Discuss how are you feeling about the DNP program leaders providing you with a mentor from the beginning?of your program to help you achieve academic

Nancy E. Edwards Medical Research Archives vol 6 issue 4. April issue 4 Medical Research Archives

Copyright 2018 KEI Journals. All Rights Reserved

The Impact of the Role of Doctor of Nursing Practice Nurses

on Healthcare and Leadership

Authors 1 Nancy Edwards, PhD, MSN, ANP-BC

2 Jennifer Coddington, DNP, CPNP

3 Cheryl Erler DNP, CNE

4 Jane Kirkpatrick, PhD, RNC-OB, ANEF

Affiliation: 1 Associate Professor. Director of the Primary Care Adult Gerontology Nurse Practitioner

Program.

2 Clinical Associate Professor. Director of the Primary Care Pediatric Nurse Practitioner

Program.

3 Clinical Associate Professor. Director of DNP Program.

4 Professor Emerita of Nursing. Interim Head School of Nursing and Associate Dean College

of Health and Human Sciences.

* Correspondence:

Nancy E Edwards

[email protected]

Abstract

The Doctor of Nursing Practice (DNP) is a clinical doctorate that prepares graduates for

advanced nursing roles that include clinical practice and leadership. These individuals are well

positioned to meet the Institute of Medicine’s mandate for nurses to add their unique perspective

to the interprofessional efforts to improve health care. This article demonstrates how DNP

graduates design, evaluate and create innovative patient care models, evaluate the cost

effectiveness of patient care strategies and influence health policy at multiple levels. The DNP

project is the culmination of the educational process where core competencies and the clinical

scholarship of the graduate become evident. A discussion of projects is included. Nurses who

have completed the DNP are making significant impact on quality, efficiencies, and effectiveness

of health care systems through their contributions in clinical practice, advocacy in health policy,

implementation and evaluation of evidence-based practice, and contribution to nursing education.

Keywords: Doctor of Nursing Practice, Impact, Quality Health Care

REVIEW ARTICLE

Nancy E. Edwards. et al. Medical Research Archives vol 6 issue 4. April 2018 issue 4 Page 2 of 11

Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra

1. The Overview of Doctor of Nursing

Practice

The American Association of Colleges

of Nursing (AACN) position statement

recommending that the Doctor of Nursing

Practice (DNP) be the entry level for Advanced

Practice Nursing led to unprecedented changes

in graduate nursing education. The complexity

of the healthcare system, the volume of new

best practices, the driving forces of policy and

the evolving models of healthcare financing

have generated the need to ensure nurses are

well prepared to meet the Institute of Medicine

(IOM) mandate of adding nursing’s unique

perspective to the interprofessional approach,

thus improving the health of the nation. 1-3

This

relatively new degree strategically prepares

nurses in advanced practice and leadership roles

to enhance health outcomes across all care

settings and optimize quality in healthcare

delivery.

The challenge of timely implementation

of best practices and the need for leaders to

execute change contributed to the development

and design of DNP programs. Since 2005, there

has been a dramatic growth from 11 programs

enrolling 392 students 4 to 303 programs in

2017 enrolling 25,289 students with 124 new

programs in various stages of planning. 5 During

a similar time frame, the research-focused

doctorate (PhD) has increased from 103

programs in 2006 to 133 programs in 2013. 6

This growth in doctoral programs is consistent

with the Institute of Medicine “Future of

Nursing Report” recommendation of doubling

the number of nurses with a doctorate by 2020. 1

The DNP is a clinical doctorate

consistent with other disciplines, such as

pharmacy, speech and audiology, and physical

therapy that have set the doctorate as their

terminal practice degree. For nurses, there are

multiple pathways to achieve the DNP that

include post BSN to DNP or post MSN to

DNP. There are two major foci for the DNP;

(1) Advance Practice Registered Nurses

(APRN) (nurse practitioners, clinical nurse

specialists, nurse midwifes and nurse

anesthetists) and (2) executive leadership

(preparing chief nursing officers and other top

level managers. Regardless of specialty, all

DNPs have core competencies that center

around leadership, organizational systems,

health policy, healthcare finance, informatics,

and integration of evidence based practice.

