Fluent Essays

This order has been set on revision status. Please press the Confirm button to tell us you are aware of this revision, and will complete it within the time provided. JONA Volume 44, Number 2, pp 74-78 Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N Exploring Early and Future Use of DNP Prepared Nurses Within Healthcare Organizations Catherine Nichols, DNP, APRN, BC Nancy O’Connor, PhD, RN, ANP-BC Deborah Dunn, EdD, MSN, GNP-BC A strategy to gather data on DNP utilization and impact was designed using Donabedian’s conceptual model and was piloted by surveying chief nursing of- ficers (CNOs) leading Michigan’s public and teaching hospital systems. Few of the responding CNOs reported currently employing DNP-prepared nurses. The major- ity reported gaps in knowledge related to role expecta- tions and projected outcomes from a DNP-prepared nurse. Nurse leaders should become familiar with the role competencies of the DNP in order to maximize the potential contribution of this new level of care provider to improving care quality and access. The proliferation of DNP degree programs continues. Little has been published about the utilization and effects on healthcare outcomes of the DNP degree. An initial strategy to gather data on DNP utilization and impact was designed using Donabedian’s1 conceptual model and was initially piloted by surveying chief nursing officers (CNOs) leading Michigan’s public and teaching hospital systems. Background The complexity of the US healthcare system has re- sulted in increasing fragmentation and led to challenges and innovation in care delivery models.2 In the past 14 years, the Institute of Medicine (IOM) reported astonishing deficits in the nation’s healthcare systems and provision of care2-4 including preventable medical errors, lack of chronic condition care, and poor access to timely care.2-4 In the 2011 publication, The Future of Nursing: Leading Change, Advancing Health,4 the IOM called upon nursing to increase education levels of both undergraduate and graduate nurses. In response to the need for clinical nurses prepared at the doctoral level, DNP programs have been developed and continue to expand in number.6 In January 2013, the American Association of Colleges of Nursing (AACN) reported 221 current colleges and universities across the United States offering DNP degrees with more than 100 programs in the planning stages.5 This surpasses the number of nursing PhD programs now offered across the United States. The AACN also reported nearly double the number of en- rollees in DNP programs as compared with those in PhD programs. From 2010 to 2011, the number of DNP enrollees grew from 7 034 to 9 094.6 The numbers of DNP graduates are steadily increasing as well with 1 282 graduating in 2010 and 1 595 in 2011.6 The acceptance of the DNP degree by nurses returning to school has presented new challenges as nurse leaders enhance their own knowledge about possible contributions to the care domain and work to develop programs and services to support these 74 JONA � Vol. 44, No. 2 � February 2014 Author Affiliations: Nurse Practitioner (Dr Nichols), Women’s Wellness Clinic, Walt Breast Center, Detroit, Michigan; Chairper- son, Graduate Nursing Program (Dr O’Connor), Director, Grad- uate Nurse Practitioner Program (Dr Dunn), School of Nursing, Madonna University, Livonia, Michigan. The authors declare no conflicts of interest. Correspondence: Dr Nichols, Women’s Wellness Clinic, Walt Breast Center, 4100 John R St, Detroit, MI 48201 ([email protected] karmanos.org). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonajournal.com). DOI: 10.1097/NNA.0000000000000029 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. mailto:[email protected] mailto:[email protected] http://www.jonajournal.com opportunities. The employment patterns, utilization, and impact of DNP graduates need to be monitored and reported, because there are few if any published studies to date documenting the market penetration and utilization of DNP-prepared nurses. Survey Development The Current Trends in DNP Utilization CNO Survey (Table 1) was developed based on Donabedian’s1 con- ceptual model to quantify the numbers of DNPs em- ployed in identified organizations and to detail the DNP nurses’ scope of responsibilities.2 Donabedian developed 3 domains of inquiry for analysis: (1) struc- ture, (2) process, and (3) outcome. For this survey, structural elements include the type of DNP practice setting, including inpatient and outpatient. Process elements include the specific types of advanced prac- tice RNs (APRNs) employed in the workplace (nurse practitioner [NP], clinical nurse specialist, certified nurse midwife, certified RN anesthetist, or nurse leader). Outcome elements assessed (1) CNO’s satisfaction with the DNPs’ organizational impact and (2) patient- centered outcomes relevant to the identified DNP po- sition and (3) critical health indicators prioritized by the Michigan Department of Community Health.8 The 13-item survey was constructed to elicit current information regarding DNP practitioner utilization and impact on Michigan Public and Teaching Hos- pital systems. Survey content validity was established through expert panel review. Approval for this project was obtained from the human subject review com- mittee