health.”
The report said nurse practitioners “are a critical element of the health care team that can, in fact, improve outcomes of patient care, alongside their physician counterparts,” Radzyminksi said.
The IOM said nurses should be “allowed to practice to the extent of their education and expertise,” she said. “For that to come out of the Institute of Medicine was pretty earth-shattering at the time.”
Nurse practitioners have an important niche to fill, Radzyminski said.
It centers on this reality:
With improved public health and medical care, Americans are living longer than previous generations. But they’re also living longer with multiple, chronic geriatric health conditions, such as diabetes, heart disease, hypertension, skin cancer and sleep apnea, she said.
These conditions aren’t going to be fixed with a single pill, surgery or a simple procedure, Radzyminski said.
These are more likely to require multiple lifestyle changes and involvement by other family members, she said.
“It requires a more holistic, family-oriented kind of care. That is how nurses approach deviations in health care and work toward wellness, she said. “That’s why people say this is tailor-made for nurse practitioners and why their outcomes are usually very good.
Programs for nurse practitioners grew significantly after the Affordable Care Act became reality, Radzyminski said.
“I think that was driven by the job market,” she said. “As we have more and more underinsured individuals seeking health care, more employment opportunities become available for nurse practitioners in physician’s offices and clinics.”
Obtaining a master’s or doctorate takes an average of three years. In 2016, the median annual pay for a nurse practitioner with a master’s degree was $107,460, nearly three times the median annual wage for all U.S. workers, according to the Bureau of Labor Statistics.
Nurse practitioners with doctorate degrees can earn $140,000 a year, although salaries vary by region.
“The need for doctorally prepared nurses is particularly acute,” Emory’s McCauley said.
Only one percent of the nation’s nursing workforce hold doctoral degrees, although that’s quickly changing, she said.
“Nurses with PhDs are the knowledge generators for the nursing profession,” McCauley said.
They’re also “our faculty leaders, playing a critical role in educating the nursing workforce of the future,” she said.
McCauley sees the demand for nurse practitioners continuing – especially with projections of a primary care provider shortage of 200,000 by 2020.
“Nurses trained at the graduate level will help fill the gap,” she said. “Nurse practitioners (NPs) who earn a Master of Science in Nursing (MSN) or a Doctorate of Nursing Practice (DNP) degree are the fastest-growing group of primary care providers.”
The number of nurse practitioners is projected to double to more than 244,000 by 2025, according to a recent RAND Corporation analysis, McCauley said.
The Bureau of Labor Statistics is predicting that employment for nurse anesthetists, nurse midwives and nurse practitioners will grow 31 percent between 2014 and 2024, much faster than the average for all occupations.
The BLS says growth in these job sectors will occur primarily as a result of healthcare legislation, an increased emphasis on preventive care and demand for healthcare services from the longerliving but less active babyboom population.
Sharon Vanairsdale, program director for the Serious Communicable Disease Unit at Emory University Hospital, said she wrestled with the idea of whether to pursue her doctorate.
“I have been very lucky,” she said. “I’ve had a very rewarding and enriching nursing career.”
But Vanairsdale, who became part of history when she admitted three humanitarian aid workers with to Emory in, ultimately decided it was the right move.
“I just felt that getting my DNP would help give me those tools that I need to get evidence that we are doing best-practices at the bedside,” Vanairsdale said.
She said she also believes a doctorate will help her to ensure “nurses have a voice at the table.”
Dr. Carolyn Clevenger, Emory’s associate dean for clinical and community partnership, said she tells students that the potential for an increased salary “is not a very fulfilling reason to suffer through graduate school.”
Then, she says, she them her story — moving from an ICU nurse to a nurse practitioner with a master’s and then to a PhD in nursing practice.
“I had more influence over people when I was diagnosing and prescribing for them as a nurse practitioner than I did as a nurse,” said Clevenger, who specializes in geriatrics and started a nurserun, comprehensive primary care clinic at Emory for patients with dementia. “Then from the master’s to the doctorate, the shift was about going from the patient level to changing the whole system. And that brings a lot of joy to me.”
McCauley said some of the stunning growth in Emory’s doctoral program is likely due to the planned launch in fall 2017 of the university’s DNP Nurse Anesthesia program, only one of two in the state.
Other factors include faculty reputation, research expertise and Emory’s ranking as the No. 1 nursing school in the nation for National Institutes of Health research funding, she said.
In Georgia, nurse practitioners still have to be in a contract with a physician to be able to practice, Radzyminski said.
That’s not as the Institute of Medicine suggested, she said.
The Medical Association of Georgia has blocked efforts to expand the role of nurse practitioners in the state, claiming nurses are not as educated as physicians, Radzyminski said.
“That’s not true. They are educated differently,” she said. “Health care is in the eye of the beholder, and you need everybody. There is a place for every single health care provider.”
“I just felt that getting my DNP would help give me those tools that I need to get evidence that we are doing bestpractices at the bedside.” Sharon Vanairsdale Program director, Serious Communicable Disease Unit at Emory University Hospital