NURS 8100 – Healthcare Policy and Advocacy Assignment Papers.

NURS 8100 – Healthcare Policy and Advocacy Assignment Papers.

Permalink: https://nursingpaperessays.com/nurs-8100-health…ssignment-papers/ ‎

If you’ve found my website, chances are you or someone you care about is facing a healthcare situation. I know it can be shocking, devastating, and distressing. I’ve spent my life working in the medical field, and have built my business around helping others work their way through one of the scariest and most challenging times of their lives.

Our Motto
“It’s Like Having a Doctor in the Family.“
Why Choose GPS Columbus?
I founded Guided Patient Services in 2014 to serve the Columbus, Ohio area’s need for private patient health advocacy and navigation. As a physician, I saw families in the hospital who were overwhelmed, confused and uncertain of the next steps. Through Guided Patient Services, I provide clients and their families with medical interpretation, direction, and support.

I firmly believe that peace of mind and empowerment is achieved through a greater understanding of one’s own healthcare. Patients need a trusted, knowledgeable counselor who can translate the medical jargon, and help them process the large volumes of health information often thrown at them in a short period of time.

I have had the honor of advocating for young people struggling with a complicated diagnosis. I’ve helped seniors who need coordination of care. I’ve assisted out-of-town families, who as much as they want to, can’t make it to their loved one’s doctor’s appointments, hospitalizations or procedures. I replace worry, confusion and crisis with personalized assistance, guidance and assurance.

My focus is to ensure my clients fully comprehend their medical situation, so they can make the best choices for their own health and well-being.

You don’t have to be alone. If you are looking for a patient advocate with an unwavering practice of empathy, honesty and integrity, I invite you to contact me.

“Though I know she had other clients at the time, she made me feel like I was the only one and her top priority.”…more
Mission and Philosophy
The mission of Guided Patient Services, Inc. is to provide unsurpassed patient advocacy and navigation to clients in an environment that promotes patient empowerment and knowledgeable decision making.

Guided Patient Services’ company philosophy is to treat clients like family. This includes an unwavering practice of empathy, honesty, patience, integrity and caring.

At Fifth Influence, we understand, embrace and celebrate this truth. We create and implement advocacy campaigns using digital performance marketing principles.

Our campaigns rapidly influence constituents and customers on vital issues impacting our clients’ goals. We are your escorts to a digital world of issue advocacy, political campaigning and outright customer marketing that delivers on your critical goals faster and more efficiently than you are practicing today.

With Congress pushing for more value-based care, hospital and organizational consolidation is on the rise. This goes beyond traditional mergers, which merely changed the name on a sign. Healthcare systems have begun to acquire many outpatient and private practices, as well.

This trend may last, or it may be remembered as a dying fad. In the midst of it, you need to be sure your plans for organizational consolidation are actually beneficial to patients, caregivers, and the organization as a whole. Bigger isn’t always better, and consolidation should ultimately streamline patient experience.

In our latest episode of Off-Script, we’ll listen in as six of the leading experts in the healthcare field offer their unscripted, unfiltered insights about the latest move toward consolidation. What does it mean for the people involved, and how can it move the organization toward its overall wellbeing goals?

Many economic, financial, and political factors influence the delivery of healthcare, making healthcare reform a challenging task. In this course, students examine these factors, challenges, and consider policy reform through legal, regulatory, ethical, societal, and organizational contexts. They examine the political and policy process, including agenda setting, stakeholder analysis, and application of policy analysis frameworks. Students also explore the importance of interprofessional collaboration in improving health outcomes through the policy process and advocacy for development and implementation of nursing and healthcare policies in organizations at the local, state, national, and international levels. Students engage in written analyses through which they develop new policies and critically evaluate existing policies though policy analysis frameworks

The Doctor of Nursing Practice (DNP) program builds on the student’s knowledge and expertise to strengthen advanced nursing practice, augment healthcare delivery, and improve patient outcomes. The program’s coursework covers a range of topics, including healthcare policy and advocacy, quality improvement, evidence-based practice, information systems/technology, advanced nursing practice, and organizational and systems leadership.

Learning Outcomes
At the end of this program, students will be able to:

Translate research findings to direct evidence-based nursing practice.
Develop organizational system changes for quality improvement in healthcare delivery in response to local and/or global community needs.
Apply optimal utilization of healthcare information technology across healthcare settings.
Advocate for the advancement of nursing and healthcare policy through sharing of science-based knowledge with healthcare policy makers.
Demonstrate leadership to facilitate collaborative teams for improving patient and populations health outcomes.
Utilize advanced nursing practice knowledge to implement methodologies to improve population health outcomes.
Establish a foundation for lifelong learning for continual elevation of contributions to the field of nursing through active involvement in professional organizations and/or other professional bodies.
Accreditation
Walden University’s DNP program is accredited by the Commission on Collegiate Nursing Education (CCNE), One Dupont Circle, NW, Suite 530, Washington, D.C. 20036, 1-202-887-6791. CCNE is a national accrediting agency recognized by the U.S. Department of Education and ensures the quality and integrity of baccalaureate and graduate education programs in preparing effective nurses. For students, accreditation signifies program innovation and continuous self-assessment.

Degree Requirements
47–53 total credits, depending on number of previously documented clinical hours
Foundation course (1 cr.)
Core courses (46 cr.)
Field experience (up to 6 cr., for students with fewer than 500 documented clinical hours)
Minimum 4 quarters enrollment
Core Curriculum
Foundation Course (1 cr.)
NURS 8000 – Foundations and Essentials of Doctoral Study in Nursing
Core Courses (46 cr.)
NURS 8100 – Healthcare Policy and Advocacy
NURS 8110 – Theoretical and Scientific Foundations for Nursing
NURS 8200 – Methods for Evidence-Based Practice
NURS 8210 – Transforming Nursing and Healthcare Through Technology
NURS 8300 – Organizational and Systems Leadership for Quality Improvement
NURS 8310 – Epidemiology and Population Health
NURS 8400 – Evidence-Based Practice I: Assessment and Design
NURS 8410 – Best Practices In Nursing Specialties
NURS 8500 – Evidence-Based Practice II: Planning and Implementation
NURS 8510 – Evidence-Based Practice III: Implementation, Evaluation, and Dissemination
Field Experience (up to 6 cr.)
Students with fewer than 500 documented clinical hours take up to 6 credits of field experience (see Determining Clinical Hours for Admissions section).N

NURS 8600 – DNP Field Experience
Course Sequence
Course Sequence
Quarter

Course

Credits

1

NURS 8000 – Foundations and Essentials of Doctoral Study in Nursing
1

NURS 8110 – Theoretical and Scientific Foundations for Nursing
5

2

NURS 8200 – Methods for Evidence-Based Practice
5

NURS 8210 – Transforming Nursing and Healthcare Through Technology
5

3

NURS 8300 – Organizational and Systems Leadership for Quality Improvement
5

NURS 8410 – Best Practices In Nursing Specialties*
(4 didactic, 1 clinical) = 72 clinical hours

5

4 cr. didactic,

1 cr. clinical

(72 hours)

4

NURS 8310 – Epidemiology and Population Health
5

NURS 8400 – Evidence-Based Practice I: Assessment and Design*

5 credits (4 didactic, 1 clinical) = 72 clinical hours

5

4 credits didactic

1 credit clinical

(72 hrs)

5

NURS 8100 – Healthcare Policy and Advocacy
5

NURS 8500 – Evidence-Based Practice II: Planning and Implementation
(216 clinical hours)
3 cr. clinical

(216 clinical hours)

6
NURS 8510 – Evidence-Based Practice III: Implementation, Evaluation, and Dissemination *
(216 clinical hours)

3 cr. clinical

(216 clinical hours)

3–6
NURS 8700 – DNP Project Mentoring **
0
Post NURS 8510
NURS 8701 – DNP Project Completion ***

3

*Note: NURS 8400, 8410, 8500, and 8510 are a series of four courses in which students develop and complete their DNP Project.
**Note: NURS 8700 is taken concurrently with the practicum series courses specifically for working on DNP doctoral scholarly project.
***Note: NURS 8701 is taken after completion of the practicum courses specifically for DNP doctoral scholarly project completion

Determining Clinical Hours for Admissions
To determine how many clinical hours students have upon entering the program, students must submit a letter from their previous master’s in nursing program. It must be sent from the program director, associate dean, or dean of their previous institution.

The letter must include all of the following items:

Date
Student’s full name
University name, department, school
Name and title of authority sending the letter (must be the program director or above), and contact information for follow-up if necessary
Program director, associate dean, or dean’s signature
University letterhead
Date and title of degree earned
Specialization earned
Total number of preceptor verified field experience hours
The signed letter will be submitted as an element. Admissions will determine how many documented clinical hours students have completed prior to DNP entry and how many they will be required to complete in the DNP program (NURS 8600 – DNP Field Experience).

Program Data
Walden is committed to providing the information you need to make an informed decision about where you pursue your education. Click here to find detailed information for the Doctor of Nursing Practice (DNP) program relating to the types of occupations this program may lead to, completion rate, program costs, and median loan debt of students who have graduated from this program.

The American Nurses Association (ANA) believes that every person has the right to the highest quality of healthcare. For decades, ANA has utilized the experience and expertise of its members to fight for meaningful health care reform.

Advocating in reaction to political policy
At the highest levels, ANA advocates for policymakers to recognize the true value of nursing, and the unique perspective that nurses have to offer. The voices of nurses are instrumental in advancing public health. The passage of the Patient Protection and Affordable Care Act (PPACA, often referred to as the ACA) in 2010 created essential health benefits, increasing protection for millions of people against losing or being denied insurance. ANA has outlined cornerstones of effective reform.

What’s at Stake Without the Affordable Care Act?

DOWNLOAD THE INFOGRAPHIC

There have been many attempts to repeal the ACA but the strongest began at the end of 2016. In determining whether to support these proposals, ANA analyzed the proposed reforms against its four principles for health care reform. As the nation’s largest group of healthcare professionals, ANA was instrumental three times in 2017 in stopping the passage of legislation that would undermine the current health care delivery system, impacting nurses and their patients.

ANA’s Principles for Health System Transformation
In December 2016, ANA delivered a letter to then President-elect Trump outlining ANA’s Principles for Health System Transformation.
The system must:

Ensure universal access to a standard package of essential health care services for all citizens and residents.
Optimize primary, community-based, and preventive services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services.
Encourage mechanisms to stimulate economical use of health care services while supporting those who do not have the means to share in costs.

Ensure a sufficient supply of a skilled workforce dedicated to providing high quality health care services.
ANA also spoke out against the proposed American Health Care Act (AHCA) in May 2017, arguing that the reforms would endanger the health of Americans, eliminate the Prevention and Public Health fund, and fundamentally jeopardize the quality of healthcare delivery.

Reform for an aging population
In addition to shifts in political policy, the aging population may necessitate dramatic health care reform. These changing demographics present the need for more complex and longer-term care. To provide the best possible experience for patients, innovative approaches should be considered; whether through utilizing new technologies or by extending the nursing scope of practice to reflect the true extent of nursing expertise.

Promoting ongoing conversations
Like in the case of our aging population, ANA recognizes that the debate over healthcare is ongoing, and we remain committed to educating the public about how nursing impacts our lives and the profession.

ANA continues to deliver the role of the nurse and the profession in a manner that is informative, rich in resources, and solution oriented. We encourage nurses to take action, and advocate for themselves and their patients to all receive the highest quality care.

To keep abreast of ANA’s efforts, join the Capitol Beat blog and for additional details about ANA’s federal legislative agenda and /or to get involved, sign up at www.rnaction.org.

World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries.

Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from ‘task delegation’ to ‘team care’ is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession.

Clear definitions of each team-member’s role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide.

Previous articleNext article
Keywords
Primary health careWorkforceSkill mixReviewNursesNurse practitioners
What is already known about the topic?
•
Internationally, primary care is delivered by teams of physicians and healthcare professionals.

•
Significant differences regarding education, tasks, remuneration and terminology of health professionals in primary care can be observed internationally.

What this paper adds
•
Nurses are the major non-physician workforce in primary care teams in the US, Canada, Australia, UK and the Netherlands.

•
In general, remuneration follows complexity of tasks in most countries under study.

•
“Team-care” rather than “delegation” is an upcoming trend as well as integration of “allied health professionals” under the supervision of doctors and nurses, but this is often limited by local legislation and traditional role concepts.

1. Background
Primary care systems across the world face the challenge of decreasing medical workforce in tandem with increasing care demands. On the supply side, the numbers of medical graduates entering primary care specialties such as general internal medicine, family medicine or geriatrics are decreasing in the United States (US) (Swartz, 2012) and internationally (OECD, 2012). On the demand side, numbers of patients (Hofer et al., 2011, Petterson et al., 2012) as well as care demands (Tinetti et al., 2012) are substantially increasing. In some countries changes to health systems also increase demand. For example, in the US, the Patient Protection and Affordable Care Act of 2010 expanded insurance coverage to millions of uninsured individuals by the year 2014 thereby further increasing the demand for primary care (Hofer et al., 2011). In the face of these developments, the traditional concept of the ‘lone-doctor-with-helpers model’ may induce substantial problems with access to primary care (Ghorob and Bodenheimer, 2012).