at Madonna University. CNO Satisfaction With DNP Employees Organizational Impact Early literature regarding interest and support for DNP- prepared nurses included 2 studies that influenced the development of this survey. The 1st was a structural study conducted at the University of Kentucky (UK) and cited by the AACN in its 2004 DNP position state- ment.9 The study was a market analysis survey of 111 top executives in acute, long-term, and public health- care settings in Kentucky, to determine their interest in hiring a DNP graduate from the UK program. Most (61\%; n = 68) of the respondents indicated they would be interested in hiring DNP graduates in the next 5 years, and forecasted at least 80 positions would be available during that time. Nine specific positions were identified by respondents for potential utilization of a DNP graduate are (a) vice president for clinical service, (b) program director, (c) vice pres- ident for patient care, (d) chief executive officer, (e) quality improvement director, (f) director of clinical services, (g) clinical information technology special- ist, (h) direct care clinician, and (i) faculty member. The 2nd study informing survey development was from the University of Washington’s School of Nurs- ing.10 In this study, Kaplan and Brown10(p364) propose ‘‘capturing the profession’s transition’’ (to the DNP) from a survey of employers to determine the contri- butions of DNP graduates. The idea of capturing DNPs’ initial contributions to organizational outcomes by surveying employers was used to design the cur- rent CNO survey of DNP impact. A 3rd published study11 that informed survey con- struction was conducted at the University of Alabama. Researchers examined the newly developed role of the clinical nurse leader (CNL). The aim of the study was to determine if CNL graduates were being utilized to the fullest extent of the ‘‘9 components outlined by the AACN’s vision.’’11 While not pertinent to the DNP role, the idea of using the stipulated role components of a newly developed role to assess its uptake and im- pact was informative to this survey construction par- alleling the stipulated DNP role components. Process Measures CNO Satisfaction With the DNPs’ Organizational Impact CNO satisfaction with the DNPs’ impact on the or- ganization was addressed through CNO evaluation of DNP impact on healthcare indicators, DNP role types and their specific organizational impact, and current employment trends of DNPs. Of the 5 APRN/DNP role types, only the NP and CNO/leader role type were reported as DNP positions. Patient-Centeredness Outcomes This measure was evaluated by CNO perception of specific patient benefit in their organization. A poten- tially hopeful finding for the indigent and healthcare- naive populations was the resounding 100\% agreement of respondents to an increase in access to care pro- vided by the DNP. Another promising finding was the 50\% positive response of the likelihood of hiring a DNP in the future, based on their current experi- ence. This suggests the DNP is having a positive ef- fect on Michigan’s healthcare systems overall. Critical Health Indicator Outcomes To elicit the impact of outcomes of DNP practice re- lated to critical health indicators in surveyed organi- zations, the instrument contained an embedded list of Michigan’s leading health indicators, as priori- tized by the Department of Community Health.8 These were selected to identify the impact of the DNP- prepared nurse in healthcare organizations and on population health. Survey questions included open- ended responses regarding the impact on populations JONA � Vol. 44, No. 2 � February 2014 75 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Table 1. CNO Survey Items and Responses by Frequency and Percentage Frequency \% of Respondents CNO Survey Results (n = 17) n \% 1. Does your system employ DNPs? Yes 7 41.2\% No 10 58.8\% 2. What DNP role type has been most beneficial to your institution? Nurse practitioner 3 75\% Nurse executive 2 50\% 3. How has the employment of a DNP changed your perception of the degree? Somewhat improved 1 20\% No change 4 80\% 4. How much has the practice of DNPs improved health outcomes with your system? Somewhat improved 2 40\% No change 3 60\% 5. What populations have most benefited by DNP practice in your system? Insured 2 50\% Uninsured 3 75\% Hispanic 1 25\% African American 2 50\% White/non-Hispanic 2 50\% 6. Which of Michigan’s major health disparities have been impacted most by DNP practice in your system? (MDCH) Coronary heart disease 2 66.7\% Diabetes mellitus 2 66.7\% Breast cancer 1 33.3\% Influenza and pneumonia 1 33.3\% Obesity/poor nutrition 1 33.3\% Access to healthcare 3 100\% 7. Rate your level of satisfaction with the practice of the DNPs at your institution Very satisfied 1 20\% Somewhat satisfied 2 40\% Neutral 2 40\% 8. Based on current DNP experience, how likely are you to hire more DNPs? Extremely likely 3 21.4\% Somewhat likely 4 28.6\% Neutral 3 21.4\% Somewhat unlikely 1 7.1\% Extremely unlikely 3 21.4\% 9. Does your institution offer incentives for nurses to obtain the DNP? Yes 10 71.4 No 4 28.6 10. How many RNs in your system are currently enrolled to obtain a DNP degree? 