Foundations and essentials for the doctor of nursing practice

FoundationsandEssentialsfortheDoctorofNursingPractice.docx

Foundations and Essentials for the Doctor of Nursing Practice

THE DOCTORAL DEGREE AND PROFESSIONAL NURSING PRACTICE

This is a graded discussion: 100 points possible

A doctoral degree carries a certain set of expectations associated with the completion of advanced educational attainment. Earning a DNP degree is no exception. What are the expectations associated with a DNP-prepared nurse? How might these expectations differ among nursing staff without a DNP degree?

The role of a DNP-prepared nurse is multifaceted; they can serve as nurse educators, policy and legislation advocates, direct nursing care supervisors, or advanced practice nurses responsible for tracking, installing, and monitoring initiatives aimed at improving nursing and healthcare delivery. Regardless of the expectations associated with a DNP-prepared nurse, throughout your program of study, you will hone the skills necessary to enact each of these roles. Consider which role you are most excited about. What do you hope to accomplish in the realm of professional nursing practice with your DNP degree?

For this Discussion, reflect on your personal motivations to pursue a DNP degree. Consider the expectations associated with the DNP-prepared nurse, including how these may differ with a PhD-prepared nurse. Reflect on the DNP degree requirements, including your practicum/field experience and completion of your Doctoral Project. Then, think about how you will demonstrate the alignment of the AACN DNP Essentials to the completion of these program-of-study milestones.

TO PREPARE:

· Review the Learning Resources and reflect on the reasons you have chosen to pursue a DNP degree. How do you anticipate that earning this degree will support your professional goals?

· Reflect on the differences between DNP and PhD degrees. How may this relate to your decision to pursue the DNP degree?

· Review the degree requirements for completing your DNP at Walden. Specifically, consider the focus of the Doctoral Project and practicum experiences as discussed in the DNP Essentials document. Keep in mind that you will be required to identify a site or sites for completion of your DNP project and your practicum hours required for the degree.

· DNP programs require 1000 practicum hours post baccalaureate degree. 400 of those hours are earned while in the DNP program. 600 or more hours are earned in the MSN or in NURS 8601 during the DNP program. (I have met this requirement 600 or more practicum hours).

· After reviewing the DNP Essentials document and the DNP Project Process Guide for the DNP project, reflect on what it means to address an organization’s needs to attend to a gap in practice or implement a practice change. What is the difference between a gap in practice and a practice change? How does your role as the DNP-prepared nurse contribute to meeting a stakeholder need?

Post a brief explanation of the role of the nurse with a practice doctorate. Be specific. Explain the expectations associated with obtaining this degree, including how these expectations might be different for a nurse who holds a different degree. Then, explain how these considerations relate to your motivation to pursue a DNP, including a brief description of how your role as a DNP-prepared nurse will meet a potential organization’s need to address a gap in practice or implement a practice change. Discuss any experiences you have had in addressing a gap in practice or a practice change within an organization. Be specific.

TheImpactoftheDoctorateofNursingPractice.pdf

The Impact of the Doctorate of Nursing Practice Nurse in a Hospital Setting

Todd E. Tussing, DNP, RN, CENP, NEA-BC Bevra Brinkman, DNP, RN, APRN, ACNS-BC Deborah Francis, DNP, RN, ACNS-BC Brenda Hixon, DNP, RN, ACNS-BC, ANP-BC Ruth Labardee, DNP, RNC, CNL Esther Chipps, PhD, RN, NEA-BC

This article describes the initiatives of doctorate of nursing practice (DNP)Yprepared nurses in a large healthcare system supporting the DNP competencies as outlined by the American Association of Colleges of Nursing. The goal of this group was to demonstrate the impact of DNP education on the roles for nurse

administrators, advanced practice nurses, and educators in a large health system. Exemplars profile nurse administrators, clinical nurse spe- cialists, and a nurse educator.

Despite the growing numbers of nurses prepared with a doctorate of nursing practice (DNP), the im- pact of the DNP in the acute care hospital setting has not been well described. At our institution, a work- group of DNP-prepared adminis- trators, clinicians, and educators formed to examine the current practices and complete a gap anal- ysis comparing their current DNP practices with the American Asso- ciation of Colleges of Nursing DNP competencies.1 The goal of this group was to demonstrate the impact of the DNP education on the enhance- ment of roles for nurse administra- tors, advanced practice nurses, and educators in our setting.

