New standards for NP education emphasize competency, more clinical hours, and outcome measures
An Overview of the 2022 NTF Standards
Nurse practitioner education programs in the United States are now tasked with meeting a new set of standards designed to ensure quality in the academic preparation of NPs. The National Task Force (NTF) for Quality Nurse Practitioner Education endorsed the standards and released them to the public in April 2022. Find these criteria here.
The NTF is facilitated by two organizations, the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN). NONPF and AACN have coordinated and provided administrative support for the NTF’s work since the first panel was convened in 1997. The 2022 standards are an update to criteria released in 2016 (Criteria for Evaluation of Nurse Practitioner Programs, 5th edition).
Four Standards for All NP Programs
The 2022 Standards for Quality Nurse Practitioner Education (6th edition) are the result of 2 years of research and discussion by a task force comprised of representatives of the NTF’s 19 collaborating organizations (view the list at the end of this post). The document establishes four standards for all NP education programs, regardless of academic degree or population focus area:
- Standard I focuses on the institutional mission/philosophy/values and governance necessary to advance NP program excellence.
- Standard II focuses on the fiscal, human, student support, and physical resources required for a quality NP program.
- Standard III focuses on the curriculum necessary to prepare students for the nurse practitioner role, including meeting national standards and outlining the depth and breadth of requisite knowledge and skills for student success.
- Standard IV focuses on the systematic evaluation process for ongoing quality improvement through assessment of program outcomes, resources, curriculum, faculty, and students.
The transition to the new NTF Standards is expected to take 3 to 5 years. Full implementation of the NTF Standards will require time and involvement of faculty members as well as university administrators. The FAQ document posted by the task force states: “Schools can gradually incorporate the NTF Standards into their programs by reviewing institutional and school policies and procedures for alignment with the standards. These activities might include identifying activities that require institutional approval for change, planning and implementing required evidence, and encouraging faculty to create ways to implement criteria and the collection of evaluation evidence.” Find the FAQ document here.
The NTF plans to continue to review and revise the standards every 3 to 5 years. However, the task force will perform more frequent review and revisions if changes in nurse practitioner education warrant it.
Meeting Needs in 4 Areas
As they began their work in December 2019, NTF panelists identified major influences on healthcare, the health professions, and higher education. The standards document explains that the NTF decided to focus on four issues affecting the education of healthcare professionals. Through this analysis, the panel identified:
- A need for transition to competency-based education (CBE) in NP programs
- A need for interprofessional education experiences in NP programs
- A need for use of simulation in the learning and assessment of NP students — in support of, but not replacing, direct patient care experiences
- Increased emphasis on diversity, equity, and inclusion (DEI) in NP programs.
The NTF Standards contain recommendations for meeting the four needs identified by the panel. Addressing these needs will require adjustment in the way some NP programs assure adequate clinical experiences and demonstrate attainment of competencies.
For example, Criterion II.E states that an NP program must have “sufficient learning resources to facilitate quality didactic and clinical experiences for NP students to achieve program outcomes, attain national NP competencies for the role and population, and ensure timely completion of the NP program, regardless of delivery modality.” The evidence required to meet this standard includes “documentation that simulation resources used are in alignment with national best practices or standards identified by the NP program.”
Criterion II.G states that programs must “secure clinical sites and preceptors to ensure students enrolled in clinical courses have experiences to meet learning objectives and demonstrate expected course competencies.” The evidence required to meet this standard includes “sufficient number of appropriate clinical placement sites to support enrolled students’ direct care clinical experiences and learning outcomes for the population foci and timely completion of the NP program.” Another evidence item is “documentation of the faculty role in ensuring clinical placement of students and oversight to ensure appropriateness of clinical sites, preceptors, and experiences.”
Number of Clinical Hours
Standard III, which is focused on curriculum, requires that every NP track contain a minimum of 750 direct patient care clinical hours. These hours may include care delivered through telehealth and global health experiences. Of note, the FAQ document states that “simulation is not direct patient care, and these hours may not be included in the 750 direct patient care total.”