0 6 46.6 1 3 23.1 4 2 15.4 10 1 7.7 Unknown 1 7.7 11. How likely is your institution to develop new positions for DNPs to fill? Extremely likely 2 15.4 Somewhat likely 1 7.7 Neutral 3 23.1 Somewhat unlikely 2 15.4 Extremely unlikely 5 38.5 12. Which employment position listed would your institution consider a DNP for? Vice president for clinical service 8 66.7 Program director 8 66.7 Vice president for patient care 9 75 Chief executive officer 3 25 Quality improvement director 7 58.3 Director of clinical services 6 50 Clinical information technology specialist 6 50 Direct care clinician 5 41.7 Faculty member 3 25 13. Share any other information or thoughts regarding DNP employment or degree (See Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A285) Note: Percentages do not equal 100\% based on multiple response items. Abbreviation: MDCH: Michigan Department of Community Health. 76 JONA � Vol. 44, No. 2 � February 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. http://links.lww.com/JONA/A285 as perceived by the CNO respondent. The resulting survey (Table 1) can be used by CNOs to systematically gather data on DNP utilization in their organizations, and it can be targeted to any state’s population health indicators or identified organizational priorities. Lessons Learned In a preliminary Internet-based exploration of 17 CNOs leading Michigan’s public and teaching hospitals, only 6 (35\%) reported employing DNPs. The CNOs endorsed 8 of the 9 identified position titles (extracted from the UK study) that would neces- sitate DNP preparation within their institutions (see Document, Supplemental Digital Content 1, http:// links.lww.com/JONA/A285). In considering DNPs’ impact on health outcomes, CNOs identified those that were targeted to 1 or more of Michigan’s leading health indicator, for example, (1) support for increasing access to healthcare and (2) providing care for those with coronary heart disease.8 Discussion The small group of Michigan CNOs who completed the survey showed in their open-ended responses that knowledge of actual DNP practice and its potential impact on targeted outcomes are little known among senior administrators (see Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A285). This is the 1st known study probing where, how, to what degree, and in what capacity DNPs are being employed. Although the response rate was low, the information obtained was valid, sound, and very use- ful. It is encouraging that CNOs affirmed support for advancing education among nursing employees, albeit mostly reported as general support for any type of healthcare degree pursued, not exclusively DNP edu- cation. DNP-prepared APRNs are being called upon by the IOM to fill the void in primary care, and this study reports an interest in utilization of these practitioners for this role plus other roles that can contribute to healthcare quality and access. Ironically, although the majority of the respon- dents stated they would likely hire a DNP in the fu- ture, only 2 DNP/APRN roles were reported as having benefited the institution. Seventy-five percent of re- spondents stated that the NP benefited the system the most, with only 1 other reported APRN/DNP role, the nurse executive, benefiting the institution with a 50\% response rate. This may represent a true self-selection of DNP utilization by nurse executives. When forced to choose a position from a list of ad- vanced practice and executive positions, however, it was remarkable the CNOs were not reporting that they would likely hire a DNP to do their job. Again, this exposes the lack of consistent understanding of these executives regarding the value of a DNP- prepared nurse. Validating this deficit of knowledge are the actual narratives plainly stating a lack of under- standing in the qualitative data (see Document, Sup- plemental Digital Content 1, http://links.lww.com/ JONA/A285). Limitations Limitations include that this was a convenience sam- ple in this study with a limited sample size. The major- ity of respondents represented inpatient hospital care settings, whereas few respondents represented the out- patient care sector. This study should be replicated in other states and practice settings to monitor the impact and ongoing utilization of DNP graduates. Additional methods such as telephone follow-up interviews may assist in collecting the targeted and qualitative data, especially the impact on health outcomes. Conclusion and Implications for Nurse Leaders The DNP degree was developed to enable the nursing profession to prepare professionals as advanced practice providers of care and as senior leaders within health organizations.9 Assessing the adoption and sup- port of DNP-prepared nurses among CNOs is es- sential to promulgating this level of practitioner into healthcare systems. This survey supports that CNOs are not well versed in the clinical outcomes of DNP practice or the population health outcomes that may be impacted by DNP-prepared providers. Continued research and dissemination of information regarding these issues are essential to support the growth and support of roles for DNP nurses and the widespread recognition of their impact. Acknowledgment The authors would like to acknowledge the helpful comments of Dr Diane Burgermeister on earlier versions of this manuscript. References 1. Steinwachs DM, Hughes RG. Health services research: scope and significance. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US); 2008. http://www.ncbi.nlm.nih.gov/books/NBK2660/. Accessed February 8, 2013. JONA � Vol. 44, No. 2 � February 2014 77 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. http://links.lww.com/JONA/A285 http://links.lww.com/JONA/A285 http://links.lww.com/JONA/A285 http://links.lww.com/JONA/A285 http://links.lww.com/JONA/A285 http://www.ncbi.nlm.nih.gov/books/NBK2660/ 2. Institute of Medicine. To err is human: Building a safer health system. Washington DC: National Academies Press; 1999. http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is- Human/To\%20Err\%20is\%20Human\%201999\%20\% 20report\%20brief.pdf; http://iom.edu/~/media/Files/Report\% 20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20 Human\%201999\%20\%20report\%20brief.pdf. Accessed October 12, 2013 3. Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academies Press; 2001. http://www.nap.edu/html/quality_ chasm/reportbrief.pdf. Accessed February 8, 2013. 4. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2011. 5. DNP Program Schools. American Association of Colleges of Nursing Web site. http://www.aacn.nche.edu/dnp/ program-schools. Updated January 2013. Accessed February 8, 2013. 6. New AACN Data Show an Enrollment Surge in Baccalaureate and Graduate Programs Amid Calls for More Highly Edu- cated Nurses. [press release]. Washington, DC: American Asso- ciation of Colleges of Nursing; 2012. http://www.aacn.nche. edu/news/articles/2012/enrollment-data. Accessed February 8, 2013. 7. American Association of Colleges of Nursing. The Essen- tials of Doctoral Education for Advanced Nursing Practice. American Association of Colleges of Nursing Web site. October 2006. http://www.aacn.nche.edu/publications/position/ DNPEssentials.pdf. Accessed February 8, 2013. 8. Michigan Department of Community Health. 2011 Michigan. http://www.michigan.gov/documents/mdch/CompToUS_ 381382_7.pdf. Accessed February 8, 2013. 9. American Association of Colleges of Nursing. AACN Position Statement on the Practice Doctorate in Nursing. American Association of Colleges of Nursing Web site. October 2004. Accessed February 8, 2013. 10. Kaplan L, Brown MA. Doctor of nursing practice program evaluation and beyond: capturing the profession’s transition to the DNP. Nurs Educ Perspect. 2009;30(6):362-366. 11. Stanton MP, Barnett Lammon CA, Williams ES. The clinical nurse leader: a comparative study of the American Associ- ation of Colleges of Nursing vision to role implementation. J Prof Nurs. 2011;27(2):78-83. 78 JONA � Vol. 44, No. 2 � February 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20Human\%201999\%20\%20report\%20brief.pdf http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20Human\%201999\%20\%20report\%20brief.pdf http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20Human\%201999\%20\%20report\%20brief.pdf http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20Human\%201999\%20\%20report\%20brief.pdf http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20Human\%201999\%20\%20report\%20brief.pdf http://iom.edu/~/media/Files/Report\%20Files/1999/To-Err-is-Human/To\%20Err\%20is\%20Human\%201999\%20\%20report\%20brief.pdf http://www.nap.edu/html/quality_chasm/reportbrief.pdf http://www.nap.edu/html/quality_chasm/reportbrief.pdf http://www.aacn.nche.edu/dnp/program-schools http://www.aacn.nche.edu/dnp/program-schools http://www.aacn.nche.edu/news/articles/2012/enrollment-data http://www.aacn.nche.edu/news/articles/2012/enrollment-data http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf http://www.michigan.gov/documents/mdch/CompToUS_381382_7.pdf http://www.michigan.gov/documents/mdch/CompToUS_381382_7.pdf Chapter 14 Where Do We Go From Here? The Future of the DNP Degree Nursing’s Debate Regarding the DNP Degree Dracup and Bryan-Brown (2005) A new nursing degree will add to public’s confusion about educational requirements in nursing. Practice doctorates will threaten the supply of nurses who pursue a PhD. DNP degree will enlarge gap that exists between academic and clinical nursing and increase discord within profession. Nursing’s Debate Regarding the DNP Degree Burman and colleagues (2005) DNP degree will not enlarge gap that exists between academic and clinical nursing but will do the opposite. DNP degree will not force nurses to choose between a research and a practice doctorate. DNP gives nursing the opportunity to reconceptualize what advanced practice nursing is. Nursing’s Debate Regarding the DNP Degree Master’s degree still required for entry into practice for APRNs. If and when DNP degree mandated for entry into practice, individual state boards reflect these standards. AACN recommended that one title, doctor of nursing practice, be used. Nursing’s Debate Regarding the DNP Degree DNP degree accommodates increased preparation required to meet demands of a complex healthcare system. Provides nursing with parity among other healthcare professionals. Doctorate level will convey level of competence to legislators and facilitate increased scope of practice and privileges. Nursing’s Debate Regarding the DNP Degree Nursing professoriate has achieved senior ranks in academia at leading universities. DNP is academic degree; remains unclear how certifying bodies will credential DNP