Clinical Nurse Specialist Exemplars A major challenge faced in medical- surgical inpatient units is the balancing

of the continuous need to increase quality of care and patient outcomes while simultaneously decreasing length of stay (LOS), and overall costs of care. To enhance patient care and meet these challenges, a DNP-prepared clinical nurse spe- cialist (CNS) developed the role of clinical coordinator (CC) for each medical-surgical unit. The role of the CC (see Supplemental Digital Content 1, http://links.lww.com/ JONA/A653) is to facilitate com- prehensive care planning, ensure patient progress toward discharge goals, and eliminate barriers to plan of care and to be the consistent point of contact with the patient and family. The DNP-prepared CNS used the principles of Essential: Organizational and Systems Lead- ership for Quality Improvement and Systems Thinking1 during the design of the CC role, emphasiz- ing the importance of focusing on panels of patients and the need to reexamine care delivery models. To establish and communicate the vision of the project and to work with stakeholders to obtain approval

600 JONA � Vol. 48, No. 12 � December 2018

Spotlight on Leadership

Author Affiliations: Administrative Director of Nursing/Patient Care Services (Dr Tussing); Patient Care CoordinatorYClinical Nurse Spe- cialist (Dr Brinkman); Clinical Nurse Specialist (Dr Francis), The Ohio State University, Wexner Medical Center, University Hospital, Columbus; Director of Health System Nursing Education (Dr Hixon); Associate Director of Nursing Evidence-Based Practice and Standards (Dr Labardee), The Ohio State University, Wexner Medical Center, Columbus; Associate Professor of Clinical Nursing (Dr Chipps), The Ohio State University College of Nursing Clinical Nurse Scientist, Wexner Medical Center, The Ohio State University, Columbus.

The authors declare no conflict of interest. Correspondence: Dr Tussing, Wexner

Medical Center, University Hospital East, 181 Taylor Ave, Columbus, OH 43203 ([email protected]).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text andareprovided in theHTML and PDF versions of this article on the journal’s web site (www.jonajournal.com).

DOI: 10.1097/NNA.0000000000000688

http://links.lww.com/JONA/A653

http://www.jonajournal.com

and resources, the DNP-prepared CNS drew upon knowledge from the Essential: Inter-professional Collaboration for Improving Patient and Population Health Outcomes.1

The effectiveness of the CC role was supported by multidisciplinary involvement, rounding and com- munication, and the development of a patient-specific plan of care, goal setting, and family involvement. The Essential: Advanced Nursing Practice1 provided the framework for role development for top of licensure practice for the CC. The CCs are members of the patient care team, and outcomes mea- sured include patient satisfaction, LOS, and all-cause readmission rate and have revealed to be prom- ising (see Supplemental Digital Content 2, http://links.lww.com/ JONA/A654).

A 2nd DNP-prepared CNS was interested in facilitating and helping staff prioritize unit-level quality improvement (QI) processes. A total of 22 registered nurses (RNs) representing 10 units were selected to form a QI workgroup. These RNs were provided 6 hours of course work that included QI and an 8-hour immersion course on evidence-based practice (EBP) (see Supplemental Digital Content 3, http://links.lww.com/JONA/A655). The DNP-prepared CNS who or- ganized and led this effort was guided by Essential: Organizational and System Leadership for Quality Improvement and Systems Think- ing,1 which emphasizes the impor- tance of advanced communication skills to lead practice change initia- tives. Framing the development and organization of this new work group was the understanding that sustainability of practice improve- ments requires mentoring and edu- cation of frontline staff. Role

modeling and teaching the impor- tance of QI and bedside scholar- ship to the selected nursing staff were guided by Essential: Clinical Scholarship and Analytical Methods for Evidence-based Practice.1 To date, 2 staff nurseYled QI projects have had positive outcomes. An out- patient wound care center changed their nursing care delivery model to enhance staff efficiency and im- prove discharge teaching resulting in improved patient satisfaction scores (from 75% to 99%). The 2nd project on an inpatient cardi- ology unit resulted in improvement of patient intake/output documen- tation over a 3-month period (from 45% to 69%) (see Supplemental Digital Content 4, http://links.lww. com/JONA/A656).

