For the Spring 2018 semester, master’s students at Duke University School of Nursing (DUSON) have the opportunity to enroll in a new major: Psychiatric Mental Health. It’s the eighth and latest major offered for nurse practitioner students, following closely on the heels of the Women’s Health major, which was added three years ago. The Master of Science in Nursing (MSN) program has also recently added two new specialties: Endocrinology and HIV/AIDS, and a pediatric mental health specialty will be launched in the near future.

This uptick in new major and certificate offerings is no accident. Specialty nursing is more and more prevalent, and DUSON is “aiming to identify community health care needs and respond proactively to meet those needs,” said Beth C. Phillips, PhD, MSN’93, RN, CNE, associate professor and interim director of the Institute for Educational Excellence.

“To think about why we do a new program — it’s not because we have a faculty member who would be great at it, so let’s create a new program,” Phillips said. “We create a program based on community need — local, national or global.” The newest major, for example, was added after we recognized there was a scarcity of mental health providers in the state. Behavioral concerns and the addiction crisis in our country demanded a more advanced and skilled workforce in nursing.

The program emerged from tracking legislation, examining the literature and identifying other programs and providers to see what needs were being met by the health care community already, and what needs weren’t. It can be a long process, Phillips said, with vetting by faculty and staff, hiring credentialed and experienced faculty and identifying appropriate clinical sites. Ultimately, the approval of the faculty is needed and financial resources must be provided by the Dean to support the program start-up.

“Any curriculum in place must evolve,” said Michael E. Zychowicz, DNP, ANP, ONP, FAAN, FAANP, professor and director of the MSN program. “It needs to be reflective not only of current societal needs, but future needs based upon trends we’re seeing,” such as the slow but steady movement of Advance Practice Registered Nurses (APRN) into specialty and even sub-specialty areas (i.e. HIV, Endocrinology, etc.) of practice, he said. “That trend really necessitates that we create these types of specialty education programs, so we can do our part to ensure that students who go into specialty areas have the formal training they need.”

While there has been a move nationally to standardize APRN education within broader defined population areas – family care, for instance – the specializations within those broader population areas are just as important. “When graduates are seeking specialty practice positions, these concentrations help them prepare, and when interviewing, it helps differentiate them from the competition,” Zychowicz said.

Practicing in primary care with a specialty can be very effective, he said. “For instance, maybe you’re a primary care pediatric nurse practitioner (NP) and you want to be educated and have additional preparation on how to take care of children with Attention Deficit Disorder or depression or anxiety.” Pediatric patients in need of mental health care might not make it to a psychiatric clinic, but having a primary care nurse practitioner with that specialty can help treat those patients in that setting. “We bring a niche area of knowledge into primary care,” he said.

A student enrolling in the MSN program has several opportunities to find his or her niche as a nurse practitioner. He or she first chooses one of the eight NP majors and then has the option of choosing a specialty. There are course requirements, and a formal clinical rotation requirement that must be met to earn the specialty certificate.

Veterans heath care is an area of particular focus at DUSON. Through a unique partnership with the Durham Veterans Administration (VA), issues surrounding veterans care are woven through the MSN curriculum. The initiative, partially funded by a five-year grant, allows APRN students to access preceptored clinical experiences at the Durham VA to provide care to veterans. Additionally, new APRN graduates have a unique opportunity to further their veteran health care education through innovative psychiatric mental health and primary care nurse practitioner residency programs created in partnership between DUSON and the Durham VA.

“The VA helps to inform our curriculum in the master’s program with regard to veterans’ health care,” Zychowicz said. Because many veterans receive their health care from primary care providers in their community, it gives APRNs a leg up to have had cursory education on their specific veteran’s needs. “All of these things add to the uniqueness and signature of our school.”

Being aware of societal demands and health care trends as the school looks to the future is an ongoing challenge the MSN program continually strives to meet. “It’s very important to stay current and focused to address the health needs of our population,” Phillips said. “There’s always a new disease, new health problem, new treatments and new population needs. In addition, it is critical our graduates are prepared to promote wellness and disease prevention.”

“This is the evolution of nursing education, we are never really finished if we want the students who come to us for their education to be prepared not just for today, but for the future,” she said.