In response to these problems, the diversity of the primary care workforce is expanding to include non-physician health professionals such as nurse practitioners, registered nurses and other clinical staff members (Green et al., 2013). Although this development can be observed internationally, the skill mix in the primary care workforce as well as speed of progress to deliver primary care as a team differs across countries (Buchan and Dal Poz, 2002, Richards et al., 2000, Sibbald et al., 2004). This paper aims to discuss skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. We characterize and compare health professionals and provide insight into global trends in changing skill mix of the primary care workforce.

1.1. Classification of health professionals
Differences in terms and names describing non-physician health professionals in different countries hinder international comparison. Therefore, in this paper health professionals are classified by the care continuum framework proposed by Kernick (1999). This scheme divides health professionals into five distinct areas of care delivery according to complexity of tasks and resource allocation ranging from full management of all clinical cases (Area A = general practitioner) to simple well-defined tasks like urine analysis or phlebotomy (Area E = nursing aide/assistant).

In this article, skill mix in the primary care workforce of six countries is discussed by a team of national experts; each country is represented by one expert (i.e., the authors). We include the US, Canada, Australia, England, Germany and the Netherlands as publications from these six countries cover over 80% of the literature on primary care skill mix and workforce (as determined by a MEDLINE search on May 10, 2013 by using the keywords “primary care”, “workforce” and “skill mix”) Each national expert (i.e., author) decided on the position of the providers on Kernick’s continuum. By means of this framework, non-physician health professionals in primary care can be compared and matched with each other across countries, although we acknowledge that this framework is limited by its focus on medical tasks. Characterization of the workforce and issues for each country was informed by scientific publications, policy reports of local authorities (including websites) and supplied by personal communication if further information was needed (referenced at the end of each table).

Skill mix of the primary care workforce is characterized as follows: Original titles/roles of members of primary care teams in all countries are provided in local language. This may enable international readers to map from titles/roles of local health professionals to similar roles in other countries. The ‘Basic education’ required to enter professional training includes minimum years of primary and secondary school. ‘Professional education’ refers to basic training which is required for becoming a specific health professional with ‘special training’ referring to mandatory or optional training prior to working in primary care practice. We report on the licensing for each health profession extended by information on the accreditation of specialty training (if applicable). Common medical work performed by each health professional is displayed according to either legal frameworks, official statements or common practice where legal frameworks or official statements do not exist. We inform about the existence of professional organizations for each health profession and whether membership is mandatory for those practicing in primary care. Finally, information about average annual salary is given in US dollars by converting local currency into US dollars by averaged exchange rates for the year 2012 (Interbank, 2013).

2. The national perspective: primary care workforce in six countries
2.1. United States
A constellation of social and political factors have set the stage for team-based primary care in the US. With the aging of the population and the mandated expansion of insurance coverage specified in the Affordable Care Act, demand for services is expected to increase significantly. Combined with a shrinking number of medical trainees planning for careers in primary care, a significant shortage of primary care physicians is predicted by 2025 (Swartz, 2012). This mismatch between demand and supply, as well as new policy initiatives focused on improving access and quality while reducing cost, has increased the interest in team-based primary care practice redesign (Margolius and Bodenheimer, 2010).

Currently skill mix in primary care includes a number of different non-physician health professionals summarized in Table 1a, Table 1b. While there appears to be general agreement that transformation to multidisciplinary teams is necessary, the approaches to implementing primary care teams are highly varied (Bodenheimer and Laing, 2007, Nelson et al., 2010, Smith et al., 2010). The factors associated with this variation have not been studied, but are likely due to a variety of local factors, including differences in state scope of practice laws. Some approaches utilize traditional primary care health professionals but redefine or extend their roles. For example, some models refocus the roles of medical assistants to completing additional tasks such as ordering routine tests and supporting patient self-management (Bodenheimer and Laing, 2007, Nelson et al., 2010). NURS 8100 – Healthcare Policy and Advocacy Assignment Papers. Other models include healthcare professionals not traditionally utilized in primary care, including social workers, pharmacists (Smith et al., 2010), or community health workers, and expand the expertise within the primary care team. In each example, the goals include efficient utilization of all providers (i.e., “working to the top of the license”) and improving the quality of care. The comparative effectiveness and the extent to which multidisciplinary teams have been implemented are currently unknown.

Table 1a. Primary care workforce of the United States of America.

United States of America
313.9 Mio population Area A (general practitioner) Area B (nurse practitioner/physician assistant) Area C (extended role practice nurse) Area D (practice nurse) Area E (practice nurse auxiliary)
Original Name Primary care physician Nurse practitioner or physician assistant Clinical Nurse Specialist (CNS) and Certified Nurse-Midwives (CNM) Registered nurse Licensed practical nurse or medical assistant
Total number Internal medicine: 109,048a
Family medicine: 106,549a
Pediatrics: 5509a
Internal medicine/peds: 3844a Total NP = 155,000 in 2010; 105,400 in primary carec
Total PA = 83,466 in 2010; Estimated 25,874 in primary cared Not available for primary care only (total CNS = 69,000)g
(total CNM = 13,071)h Not available for primary care only (total = 2,737,400)b LPN: not available for primary care only (total = 752,300)b
CMA: not available for primary care only (total = 527,600)b
% Practices employing There are some NP-only clinics, but there is no single source of information on this and would be difficult to estimate Not available for primary care only. Approximately 49% of physicians in outpatient settings work with PA/NPs.e 60% of family medicine physicians report working with PAs, NPs or Midwivesf Not available Not available Not available
Years of basic education 4 (undergraduate degree) NP: 4 year undergraduate, usually Bachelors in Nursing to achieve RN
PA: 4 year undergraduate degree with necessary prerequisites 4 years (undergraduate degree) All education is professional (see professional education) All education is professional (see professional education)
Professional education Med school 4 years
Internship: 1 year
Residency: 3 years NP: Registered Nurse (3 years) + years full-time (or part-time equivalent
Previously Masters program, now Doctorate: 2–3 years
PA: Masters degree: 2–3 years Registered Nurse + Masters or Doctorate in specialized area of nursing (2–4 years) Bachelor’s, associates or diploma programs (2–4 years of education)
Masters degree for nurse administrators, educators, or leaders LPN: accredited 1 year certificate program
MA: certificate program or experience such as military training
Licensing State medical boards PA: State Medical Board; need to pass National Certification Exam – two exams (adult only or adult plus pediatric)
NP: State Nursing Board; need to pass National Certification exams – different exams for different specialties State Nursing Board; need to pass national certification exams for some specialties)h State Board of Nursing LPN: State Board of Nursing – need to pass National Council Licensure Examination
MA: There is no licensing for MAs, however, some states require tests before certain duties can be performed (e.g., X-rays)
Special training Board Certification required for each specialty. Qualify for test when complete residency PA: Some post-graduate fellowships, but none required
NP: Piloting NP fellowships Training is limited in scope to area of specialty
Can include such services as prenatal services, transitional care, chronic disease management, and mental health Not applicable Not applicable
Accreditation of special training Board Certification of each specialty: American Board of Internal Medicine; American Board of Family Medicine; American Board of Pediatrics Not applicable Certification by exam in some specialties, but not all. May need to be certified by state licensing board Not applicable Not applicable
Medical tasks Examination, clinical diagnosis and treatment of all presentations
Coordination of care delivered in all healthcare settings NP: Nursing functions plus examination, diagnosis and treatment of patients plus coordination of care delivered in all healthcare settings
PA: examination, diagnosis and treatment of patients plus coordination of care delivered in all healthcare settings Depends on specialty, but involves diagnosis and treatment of diseases, injuries and/or disabilities within field of expertise Coordinate patient care, educate patients and the public, provide advice and emotional support to patients and families, preventive activities (e.g., immunizations); expanded roles include delivery of algorithm-based care such as medication adjustment for non-complex patients with chronic illness LPN: operate under direction of RN and doctors. Perform basic nursing functions
MA: Duties vary. Perform administrative and clinical procedures, such as collecting patient history and collecting vitals (pulse, respirations, temperature)
Professional organization American College of Physicians; American Academy of Family Physicians; American Academy of Pediatrics There are many, but a few include: American Association of Nurse practitioners; American Academy of Nurse Practitioners, American Academy of Physician Assistants, National Commission on Certification of Physician Assistants National Association of Clinical Nurse Specialists Not applicable LPN: National Federation of Licensed Practical Nurses; National Association for Practical Nurse Education and Service
MA: American Association of Medical Assistants; American Medical Technologists
Salary per year (USD)
Internal medicine: 191,520b
Family practice: 180,850b
Pediatrics: 167,640b
PA: 92,460b (not primary care specific)
NP: 91,450b (not primary care specific) 50,800–100,000g (not primary care specific) 67,930b (not primary care specific) LPN: 42,400b
MA: 30,550b (not primary care specific)
Data sources:

a
Center for Workforce Studies, Association of American Medical Colleges, 2012. Physician Specialty Data Book. November 2012. https://members.aamc.org/eweb/DynamicPage.aspx?Action=Add&ObjectKeyFrom=1A83491A-9853-4C87-86A4-F7D95601C2E2&WebCode=PubDetailAdd&DoNotSave=yes&ParentObject=CentralizedOrderEntry&ParentDataObject=Invoice%20Detail&ivd_formkey=69202792-63d7-4ba2-bf4e-a0da41270555&ivd_prc_prd_key=C7F68470-F2D7-45AA-BC1D-DB67C3F2D318 (accessed 10.05.13).

b
May 2012 National Occupational Employment and Wage Estimates, Bureau of Labor Statistics: http://www.bls.gov/oes/current/oes_nat.htm#29-0000 (accessed 10.05.13).

c
American Academy of Nurse Practitioners. Nurse Practitioners Facts. http://www.aanp.org/all-about-nps/np-fact-sheet (accessed 10.05.13).

d
American Academy of Physician Assistants. Physician Assistant Census Report: Results from the 2010 AAPA Census. www.aapa.org (accessed 12.01.13).

e
Park, M., Cherry, D., Decker, S.L. Nurse Practitioners, certified Nurse Midwives, and Physician Assistants in Physician Offices. NCHS Data Brief No. 69, August 2011.

f
Peterson, L.E. Most family physicians work routinely with nurse practitioners, physician assistants, or certified nurse midwives. JABFM 26(3), May–June 2013.

g
Clinical Nurse Specialist: http://explorehealthcareers.org/en/Career/82/Clinical_Nurse_Specialist.

h
Certified Nurse-Midwife: “Essential Facts about Midwives” American College of Nurse-Midwives. http://www.midwife.org/Essential-Facts-about-Midwives, June 2014.

Table 1b. Additional Primary Care Team Members in the United States of America.

United States Area F (social worker) Area G (pharmacist) Area H (community health workers)
Original Name Social worker
Total number Not available for primary care only (total = 650,500)a Not available for primary care only (total = 274,900)a Not available for primary care only (total = 38,020)a
% Practices employing Not available Not available Not Available
Years of basic education All education is professional At least 2–3 years of undergraduate study; usually 4 year undergraduate degree No standardized training
Professional education Bachelor’s degree in social work (BSW – 4 years) or Masters degree in social work (MSW – 1–2 additional years) 4 year Doctor of Pharmacy (PharmD) No standardized training
Special training Multiple types, including advanced practice, independent, licensed clinical Many categories of pharmacists Not applicable
Accreditation of training Association of Social Work Boards Licensing Examination Requires two exams: national exam and state law exam None. Some states are developing credentialing criteria
Licensing State Social Work Board State Pharmacy Board Not applicable
Medical tasks Assist people with solving problems in everyday lives, diagnose and treat mental, behavioral, and emotional issues In general, pharmacists dispense prescription medications to patients and offer advice on safe use. Expanded roles in primary care include algorithm-based medication management for patients with chronic illness Assist individuals and communities to adopt health behavior. Conduct outreach for medical personnel or health organizations to promote community programs. May provide information on available resources, provide social support and informal counseling, and advocate for individuals and community health needs. Can perform some basic screening procedures (i.e., blood pressure)
Professional organization National Association of Social Workers Many organizations, including American Pharmacists Association No national organization. Some state have professional organizations
Salary per year (USD) 51,460a (Healthcare Social Workers) – (not primary care specific) 114,950a (not primary care specific) 37,490a (not primary care specific)
Data source:

a
May 2012 National Occupational Employment and Wage Estimates, Bureau of Labor Statistics: http://www.bls.gov/oes/current/oes_nat.htm#29-0000 (accessed 10.05.13).

2.2. Canada
Until the last decade, primary healthcare services in Canada were delivered mainly by family physicians and general medical practitioners. Numerous studies of the health care system have emphasized the importance of primary healthcare reform (Health Canada, 2012).

