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Journal of Professional Nursing

journal homepage: www.elsevier.com/locate/jpnu

Academic-Practice Partnerships: Building a sustainable model for Doctor of Nursing Practice (DNP) projects

Barbara K. Hincha,⁎, Sarah Livesaya, Janet Stifterb, Frederick Brown Jrb

a Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, 600 South Paulina, Chicago, IL 60612, USA bDivision of Nursing, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612, USA

A R T I C L E I N F O

Keywords: Doctor of Nursing Practice (DNP) DNP project Academic-Practice Partnership

A B S T R A C T

Background: DNP programs should follow the Academic-Practice Partnership guiding principles developed by the AACN-AONE Task Force of Academic Practice Partnerships (2012) to support students educational and practice experiences. This paper outlines the collaboration between a college of nursing (CON) and academic medical center in establishing a formal process for identification and vetting of student DNP projects. Methods: A collaborative committee called DNP Project Oversight Committee (DNPPOC) was formed. DNPPOC members outlined a number of processes to facilitate DNP project review, key stakeholder input, and developed several tools to accomplish the committee's goals. A survey was sent to DNPPOC members to solicit their feedback on meeting the committees overall goals. Results: Medical center leadership reported improvements in the collection of key DNP project information and the distribution of DNP projects across facilitators and geographic locations. There was also report of perceived improvement in the overall quality of student learning opportunities, strategic direction of DNP projects, and alignment between CON and healthcare system goals. Conclusions: Processes developed by the DNPPOC have allowed the organization to handle the increase in DNP projects and maximize organizational resources. The DNPPOC structure has ensured high-quality DNP projects and that DNP students are prepared to be leaders in quality improvement.

1. Introduction

Since the 2006 American Association of College of Nursing (AACN) Essentials for Doctoral Education were established, the number of practice doctorate nursing programs in the United States has grown tremendously. The Doctor of Nursing Practice (DNP) degree is a clinical doctorate developed to prepare graduates who will become leaders with the skills to positively impact patient outcomes (AACN, 2015). Many advanced practice programs transitioned from master's to DNP degrees once the DNP degree was defined. (AACN, 2015).

According to the AACN Report from the Task Force on the Implementation of the DNP (AACN, 2012), programs should follow the Academic-Practice Partnership guiding principles developed by the AACN-AONE Task Force of Academic Practice Partnerships (2012) to support students educational and practice experiences. The joint task force recommended a systems approach to develop a collaborative re- lationship that can create and support these educational and practice experiences. The rapid changes in healthcare practice necessitate strong partnerships between academia and practice. Partnerships between

academia and practice provide more efficient sharing of resources and expertise.

As multiple programs, which had previously offered a Master degree transitioned to a doctoral degree and new DNP programs were initiated, the number of students completing a DNP project increased sig- nificantly. The DNP project is designed to be the culmination of the knowledge integration gained from the doctoral education demon- strating the student's ability to lead teams and influence health system change (Roush & Tesoro, 2018).

The purpose of this paper is to outline the collaboration between a college of nursing (CON) and academic medical center in establishing a formal process for identification and vetting of student DNP projects. Establishing a partnership between the two entities laid the ground- work for ensuring that student's DNP project work would positively impact patient outcomes and quality indicators. An additional goal of the collaboration was to develop processes that would ultimately ele- vate the quality and rigor of DNP student education by identifying project topics and removing barriers to increase the likelihood of stu- dent success.

https://doi.org/10.1016/j.profnurs.2020.08.008 Received 15 April 2020; Received in revised form 30 July 2020; Accepted 10 August 2020

⁎ Corresponding author at: Rush University College of Nursing, 600 South Paulina, Suite 1080, Chicago, IL 60612, USA. E-mail address: [email protected] (B.K. Hinch).

Journal of Professional Nursing 36 (2020) 569–578

Available online 12 August 2020 8755-7223/ © 2020 Elsevier Inc. All rights reserved.

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2. Background

The CON, Rush University and academic medical center (AMC), Rush University Medical Center (RUMC) exist in the metropolitan Chicagoland area, serving patients across multiple hospitals and clinics throughout the region, and a DNP student body that is largely local, but also extends across the nation. The Rush CON and RUMC are affiliated, and many students engage in clinical practicum and DNP project work at RUMC, although neither activity is exclusive to RUMC. Related to DNP Project work, RUMC prioritizes students who are also employees as a Registered Nurse (RN) or nurse leader in other capacities. Rush CON students who complete their DNP Project at RUMC participate in

the Institutional Review Board (IRB) process or the parallel review process that determines a project does not constitute human subjects research and does not need additional IRB review. The Rush CON DNP Project structure includes a DNP Project Team, including the student, the faculty advisor, a second faculty member and a facilitator identified at the project site. The Facilitator role is defined in Rush CON DNP Project Guidelines. The Facilitator must agree to serve in this capacity, and provides an evaluation of the student's activities as a part of DNP Project coursework.