Administrator Exemplars Our academic community hospital serves a low socioeconomic minor- ity population. As part of a long- range strategic plan, the university entered into partnership with the city and local metropolitan hous- ing authority to transform the neighborhood into spaces for health living and growth. A com- ponent of the community transfor- mation plan was to develop the 7 local schools into magnet schools for health careers (Health Sciences Academy). The partnership with this community school system was a new opportunity to form a bridge between the academic medical center’s health system and the local community. To move this effort forward, a DNP-prepared nurse administrator served as an advo- cate for promoting equitable health- care (Essential: Health Care Policy for Advocacy in Health Care1) and exploring new avenues for health education/promotion to improve gaps in care for an underserved

community (Essential: Clinical Prevention and Population Health for Improving the Nation’s Health1). This project required skills related to Essential: Clinical prevention and Population Health for Improving the Nation’s Health1 as the project required exploring avenues for health education/health promotion to improve care gaps for vulnerable populations. The outcome from the project was a curricular plan for grade levels prekindergarten thru 12th grade that included medical experiential content involving the medical center and its professionals.

The 2nd administrator serves as the associate director of EBP and Standards and led an interdisci- plinary team. This group reviewed internal quality data, identified stake- holders, completed a literature re- view, and critically appraised the evidence to develop the STAND skin bundle (a practice bundle used to prevent hospital-acquired pres- sure injury [HAPI] for patients at risk). This leader’s expertise led the interdisciplinary team through the 7-step EBP process2 using Essen- tial: Clinical Scholarship and Ana- lytical Methods for Evidence-Based Practice.1 Essential: Interprofes- sional Collaboration for Improv- ing Patient and Population Health Outcomes1 provided the frame- work as the team consisted of nurses, would ostomy continence team members, and a registered dietician. Reduction of HAPIs has broad implications for improving the health of patients and reducing healthcare costs using the knowl- edge from Essential: Clinical Pre- vention and Population Health for Improving the Nation’s Health.1

Although data on the impact of the STAND Skin Bundle is not avail- able yet, the educational prepara- tion as a DNP nurse positively

JONA � Vol. 48, No. 12 � December 2018 601

Spotlight on Leadership

http://links.lww.com/JONA/A654

http://links.lww.com/JONA/A655

http://links.lww.com/JONA/A656

impacted the structure and process of this workgroup.

Educator The DNP-prepared Director of Education lead a multidisciplinary team in the development of educa- tional resources and a staff training plan for the care for patients ex- periencing infection and emerging pathogens such as Ebola Virus disease. This project required fact- based, goal-directed health system- wide collaboration to prepare for an unexpected health crisis. The Essential: Clinical Prevention and Population Health for Improving the Nation’s Health1 provided the framework for understanding the impact of emerging infectious dis- ease and preparation for unexpected disasters. The interdisciplinary team reacted efficiently and quickly to

develop the care protocol and begin training (see Supplemental Digital Content 5, http://links.lww.com/ JONA/A657). The outcome from the project was the development of an institutional guideline for the care of patients experiencing a new emerging pathogen and education of the care team members. More than 100 staff members were trained (see Supplemental Digital Content 6, http://links.lww.com/JONA/A658; Supplemental Digital Content 7, http://links.lww.com/JONA/A659).

Conclusion The growing number of DNP graduates presents a great poten- tial for innovation around new care delivery models, interdisciplinary projects, and community involve- ment for a healthier society. Hos- pital and health system leaders must

be open to the contribution of these advanced practice nurses in new and redesigned roles. The time has come to integrate the essential com- petencies of the DNP graduate into healthcare system roles and com- petencies. Nurses prepared at the DNP level must demonstrate their value to healthcare administrators and nurse executives by sharing their out- comes and engaging in empirically based work to substantiate their value.

REFERENCES

1. American Associations of College of

Nursing. AACN Position Statement on the Practice Doctorate. Washington, DC: American Association of Colleges of

Nursing; 2004.

2. Melnyk B, Fineout-Overholt E. Evidence- Based Practice in Nursing & Healthcare. Philadelphia, PA: Lippincott Williams &

Wilkins; 2015.

602 JONA � Vol. 48, No. 12 � December 2018

Spotlight on Leadership

http://links.lww.com/JONA/A657

http://links.lww.com/JONA/A658

http://links.lww.com/JONA/A659