In 2000, an Action Plan for Health System Renewal was adopted with increased investments to primary healthcare delivery so that “Canadians receive the most appropriate care, by the most appropriate providers, in the most appropriate settings” (Canadian Intergovernmental Conference Secretariat, 2000). The 2002 Romanow report discussed the need for an overhauled approach to primary healthcare, calling for comprehensive 24 h a day, 7 days a week on-call care, interprofessional health care teams, and more emphasis on health promotion (Romanow, 2002). Romanow suggested that basic guidelines for improvement in the delivery of primary healthcare would allow provinces to each develop a unique approach. In 2004, the federal government and all provinces and territories (Québec agreed to the overall objectives but committed to developing its own plan) committed to ensuring that 50% of Canadians have access to multidisciplinary teams in primary healthcare by 2011.

All provinces and territories had designed models of care and multidisciplinary teams with innovative approaches. For example, in British Columbia, interprofessional care networks were developed for patients with chronic health conditions. The Divisions of Family Practice were created, through which groups of primary care physicians could address gaps in patient care and promote family medicine. On the other side of the country, Newfoundland and Labrador divided the province into 30 team areas to serve the entire population. The Ontario government has also developed new approaches to primary healthcare, such as the family health team (184 in 2012) (Ministry of Health and Long-term Care Canada, 2012). A unique feature of family health teams is their emphasis on interprofessional care. A Family Health Team provides ongoing health care through a team of primary care physicians, registered nurses and other health care providers like dietitians and social workers (Donald et al., 2010). In Quebec, the Family Medicine Groups (250 in 2012) play a similar role.

Table 2 displays skill mix of the primary care workforce in Canada. However, the implementation of multidisciplinary teams across Canada is unequal. Presently, relatively few Canadians access primary healthcare services in this way. Although there has been considerable progress made in integrating nurse practitioners into the healthcare system and there is mounting evidence to support the value of the role, there is more to do to fully integrate and sustain the role (Donald et al., 2010).

Table 2. Primary care workforce of Canada.

Canada
35 Mio populationa Area A (general practitioner) Area B (nurse practitioner/physician assistant) Area C (extended role practice nurse) Area D (practice nurse) Area E (practice nurse auxiliary)
Original name Family physician Primary Healthcare Nurse Practitioner (PHCNP) – Registered nurse Licensed practical nurse (or registered practical nurse in Quebec and Ontario)
Total number 36,769 (2011)b 1626 (2010)k
These data do not distinguish between types of NPs but the majority was primary health care NP – 5473 (2010)m Data not available in primary health care
% Practices employing 100% Data not available – Data not available Data not available
Years of basic education (primary school + secondary school) 11–13 yrsc 11–13 yrsk – 11–13 yrsn 11–13 yrss
Professional education Med school: 4–5 yrs, including clerkshipc A master’s degree from an approved graduate level PHCNP programk – Entry-to-practice (ETP) programs
Bachelor’s degreen Licensed practical nurse program (1–2 years)
Licensing Yes
Provincial College of Physiciansd Yes
Provincial College of Registered Nursesk – Yes
Provincial College of Registered Nursesn Yes
Provincial College of Licensed Practical Nursess
Special training Yes
Residency: 2 yrse Yes
About six months included in the master’s degree – Yes
Included in the programo Yes/No
Depending on the program
Accreditation of special training Yes
The examination of the College of Family Physicians of Canada + the Licentiate of the Medical Council of Canadaf,g,h Yes
Canadian Nurse Practitioner Examination or examinations approved by the Provincek – Yes
Canadian Registered Nurse Examination by the Canadian Nurses Association (except in Quebec: examination of the provincial College of Registered Nurses)p Yes
Canadian Practical Nurse Registration Examination (CPNRE)in most provinces ± provincial examinationss
Medical tasks Clinical diagnosis and treatment of all presentationsi The focus of their practice is health promotion, preventive care, diagnosis and treatment of acute common illnesses and injuries, and monitoring and management of stable chronic conditionsk – They provide direct nursing care to patients, deliver health education programs and provide consultative services regarding issues relevant to the practice of nursingq Provide nursing care usually under the direction of medical practitioners or registered nursest
Professional organization Mandatory
Provincial College of Physicians Mandatory
Provincial College of Registered Nurses – Mandatory
Provincial College of Registered Nurses Mandatory
Provincial College of Licensed Practical Nurses
Salary per year (USD) 240,000 (2010)j 65,000 (2011, median)l – 34,000–67,000r 33,000–55,000u
a
http://www.statcan.gc.ca/start-debut-fra.html (accessed 14.05.13).

b
The Canadian Institute for Health Information. Supply, Distribution and Migration of Canadian Physicians, 2011. Ottawa, Ont.: CIHI; 2012.

c
The Association of Faculties of Medicine of Cananda. Admission Requirements of Canadian Faculties of Medicine, 2013;http://www.afmc.ca/pdf/2013_ad_bk.pdf (accessed 14.05.13).

d
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/postgrad-postdoc/action-fam-eng.php (accessed 14.05.13).

e
Oandasan, I., on behalf of the Working Group on Postgraduate Curriculum Review, 2011. Advancing Canada’s family medicine curriculum: triple C. Canadian Family Physician 57 (6), 739–740.

f
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/postgrad-postdoc/action-fam-eng.php (accessed 14.05.13).

g
http://www.cfpc.ca/FMExam/ (accessed 14.05.13).

h
http://www.mcc.ca/en/exams/ (accessed 14.05.13).

i
http://www.servicecanada.gc.ca/eng/qc/job_futures/statistics/3112.shtml (accessed 14.05.13).

j
http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Membership/profiles/Family_en.pdf (accessed 14.05.13).

k
Donald, F., Martin-Misener, R., Bryant-Lukosius, D., Kilpatrick, K., Kaasalainen, S., Carter, N., Harbman, P., Bougeault, I., DiCenso, A., 2010. The primary healthcare nurse practitioner role in Canada. Advances Practice Nursing 23, 88–113.

l
Mathai, B., 2012. Nurse Practitioners in Canada. http://healthcarecoopscanada.files.wordpress.com/2012/07/2012-03-nurse-practitioners-in-canada-2.pdf (accessed 14.05.13).

m
Canadian Nurses Association. RN Workforce Profile by Area of Responsivbility, 2010, Ottawa 2012; http://www.arnbc.ca/images/pdfs/news-cna/2010-Workforce-Profiles-of-RN.pdf (accessed 14.05.13).

n
Canadian Institute for Health Information; http://www.cihi.ca/cihi-ext-portal/internet/en/document/spending+and+health+workforce/workforce/other+providers/hpdb_regnu (accessed 14.05.13).

o
Ordre des infirmiersetinfirmières du Québec. Comparaison de la formation infirmière Québec–Autres provinces canadiennes, Québec 2011; http://www.oiiq.org/sites/default/files/uploads/pdf/l_ordre/dossiers_strategiques/Comparaison_formations.pdf (accessed 14.05.13).

p
Canadian Nurses Association. Becoming a RN; http://www.cna-aiic.ca/en/becoming-an-rn/rn-exam/ (accessed 14.05.13)

q
Canadian Nurses Association. Framework for the Practice of Registered Nurses in Canada, Ottawa 2007; http://www2.cna-aiic.ca/CNA/documents/pdf/publications/RN_Framework_Practice_2007_e.pdf (accessed 14.05.13).

r
http://www.workingincanada.gc.ca/job_search_results.do?searchstring=family+practice+rn (accessed 14.05.13).

s
Canadian Institute for Health Information; http://www.cihi.ca/cihi-ext-portal/internet/en/document/spending+and+health+workforce/workforce/other+providers/hpdb_lispn (accessed 14.05.13).

t
http://www.servicecanada.gc.ca/eng/qc/job_futures/statistics/3233.shtml (accessed 14.05.13).

u
http://www.workingincanada.gc.ca/job_search_results.do?searchstring=licensed+practical+nurse (accessed 14.05.13).

2.3. Australia
Primary care is still the cornerstone of the Australian health care system but the delivery of care and business side has been changing due to changing workforce dynamics (Australian Medical Workforce Advisory Committee, 2005). General practices run as private businesses in Australia. The primary care landscape is changing in Australia.NURS 8100 – Healthcare Policy and Advocacy Assignment Papers. There is a shift away from medically qualified general practitioners working as solo practitioners providing episodic opportunistic care, one way referral processes and fee-for-service financing only. General practices now tend to have two to five primary care physicians and provide a greater focus on prevention and early intervention, structured chronic disease management, within multidisciplinary care team approaches. General practice clinic ownership is becoming concentrated into fewer hands, due to the emergence of corporate ownership and the rise of the ‘GP super clinics’ (Naccarella et al., 2012).

Table 3 provides a snapshot of the current workforce composition and skill mix within Australian primary healthcare. Currently, the composition and skills mix within primary care is changing. The 2012 Australia Medicare Local Alliance National survey reports that the number of registered nurses working in general practice is continually increasing.. The percentage of practices employing a registered nurse has also increased; as is the number of registered nurses per practice (Australian Medicare Local Alliance, 2012). Over the past decade, the Australian Commonwealth Government has introduced Enhanced Primary Care Chronic Disease Management Medicare Benefit Schedule Item number for primary care practices to support team-based models of care. More specifically the funding items enable primary care physician-led care planning and access to Medicare Benefit Schedule-rebatable allied health services for clients with chronic disease and complex care needs. The Medicare Benefits Schedule (MBS) lists the range of consultations, procedures and tests, and the schedule fee for each item (for example, an appointment with a GP or blood tests to monitor cholesterol level). They include Coordination of ‘Team Care Arrangements’ (MBS Item 723) and ‘GP Management Plans’ (MBS Item 732). Medicare rebates are also available where registered nurses provide specific types of services on behalf of a primary care physician. In 2012, the Commonwealth government also introduced the ‘Practice Nurse Incentive Program’ to provide incentive payments to eligible practices to offset the costs of employing a registered nurse and support an expanded role for nurses working in primary care (61 ‘Medicare Locals’ across Australia).

Table 3. Primary care workforce of Australia.

Australia
22.3 Mio population Area A (general practitioner) Area B (nurse practitioner physician assistant) Areas C and D (practice nurses and extended role practice nurse) Area E (practice nurse auxiliary)
Original name General practitioner Nurse practitionera, e/advanced nurse practitioner/nurse consultant Senior Practice nurse/nurse specialist and practice nursec, e Medical assistanta
Total number 24,720 (2011) Overall 595 in Australia in 2011 (of these 75 are in Victoria, Australia)
Based on the 2012 AMLA GP Nurse surveyb – 0.3% of nurses were nurse practitioners (i.e., only 2) in general practice 10,693 practice nurses in 2012
Note: In Australia, the Australian Nursing and Midwifery Board recognizes the titles of Nurse practitioner, registered nurse and enrolled nurses only 76 qualified medical assistants are working across Queenslanda, d (but also working in other states in territories) (not currently registered by the Australian Health Practitioner Registration Agency (AHPRA)
% Practices employing 100% Not available 63% Not available
Years of basic education 12 12 12
Note: In Australia there are two categories of nurse regulated to practice: the registered nurse and the enrolled nurse (see http://anmf.org.au/documents/policies/P_Nursing_education_EN.pdf)
Enrolled nurse education is provided at the Diploma and Advanced Diploma level of the Australian Qualification Framework 12
Professional education Med School 4–6 yrs
Internship 1 year
GP training 3 years Registered Nurse (3 years) + years full-time (or part-time equivalent Master of Nurse Practitioner Studies program Registered nurses (3 yrs), enrolled nurses, registered midwives Certificate IV in Medical Practice Assisting (HLT43307)
The course is a competency-based training program, duration varies depending on the trainee’s existing qualifications, skills and experience. Without any prior knowledge, skills or experience, trainees are expected to complete the course over 12–18 months full-time, or 2 years part-time
Licensing Royal Australian College of General Practitioners (RACGP) Fellowship Nursing and Midwifery Board of Australia The professional regulation of RN, ENs and NPs is undertaken by a single national Nursing and Midwifery Board Accreditation by: Community Services and Health Industry Skills Council (CSHISC) as part of the National Health Training Package (NHTP)
Special training Mandatory
3 years general practice training Mandatory
Current registration as a Nurse in Australia. Bachelor of Nursing (or equivalent). A minimum of five years full-time equivalent (FTE) experience as a Registered Nurse including; three years FTE in a speciality area and one year FTE at an advanced practice level in the relevant speciality area of practice None None required
Accreditation of special training Entry to general practice may be achieved by the admission to Fellowship of the Royal Australian College of General Practitioners (RACGP) Nurse practitioners are registered nurses with advanced educational preparation and experience who are authorized to practice in an expanded nursing role in clinical settings as diverse as hospitals and aged care facilities, as well as in the community Not applicable Not applicable
Medical tasks Clinical diagnosis and treatment of all presentations Assessment and management using nursing knowledge and skills, direct referral of patients to other healthcare professionals, prescribing medications, ordering diagnostic investigations Preventive activities (immunization, antenatal/postnatal, child health, adults checks, assessment, delivery of health promotion), care coordination (case management, preparing care plans, liaison with hospitals, undertake patient advocacy, conduct home visits), clinical activities (triage, suturing, sterilizing)
Note: Competency standards for nurses in Australian general practice also exist (see http://anmf.org.au/documents/reports/compstandards_nursesingp.pdf) Operate under the delegation of a supervising GP scope of practice
Administrative and clinical-assist duties: confirm physical health status of patients; assist with clinical measurements and procedures; facilitate a care coordination, manage emergency cases and challenging patient behavior, apply first aid; handle specimens; clean re-usable instruments and equipment, and; maintain medication stocks, among other duties, manage front desk and patient contact
Professional organization Royal Australian College of General Practitioners Australian College of Nurse Practitioners
APNA Australian Primary Health Care Nurses Association (APNA)
Australian College of Nursing None
Salary per year (USD) 207,100 93,200 64,600 According to the RACGP due to the infancy of the role, salaries are yet to be determined
Data sources:

a
http://www.nursepractitioners.org.au/.

b
http://www.racgp.org.au/download/Documents/PracticeSupport/informationsheet-medicalassistants.pdf.

c
http://www.amlalliance.com.au/__data/assets/pdf_file/0003/46731/2012-General-Practice-Nurse-National-Survey-Report.pdf#2012%20National%20GPN%20Survey.

d
http://www.mnbml.com.au/content/Document/ma_infosheet.pdf.

e
Comment:
•
Please note: The below definitions are not defined by the nurse registration authority in Australia.