In 2012, the American Association of Colleges of Nursing partnered with the American Organization of Nurse Executives and published guiding principles of Academic-Practice Partnerships (AACN, 2012).

Process A Project ideas generated

from the organization/site based upon problem, need, & organizational priorities

Process B DNP project discussed with faculty on interview student enters DNP program with

project idea

Leadership across the enterprise queried 4 to 6

months before student match to identify problems, needs,

issues that may be appropriate for a DNP project

Redcap Leader DNP Project

Identification form completed1

List of projects generated based on Redcap submissions

Program Director (PDs) reviews list for appropriate projects for

their specialty

Student completes Redcap Student DNP Project Idea2

form to submit to DNPPOC before starting DNI project

courses

Problems are presented to DNPPOC via Redcap forms

DNPPOC review forms for approval, sends

recommendations to students

Identifies/confirms facilitators

PD matches students based on area of interest - student

assigned

Information is sent by PD to facilitator, student and advisor

connecting all parties

Program directors complete student project spreadsheet

DNPPOC College of Nursing (CON) representatives will present at the DNPPOC in

December, May and August

DNPPOC, facilitators and key stakeholder invited to DNP

proposal and final presentation

CON sends Executive Summaries from final DNP

paper to DNPPOC

Process C Project ideas generated

from student assessment of site/unit

Student discusses idea/interest with Program Director/advisor

and appropriate hospital leadership

Student (and advisor if needed) meets with site leadership to

confirm project idea

Student completes Redcap Student DNP Project Idea2

form to submit to DNPPOC before starting DNP project

courses

Fig. 1. DNP Project Identification Pathways.

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Fig. 2. Medical Center Leader DNP Project Idea Form.

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Fig. 2. (continued)

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This document highlighted 8 guiding principles, the first emphasizing the role of collaborative relationships between academia and practice. Specifically, formal relationships should be established at the level of senior leadership and practiced at multiple levels throughout the or- ganizations, with mutual goals and set evaluation periods. However, the 2016 American Association of Colleges of Nursing (AACN) Advan- cing Healthcare Transformation (AACN, 2016) found that many col- leges of nursing were not well positioned or partnered with AMCs. The report was commissioned to understand the existing and potential partnerships between academic nursing and AMCs, and revealed a number of opportunities for improvement. Barriers to the advancement of academic nursing included lack of nursing involvement in govern- ance and organizational structures, siloed leadership between colleges of nursing and healthcare organizations, and lack of nursing faculty integration into the health system. The report also highlighted the lack of integration and collaboration of nurse researchers between colleges of nursing and AMCs.

DNP Projects are the cornerstone of doctoral education as a DNP prepared nurse. The DNP Project is a scholarly project that demon- strates synthesis of program learning and mastery of the Essentials for DNP Education, often addressing change initiatives in the clinical set- ting (AACN Essentials, 2006). Projects may be operationalized in a variety of ways, and generally should include planning, implementa- tion, evaluation and dissemination (AACN Clarification, 2015).

Much is written in the literature about DNP project rigor (VanderKooi et al., 2018, Terhaar & Sylvia, 2016), however there is little addressing how academic-practice partnerships are able to influ- ence the increasing number and overall impact of DNP projects on the health care system. Howard and Williams (2017) found in their work that developing the academic-practice partnership assisted the organi- zation in meeting their goals through student DNP projects. Dols et al. (2017) study revealed that DNP projects were most successful when they were able to make a significant impact for the site.

3. Methods

In 2018, leaders from a Rush CON and RUMC identified opportu- nities to improve the process of DNP project identification, im- plementation and sustainability. The Rush CON, one of the first in the country to initiate a DNP program, had a lengthy history of experience with students conducting doctoral projects though the process for project identification and vetting was less formal and generally student- directed. The growth in number of DNP students and projects, without a process for vetting projects, was placing significant strain on various

units within the medical center. At the same time, leaders from both the RUMC and Rush CON identified opportunities to strengthen student communication as well as to clarify the facilitator role at the medical center. Recognizing areas of both weakness and opportunity, a colla- borative committee called DNP Project Oversight Committee (DNPPOC) was formed.