National nursing organizations have

advocated the DNP to prepare nurses for

clinical practice, clinical leadership,

restructuring the health care system, and

translation of research into the clinical setting. 5

The American Association of Nurse

Anesthetists has mandated the DNP as the entry

level into practice by 2025. 7 As well, the

National Organization of Clinical Nurse

specialists have endorsed the DNP as the entry

to practice by 2030. 8 The American Association

of Colleges of Nursing also reinforces the need

to prepare practice leaders for complex

organizations and systems and prepare expert

practitioners to be leaders and fully participate

in interprofessional health teams. 9 DNP

graduates generate new knowledge through

unique practice innovations and translation of

evidence and quality improvement outcomes

into clinical areas. 10

The DNP prepares expert

clinicians who lead by applying evidenced

based research to clinical and/or systems to

improve health outcomes.

The focus of the PhD is to prepare nurse

scientists to conduct research in order to

generate new knowledge and external evidence

to advance the science of nursing. 11

Some

doctors of practice disciplines also conduct

research but that is not the purpose of the

Nancy E. Edwards. et al. Medical Research Archives vol 6 issue 4. April 2018 issue 4 Page 3 of 11

Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra

clinical doctorate degree. 12

The two doctoral

programs have distinct preparations, yet are

complimentary and even synergistic. The DNP

prepares graduates to practice at the most

advanced practice level and to create evidenced

based strategies through the application of new

knowledge to improve clinical practice, which

results in optimizing health outcomes. 13

The

roles for the PhD prepared nurse include those

related to researcher, while the DNP prepared

nurse will assume leadership and executive

positions in health care organizations, including

hospitals and clinics, coordinating quality

improvement teams and directing patient care,

analyzing cost effective protocols and

influencing health policies. 14

In keeping with

the IOM’s recommendation, DNP prepared

nurses hold positions that lead collaborative

projects to improve quality of care, improve

health care systems and patient outcomes. 15

The

DNP nurse takes an active role in various

patient care settings and academia preparing

other advanced practice nurses, while the PhD

typically seeks positions in academia and

research settings.

The rapid growth in DNP roles led to

variations across DNP curricula that included

the number of required credits, entry from

baccalaureate and post-master’s level, the

multiple distinctive program foci and the

requirements and products of the final project. 16

To better clarify program outcome

expectations, the American Association of

Colleges of Nursing commissioned the RAND

Corporation in 2013 to examine the state of

current DNP programs offered and to identify

barriers and facilitators to embracing the DNP

as the entry level into advanced practice

nursing. 2 The outcome of this work serves to

guide DNP programs as they continue to grow

and evolve.

While there are common core

competencies, the strength of the DNP can best

be identified by the scholarly project completed

during the educational program and the

educational pathway selected by the individual.

The project is the synthesis of the clinical

doctorate education process to demonstrate

clinical scholarship. As with varying fields of

clinical practice, the scope and impact of DNP

projects can differ greatly. In order to determine

the potential impact and fit for an organization,

examination of the DNP project leads to insight

about how the DNP complements strategic

goals. Potential questions to ask DNP graduates

to determine how their expertise aligns with an

organization are outlined in Box 1.

Box 1

 What was the focus of your DNP project?

 How have you impacted system

changes?

 What change has occurred through your

leadership?

 What economic impact have you made?

 What is your contribution to policy

development? What skills do you bring

to impact policy?

2. DNP Impact

Since the development of the first DNP

program, graduates have significantly impacted

the practice of nursing and the shaping of

health care systems in the U.S. 3 They are

prepared to design and evaluate innovative

patient care models, evaluate cost effectiveness

of patient care strategies and influence health

policies at various levels. Evidence based

practice, which is a thread throughout all DNP

education, strengthens the application of

research-based interventions used to improve

patient outcomes. The DNP graduate influences

Nancy E. Edwards. et al. Medical Research Archives vol 6 issue 4. April 2018 issue 4 Page 4 of 11

Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra

health systems, clinical practice, health policy,

academia and various other areas such as health

economics, health insurance, administration

and information technology. 13,17

Table 1

summarizes areas where DNP contributions

have made an impact

.