•
An advanced practice nurse who is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the features of which are shaped by the context of the health service in which the practice is based (http://www.rcna.org.au/WCM/Images/RCNA_website/Files%20for%20upload%20and%20link/policy/documentation/position/advanced_practice_nursing.pdf).

•
An advanced registered nurses Registered Nurse who is a person who has undertaken a bachelor level education program of not less than three years (prior to 1985, training was hospital based) and is licensed to practice nursing under an Australian state or territory Nurses Act http://rcna.org.au/WCM/Images/RCNA_website/Files%20for%20upload%20and%20link/nursing_in_general_practice_project_kit.pdf – based on 2012 AMLA GP Nurse survey – 12.6% of PNs are enrolled nurses.

•
An advanced enrolled nurses Enrolled Nurse – a person who has undertaken a shorter program of education (usually in a vocational education setting), and is licensed under an Australian State or Territory Nurses Act to provide nursing care under the supervision of a Registered Nurse. http://rcna.org.au/WCM/Images/RCNA_website/Files%20for%20upload%20and%20link/nursing_in_general_practice_project_kit.pdf. Based on 2012 AMLA GP Nurse survey – 86.0% of PNs are enrolled nurses.

The 2012 AMLA PN Survey data (based on 709 nurse respondents) identified registered midwives and nurse practitioners working in general practice as well as general practice nurses. As all but six of the 72 registered midwives also reported they were registered nurses. Overall 12.6% of the population were enrolled nurses, 86.0% were registered nurses, 10.5% were registered midwives and 0.3% (two respondents) were nurse practitioners. BUT we DO NOT appear to have comprehensive information on nurses in advanced roles.

Despite the current investment in Australia to profile the health workforce, Australian based surveys of nurses do not ask about the specific workplace location (e.g., general practice setting) (Health Workforce Australia, 2013). Australia’s Health Workforce Series – Nurses in focus. Health Workforce Australia: Adelaide, www.hwa.gov.au.

Although there is a willingness to shift from a traditional delegated care models to task substitution (Harris et al., 2011) current financial incentives (e.g., Medicare Benefit Schedule Funded Team Care Arrangements and GP Management Plans) still emphasize primary care physician-led care (as only general practitioners can claim the MBS Items) – hence not true shared/team care arrangements within primary care. Furthermore, true team care cannot take place until primary care physicians authorize or create supportive authorizing environments (i.e., with appropriate clinical governance and supervisory arrangements) for other members of their practice (e.g., general practice nurses, medical assistants) to perform intended roles and tasks.

2.4. England
Primary care in England is delivered mainly by a network of over 8000 primary care practices which are contracted to provide services by the National Health Service. In addition, pharmacies are considered a part of the English primary care service and registered pharmacists in many high street stores provide screening services, health advice and have some prescribing rights (Dawoud et al., 2011). Long established community nursing services provide nursing care in the home but also undertake some aspects of chronic disease management that might generally be considered as ‘primary care’.

Most general practices are partnerships of several primary care physicians (i.e., general practitioners) although there remain a substantial but declining number of solo practices and there are an increasing number of practices run by private companies who employ primary care physicians and others. The vast majority of the non-physician primary care workforce is directly employed by practices although other members of the primary care team (for example nurses) can be partners in a primary care practice. Team members employed in primary care are diverse although registered nurses and medical/nursing assistants (i.e., health care assistants) are the largest groups of direct care providers (Table 4).

Table 4. Primary care workforce of England.

England
53 Mio population
∼8100 primary care practices Area A (general practitioner) Area B (nurse practitioner/physician assistant) Area C (extended role practice nurse) Area D (practice nurse) Area E (practice nurse auxiliary)
Original name General Practitioner Nurse Practitioner/Advanced Nurse Practitioner/Nurse Consultant Senior Practice Nurse/Nurse Specialist Practice Nurse Health Care Assistant
Total number 40,265 23,458 (includes all practice employed registered nurses – detailed breakdown not readily available and role descriptors are not used consistently) 6700
% Practices employing 100% 95% 55%
Years of basic education 13 11 11
Professional education 5 years (basic training) 3 years None required
Licensing General Medical Council Nursing and Midwifery Council Nursing and Midwifery Council Nursing and Midwifery Council None
Special training Mandatory
MRCGP – 3 years No formal requirements – job titles and roles applied in a non-standardized fashion. Prescribing can be undertaken only after additional training accredited by the Nursing and Midwifery Council None required
Accreditation of special training Royal College of General Practitioners Advanced Nurse Practitioner Courses are available and the Royal College of Nursing Accredits masters level courses (1 year full time equivalent) but taking an accredited course is not a requirement. Prescribing can be undertaken only after additional training accredited by the Nursing and Midwifery Council None
Medical tasks Clinical diagnosis and treatment of all presentations Ranges from clinical diagnosis and treatment of less complex presentations and some aspects of chronic care with considerable discretion, More commonly well-defined protocol-directed clinical care in specific areas including long term conditions: e.g., asthma, cervical screening, diabetes, HRT, contraception management through to “traditional” nursing care: e.g., immunization, ulcer management, management of minor injuries & phlebotomy Simple, well-defined tasks that can be undertaken with limited training: e.g., urine analysis, simple dressings but also some ‘extended’ tasks including phlebotomy and blood pressure measurement
Professional organization Royal College of General Practitioners Royal College of Nursing Royal College of Nursing Royal College of Nursing None
Salary per year (USD) 170,677 Overall average salary is approx. 50,344 26,641
Data source: RCGP General Practice Foundation|General Practice Nurse competencies, 2012.

There has been a steady increase in both the number of nurses employed in primary care and the proportion of consultations that are undertaken by them (Hippisley-Cox et al., 2007) although the growth appears to have plateaued in more recent years. This growth has been associated with the introduction of a pay-for-performance system linked to a number of chronic diseases where practice income was enhanced for meeting certain performance thresholds. NURS 8100 – Healthcare Policy and Advocacy Assignment Papers. The use of nurses to deliver performance against these targets was associated with increased quality of care and hence increased practice income (Griffiths et al., 2010). Registered nurses work in a variety of roles in primary care practices. Within the UK career framework for practice nurses there are no formal academic training requirements above those required for registration as a nurse and while many work at advanced levels there is no clear data, as job titles are not applied consistently and there are concerns that training for advanced roles is not always adequate or properly supported by employing practices (Rashid, 2010). The introduction of UK competency standards for practice nurses is a strategy that has sought to improve this situation (RCGP, 2012) although this largely relates to fundamental aspects of the role and is not explicit about training requirements. Registered nurses can undertake prescribing from the full formulary (i.e., the same prescribing powers as doctors) but only with additional training, a feature which is unique of UK nurses. Numbers of nurse prescribers are growing but only about 25% of nurses are so trained and many undertaking aspects of chronic disease management do not prescribe (Kelly et al., 2010). Training for medical assistants is primarily on the job and there are no formal educational requirements.

2.5. Germany
Primary care in Germany is mainly delivered by small- to middle-sized practices with 1–2 self-employed primary care physicians (i.e., Allgemeinmediziner or Internisten). As shown in Table 5, beside primary care physicians only one non-physician health professional (Medizinische Fachangestellte) is involved in primary care. This role is comparable to medical assistants in the US. Primary care physicians in Germany have a high number of patient visits per day (mean 34) with a mean consultation time of 7.8 min (The Commonwealth Fund, 2010). This may reflect working practices in line with the traditional concept of “the-doctor-does-it-all”. However, as a steadily decreasing number of primary care physicians faces an increasing number of patients with complex care needs, the roles of medical assistants have increasingly been expanded from administrative and simple medical tasks to more complex tasks like disease and care management (Gensichen et al., 2009, Peters-Klimm et al., 2010) and home visits (van den Berg et al., 2012). A number of optional special training programs are provided for medical assistants. Newly developed reimbursement schemes for primary care (e.g., GP-centered care contracts) increasingly compensates extra spending for specifically trained medical assistants which will likely increase the role expansion of medical assistants in German primary care. Since 2012, delegation of complex medical tasks to registered nurses is based on a legal framework. However, given an overall nurse shortage in Germany and a lack of nurses working in primary care (Mahler et al., 2007) it is questionable if nurses will play a major role in primary care in Germany in the near future.

Table 5. Primary care workforce of Germany.

Germany
82 Mio population
Primary care practices Area A (general practitioner) Area B (nurse practitioner) Area C (extended role practice nurse) Area D (practice nurse) Area E (practice nurse auxiliary)
Original name Hausarzt/Kinderarzt – – – Medizinische Fachangestellte
Total number 41,712 general practitionersa
15,982 general internistsa
6083 pediatriciansa – – – 100,700b(2012)
% Practices employing 100% – – – 100%
Years of basic education 12–13 yrs – – – 9 yrs
Professional education 5 yrs curriculum at medical school – – – 3 yrs curriculum:
1–2 days vocational school/week
4–3 days in practice/week
Licensing Chamber of physicians – – – Chamber of physicians
Special training Mandatory
5 yrs vocational training (either general practice or general internal medicine) – – – Optional:
200–420 h
Different certified qualifications available (e.g., chronic care, wound care, home visits, prevention, quality management)
Accreditation of special training Chamber of physicians – – – Chamber of physicians (not all special training programs)
Medical tasks Clinical diagnosis and treatment of all presentations – – – – Taking blood samples
– Intramuscular injections
– ECG, spirometry
– Patient education
Professional organization Mandatory:Chamber of physicians
Optional: German College of General Practitioners and Family Physicians
German Association of General Practitioners – – – Optional:
Verband medizinischer Fachberufe e.V.
Salary per year (USD) 135,777c
– – – 23,730–41,118d
Data sources:

a
http://www.bundesaerztekammer.de/downloads/Stat11Abbildungsteil1.pdf.

b
Bundesärztekammer. Personal communication 2013 May 7.

c
Guenterberg, K., Beer, C., 2010. Income of ambulatory physicians (Das Einkommen niedergelassener Ärzte. PaPfle Re Q 4, 87–93).

d
http://www.aerztekammer-bw.de/30mefa/50tarifvertraege/10gehaltstarifvertrag.pdf.

2.6. The Netherlands
The Netherlands has a strong primary care system, with more than 90% of all care taking place in primary care for only 4% of total care budget (Wiegers et al., 2011). Primary care physicians (i.e., huisarts) are the gatekeepers of care. Historically they worked as solo practitioners, but since the 70s they have started working in partnerships with other primary care physicians. Although at a national level there is no primary care physician shortage, GP-trainees express less willingness to open practices in certain regions which might cause shortages in a number of regions in the near future (Schoots et al., 2012).

In the last two-and-a half decades, the roles of medical assistants (i.e., Praktijk-/doktersassistent) have grown. Initially, these medical assistants have mainly performed administrative-organizational tasks, but their role has been expanded to perform medical-technical tasks (e.g., removes sutures, apply liquid nitrogen to warts, check blood pressure, check diabetic patients, et cetera) and patient education (e.g., instruct on blood sugar testing, provide dietary advice, provide information on animal and dust allergies, et cetera) (Engels et al., 2004).  With the introduction of registered nurses into primary care (i.e., Praktijkondersteuner/-verpleegkundige) in 1999, the growth of responsibilities of medical assistants slowed. These registered nurses take care of patients with chronic conditions, especially diabetes, asthma/COPD and cardiovascular disease. For example, the nurse educates patients about the disease, instructs the patients how to take their medication, encourages patients to change lifestyle and monitors patients according to the evidence based guidelines (Wiegers et al., 2011). Certain tasks, in particular those related to the management of chronically ill patients (Heiligers et al., 2012), have shifted from medical assistants to registered nurses while some of the medical assistant roles have expanded to become similar to those of registered nurses (Table 6).