Membership for DNPPOC initially included senior nursing leader- ship from two hospital campuses (Chief Nursing Officer, several Assistant Vice Presidents of Nursing and Advanced Practice Nurses) and CON leadership including the Assistant Dean of DNP Specialty Education and several DNP Specialty Program Track Directors. There are 17 committee members of the DNPPOC; 5 faculty from CON and 12 clinicians from AMC. The committee identified a central goal; to facil- itate DNP projects that align with the strategic goals and initiatives of the health system and that add value to the organization, in addition to providing a positive learning experience for the student. To accomplish the goal, DNPPOC key monthly activities included: identifying pro- blems within the medical centers that could develop into quality DNP projects, reviewing and endorsing DNP projects, identifying appropriate resources and key stakeholders, identifying project facilitators, out- lining appropriate project timelines based on student course work, and contributing to a sustainability plan for DNP projects.

DNPPOC members outlined a number of processes and developed several tools to accomplish the identified goals and key activities. First, the group worked together to identify 3 pathways for DNP project de- velopment. The first pathway (Process A) involved medical center leaders identifying a problem with CON leaders then matching a DNP student to the problem to evaluate and develop a DNP project. The second pathway (Process C) involved assigning the student to a specific location (generally an ambulatory clinic) where the student would then work with leaders at the location to identify a problem and resulting DNP project. The third pathway (Process B) involved student-identified projects, most often identified by post-master's DNP students. The three pathways illustrate the flexibility needed for the healthcare organiza- tion and DNP program tracks to develop DNP projects. DNPPOC pro- vides review for projects identified through all three pathways (Fig. 1).

Once the pathways for DNP project generation were well identified, DNPPOC developed several tools to facilitate project review and input. The committee developed the Medical Center Leader DNP Project Idea Form (Fig. 2). This form is utilized by medical center personnel to collect key information needed to vet an issue identified as a possible DNP project, including the problem background, type of project, whe- ther data exists to substantiate the problem, and how the problem is aligned with the organization's mission, vision, and/or strategic

Fig. 2. (continued)

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initiatives. The form also collects suggestions for key stakeholders and a proposed timeline for the project. The link to the electronic form is circulated throughout the 2 medical center campuses regularly to identify opportunities for DNP projects. The committee also developed a Student DNP Project Idea form, utilized by students, that collects si- milar information (Fig. 3). Both forms were developed using the

Research Electronic Data Capture (REDCap) ™ database (Harris et al., 2009). All form submissions are reviewed monthly by the DNPPOC, and information on follow up and recommendations for each form com- pleted are cataloged in REDCap™.

A survey was developed to better understand how the development of the DNPPOC impacted the academic-practice partnership, including

Fig. 3. Student Project Identification Form.

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how DNPPOC improved DNP project identification between students, faculty, and facilitators, and identification of opportunities for con- tinued improvement. The institution's Internal Review Board (IRB) deemed this quality improvement, non-human subject work and the survey was administered using the Research Electronic Database (REDCap™). Fifteen members of DNPPOC received the survey via se- cured email and 11 responded (73% response rate). The survey con- tained 9 questions with Likert scale responses and 1 open- ended question.

Results of the survey reveal that 100% (11/11) either agreed or strongly agree that DNPPOC had improved communication across the

academic-practice partnership as well as enabled the identification of DNP project facilitators. Full survey results can be found in (Fig. 5). As a result of DNPPOC, RUMC leadership reported improvements in the collection of key DNP project information and the distribution of DNP projects across facilitators and geographic locations. RUMC and Rush CON Leadership both reported an improvement in the overall quality of student learning opportunities, strategic direction of DNP projects, and alignment between CON and healthcare system goals. Participating in the DNPPOC permitted medical center clinical leaders to meet annual scholarship goals, which further supported the collaboration between the medical center and CON. Additionally, the collaboration facilitated

Fig. 3. (continued)

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clarification of clinician roles and responsibilities regarding DNP oversight.

The open-ended question was completed by 5/11 (45%) of re- sponders. Overall themes included recommendations for: continued improvement in communication across key members of the DNP team

(student, advisor, and facilitator); development of processes for iden- tifying DNP projects that may deviate from original plans; development of resources for facilitators, and a need for easier tracking of number of projects across clinical areas and per facilitator.

Fig. 4. Types of projects identified through the DNP project oversight committee REDCap™ forms. Submitters are asked to select all that apply; therefore many projects have multiple projects types selected.

Fig. 5. Percent of respondents who Agreed or Strongly Agreed to the DNP Project Oversight Committee survey questions.

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4. Discussion

While multiple publications have addressed the content and rigor of the DNP project and the role of academic-practice partnerships in providing clinical preceptorship opportunities, this paper highlights the importance of formalizing academic-practice partnerships related to DNP project oversight. A DNPPOC offered senior leadership from the CON and Medical Center to set mutual goals and develop workflow around DNP projects that would serve the needs of the student and the patients served by the programs developed. Additionally, DNPPOC of- fered an avenue to formalize DNP project sites rather than having student-directed projects without oversight.