graduates. There is a variance among current DNP degree curricula and outcomes. Nursing’s Debate Regarding the DNP Degree With adoption of DNP degree, there has been an increase in the number of nurses returning to school for doctoral work. DNP degree fosters theory–research–practice feedback loop, which has been a goal of nursing for years. Nursing’s Debate Regarding the DNP Degree DNP prepared nurses uniquely qualified to reduce research-to-practice gap. DNP prepared nurses transform knowledge generated in research into feasible studies and application. The Future of the DNP Degree The Growth of DNP Programs 241 DNP programs currently enrolling students at schools of nursing nationwide 59 DNP programs in planning stages Programs will vary in their clinical content AACN Essentials of Doctoral Education for Advanced Nursing Practice should be used as a guide for program content The Future of the DNP Degree Faculty Availability AACN reported schools of nursing turned away 79,659 applicants in 2012 Reasons cited include: Insufficient numbers of faculty Insufficient numbers of clinical sites Limited classroom space Limited preceptors Budget constraints The Future of the DNP Degree Faculty Availability 2013: 1,358 vacancies for faculty positions 2012–2018: 220 to 280 master’s-prepared nurse faculty eligible for retirement Ideally, influx of new DNP graduates will help meet the need for clinical faculty positions. The Future of the DNP Degree Program Development DNP curricula guided by Essentials of Doctoral Education for Advanced Nursing Practice outlined by the AACN (2006b). National Organization of Nurse Practitioner Faculties (NONPF): curriculum templates for DNP programs to help guide course development (2013). The Future of the DNP Degree Program Development National Association of Clinical Nurse Specialists (NACNS) Core Practice Doctorate Clinical Nurse Specialist Competencies to guide curriculum development for CNS-focused DNP programs (2009). Content and length somewhat unified for DNP programs to establish credibility. The Future of the DNP Degree Student Enrollment APRNs concerned about time commitment, cost, and marketability of a DNP degree. Current enrollment has continued to increase. DNP enrollment up 21.6\% from 2012 to 2013. Motivation for returning to school: Pursue practice-focused doctorate To develop expertise in leadership, evidence-based practice, policy, population health A Word About Nurse Residencies Many DNP programs offer a residency, or clinical experience. NONPF: minimum of 500 hours post-BSN for nurse practitioner students. Additional clinical hours required to achieve the DNP competencies. A Word About Nurse Residencies Many DNP programs have integrated residencies or role-immersion experiences that focus on skills outlined in NONPF competencies and AACN essentials. An Update from the AACN 2013: CIC Dean’s Conference on the Doctor of Nursing Practice Consensus regarding interest in DNP degree Consensus on intent of DNP degree to expand role of APRNs Controversy focused on what DNP end product is Controversy: inconsistencies in content and clinical hours/residencies across programs An Update from the AACN 2013: CIC Dean’s Conference on the Doctor of Nursing Practice Controversy regarding outcomes of DNP programs AACN developed DNP Summit (2013) Explore program plans of study, clinical practicums, scholarly projects, outcomes of DNP programs, revisions of the essentials document An Update from the AACN As a result of DNP Summit Task force formed regarding implementation of the DNP degree. Formulate white paper to clarify expectations of DNP scholarly project and practice requirements of the DNP degree. DNP Degree and Societal Needs DNP movement compared to nurse practitioner movement in that societal needs noted. Response: to increase nursing’s capacity to lead and improve health of the nation. Complex and chronically ill population has driven need for increased preparation of healthcare professionals. DNP Degree and Societal Needs Societal needs: Require healthcare professionals develop awareness of disparities that exist in health care today. Influenced necessity for nursing to deliver safe, effective, high-quality health care. Summary Adoption of DNP degree has evolved over the past decade. Early discussions regarding DNP degree focused on advantages/disadvantages of practice doctorate in nursing. Accurate information about DNP degree and entry into practice needs to be disseminated. Summary There is confusion regarding titles. Increasing educational preparation of APRNs to doctorate level will convey competence to legislators and facilitate increased scope of practice and privileges. Nursing professoriate has achieved senior ranks in academia in leading universities. Summary Chase and Pruitt (2006) related concerns regarding titling and licensure. Lack of course work devoted to the development of the discipline of nursing noted as concern. Concerns regarding addition of nurse residency programs to DNP degree course work. Summary Counterarguments for DNP program noted in the literature. AACN maintains updated program list of all approved DNP programs. Content and length of programs unified for DNP programs to establish credibility. NONPF designed curriculum templates to help guide course development. Summary New DNP graduates will help meet need for clinical faculty positions. The success, productivity, enthusiasm of DNP graduates will help to determine whether others pursue this degree. Additional clinical hours required to achieve DNP competencies outlined by NONPF. Summary 2010: AACN published The Doctor of Nursing Practice: A Report on Progress. 