Table 6. Primary care workforce of the Netherlands.

Netherlands
16,8 Mio Population
∼4,090a primary care practices Area A (general practitioner) Area B (nurse practitioner) Area C (extended role practice nurse) Area D/Area E (practice nurse/auxiliary)
Original name Huisarts Physician Assistant Verpleegkundig Specialist Praktijkonders-teuner (Somatiek of GGZ) of praktijkverpleeg-kundige Praktijk-/doktersassistent
Total number 10,598 42b–75i 121c–160i Somatic disorders: 3000 (1550 ft)
Mental health: 360 12.883 (6.629 ft)
% Practices employing 100% <2% <3% Somatic disorders: 80%
Mental health: 25% 100%
Years of basic education (primary school + secondary school) 14 13 13 12 12
Professional education 6 years medicine (academic/university) 4 year healthcare professional education (e.g., physical therapist, speech therapist, nursing, dietitian, etc. → professional Bachelor) + 2 year working experience 4 year nursing education (professional Bachelor) + 2 year working experience 4 year nursing education (professional Bachelor); or a nursing education at MBO-levelj (qualification-level 4)/3 year MBO-level education ‘praktijkassistent’ (qualification-level 4) (appr. 42%)
For mental health (‘GGZ’) 4 years nursing education, social work or psychology (professional Bachelor) Various options for education, maximum 4 years MBO-level
Licensing Registration Committee Medical Specialists (RGS)
Individial Healthcare Professionas Act CommissieAccreditatie NAPA National Association Physician Assistants
Individial Healthcare Professionas Act Nurse Practitioner Register (VSR)
Individial Healthcare Professionas Act Only professionals with nursing education licensed by Individual healthcare Professional Act Not yet, but intention to get licensed by Individual healthcare Professional Act
Special training Mandatory:
3 years specialization family medicine Mandatory:
2.5 year Master at the University of Applied sciences Mandatory:
2 year Master at the University of Applied sciences Optional:
1 or 2 year dual post Bachelor education (combination practice and education), depending on basic education
Appr. 48% Bachelor level (1 year special training) and 42% MBO-level (2 year special training).
Education load varies from 420 to 850 h (1 year) and for extra year for professionals with MBO-level workload varies from 120 to 500 h None
Accreditation of special training Yes
Since January 2013: Registration Committee Medical Specialists (RGS), before GP, nursing home and mental disabled doctor Registration Committee (HVRC) Yes
Accreditation Organization of the Netherlands and Flanders (NVAO) Yes
Accreditation Organization of the Netherlands and Flanders (NVAO) None, although there is an agreement between schools that offer Post Bachelor Education and National Association of General Practitioners about competences of the practice nurses N/A
Medical tasks Clinical diagnosis and treatment of all presentationsd Clinical diagnosis and treatment of all presentationse,h Clinical diagnosis and treatment of less complex presentations (minor illnesses) and also chronic care managemente,h (Well-defined) protocol-directed clinical care in specific areas: e.g., chronic care management; elderly; and mental healthd Health education and advice for simple complaints, and simple, (well-defined) protocol led medical tasks, e.g., (>60%) removes sutures, ear syringing, applicates liquid nitrogen to warts, removes splinters give injections, pap smears, checks blood pressure,write prescriptions rquested by telephone for common complaintsf
Administrative-organizational tasks: e.g., >60% fills in forms with name/address/residence, calls up risk patients, sorts and handles mail, maintains supply of patient information leaflet. Enter basic data from specialist correspondence, operate answering machine
Professional organization Optional:
Dutch College of General Practitioners (NHG)
National Association of General Practitioners (LHV) Mandatory (in order to be licensed):
Netherlands Association of Physician Assistants (NAPA) Optional:
Nurses and Caregivers Netherlands – Nurse Practitioners (V&VN-VS) Optional:
Dutch Association Practice Nurses (NvPO); Nurses and Caregivers Netherlands – Practice Nurses (V&VN-praktijkondersteuners); Dutch Association for Practice Assistants (NVDA) Optional:
Dutch Association for Practice Assistants (NVDA)
Salary per year (USD) GP employed by GP practice owner: 79,300–102,600
GP practice owner: 125,300–167.000g 60,000–84,700 54,700–70,400 39,200–53,600 37,600–46,750
Data sources:

a
Hingstman, L., Kenens, R.J., 2011. Cijfers uit de registratie van huisartsen. Peiling. Utrecht: Nivel.

b
Van der Velde, F., van der Windt, W., 2013. Alumni van de masteropleiding Physician Assistant. Utrecht: Kiwa Prismant.

c
Van der Velde, F., van der Windt, W., 2013. Alumni van de masteropleiding Advanced Nursing Practice. Utrecht: Kiwa Prismant.

d
Heiligers, P.J.M., Noordman, J., Korevaar, J.C., Dosrsman, S., Hiingsman, L., van Dulmen, A.M., de Bakker, D.H., 2012. Kennisvraaag. Praktijkondersteuners in de huisartspraktijk (POH’s), klaar voor de toekomst? Utrecht: Nivel.

e
Eindrapport Nurse Practitioner in de huisartsenpraktijk. Onderzoeksrapport Auteurs: Dierick-van Daele ATM, Metsemakers JFM, Derckx EWCC, Spreeuwenberg C & Vrijhoef HJM. Uitgave: Maastricht UMC, 2008.

f
Engels, Y., Mokkink, H., van den Homberth, P., van den Bosch, W., van den Hoogen, Grol R., 2004. Het aantal taken van de praktijkassistnet in de huisartsenpraktijk is toegenomen. Huisarts wen Wetenschap 47(7), 325–330.

g
http://lhv.artsennet.nl/Actueel/Nieuws6/Nieuwsartikel/Nieuwe-CBScijfers-over-inkomen-huisarts-uitspraken-minister-volstrekt-onjuist.htm.

h
Laurant, M., Wijers, N., 2014. Een studie naar functieprofielen, taken en verantwoordelijkheden van Physician Assistants en Verpleegkundig Specialisten werkzaam in de huisartsenzorg. Nijmegen: IQ healthcare/Radboudumc.

i
Personal communication Stuurgroep Taakherschikking Eerstelijn (19 juni 2014): estimation 75 PAs and 160 NPs general practice.

j
Comment: MBO-level is equal to further education colleges in England, and community colleges in United States.

The employment of registered nurses is reimbursed, but only where three primary care physicians work in collaboration and have a total patient size of 4500 patients. In 10 years, the number of registered nurses has grown substantially. Nowadays, almost all practices employ registered nurses to take care of patients with chronic conditions.

In 2008, a second covenant was signed introducing registered nurses specialized in mental health care to the primary care setting.

Nurse practitioners and physician assistants were introduced in 2001. These professionals followed, respectively, 2 year and 2.5 years master programs at the University of Applied Sciences. In contrast to the US, only 9–12% of all graduated nurse practitioners and physician assistants work in primary care practices. Nurse practitioners focus on patients with minor illnesses, whilst physician assistants share a broad range of work with the primary care physicians. Since January 2012, nurse practitioners and physician assistants are also allowed to prescribe drugs and perform certain tasks related to diagnosis and treatment independently.

Despite research showing positive effects of nurse practitioners and physician assistants on safety and quality of care as well as on patient outcomes (de Leeuw et al., 2008, Dierick-van Daele et al., 2009) the employment of these professionals is not strongly encouraged by professional organizations (i.e., the Dutch College of General Practitioners (NHG) and National Association of General Practitioners (LHV). In their policy the primary care physicians, medical assistants and ‘advanced’ registered nurses form the core team in primary care practices and not nurse practitioners and physician assistants “Although the NP and PA in the hospitals are employed to take over tasks such as diagnosis and treatment of patients, for general practice they are not taken over tasks from the GP in the medical field (NHG/LHV-Standpunt, 2011).” Therefore, the role of registered nurses, as members of the primary care team, will likely be further expanded: they will additionally be trained to carry out complex care (i.e., patient with multi-morbidity or social-psychiatric complaints), prevention and lifestyle counseling. However, the government launched a two-year incentive scheme “Strengthening Education nurse practitioners and physician assistants in general practice” to increase the number of positions of nurse practitioners and physician assistants in primary care. General practitioners who want to educate these non-physician professionals and intend to embedded them in their primary care team in a fully integrated manner will receive a financial contribution during the education of these professionals (Stimuleringsregeling, 2013).

3. Skill mix in the international context
Primary care in many Western Countries faces common challenges.

On the one hand, numbers and working time of primary care physicians is decreasing due to a variety of reasons including an increasing proportion of female doctors preferring a work-life balance and working fewer hours or electing to work part-time. On the other hand patients’ numbers as well as care demand steadily increase.

In response to this situation, all six countries have created primary care teams with differing skill mix. While we have focused our paper on traditional primary care practices, because these remain the largest component of the service in most countries, other primary care services, for example nurse-led walk in centers, also reflect a change in skill mix with more non-physician practitioners. However, it is still the case that in all these countries the number of physicians working in primary care exceeds the number of non-physician health professionals. In general, as the complexity of medical tasks decreases, so does the remuneration of the health professionals. Although it has been shown that nurse practitioners and physician assistants are able to deliver at least 60% of office-based primary care (Ginsburg et al., 2009), numbers of nurse practitioners or physician assistants working in primary care are low in most of the countries. This may be due to a variety of factors, including extensive training requirements and significantly lower pay than similar positions in other specialties and when compared to that of primary care physicians (Hooker, 1996). Whereas the role of registered nurses is similar in most countries we studied, including care coordination as well as clinical management of less complex cases (except in the US), the role of extended role practice nurses is less clearly defined. As an emerging trend, practice nurse auxiliary staff-like medical assistants or licensed practical nurses have increasingly been introduced in primary care teams in many countries. Their professional training varies greatly, with a range from no required training (England) to three-year curriculum at vocational school (Germany). However, practice nurse auxiliary staff share common tasks across all countries, mainly focusing on administration and simple clinical or nursing procedures under the supervision of doctors or nurses.

To meet the challenge of primary care in the 21st century workforce innovations are needed aiming at reduced workload for primary care physicians (Macdonnel and Darzi, 2013). A key element of these innovations is task shifting from physicians to non-physician health professionals. However, task shifting requires both willingness to give up tasks on physicians’ side as well as the ability and capacity to perform these tasks on non-physician health professionals’ side.The first requirement is commonly met in emerging countries (e.g., Brazil, India) where workforce innovations have more easily been implemented (Martiniano et al., 2014) partly because of a lack of established professional roles which in other circumstances may hamper task shifting by expectations and attitudes of each profession (Donelan et al., 2013, Macdonnel and Darzi, 2013). Non-physician health professionals’ ability to perform specific tasks is dependent upon education and training. However, the number of highly trained non-physician health professionals like nurse practitioners or physician assistants employed in primary care is generally low. Furthermore, in some countries, notably the US, nurse practitioners are not consistently allowed to work independently from physicians thereby limiting their ability to compensate for shortages in the primary care workforce (Cassady, 2013). Current regulations and reimbursement schemes may also hinder role expansion of non-physician health professionals and paraprofessionals in many countries (Halcomb et al., 2008). Particularly, fee-for-service schemes may hamper role expansion of non-physician health professionals if only services delivered by physicians are reimbursed. Capitation-based reimbursement schemes offer the opportunity to deliver non-billable services like health coaching as well as role expansion of medical assistants and other health workers. In the US, patient-centered medical home programs offer the opportunity to expand roles of non-physician health professionals such as medical assistants by capitation-based reimbursement (Nelson et al., 2010). Similar programs have been started in Australia (Naccarella et al., 2012), Canada (Ministry of Health and Long-term Care Canada, 2012) and Germany (Gerlach and Szecsenyi, 2013).

Task shifting from doctors to non-physician health professionals has raised two major concerns: patient safety/quality of care and decreasing continuity of care. To date evidence supporting each of these concerns is lacking. In contrast, a number of studies have shown that quality of care delivered by non-physician health professionals like nurse practitioner is not inferior if compared to physicians (Laurant et al., 2005, Laurant et al., 2009, Naylor and Kurtzman, 2010). However, evidence on the quality and safety of care delivered by practice nurse auxiliary staff remains scarce (Gensichen et al., 2009, Nelson et al., 2010, Peters-Klimm et al., 2010). Introducing protocol-based care (e.g., standing orders for medication refill) may further help to facilitate task shifting as it may face problems deriving from limited training and lack of legal accountability (Ghorob and Bodenheimer, 2012).