The AACN Essentials: Core Competencies for Professional Nursing Education (2021) require 500 practice hours to attain and demonstrate the advanced-level education competencies identified by AACN. These practice hours can include both direct patient care hours and nondirect patient care hours. Find the AACN Essentials document here. The AACN Essentials, which are foundational for all professional nursing programs, delineate the competencies and curriculum expectations for all programs that prepare graduates for any advanced specialty or role; they are not limited to NPs or the other APRN roles.
In the NTF Standards FAQ document, the panel explains that “the decision to increase the minimum number of hours for all NP programs was made after extensive discussion by the NTF, as well as listening to extensive feedback from diverse stakeholders including employers, graduates, and faculty.” The increasing complexity of healthcare, the growing number of states passing full practice authority laws, and the expanding number of postgraduate NP residencies and fellowships underscore the need for additional clinical experiences before graduation from an NP program, the FAQ document states.
The AACN Essentials transition nursing education to competency-based education (see page 16 in the PDF linked here). Like the AACN Essentials, the 2022 NTF Standards express clear support for the transition to CBE and note that nursing education, and specifically NP education, “has not developed CBE and assessment processes sufficiently to support the transition to time-variable education and the elimination of a minimum number of direct patient care clinical hours for quality education.”
To facilitate the initial transition to CBE, NTF Standards Criterion III.G states that every NP program must prepare students with nationally recognized patient care competencies at the beginning advanced practice level. This preparation must be delivered through faculty-guided learning experiences before students enter precepted experiences focused on patient management or the required direct patient care hours. This criterion supports the move to CBE and sets a quality standard for all NP programs to achieve.
More specifically, this criterion states that NP programs must document that NP students demonstrate patient care competencies at the achievement of Time 1 progression as defined in the AACN Common Doctoral APRN Competencies. Find these competencies here.
The first progression indicator (Time 1) is the expected level of achievement when a student begins their first meaningful clinical experience. The second progression indicator (Time 2) describes the expected level of performance at completion of an APRN program. The competencies required in Time 1 are:
- Perform a comprehensive evidence-based assessment
- Use advanced clinical judgment to reach a diagnosis
- Synthesize relevant data to develop a patient-centered, evidence-based plan of care
- Manage care across the health continuum, including prescribing, ordering, and evaluating therapeutic interventions
- Educate patients, families, and communities to participate in their care, and enable shared decision making.
To keep NP education programs and faculty members apprised of issues related to the implementation of the 2022 NTF Standards, The NP Insider blog will continue reporting on this topic. Please send comments and questions to Michelle.Perron@ascendlearning.com.
The following organizations have endorsed the 2022 NTF Standards:
- Accreditation Commission for Education in Nursing
- American Academy of Nurse Practitioners Certification Board
- American Association of Colleges of Nursing
- American Association of Critical-Care Nurses Certification Corporation
- American Association of Nurse Practitioners
- American Nurses Credentialing Center
- American Psychiatric Nurses Association
- Association of Faculties of Pediatric Nurse Practitioners
- Commission on Collegiate Nursing Education
- Gerontological Advanced Practice Nurses Association
- International Society of Psychiatric-Mental Health Nurses
- National Association of Neonatal Nurse Practitioners
- National Association of Nurse Practitioners in Women’s Health
- National Association of Pediatric Nurse Practitioners
- National Certification Corporation
- National League for Nursing Commission for Nursing Education Accreditation
- National Organization of Nurse Practitioner Faculties
- Pediatric Nursing Certification Board
The NTF welcomes endorsement of the standards by other stakeholders. For information on endorsement, contact Mary Beth Bigley, DrPH, ANP-BC, FAAN, chief executive officer for the National Organization of Nurse Practitioner Faculties, at firstname.lastname@example.org.