2013: CIC Dean’s Conference on the Doctor of Nursing Practice. AACN developed DNP Summit. Task force formed regarding implementation of the DNP degree. Summary DNP degree enables nursing to continue to serve societal needs. Knowledge and expertise acquired in a DNP program assist graduates in meeting changing needs of society. DNP graduates on cutting edge of shaping future of nursing education and healthcare delivery. * At the end of this lecture you will: Have gained an understanding of the meaning of sustainability and sustainable development Be able to differentiate between weak and strong sustainability, and Be able to see the importance of viewing business management with a lens of sustainability Environmental Issues in Business 201 * Lecture 1 Environmental Issues in Business 201 * ? ? ? ? Lecture 1 Environmental Issues in Business 201 * Lecture 1 Environmental Issues in Business 201 * The 15 Global Challenges provide a framework to assess the global and local prospects for humanity. The Challenges are interdependent: an improvement in one makes it easier to address others; deterioration in one makes it harder to address others. Arguing whether one is more important than another is like arguing that the human nervous system is more important than the respiratory system. Can you see why there is a growing desire to shift away from the economic paradigm of development? Lecture 1 Environmental Issues in Business 201 * Silent Spring – warned of toxicity of chemicals Carson, R 1962, Silent Spring, Penguin Books, New York. Tragedy of the Commons – warned of demise of open access resources Hardin, G 1968, The tragedy of the commons, Science, vol. 162, pp. 1243-8. Population Bomb – warned of overpopulation Ehrlich, P 1970, The Population Bomb, Ballantine Books, New York. Limits to Growth – warned about the cost of unlimited economic growth Meadows, D, Meadows, D, Randers, J & Behrens, W 1972, The Limits to Growth: A Report to the Club of Romes Project on the Predicament of Mankind, Pan, London. Lecture 1 Environmental Issues in Business 201 * Hardin (1968) suggested that excessive population growth and exploitation of natural resources leads to the: ‘tragedy of the commons’ When nobody owns a particular resource, it gets exploited to the extent that the resource becomes unusable for everybody e.g. The Tragedy of the Commons * * So, is sustainability a new concept? Lecture 1 Environmental Issues in Business 201 * * June 1962:  Rachel Carson’s Silent Spring is published. Acclaimed as the catalyst of the sustainability movement Greater focus on environmental awareness and the need for paradigm shift away from economic emphasis Lecture 1 Environmental Issues in Business 201 * * Source NASA: http://www.nasa.gov/multimedia/imagegallery/image_feature_1249.html December 1968: The crew of Apollo 8 took the first photo of the Earth from lunar orbit - The Earthrise Lecture 1 Environmental Issues in Business 201 * * Sustainable Development (WCED, 1987 p. 43) Lecture 1 Environmental Issues in Business 201 * * What about in Western Australia? Antecedents to environmental movement in WA dates back to the late 19th century e.g. The Natural History Association estd. in 1880s Community activism saved Kings Park in 1950s Lecture 1 Environmental Issues in Business 201 * * Greater Focus on Participation and Local Solutions to existing and emerging problems Lecture 1 Environmental Issues in Business 201 * * The 1992 Earth Summit: Rio, Brazil http://www.youtube.com/watch?v=TQmz6Rbpnu0&feature=share&list=PLD940256D2E56A15F Miss Suzuki - The girl who silenced the world for 5 minutes … The 2016 Olympics: Rio, Brazil Lecture 1 Environmental Issues in Business 201 * Social and environmental problems are interrelated with economic challenges and they all need to be addressed together Lecture 1 Environmental Issues in Business 201 * 2015 +: 4th Era? Paradigm shift towards Sustainable Development for all not just selected few 189 countries adopted the UN Millennium Declaration and committed to the Millennium Development Goals (MDGs) in 2000 MDGs reflect on a shared vision for reducing poverty around the world The central goal is to reduce by half the proportion of people living on less than US$1.25 a day by 2015 relative to 1990 * http://www.abc.net.au/worldtoday/content/2011/s3154334.htm Lecture 1 Environmental Issues in Business 201 * Lecture 1 Environmental Issues in Business 201 * Paradigm - a framework for observation and understanding the patterns that influences what we think and how we want to solve problems e.g. theory, norm, common sense. So paradigm shift is a change from one of way of thinking/examining to another http://janefriedman.com/2012/05/11/distinguishing-between-straight-up-advice-and-paradigm-shift/ Lecture 1 Environmental Issues in Business 201 * “to sustain”: Support Keep in being Keep in certain state Keep at proper level or standard So, “sustainability” has something to do with: continuance maintenance, and