Adding members to care teams obviously increases the risk of decreasing continuity of care if defined as ‘seeing-the-same-health-care-provider-every-time’. However, electronic health records shared across all team members may at least in part overcome the potential harms of increasing numbers of health care providers per case (Green et al., 2013). Finally, the notion of delegating tasks ‘downward’ to non-physician health professionals has increasingly been replaced by efforts to form ‘care teams’ in all countries under study. Although further attempts to promote team constitution are greatly needed in all of the countries, awareness and appreciation of each team ‘players’ role may be the first step and facilitated by this overview.

Accountability for patient care may best be shared across different members of the primary care team if sufficient training is provided, information is shared timely and comprehensively among all team members and reimbursement schemes account for services delivered by non-physician health professionals. Benefits should be weighed against national or regional legislation and requirements, but this paper provides insight into a variety of skill mix changes implemented in six countries. This information can be utilized to develop strategies to maintain access to primary care and quality of care delivery. In this manner, countries may learn from international experiences provided that the system-specific context of skill mix reviewed in this paper is acknowledged.

NURS2420 Introduction to Nursing 3 s.h.
Introduces the roles and responsibilities of professional nursing. Introduces students to the historical, economic, political and legal/ethical trends in nursing. Introduces concepts necessary for scholarly writing using APA formatting.

NURS2460 Health Assessment 4 s.h.
Focuses on learning foundational assessment skills. Systematic holistic nursing process approach to health history and physical examination for the purpose of differentiating normal from abnormal states of health and critical assessment of client needs. Application of concepts are facilitated in the laboratory experience. (For on campus BSN-RN students only.) Prerequisite: NURS2010.

NURS2470 Informatics for Health Care 2 s.h.
An introduction to the basic concepts and skills associated with the use of technology as it relates to nursing and electronic healthcare systems. The content will provide a conceptual foundation and hands-on exposure to the use of information management in nursing which is necessary in providing quality patient care.

NURS3000 Individual Study 1-3 s.h.

NURS3010 Transcultural Health Experience 3 s.h.
The focus of this course is to provide the student with tools to improve the health status of a vulnerable population. Students will apply transcultural concepts and principles of global health at the local, national, or international level. Depending on the specific area the student is working in, experiences may include individual and small group teaching, primary care support services, promotion of hygiene principles with modifications to the local culture, community assessment and interventions, or intensive language acquisition. An international multi-day and/or overnight experience may be required.

NURS3120 Fundamentals of Health Care 4 s.h.
Introduction to basic concepts and psychomotor skills necessary to provide therapeutic interventions for individual clients. Laboratory and clinical experience provided. Prerequisites: NURS2420, 2460, 2470.

NURS3160 Evidence Based Practice 2-3 s.h.
Study of the evidence-based practice research process to develop informed consumers of nursing research. Exploration of the application of the research evidence to the health care environment. Prerequisites: NURS3120, 3270, 3440, 3451.

NURS3290 Gerontology 2 s.h.
An examination of the basic conceptual and theoretical perspectives of gerontology. Topics discussed relate to adjustments to physiological and psychosocial changes and the aging process. Examination of special concerns of the older adult, specifically age-related health problems, sexuality, religion, finances, caregiver role, Alzheimer’s disease and other dementias, depression, and loss of spouse/peers. Prerequisites: NURS3120, 3270, 3440, 3451.

NURS3430 Pathophysiology and Related Pharmacology 3 s.h.
Study of the concepts and altered processes of organs, cells, and biochemical functions of systems related to homeostasis, neural control and integration. Related pharmacology with application of principles to nursing practice will be integrated throughout.

NURS3451 Pharmacology I 2 s.h.
Introduces students to the principles of pharmacology and their application to nursing. Emphasizes drug classifications of pharmacological agents, their actions, side effects, uses and nursing responsibilities regarding administration and basic calculations of medication administration for all routes of administration. Prerequisites: NURS2420, 2460, 2470.

NURS3452 Pharmacology II 2 s.h.
Continues investigation of pharmacology with specific medications that are seen in the clinical setting from the various drug classifications and medications used in advanced adult health settings. Drug calculations include those for the critical care setting and those using the intravenous route.

NURS3460 Professional Seminar I 3 s.h.
A transitional course to prepare the RN student for entry into baccalaureate nursing and continuing socialization into the profession. Exploration of major curricular and historical concepts. Prerequisite: Nursing major with junior standing.

NURS3900 Topics in Nursing 1-3 s.h.
An in-depth study of a specific, timely topic in nursing. May be repeated for credit when the topic varies.

NURS4000 Individual Study 1-3 s.h.

NURS4280 Global Health and Policy Issues 3 s.h.
The course focuses on an analysis of the forces shaping our community and global health patterns. Drawing on multidisciplinary sources, this course explores the impact of these global processes as they manifest in the health of our own and other societies. Emphasis is placed on analysis of the broad cultural, environmental, social-economic, and political systems that contribute to health status and outcomes, health policies, and health care delivery around the world.

NURS4420 Professional Seminar II 2 s.h.
Continuing exploration of current health care issues facing the nursing profession using a critical thinking process designed to move the RN student into the professional baccalaureate role for practice in the 21st century. Prerequisites: Nursing major with senior standing and NURS3460.

NURS4460 Senior Capstone 3 s.h.
Synthesize new knowledge with past knowledge and skills to provide a higher level of indirect and/or direct care to clients in a variety of health care environments. Integrate knowledge from prior courses to develop, implement, and evaluate a project with the intention of improving health outcomes for individuals, families, groups, communities, or populations.

NURS4480 Trends and Issues 2 s.h.
Examines the social, cultural, political, legal, economic, and ethical issues that surround the practice of professional nursing. Explores the concepts that prepare the graduate for entry into the professional role. Prerequisites: NURS3160, 3250, 3260, 3290, 4340.

CLINICAL COURSE OFFERINGS

NURS3250 Adult Health Care I 4 s.h.
Focus on the development of abilities to manage the care of adults, at various life stages, in a variety of health care settings. Emphasis on person-centered communication and application of cognitive, psychomotor and affective skills in providing basic nursing care to clients and their families. Prerequisites: NURS3120, 3270, 3440, 3451.

NURS3260 Adult Health Care II 4 s.h.
Focus on the development of abilities to manage the care of adults, at various life stages, in a variety of health care settings. Emphasis on person-centered communication and application of cognitive, psychomotor and affective skills in providing family centered nursing care to individuals and groups of clients. Prerequisites: NURS3120, 3270, 3440, 3451.

NURS3270 Psychosocial Aspects of Client Care 4 s.h.
Emphasis on promotion of healthy individual and family system responses to psychosocial stressors (violence, poverty, substance abuse). Psychopathology will be explored with opportunities to practice primary, secondary, and tertiary nursing interventions in the clinical setting. Prerequisites: NURS2420, 2460, 2470.

NURS4160 Leadership Roles in Nursing 3 s.h.
Examination of leadership, management, role, and change theories. Emphasis on acquiring the knowledge, skills, abilities, and resources required to lead an interdisciplinary team to achieve excellence and high quality outcomes. Prerequisites: Junior level nursing courses.

NURS4170 Manager of Patient Care 3 s.h.
Discusses management of patient care in a clinical setting in the capacity of unit manager, charge nurse and patient care coordinator. Focuses on knowledge, skills, abilities, and resources required to lead an interdisciplinary team to achieve excellence and high quality outcomes. Prerequisites: NURS3160, 3250, 3260, 3290, 4340.

NURS4220 Maternal and Newborn Care 4 s.h.
Study of women’s health across the lifespan with an emphasis on maternity/newborn care. Employs holistic approach to health promotion and intervention. Prerequisites: Junior level nursing courses. Prerequisites: NURS3160, 3250, 3260, 3290, 4340.

NURS4240 Pediatric Nursing 4 s.h.
Investigates a holistic, family focus on acute illness and health promotion for pediatric patients from birth through adolescence. An emphasis on developmental stages of childhood and nursing interventions within the home and acute care settings and the impact of societal and family decisions on childhood growth and development. Prerequisites: NURS4170, 4220, 4480.

NURS4260 Critical Care Nursing 4 s.h.
Emphasis on the key concepts required to deliver care to clients and their families during severe physiological stress. Importance placed on critical thinking to analyze the relationship between multidimensional stressors in the midst of critical illness. Prerequisites: NURS4170, 4220, 4480.

NURS4340 Community Health Care 2.5 s.h.
Focuses on community/public health issues with the family and community as clients, including community assessment and the examination of a variety of core concepts in the practice of community/public health nursing. Topics include epidemiology, community focused health promotion, and prevention within a sociopolitical environment. Prerequisites: NURS3120, 3270, 3440, 3451.

NURS4350 Community Health Nursing 3 s.h.
Emphasis on the community as client and population groups within the community, including a comprehensive community assessment, the exploration of epidemiology, disaster nursing, community-focused health promotion, and prevention within sociopolitical environment.

NURS4390 Capstone Practicum 4 s.h.
Emphasis on advanced cognitive, psychomotor and affective skills and therapeutic communication in the care of clients and families in acute-care settings. Prerequisites: NURS4170, 4220, 4480.

NURS4410 Reflective Practice in Nursing 2 s.h.
Emphasis on knowing in nursing with practice field experiences designed to guide the student toward becoming a more reflective practitioner.

Return to Top

Courses in Nursing (MSN)
NURS5010 Introduction to MSN and Post-graduate Certificate Programs 0 s.h.
Focuses on preparing the MSN and post-graduate certificate student to be successful in an online graduate program of study. Includes mandatory completion of selected tutorials, review of academic policies, pre-clinical HIPAA and Standard Precaution requirements, and participation in pre-scheduled Live Chat sessions. Information related to university resources and services available to support successful progression and completion of the selected program of study is provided. Successful completion within the first term of enrollment is required for progression in the selected program of study. (Graded on a Pass/Fail basis.)

NURS5100 Pharmacotherapeutics 4 s.h.
Provides the graduate advanced practice nursing student foundational knowledge and application of pharmacotherapeutics to meet the health care needs of clients, from childhood through the older years. Content focuses on the principles of pharmacokinetics and pharmacodynamics, and provides an overview of selected therapeutic drug classes and complementary/alternative treatments, which allows students to evaluate client situations and determine therapy within the context of the overall treatment plan. Prerequisite:

NURS5121 Theory of Nursing 3 s.h.
Focuses on the theoretical concepts that are essential to advanced nursing roles and the interactions between theory, research and practice. Grand, mid-range and practice level theories are examined and compared. The influence of theories from other disciplines on the development of nursing theory is appraised. Students will analyze, compare, and evaluate selected nursing theories for their use in nursing education or clinical practice. Concept analysis, synthesis, and theory application are also important components of this course. Prerequisite: NURS5170.

NURS5143 Advanced Health Assessment and Diagnostic Reasoning 4 s.h.
Builds on health assessment skills developed during the professional nurses basic educational program. The course teaches students how to obtain a comprehensive assessment and use this information to develop and/or evaluate evidence based treatment plans for diverse patients with common acute and chronic health problems. Emphasis is placed on the process of clinical/diagnostic reasoning to enable the student to identify problems and make accurate diagnoses. The use of technology and electronic medical records are important components of this course.

NURS5170 Research Methods and Evidence-based Practice 4 s.h.
This course focuses on methods in generating and evaluating research for nursing practice. Principles and applications of quantitative and qualitative research designs will be explored. Ethical and legal issues in conducting research will be examined. Students will be prepared to assess needs for practice change, critically appraise existing evidence, and develop a plan for implementation and evaluation of the evidence-based practice interventions.

NURS5192 Advanced Practice Procedures in Acute Care 2 s.h.
Focuses on skill development in diagnostic and treatment modalities utilized in acute & critical care settings. Content includes fluid replacement, hemodynamic monitoring, defibrillation, ventilation. Analysis of relevant laboratory data and interpretation of radiographs and ECGs. Laboratory practice will include procedures such as suturing, intubation, line insertion. Pre-requisites: NURS5440, NURS5100.

NURS5193 Advanced Practice Nursing in Primary Care 2 s.h.
Provides a foundational knowledge of the multifaceted role of the Advanced Practice Nurse in the primary care setting; addressing selected advanced practice procedures diagnostic test interpretation and analysis of the APN as a member of the multidisciplinary healthcare team.

NURS5194 Advanced Practice Competencies Lab 1 s.h.
Focuses on assessment of selected advanced practice competencies during a mandatory face-face focus session on the Independence Campus. Prerequisite: NURS5192 (AGACNP), NURS5143 (Prerequisite must be taken no more than 2 terms in advance of lab course.), Corequisite: NURS5193 (FNP).

NURS5200 Primary Care of Families : Pediatrics 3 s.h.
Examines the common, acute, and chronic health problems occurring in infancy through adolescence using a body-system scheme and a physical, emotional, psychosocial, spiritual, intellectual, and cultural approach. Advanced pathophysiology, assessment and diagnostic strategies specific to acute and common problems in children will be emphasized. Nursing strategies to enhance, maintain and restore health will be emphasized. Prerequisites: NURS5100, NURS5143.