Table 1. Examples of DNP Impact

Health Care Systems Examples of DNP Projects and Impact

Organizational

Systems Leadership

 Roles in Quality improvement,

 Disaster planning

 Analysis of Indiana Hospitals Preparedness and Response to H1N1 Pandemics

 Organization Variable and Perceived Patient Safety of Health Care Providers in a Critical

Care Transport Program

 A Nurse-Led Transition of Care Intervention

 Identification of Factors that Impact Delivery

of Essential Public Health Services in Indiana

Local Public Health Systems

 Improving the Discharge Process in the Ambulatory Surgery Center Environment

 The Impact of a Frontline Patient Safety Program on Nursing Turnover

 Improving the Referral Tracking System and

Coordination of Care in a Patient Centered

Medical Home Nurse-Managed Clinic

 Open Access Scheduling in a Community Health Clinic

 Nursing Workload Management Approaches and Nursing Staff

Population Health  Community Agencies/ Organizations such as

Red Cross, American

Heart Association

Long Term Care

Facilities  Reducing hospital

readmissions

 Improved Care transitions

Public Health

Department  Increased access to

healthcare

 Employee health

 Addressing public health issues e.g.,

obesity, diabetes

 Gender issues

 Cultural training

School Systems  Tobacco free

programs

 Mental Health diagnosis and

management

 Bullying/violence prevention

focus on unique

community- based

health indicators

 Weight loss

 Healthy eating

Clinical Practice

Acute Care  Improved care transitions, reducing

medications error,

 Evaluating the Impact of an Evidence Based Protocol for Managing Uncontrolled

Hypertension in an Underserved Population

 Reducing Surgical Site Infections

 Risk for Postoperative Complications in Older Patients Undergoing Elective Hip and Knee

Ambulatory Surgery

Centers  Patient flow

 Preventing surgical complications

Nancy E. Edwards. et al. Medical Research Archives vol 6 issue 4. April 2018 issue 4 Page 5 of 11

Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra

Urgent Care Facilities  Reducing wait times, appropriate antibiotic

use

Arthroplasty

 Identifying Eating Disorders in Young Female Athletes: Preventing Female Athlete Triad

 Evidence Based Pain Management in Hospice

Setting

 Increasing Colorectal Cancer Screening Utilizing a Quality Improvement Approach in

a Nurse Managed Primary Care Clinic

 African Americans and their Intent to Quit Smoking

 Drug Recovery Retention in Women Who Participated in Prenatal Substance Treatment

 Parental Readiness for Infant Safe Sleep

Interventions

Prisons Systems  Effective chronic disease management,

mental health

management

Community-based

Care Network  Increase access to care

 Quality improvement

 Positive impact on population health

indices

Rural Care,

Underserved  Native American

Reservations/Indian

Health Services

 Increasing access to

care by underserved

populations, e.g.,

LGBTQ and

immigrants

 Health Literacy

Primary Care

Facilities/Outpatient

clinics

 Primary care offices,

FQHCs, Nurse

managed Clinics

Health Policy

Health Policy  At institutional, local, state, national levels

 Quality of Care and Policy Barriers to Providing Health Care at a Pediatric Nurse

Managed Clinic

 Emergency Preparedness: An After Action Analysis of the 2009 Kentucky Ice Storm

Academia

Academia  Educating the next

generation of nurses

and Advanced

practice nurses,

 Translating evidence

 Evaluation of the Impact of High Fidelity

Simulation on Competence and Confidence in

Knowledge Transference by Nursing Students

 Preparing Future Health Professionals for an Aging Population

 Minority Undergraduate Nursing Student Success

 The Effectiveness of Using Video Cameras to Assess Nurse Practitioner Students in the

Clinical Setting

 Knowledge, Satisfaction, and Confidence

Levels of Simulation Education

Other area of impact: Finance, Health

Insurance

Nancy E. Edwards. et al. Medical Research Archives vol 6 issue 4. April 2018 issue 4 Page 6 of 11

Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra

Corporations  Improve employee health

 Influencing food

choice options

 Decreasing employee BMI

 Healthy Work environment

 Hyperglycemia and the Cost of Healthcare

 Implementation of Evidence Based Practice

and Healthy Work Environment

 Nurses Working Overtime and Risk for Cardiovascular Disease

Insurance Companies

 Health Outcomes

2.1 Health Care Systems

DNP education has elevated nursing

leadership skills. Emphasis on quality

improvement and leading collaborative teams

has brought about knowledgeable engagement

in quality initiatives throughout all areas of

healthcare, highlighting the importance of

multi-disciplinary partnerships. Their ability to

significantly impact in all areas of the health

care system can be evidenced in many ways,

e.g., the design of electronic medical records,

redesign of systems of care, and patient flow

through a healthcare system. 3 For example, a

DNP student was working in a pain clinic that

was scheduled to build three new examination

rooms to cut patient wait times. Through

looking at intake processes, she was able to

implement system efficiencies to cut patient

wait times, improve patient satisfaction and

increase patient flow without the additional cost

of building new exam rooms. 18

Magnet distinction has become a gold

standard for excellence in healthcare

organizations. DNP preparation provides

knowledge of systems, leadership, scholarly

evidence and policy, along with

interprofessional collaboration skills for

improving patient outcomes and maintaining

Magnet designation. 19

Krebbeks and

Cunningham report quality and cost

effectiveness of a DNP nurse managed

Hepatitis C clinic in a rural community setting

and that the DNP nurse leadership meets the

gap in rural and communicable disease care. 20

A DNP team led quality improvement program

in a primary care, cardiovascular population

resulted in improved self-care management of

patients over a six-month period. 21

Ramira et al,

used the Iowa Model of Evidence Based

Practice as a framework for a quality

improvement project to more effectively assess

and manage pain in pediatric patients in an

Emergency Department setting. 22

2.2 Clinical Practice

The Institute of Medicine and the

Affordable Care Act both acknowledge the

growing need for APRNs to fill the void in

primary care. 1,23

There is documented need for

DNP prepared APRNs throughout various

clinical settings including: home health care,

acute, primary, and long term care settings,

delivering care to a myriad of patient

populations. Such examples include the need

for DNP clinicians in palliative and end of life

care for children with cancer, the aging

population with acute and chronic health

problems, and medically underserved and

vulnerable populations. 24-27

Nancy E. Edwards. et al. Medical Research Archives vol 6 issue 4. April 2018 issue 4 Page 7 of 11

Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra

DNP prepared APRNs working

knowledge of health care systems, clinical

practice, health policy and economic issues, in

conjunction with leadership skills prepare them

to lead the ever-evolving health care milieu.

They have skills to implement practices

changes, and evaluate the impact of outcomes

including the impact on patients and their

families, the fiscal bottom line, and the care

delivery system. 3,13,17

2.3 Health Care Policy

DNP nurses are well informed,

prepared, and empowered to support health care

policy development and revision. They engage

in coalition building, policy intervention and

policy evaluation. They develop policy

agendas, serve as expert witnesses, content

experts, and garner support from legislators.

DNP educated nurses have the ability to

significantly affect health care policy and how

healthcare is organized, paid for and

delivered. 28

2.4 Academia

DNP faculty brings numerous strengths

to undergraduate and graduate education. Most

remain active in clinical practice and promote

the advancement of clinical practice to the

students. 29

The DNP essentials ensure that

faculty with a DNP degree are prepared with

advanced communication, and administrative

and leadership skills to understand the

organizational culture of education, analyze

educational initiatives and to assist with

educational budgetary concerns. 30

Knowledge

of evidence-based practice, change theory,

extensive knowledge of clinical practice and

health systems prepares new nurses for the

dynamic environment of healthcare. The

importance of understanding how to access the

evidence that guides healthcare practice and

recognizing the impact of quality improvement

is one area where DNP prepared faculty excel. 30

Opportunities for students to experience

collaboration with colleagues of varying

educational levels is enhanced as the DNP

prepared faculty infuses their clinical expertise

with the knowledge of policy, economics,

organizational systems and inter-professional

teamwork into the curriculum. 3,13

DNP faculty

can also be successful in tenure track positions.

A 2012 survey found that out of 65 DNP

faculty, 61.3% were teaching in institutions

where they were eligible for tenure. 31

2.5 Other Areas of Impact

The DNP nurse impacts other areas of

healthcare including health economics, health

insurance, administration, and information

technology. Some examples of the impact that

are already occurring: DNPs hold

administrative positions in the health insurance

industry and can influence the financing of

healthcare. They utilize electronic health

records (EHRs) to collect and extract data in

order improve patient processes, influence

patient outcomes, and contribute to the

optimization of EHRs. The future of the impact

DNPs can have on healthcare is endless and

many more areas of impact are still to be

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.