the ability to continue an activity or maintain a certain condition indefinitely Source: Eckersley (1998) * Shift towards Sustainability “to develop”: Improve Get better Progressive transformation of economy and society Lecture 1 Environmental Issues in Business 201 * * Inter-species equity : Making sure that other species and their habitat can co-exist Intra-species equity: Making sure that all of us have the same rights and opportunities now and in the future (includes inter-generational) Precautionary principle: Making sure that the lack of scientific certainty doesnt compromise common sense to minimize risks If an activity is said to be sustainable: it should be able to continue forever. SD = development that meets the needs of the present without compromising the ability of future generations to meet their own needs (WCED 1987, p.43) Sustainability or Sustainable Development? Sustainability = Goal | Sustainable Development = Objective Ethics * * Critical thinking … * Sustainability was first conceived as an environmental issue only Sustainability meant nature conservation * Today, sustainability stands for the balancing of many issues and dimensions Sustainability now encapsulates ethical, political, social and cultural as well as environmental and economic concerns What are the implications of this changed understanding??? Lecture 1 Environmental Issues in Business 201 * * … Sustainable Everything? • Sustainable advertising • Sustainable architecture • Sustainable art • Sustainable business • Sustainable city • Sustainable communities Plan • Sustainable community • Sustainable design • Sustainable fashion • Sustainable fisheries management • Sustainable forest management • Sustainable industries • Sustainable landscape architecture • Sustainable living • Sustainable packaging • Sustainable procurement • Sustainable reporting • Sustainable tourism • Sustainable transport • Sustainable urban drainage systems • Sustainable urban infrastructure • Sustainable yield * The sustainability notion has become a buzzword Lecture 1 Environmental Issues in Business 201 * * Critical reflection … My best friend! Best meal in Vietnam * Source: Hopwood et al. (2005, p.41) Pessimists Optimists Lecture 1 Environmental Issues in Business 201 * The Optimists Ecosystem integrity Climate integrity Carrying capacity Biodiversity Growth Shareholder value Efficiency Innovation Empowerment & Equity Social mobility Social cohesion Cultural identity Institutional development Sustainable Growth social objectives environmental objectives objectives economic Lecture 1 Environmental Issues in Business 201 * The Pessimists Source: Meadows, Randers & Meadows (2008, p.169) Lecture 1 Environmental Issues in Business 201 * * Optimists vs. Pessimists Who is right? Ecosystem integrity Climate integrity Carrying capacity Biodiversity Growth Shareholder value Efficiency Innovation Empowerment & Equity Social mobility Social cohesion Cultural identity Institutional development Sustainable Growth social objectives environmental objectives objectives economic Lecture 1 Environmental Issues in Business 201 * Maintenance of high standard of living through the maintenance of various forms of capital Substitutability of natural capital Natural capital can be substituted Anthropocentric Emphasis on human needs and values Mechanistic worldview All can be measured and explained If you cannot measure it, it does not exist Nature is ascribed utilitarian values only Nature only matters when useful to humans (resources) Optimist and Strong faith in: technology science technology and science will save the day human ingenuity * Anthropocentric (planet is for people to exploit) Optimistic (science & technology can fix problems) Economic rationality (substitutability of capitals) This view suggests that man-made capitals cannot serve as a substitute for (critical) natural capital Pessimistic assumptions Focuses on precaution and carrying capacity Ecocentric worldview Nature matters in its own right Challenges entrenched structures and beliefs Rejects economic rationality and technocracy Calls for radical social, political, and economic reform Trans-scientific / multi-disciplinary New approach to science based on integration and holism as opposed to sole reliance on single disciplines * Diesendorf & Hamilton (1997, p.79) Ecocentric (planet has its ecological limits) Pessimistic (no prospect of finding solutions) Holistic rationality (natural capital can’t be substituted) * Triple Bottom Line Paradox Achieving that ideal balance: to accumulate financial capital, maintain or strengthen social capital, and in the process not degrade natural capital remains paradoxical Society Environment Economy Env Economy Soc Lecture 1 Environmental Issues in Business 201 * Practice Tutorial Question: Discuss the notion of sustainability in the context of weak vs strong debate. Forms of Capital Lecture 1 Environmental Issues in Business 201 * * Forms of Resource or Capital Capital Descriptions Contextual indicators Built Physical assets including material infrastructure and man-made assets (Flora et al., 2004) Usability of business facilities e.g. offices, factories Cultural The way people understand the world and how they interact with it as well as their history and traditions (Throsby, 1999) The way of