NURS5210 Role Socialization for Nurse Educators 2 s.h.
Focuses on socialization into the role of nurse educator. Emphasis is placed on the qualifications and competencies for the role. Students will use critical thinking skills to examine barriers and opportunities for nurses in the educator role and to propose a plan for transitioning into their new role. Interdisciplinary collaboration and relationship building are integral parts of this course.

NURS5270 Care of Adult-Gerontology Populations 3 s.h.
Focuses on comprehensive care of adult-gerontology (AG) populations. Discusses disease prevention and health promotion across the adult and gerontological population. Examines common acute and chronic health problems using a body system scheme and a physical, emotional, psychosocial, spiritual, intellectual and cultural approach. Advanced pathophysiology, assessment and diagnostic strategies, and evidence based-practice specific to common acute and chronic conditions are emphasized. Prerequisites: NURS5100, NURS5143, , NURS5194.

NURS5280 Acute Care of Adult-Gerontology Populations I 3 s.h.
Focuses on the diagnosis and treatment of acute/critical health alterations. Emphasis is on the most common and highest acuity of cardiovascular, respiratory, endocrine and orthopedic/mobility disorders. Nursing strategies to restore, maintain and enhance health are emphasized. Prerequisites: NURS5270.

NURS5290 Acute Care of Adult-Gerontology Populations II 3 s.h.
Focuses on the diagnosis and treatment of acute/critical health alterations. Emphasis is on the most common and highest acuity of neurologic, hematology/oncology, GI/GU and rheumatic disorders. Nursing strategies to restore, maintain and enhance health are emphasized. Prerequisites: NURS5280.

NURS5440 Advanced Pathophysiology 4 s.h.
Provides the graduate nursing student with a well-grounded understanding of the pathophysiologic mechanisms of disease to serve as a foundation for clinical assessment, decision making, and management. Content focuses on etiology, pathogenesis, and clinical presentation of selected altered health states across the lifespan.

NURS5450 AGACNP Practicum: Chronic Care 3 s.h.
Focuses on the development and application of knowledge and skill in the advanced practice role under the direct supervision of an approved preceptor in a practice setting. Management of chronic health problems of AG populations is emphasized. Develops skills for collaboration with multidisciplinary teams and effective utilization of community resources. Prerequisite: NURS5280, Corequisite: NURS5290.

NURS5460 AGACNP Practicum: Acute Care 3 s.h.
Focuses on the development and application of knowledge and skill in the advanced practice role under the direct supervision of an approved preceptor in a practice setting. Management of acute health problems of AG populations is emphasized. Develops skills for collaboration with multidisciplinary teams and effective utilization of community resources. Prerequisite: NURS5450.

NURS5470 AGACNP Practicum: Final 3 s.h.
Focuses on integration, application and development in the advanced practice role under the direct supervision of an approved preceptor in a practice setting. Comprehensive management of acute and chronic health problems is emphasized. Develops skills for collaboration with multidisciplinary teams and effective utilization of community resources. Prerequisites: NURS5460.

NURS5650 Teaching Strategies 3 s.h.
Focuses on how human learning occurs, factors that influence learning, and use of teaching strategies based on learning theories. Emphasis is based on the application of theoretical principles, instructional methods, and research findings that support improved student learning.

NURS5661 Roles and Issues for Nurse Educators 3 s.h.
Focuses on socialization of the nurse into the role of educator and on the academic, legal, ethical, economic and organizational issues that influence the NE role. Emphasis is placed on preparing students for NE core competencies as delineated by the NLN Scope of Practice for Academic Nurse Educators. Interdisciplinary collaboration and transformation of nursing education are integral components of this course.

NURS5900 Topics in Graduate Nursing 1-3 s.h.
Graduate level study of selected topics approved by the Graduate Council. Topics are announced prior to each semester they are offered. May be repeated for credit when the topics vary.

NURS6000 Individual Study 1-3 s.h.

NURS6200 Primary Care of Families: Adults 3 s.h.
Examines the common, acute, and chronic health problems occurring in adults using a body — system scheme and a physical, emotional, psychosocial, spiritual, intellectual, and cultural approach. Advanced pathophysiology, assessment and diagnostic strategies specific to the acute and common problems in adults will be stressed. Nursing strategies used to enhance, maintain, and restore health will be emphasized. Prerequisites: NURS5100, NURS5143.

NURS6600 Assessment of Learning in Nursing Education 3 s.h.
Focuses on academic assessment, measurement, testing, and evaluation in nursing education and preparation of nurse educators for carrying out these activities as part of their role. Learning principles, qualities of effective measurement instruments, construction and use of teacher-made tests, use of standardized tests, test interpretation, and assessment of higher level cognitive skills and learning will be examined. The differences between instructional assessment, curriculum-based measurement, criterion-referenced and norm-referenced testing, clinical performance evaluation, and the social, ethical and legal ramifications of testing are integral components of this course.

NURS6620 Curriculum Development 4 s.h.
Focuses on the principles of curriculum development, implementation and evaluation. Emphasis is placed on curriculum organizing frameworks, goals and outcomes, planning, design, and implementation strategies, evaluation, and revision. Students will construct a mini-curriculum and evaluate curriculum systematic evaluation plans as part of the requirements for this course.

NURS6720 Nurse Educator Teaching Practicum 2 s.h.
Focuses on engagement in practicum activities designed to promote socialization to the role of nurse educator, application of educational theory and evidence-based teaching and assessment practices, facilitation of the cognitive, psychomotor, and affective development of learners in a selected practicum setting; and reflection/evaluation of the teaching, scholarship, and service demands of the nurse educator role.

NURS6740 Family Nurse Practitioner Practicum: Pediatrics 4 s.h.
Focuses on a holistic approach to health care from infancy through adolescence incorporating the principles of well child care, health promotion, and disease prevention including the concepts of growth and development, and screening procedures. Emphasizes advanced pathophysiology, assessment and diagnostic strategies specific to acute and common problems in children. Stresses clinical interventions to enhance, maintain, and restore health in context of family and community environments. Develops skills for collaboration with multidisciplinary teams and effective utilization of community resources. This course requires 180 clinical hours and a minimum of 180 pediatric patients. Documentation and the care is to be entered into the nurse practitioner tracking system. In addition, all clinical hours must be completed within the United States and its territories. All hours must be with pediatric patients ages birth-18 and include well visits, acute, and chronic care. No specialty hours will be allowed in this practicum. Prerequisite: NURS5200, NURS5194, NURS6800.

NURS6760 Family Nurse Practitioner Practicum: Adult 4 s.h.
Focuses on a holistic approach to health care of the adult throughout the lifespan; incorporating the principles of health promotion, disease prevention and primary and rehabilitative health care concepts which are applied to the management of adults in the context of their family and community environment. Emphasizes advanced pathophysiology, assessment and diagnostic strategies specific to acute, common and complex health problems in adults. NURS 8100 – Healthcare Policy and Advocacy Assignment Papers. Stresses clinical interventions to enhance, maintain, and restore health. Develops skills for collaboration with multidisciplinary teams and effective utilization of community resources. This course consists of 180 clinical hours and managing care for a minimum of 180 patients. Documentation of the care is to be entered into the nurse practitioner tracking system. In addition, all clinical hours must be completed within the United States and its territories. All hours must be spent with patients ages 18-100 and include well visits, acute, and chronic care. No specialty hours will be allowed in this practicum. Prerequisite: NURS6200, NURS6800.

NURS6800 Roles and Issues for Advanced Practice Nurses 4 s.h.
Focuses on the exploration, development and implementation of advanced roles for nurses. Emphasis will be placed on the standards of practice, requirements for, regulation of, and socialization into advanced nursing roles. Students will use critical thinking skills to examine barriers and opportunities for nurses in advanced roles and propose a plan for transitioning into their new role. Additionally, the course focuses on the organization of health care delivery systems, health care finance, health care policy, ethical and legislative issues affecting health care planning and delivery. Sociopolitical issues will be examined as they impact the formation of policies and the nursing profession as a whole.

NURS6810 Nurse Educator Clinical Specialty Practicum 2 s.h.
Focuses on the synthesis of previously gained knowledge to promote nurse educator development of expertise in a clinical specialty area (medical-surgical nursing, maternal-child nursing, mental health nursing, pediatric nursing, or gerontological nursing). Students will use theory and research findings to draw inferences about care of patients within their identified clinical focus area. The course includes 120 practice hours and is designed to facilitate teaching in the academic setting.

NURS6830 Family Nurse Practitioner Practicum: Family 3-4 s.h.
This practicum is the capstone course of the family nurse practitioner program requiring independent clinical management of acute and chronic illnesses across the life span highlighting multicultural care. Synthesis of practice management skills pertaining to economics, reimbursement for services and time management will be emphasized. This course consists of 240 practice hours. You will also be required to provide care for a minimum of 180 patients with all patient information being logged into the nurse practitioner tracking system. All clinical hours must be completed in the United States and its territories. During this final practicum, 120 hours of the 240 may be spent in a specialty area of your choice. Prerequisites: All pediatric and adult practicum courses.

NURS6930 EBP Synthesis Project 3 s.h.
Prepares the advanced practice graduate to improve nursing practice and patient health outcomes through the systematic selection, analysis, synthesis and application of current best evidence. Identification of clinically significant issues, use of evidence-based practice (EBP), collaboration, peer-review, and dissemination are emphasized. Prerequisites: NURS5121.

Return to Top

Courses in Nursing (DNP)
NURS8010 Introduction to Doctoral Study in Nursing 0 s.h.
Focuses on preparing the SON doctoral student to be successful in an online graduate program of study. Includes mandatory completion of selected tutorials, review of academic policies, pre-clinical HIPAA and Standard Precaution requirements, and participation in pre-scheduled Live Chat sessions. Information related to university resources and services available to support successful progression and completion of the selected program of study is provided. Successful completion within the first term of enrollment is required for progression in the selected program of study. (Graded on a Pass/Fail basis.)

NURS8100 Professionalism, Ethics and Issues 3 s.h.
This course provides a foundation for the development of the Doctor of Nursing Practice role. The content provides a broader interdisciplinary view of historical, theoretical, and political avenues of the Doctorate in Nursing Practice. It also includes health care policy advocates and macrosystems, ethics, and professional development for DNPs today, tomorrow, and into the next generation. In addition, it helps the DNP student with framing their doctoral identity and practice. Includes 12 clock hours of field experiences counted toward the post-BSN supervised practice hour requirement for the DNP degree.

NURS8120 Health Systems Policy and Regulation 3 s.h.
Focuses on the fundamental principles of health policy and the impact of the political process for health care in the United States and around the globe. The course will prepare students to accept multifaceted leadership positions and expand the role of specialty practice nurses in the development, delivery, and monitoring of health care. This course addresses the distinctive intricacies of health care policies that influence care in the U.S. and globally. It is designed to assist the student in developing the skills necessary to critically analyze health care policies and to recognize how they can be influenced by investors or special interest groups. These policies are examined from a governmental and organizational viewpoint. Includes 8 clock hours of field experiences counted toward the post-BSN supervised practice hour requirement for the DNP degree.

NURS8130 Biostatistics 3 s.h.
Focuses on the application of statistical methods and analysis of data used in research for evidence-based practice and clinical decision making.

NURS8140 Epidemiology 3 s.h.
Focuses on epidemiologic concepts and methods for disease prevention, surveillance, detection, and intervention to promote the health of populations. Morbidity and mortality data and steps in the epidemiologic investigation process and epidemiologic research methods are emphasized. Students will learn specific epidemiologic skills such as use of existing datasets, analysis of published epidemiologic studies, and data interpretation. The epidemiology of infectious diseases, environmental health hazards, new and emerging diseases, chronic disease, managerial epidemiology and disaster preparedness is included. Includes 16 hours of field experiences that emphasize epidemiological leadership.

NURS8200 Evaluation of Research for Evidence Based Practice 3 s.h.
Focuses on the application of research methods conducted to generate evidence-based knowledge to improve nursing practice and patient outcomes. Emphasis will be on students’ identification of practice problem using steps in evidence-based practice process. Students will develop skills and competencies in database searching, critical appraisal, interpretation of research findings, data analysis, synthesis, and decision making for application of evidence in clinical practice. The process of critiquing quantitative, qualitative, outcome, and intervention research methods is included. Ethics in healthcare research will be discussed. Finally, students will learn and be prepared to communicate clinical practice scholarship and research findings. Prerequisite: NURS8130.

NURS8210 Project Management 3 s.h.
Focuses on the steps and processes for comprehensive and systematic management of an evidence-based scholarly practice project designed to remediate an identified practice phenomenon. The framework will address analysis of a practice setting, identification and description of the phenomenon of interest, the PICO question, systematic review of the literature, and an outline for the project proposal. Emphasis will be placed on the resources and skills needed for successful management of a scholarly practice project. Includes 100 supervised practice hours directly related to project management in an advanced practice setting. Prerequisite: NURS8200, Corequisite: NURS8950, NURS8260.