Establishing DNPPOC and all associated processes resulted in posi- tive outcomes for students, the CON and the medical center. By aligning the DNP problem and subsequent project with the organization's stra- tegic plan, both awareness and allocation of resources to support the project were ensured. This addressed the issue that previous students had encountered when attempting to obtain funding or other resources needed to implement a DNP project. Additionally, DNPPOC member- ship works to identify key stakeholders, competing initiatives and other potential barriers from the outset that may result in DNP project fail- ures.

Multiple positive impacts have been realized by the medical center with the creation of the DNPPOC. First that DNP projects' are making an impact on health care outcomes for patients and staff. Second the DNPPOC has helped with addressing role clarity for clinicians working with DNP students; and third, by identifying DNP projects that are in alignment with the medical center's goals and initiatives, the DNPPOC has reduced the burden of students struggling to identify DNP projects and therefore reduced faculty burden.

Via DNPPOC review of DNP projects in the very early phase of project planning, DNPPOC was able to consider geographical location and issues which would increase burden on medical center clinicians, staff and faculty. Similar to others (Williams and Howard, 2017, Spoelstra et al., 2019) study coordinators found that having a structure in place for communication and ensuring alignment of DNP projects with the medical center goals allowed for development of a strong partnership with mutual intent and goals. In a quasi-experimental mixed-method design, VanderKooi et al. (2018) describe an enhanced DNP model at one practice site. Their results revealed that the inter- ventions applied (which were a more structured approach to advisor, site mentor and student expectations) enhanced the overall collabora- tion amongst the team members and had a positive impact on the health care systems goals. This also led to a strong academic-practice part- nership with standardized workflow and increased student opportu- nities for DNP projects. In a descriptive, qualitative study done by Staffileno et al. (2019) exploring the facilitator/mentor role, a key theme identified was role clarity. The facilitators/mentors in the study expressed the importance of clarification of the facilitator/mentor role as well as roles of other members of the DNP project team. The strong academic-practice partnership and ongoing communication structure that the DNPPOC created, allowed for discussion on role clarity that benefited both the CON and medical center clinicians.

The authors believe that the work of the DNPPOC has led to in- creased opportunities for student DNP projects by standardizing the communication structures, clarifying roles for both clinicians and fa- culty, and aligning DNP project focus areas to overall medical center goals. The DNPPOC survey revealed a very positive response related to improved communication and clarification of roles between academic- practice partnerships. Of note, in the DNPPOC survey result questions related to overall improvement in the quality and sustainability of DNP projects across the medical center scored poorly. This has been identi- fied as an area of improvement and prioritized as DNPPOC goals for 2020. As noted by Dols et al. (2017) implementing DNP projects that require significant change in practice and policy in the organization can be challenging. This challenge was similarly identified by CON faculty

as a challenge and forced consideration of alternative DNP project types that would still have rigor and impact. Through discussions between CON faculty, medical center leadership, and DNPPOC members it was realized that there was an opportunity for DNP students to complete comprehensive evaluation projects. Often times there are limited re- sources for these types of evaluations in organizations, which are cru- cial in ensuring that new initiatives or recent quality improvement strategies are making an impact on quality. Fig. 4 shows that approxi- mately 40% of DNP projects over the last several years that were re- viewed by DNPPOC focused on an evaluation of an existing program or intervention that has previously been formally evaluated. These eva- luation projects identified gaps in programs, and illuminated outcome data and recommendations for improvement in existing programs that the medical center may not have identified without student resources.

While this project focused on the relationship between a CON and AMC, the findings may be translatable to other colleges of nursing working with non-academic medical centers or other healthcare set- tings. The committee structure provided a platform for alignment and coordination between the CON and organization to ensure student success that may be reproducible in other environments. In fact, this alignment may be even more important for CON that is working with unaffiliated hospitals or other organizations. The Rush CON is exploring a similar model with other organizations who have expressed interest.

5. Conclusion

Developing a system to identify and vet potential DNP project ideas between the CON and affiliated medical center is essential for managing a large number of DNP students in one organization. Processes devel- oped by the DNPPOC have allowed the organization to handle the in- crease in DNP projects and maximize organizational resources. The DNPPOC structure has ensured high-quality DNP projects and has en- hanced project sustainability. In addition, these processes ensure that DNP students are prepared to be leaders in health care quality im- provement.

Declaration of competing interest

None declared by all authors.

Acknowledgments

We gratefully thank all members of the DNP Project Oversight Committee for their commitment and continued support to ensure that DNP students are supported and make significant contributions to the medical center. We specifically want to thank MaryCarol Racelis, Lillian Hall, Susan Hossli, Molly Moran, David Steedly, Melissa Browning, Karen Mayer and Mary Heitschmidt for their dedicated time and thoughtful discussions that have impacted the success of the DNP Project Oversight Committee.

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