life, differences in the way business operates in various places Financial Money or wealth that facilitates productivity (Goodwin, 2003) Profits, Stock gains, capital gains Human Skills and competencies that make people act in productive ways (Coleman, 1988) Management capacity, Educational qualification Natural Resources that reside in a certain place (e.g. land, water, organisms) which provide societal benefits through ecosystem services (e.g. forests, wetlands) services such as clean air and fresh water, or aesthetic pleasure (Costanza et al., 1997) The environment that businesses depend on Political Ability to access power, connect to resources and power brokers in order to voice concerns and be heard (Aigner et al., 2001) Representation of business interests in politics and policies Social Features of social organisations, such as trust, norms and networks, that can improve the efficiency of society by facilitating coordinated actions (Putnam, 2000) Relationships within, between, and outside firms e.g. bonds, bridges, and linkages Lecture 1 Environmental Issues in Business 201 * * Can we substitute natural capital in reality? 1.27 ha structure originally built as a dome or an artificial enclosed ecological system in Arizona (USA) The dome aimed to mimic nature and contained: rainforest, ocean with a coral reef, a mangrove wetlands, grassland, agricultural system & human habitat Lecture 1 Environmental Issues in Business 201 * Due to falling oxygen and rising CO2 levels, 8 scientists needed to be evacuated only after a few months... If we have hard time figuring out the dome for 8 people, how would we manage to keep 7 billion (and counting) people alive and at what cost? The cost of the built capital i.e. Dome that (marginally) regulated life-support systems for 8 People over two years was about $150 million, or $9,000,000 per person per year. These ecosystem services i.e. Natural capital are provided to you and me more-or-less cost-free by natural processes, if we were to be charged for such services, the total invoice (sans GST ) will run into many quintillion dollars for one generation alone! Lesson Learned from Biosphere 2 Lecture 1 Environmental Issues in Business 201 * Homer Simpson accidentally pollutes the Lake Springfield with pig manure and the government decides to encase the whole town in a dome.... ....Inside the Dome Lecture 1 Environmental Issues in Business 201 * Mission: Obtaining unobtainium  ... Outside the Dome Lecture 1 Environmental Issues in Business 201 * Sustainable development requires: Inter-species, Intra-species and Inter-generational equity considerations; and the adoption of the precautionary principle in the context of weak or strong sustainability thinking However, many unanswered questions remain: How should decision-makers address trade-offs? E.g. jobs vs. few trees; subsidy for cheap energy vs. action on climate change How do we deal with sustainability paradox? Socially and environmentally just development? Where is the successful model? Difficult institutional/behavioural changes? Are we ready? What is the specific role of business in resolving global pressing problems? There is little guidance on how to make sustainable development a reality. There are no laws and no agreement on what this should look like. Yet, many reasons exist for businesses to take it seriously. This we will explore in more detail in weeks to come… Concluding Remarks Lecture 1 Environmental Issues in Business 201 * Barbier, E. B. (1987). The concept of sustainable economic development. Environmental Conservation, 14(2), 101-110. Carson, R. (1962). Silent Spring. New York: Penguin Books. Diesendorf, M., & Hamilton, C. (Eds.). (1997). Human ecology, human economy. Ideas for an ecologically sustainable future. St Leonards: Allen & Unwin. Eckersley, R. (1998). Measuring progress: is life getting better? Collingwood, Victoria: CSIRO Publishing. Friedman, M. (1970). The social responsibility of business is to increase its profits. New York Times Magazine, 13, 32-33, 122-126. Giddings, B., Hopwood, B., & OBrien, G. (2002). Environment, economy and society: fitting them together into sustainable development. Sustainable Development, 10, 187-196. Hanley, N., Shogren, J. F., & White, B. (1997). Environmental economics in theory and practice. Oxford: Oxford University Press. Hopwood, B., M. Mellor, and G. OBrien. 2005. Sustainable development: Mapping different approaches. Sustainable Development 13 (1): 38-52. LaRouche, L.H. Jr. 1982. There are no limits to growth. Club of Life: Wiesbaden Lowe, I. (2002). Social behaviour and incentives for sustainability. Retrieved 7th July, 2003, from http://www.coastal.crc.org.au/coast2coast2002/presentations/Plenary/Social_behaviorincentives_for_sustainability.pdf Meadows, D. Randers, J. & Meadows, D. (2008). Limits to growth. The 30-year update. London: Earthscan. Spangenberg, J. (2001). Sustainable development: from catchwords to benchmarks. In M. Charter & U. Tischner (Eds.), Sustainable solutions: developing products and services for the future (pp. 24-74). Sheffield, UK: Greenleaf. World Commission on Environment and Development. (1987). Our Common Future. Oxford: Oxford University Press. Lecture 1 Environmental Issues in Business 201 * Sustainability Practical solution or theoretical trap?