NURS8220 Healthcare Informatics 3 s.h.
Focuses on information systems technology, its applications within healthcare settings, and the value of technology for managing healthcare data. Some covered content includes information technologies and applications used in healthcare for various purposes including clinical decision support, transferring expert knowledge, and for collecting and managing healthcare data. Current and emerging technologies are introduced, as well as other topics such as policy, ethical and legal issues relevant to health information technology (health IT). The value and impact of health IT implementation is covered, and students learn about technology and outcomes evaluation. They are also introduced to the role of various stakeholders in health IT planning, design, implementation, management and use. Students will acquire the skills necessary to accurately use information systems and technology and to lead the advancement of informatics practice and research.

NURS8260 Organizational Leadership and Collaboration 3 s.h.
Focuses on leadership theories and principles and innovative leadership strategies for the DNP Concepts covered include transformational leadership, measurement of outcomes, data driven decision-making, organizational culture and climate, communication skills, professional accountability, change theory, and the business realities of healthcare leadership. Students will develop and or refine leadership skills as they progress through the course in order to enhance the quality of nursing and healthcare delivery systems.

NURS8950 Advanced Practice in Organizational Leadership 1-4 s.h.
Includes up to 400 advanced practice hours for students enrolled in the DNP program with less than 364 verified post-BSN supervised practice hours. The number and nature of the practice hours will vary from student to student and is mutually agreed upon between the student, faculty advisor and cooperating agencies. Practice hours are documented by the student and approved by the faculty advisor at regular intervals. Practice hour logs are approved by the faculty advisor and filed in the online course site. This course is not a requirement for the degree. One semester hour is equivalent to 80-100 clock hours of practice experience. Course may be repeated as needed. Graded on a Pass/Fail basis.

NURS9700 DNP Practice Improvement Project Continuous Enrollment 1 s.h.
Provides continuous enrollment to complete course requirements for incomplete grades assigned to NURS9710, NURS9711, NURS9712 and NURS9720. Graded on a Pass/Fail basis.

NURS9710 DNP Practice Improvement Project Proposal 3 s.h.
Focuses on facilitating student progress through the proposal development & formal approval processes of an evidence-based quality improvement project designed to remediate an identified practice phenomenon. Project development and design requires demonstration of integration, synthesis and application of advanced practice competencies. Course requirements include 200 supervised practice hours and a formal written project proposal approved by the faculty advisor, practice mentor, practice site and institutional IRB(s). Both direct hours (time spent working on the project in the practice setting) and indirect hours (time spent working on the project outside of the practice setting) are included in this total. The nature of the practice hours will vary depending on the nature of the scholarly project and practice experience and is mutually agreed upon between the student, faculty advisor and cooperating agencies. Practice hours related to project completion are documented by the student and approved by the faculty advisor at regular intervals. Practice hour logs and project deliverables are approved by the faculty advisor and filed in the online course site. Graded on a Pass/Fail basis. Pre-requisites: Documented completion of a minimum of 500 post-BSN supervised practice hours, NURS8210.

NURS9711 DNP Practice Improvement Project Implementation 1 s.h.
Focuses on facilitating student progress through the implementation of an evidence-based quality improvement project designed to remediate an identified practice phenomenon. Project completion requires demonstration of integration, synthesis and application of advanced practice competencies. Course requirements include 100 supervised practice hours and a formal written project report, oral presentation to agency, and dissemination for peer-review. Both direct hours (time spent working on the project in the practice setting) and indirect hours (time spent working on the project outside of the practice setting) are included in this total. The nature of the practice hours will vary depending on the nature of the scholarly project and practice experience and is mutually agreed upon between the student, faculty advisor and cooperating agencies. Practice hours related to project completion are documented by the student and approved by the faculty advisor at regular intervals. Practice hour logs and project deliverables are approved by the faculty advisor and filed in the online course site. Pre-requisites: NURS9710.

NURS9712 DNP Practice Improvement Project Analysis & Dissemination 3 s.h.
Focuses on the analysis, evaluation and dissemination of an evidence-based quality improvement project designed to remediate an identified practice phenomenon. Project completion requires demonstration of integration, synthesis and application of advanced practice competencies. Course requirements include 200 supervised practice hours and a formal written project report, oral presentation to agency, and dissemination for peer-review. Both direct hours (time spent working on the project in the practice. The nature of the practice hours will vary depending on the nature of the scholarly project and practice experience and is mutually agreed upon between the student, faculty advisor and cooperating agencies. Practice hours related to project completion are documented by the student and approved by the faculty advisor at regular intervals. Practice hour logs and project deliverables are approved by the faculty advisor and filed in the online course site. Pre-requisites: NURS9711.

The NRHSN advocates on a number of issues relevant to the future rural health workforce and these are highlighted in our Network position papers. Position papers are statemenst of support for a specific topic and provide the rational and recommendation behind the position. Our position papers are regularly updated and new ones developed as needed. All position papers are developed following consultation with general NRHSN members, Rural Health Club representives, NRHSN portfolios and the NRHSN Executive, and have become official policy following endorsement by the NRHSN Council.

Program Overview:
Health care is being dramatically transformed by several converging forces including the accelerating growth of machine learning, genomics and precision medicine, digital technologies, changes in reimbursement and a renewed focus on the patient at the center of care.

Regardless of your role or the specific focus of your organization, these revolutions impact the strategic challenges and opportunities that you face as you endeavor to create new value for the industry.

Led by Dr. Stanley Y. Shaw, MD, PhD, and other renowned Harvard Medical School faculty, “Inside the Health Care Ecosystem” provides business and science leaders with a deep dive into the health care ecosystem in the context of the business of health care. Through it, participants are exposed to real-world workflows and health care delivery in action, as well as the firsthand perspectives of patients and providers.

Previously only accessed by companies like Google, GE, Amgen and athenahealth on a customized basis, this program is now open to individuals and small teams whose work impacts health care.

Our Master’s track in Health Policy and Economics is not like your generic public health degree — in fact, far from it. We train students to become leading policy analysts and researchers working to identify the most effective ways to organize, manage, finance, and deliver high quality healthcare. Students learn to apply advanced research methods such as biostatistics, econometrics, and decision science to evaluate policies and programs while gaining valuable real-world experience under the guidance of a healthcare expert during the culminating capstone project. .

This program track provides a strong foundation in healthcare research methods with specialized training in health economics, health policy, data analytics, and implementation science. Each student acquires hands-on experience through a faculty-mentored research project that begins in the first term and culminates in a capstone/portfolio final project.

The Master’s track in Health Policy and Economics has close ties to other departments within Weill Cornell Medicine and Cornell University, Cornell Tech, and NewYork-Presbyterian Hospital. Full-time students can complete the program in 11 months, and part-time students in 18-24 months.

Unique Concentration
There are great differences between an M.P.H. and our Master’s track in Health Policy and Economics. M.P.H. programs tend to place greater emphasis on public health and epidemiology; contrastingly, we emphasize a broader policy perspective to include payment policy, health insurance coverage, and structural issues related to the healthcare delivery system. Additionally, the Master’s track in Healthcare Policy and Economics is mostly practice-based while M.P.H. programs tend to be more theoretical. Our goal is to prepare professionals to work effectively in health-related policy positions and serve as well-trained healthcare researchers with strong analytic skills.

Mentorship
We keep our class size and student-to-faculty ratio low so that our students get the most personalized experience possible. Because of this, close mentorship with a faculty member throughout the entirety of the program track is provided to all of our students. Many even continue their relationship well beyond becoming alumni and working in their careers.

Opportunities
Our alumni hold positions in data and policy analysis, healthcare consulting, project management, quality improvement, and more. Our alumni are also well-prepared to pursue doctoral studies.

Innovation
Students learn to develop and evaluate innovative approaches to financing and delivering healthcare using cutting edge research methods, while gaining hands-on experience in data analysis.

Training
Understanding how incentives present in the nation’s healthcare system – from ways that physicians and hospitals are reimbursed to the regulatory requirements for the development and approval of new drugs and medical devices – influence the cost and quality of care is essential to keep up with the changing healthcare landscape and to provide the best care possible. Utilizing cutting-edge statistical approaches, our students learn to conduct rigorous analyses with healthcare data using computing packages such as SAS, Stata, and R. The results of these analyses allow them to better comprehend how changes in health policy and new interventions in the delivery of care may improve the health of people across the country.

Diversity
Our students have diverse backgrounds including social sciences, basic sciences, medicine, pharmacy, nursing, and healthcare administration. Their diversity creates a unique, collaborative learning environment.

Collaboration
Being in New York City is a huge asset. Local institutions collaborating with Weill Cornell Medicine include New York-Presbyterian Hospital, Memorial Sloan Kettering Cancer Center, the Hospital for Special Surgery, The Rockefeller University, the State Department of Health, the New York City Department of Health and Mental Hygiene, and more.

Faculty
Our faculty are nationally recognized experts in health policy, economics, health services research, biostatistics, health informatics, cost-effectiveness, and comparative-effectiveness. Our NYC location allows for collaboration between experts and researchers at neighboring institutions such as New York-Presbyterian Hospital, Hospital for Special Surgery, and Memorial Sloan Kettering Cancer Center.

Capstone
The culminating capstone project allows students to gain valuable, real-world experience under the guidance of leading healthcare experts to address problems faced by our healthcare system.

The Master of Science in Digital Health is a four-semester program at the Faculty of Digital Engineering, jointly founded by the Hasso Plattner Institute (HPI) and the University of Potsdam, nearby Berlin. The interdisciplinary, English-language master’s program is aimed at students of computer science and medical students, who want to work as highly qualified experts in the health sector at the interface between IT, computer science and medicine. The program covers the basic concepts and methods of IT systems engineering and data engineering, and the basics of medicine, as well as providing an understanding of different healthcare systems. Master’s graduates can apply their interdisciplinary skills to leadership roles in research or industry. The healthcare sector offers exiting and “future-proof” career perspectives.

Why study at Hasso Plattner Institute?
Study programs at Hasso Plattner Institute have a strong practical focus. HPI has always held a top spot in the CHE University Ranking in Germany. HPI unites research and teaching at its new Digital Health Center. The private funding of the Institute by the co-founder of SAP Hasso Plattner has made it possible to create an optimal study and work environment. At HPI, students learn in small groups with the close support of their professors, lecturers, and teaching assistants. State-of-the-art computer technology, attractive seminar rooms, and a well-equipped campus mean that student life at HPI is easy and enjoyable. The Campus is located in the immediate vicinity of the metropolis Berlin.

Students are enrolled at the University of Potsdam and the degree is conferred by this university. You do not need to pay tuition fees.

The Master of Science in Digital Health is a four-semester program at the Faculty of Digital Engineering, jointly founded by the Hasso Plattner Institute (HPI) and the University of Potsdam, nearby Berlin. The interdisciplinary, English-language master’s program is aimed at students of computer science and medical students, who want to work as highly qualified experts in the health sector at the interface between IT, computer science and medicine. The program covers the basic concepts and methods of IT systems engineering and data engineering, and the basics of medicine, as well as providing an understanding of different healthcare systems. Master’s graduates can apply their interdisciplinary skills to leadership roles in research or industry. The healthcare sector offers exiting and “future-proof” career perspectives.

Why study at Hasso Plattner Institute?
Study programs at Hasso Plattner Institute have a strong practical focus. HPI has always held a top spot in the CHE University Ranking in Germany. HPI unites research and teaching at its new Digital Health Center. The private funding of the Institute by the co-founder of SAP Hasso Plattner has made it possible to create an optimal study and work environment. At HPI, students learn in small groups with the close support of their professors, lecturers, and teaching assistants. State-of-the-art computer technology, attractive seminar rooms, and a well-equipped campus mean that student life at HPI is easy and enjoyable. The Campus is located in the immediate vicinity of the metropolis Berlin.N

Students are enrolled at the University of Potsdam and the degree is conferred by this university. You do not need to pay tuition fees.

The MSPH is an academic research degree designed for students who wish to prepare for further study at the doctoral level or to prepare for research or technical positions in government, industry, academia, or private institutions. Studies will include many of the core disciplines included in the MPH degree with an additional emphasis on advanced research methods and quantitative analysis skills.

We are committed to transmitting the skill sets necessary to conduct effective public health research to all our students, understanding that such research may take place in academic, governmental, the private sector, and international settings. Experience in public health research often involves similar skill sets as those needed by public health practitioners.

The Master of Science in Public Health (MSPH) degree is accredited by the Council on Education for Public Health (CEPH).

Upon completion of the Master of Science in Public Health (MSPH) degree, all graduates will be able to:

Competencies:
Average Program Duration: 2 years
Total required credits: 45 credits
The Curriculum
The MSPH program is accredited by the Council on Education for Public Health.

An elective credit waiver may be available for students who enter the MSPH degree program with an earned advanced degree (e.g., MD, DDS, DVM, JD).