Doctor Of Nursing Practice Graduates Research Articles

National evaluation of DNP students' use of the PICOT method for formulating clinical questions.

The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood. This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects. Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus. Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5). Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.

Celebrating over 20 years: Outcomes from the first doctor of nursing practice program.

The first Doctor of Nursing Practice (DNP) program was opened at the University of Kentucky College of Nursing (UKCON) in 2001. As the CON celebrates 20 plus years of DNP education, leaders decided to do an assessment of the accomplishments and outcomes from the work of graduates. The purpose of this study was to delineate the achievements, outcomes and perception of the impact of graduates from the UKCON DNP program and assess the correlations of specific "perception of impact" variables. DNP graduates from 2005 to 2021 (n=348) received an email about the study and a link to the survey. Ninety graduates who resided in 14 states responded. Over 84% of participants indicated that their DNP degree helped them stand out as a leader. Participants reported that having a DNP education increased their knowledge and expertise in multiple areas, including how to lead, to influence, and to improve outcomes within their organizations. Narrative feedback related to top achievements since graduation included career advancement/promotion (n=22), improving patient care quality/implementation of evidence-based initiatives (n=21), and becoming a better leader (n=19). This study illustrated the broad return on investment and the quantification of value that a DNP education brings, both to practice and academia.

Academic Practice Partnerships: Improving Doctor of Nursing Practice Project Quality.

Doctor of nursing practice (DNP) projects with impactful health system outcomes can be a challenge for graduate students and graduate program faculty to develop. Rigorous DNP projects address patient and health system needs, meet programmatic requirements, and result in a portfolio of sustainable scholarship for DNP graduates. A strong academic-practice partnership may result in a greater likelihood of successful and impactful DNP projects. Our academic-practice partnership leaders developed a strategic approach to align health system priorities with DNP student project needs. This partnership has resulted in project innovation, increased clinical application, improved outcomes within the community, and enhanced project quality.

Academic-Practice Partnership for Doctor of Nursing Practice in a Large Medical Center

This paper describes a unique academic–practice partnership model for doctor of nursing practice (DNP) initiative to prepare nurse leader in key roles within a large academic medical center. This partnership has been sustained for several years with 9 cohorts of doctoral students. It explores the DNP graduates’ and students’ narratives regarding the benefits to which doctoral education impacted their leadership roles, practice changes, professional growth, and initiation of community-based health projects.

DNP: Research or not - That is the question.

For decades the DNP (Doctor of Nursing Practice) degree has been referred to as practice focused whereas the PhD (Doctor of Philosophy) has been identified as research focused. The time has come to revisit that classification. Although the PhD has remained unchanged in its focus to prepare nurse researchers, the DNP has steadily evolved over time. Graduates of DNP programs are tasked with applying evidence-based practice research findings to the real-world environment thereby reducing the gap between research and practice. This process has been termed translational science which has evolved into translational research. If, in fact, translational research is a recognized form of research methodology, and the DNP graduate is skilled in this form of research, then the DNP should be redefined as both a practice and research degree.

Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement

The universal challenge for clinicians worldwide is to provide safe and quality patient care that is based on the best available evidence. Despite current studies indicating that patients who receive evidence-based care have better outcomes, it is well documented that current care performed at the bedside is not based on the best current available evidence because of the delay from “bench to bedside.”1 Clinical inquiry aims to improve patient safety and quality of care through methodical exploration of a clinically significant phenomenon. So why are advanced practice nurses (APNs) not routinely formulating clinical inquiries in their daily clinical practice?Advanced practice nurses play a critical role in clinical inquiry, as we are able to identify local gaps in practice, processes, or systems that have the potential to negatively affect patient outcomes. Through curiosity about best available evidence, APNs can effectively guide clinical decision-making. Advanced practice nurses also have a perspective from patients about best care given their position at the bedside, bringing the literature and the patient perspective into alignment. Accordingly, a wide range of literature documents improvements in patient care and safety using quality improvement (QI) initiatives that have been developed and implemented by APNs. Therefore, with access to the right tools and education on how to best engage in and perform QI, APNs are poised to improve the quality of care and safety of patients. Despite adequate education, most APNs remain inexperienced in executing clinical inquiry independently in the clinical practice setting. Literature is still lacking on how to most effectively teach APNs in the clinical practice setting about clinical inquiry, specifically QI. Project-based learning (PjBL) is one teaching methodology, based in experiential adult learning theory and grounded in the notion that we as APNs learn better by doing; seeing and participating as a case unfolds in the form of PjBL provides important insights and demonstrates how to succeed in conducting a QI.The purpose of this column is to provide evidence for teaching QI to APNs in the clinical practice setting through the use of PjBL as a teaching methodology for facilitating more effective QI education.Quality improvement uses a systematic approach to distinguishing current practice from best practice and evidence-based practice (EBP). Quality improvement is about identifying gaps in performance in practice, process, or systems within an organization and implementing strategies to improve outcomes related to cost and productivity of work and care, quality of care, patient satisfaction, provider satisfaction, and ultimately patient outcomes. Advanced practice nurses are vital to QI given their presence at the bedside within the clinical practice setting. Regardless of widespread acknowledgement of the importance of QI in the clinical practice setting, it is likely not being used as effectively as possible. The Essentials: Core Competencies for Professional Nursing Education cite necessary competencies related to QI in the nursing scope of practice within broader domains at each education level.2 Among entry-level and advanced-level nursing education, nurses are prepared to participate in and develop initiatives that are aimed at quality and safety. If nurses have the knowledge and skills to participate in and develop QI, why is it not being done or done better?Despite their educational preparation, most APNs are unclear on how to successfully take a QI project from an idea to implementation. Education beyond the academic setting is needed even among doctor of nursing practice (DNP)-prepared nurses.3 To carefully construct a QI project, APNs must accurately identify a gap in their practice, engage with members of the interdisciplinary team and key stakeholders, evaluate the literature to determine best practice, develop a well-constructed plan, implement their plan, evaluate outcomes, and disseminate their findings internally to the organization and externally. Little guidance can be found in the literature on how to teach APNs about QI, particularly in the context of their clinical practice. Studies have shown that a lack of available continuing education and on-the-ground training about QI processes and a lack of mentorship within the practice setting remain barriers to nurses commencing projects.4-6Other barriers to QI exist at the provider and health-system levels; therefore, it is imperative that barriers to engagement in QI be addressed and overcome. Within the literature, barriers to engagement at the provider and health-system levels have included time constraints, heavy workload, lack of educational opportunities and mentorship, and the unique hospital or clinic-based culture.6-8 In addition, there is a notable lack of knowledge and skills among those who are practicing.9 Continuing education and training have been identified as facilitators of QI,4,8,10 and yet, these resources can be difficult to find. Education about QI has been associated with increased knowledge, skills, competency, and QI implementation and is urged by leading professional nursing organizations including the American Nurses Association and its subsidiaries.11Over the past decade, the number of APNs pursuing DNP degrees has grown exponentially. In a recent publication by the American Association of Colleges of Nursing, DNP graduates endorsed applying requisite skills in QI improvement to improve practice, processes, and systems in the clinical practice setting.12 All APNs, regardless of degree, can benefit from continuing to build skills and confidence for executing QI studies. The clinical practice arena provides an opportune setting to support APNs in pursuing advanced skills for improvement science through continuing education—education that provides APNs in the practice setting with the tools necessary to succeed. There is a need to promote the development, engagement, and mentorship of APNs interested in engaging in QI.6Quality improvement education with APNs new to QI at the bedside needs to be fostered, using teaching methodologies that encourage participation in existing projects in collaboration with mentorship with experienced colleagues.3,13 Several methods for teaching QI have been explored in the literature.14 Most methodologies for teaching QI have been explored in the academic setting with little evidence for teaching methodologies that can be applied in the clinical practice setting. Methodologies range from simple to complex, isolated to blended. Those that use active learning have been found to be more effective than traditional teaching methods such as didactic lectures.15Project-based learning is one teaching approach that has the potential to be used in the clinical practice setting to allow APNs to develop the knowledge and skills to execute QI more effectively, thus improving the development, design, and rigor of QI initiatives (Figure). Project-based learning encourages APNs who are novices in QI to collaborate with colleagues who have expertise in the clinical problem of interest. Through a standardized process, APNs obtain guidance and feedback on how to best facilitate nurse-led, evidence-based best practice initiatives. Rooted in constructivism, PjBL is a learner-focused teaching methodology that uses active learning and immersion to convey new knowledge (Figure). Project-based learning challenges the learner to apply theoretical knowledge and skills to real-world experiences in collaboration with faculty and others with expertise in the clinical problem.18 Through experiential learning, students engage in “learning by doing,” using an approach that is hands-on, clinically relevant, and culturally meaningful in the hospital setting.Advanced practice nurses curious about how to successfully develop, implement, and evaluate a QI project using PjBL can adopt a mentor-APN and learner-APN relationship through a professional nursing organization or several practice-based national networks (eg, the American Association of Critical-Care Nurses or the American Association of Nurse Practitioners). Project-based learning in the context of a QI project follows the EBP model with the intention of targeting specific learning goals through formal teaching principles and methods. The 7 steps for implementing PjBL can be sequentially followed, as depicted in the Figure. Through the steps, the mentor-APN provides support and guidance to accomplish successful transfer of knowledge, understanding, and skills while promoting learner-APN independence.19 Operationalization of learning goals for PjBL in QI projects can be found in the Table.Defining the problem is the foundation upon which to develop the QI project. The problem should be an important practice, process, or system issue that is identified, through discussion with other APNs and organizational leadership at different levels, as relevant within the context of the organization. After identification of the problem to be addressed, a broad clinical question should be developed that the learner-APN intends to answer. The initial clinical question will help drive subsequent steps.Sustained inquiry entails a deeper dive into the problem through the discovery and interpretation of relevant literature and iterative revision of the initial clinical question based on the literature.19 The learner-APN should appraise and synthesize the body of evidence related to the identified clinical problem. Accordingly, the learner-APN will formulate substantial conclusions of the most effective approaches to address the clinical problem that is based on the best evidence available. The learner-APN may propose alternative or complementary clinical questions.Quality improvement should be based on conclusive evidence. A key characteristic of authenticity is ensuring applicability within the real-world context.19 Real-world context can be related to quality and safety standards as deemed by regulatory or quality agencies, significance within the organization, relevance to current clinical practice, and vested interest in the clinical problem by the learner-APN.Integration of learner-APN input in the QI project is the basis for voice and choice.19 Development and implementation of the QI project should be based on the ideas of the learner-APN with guidance from the mentor-APN. Voice and choice fosters better learner-APN engagement and accountability within the QI project.Reflection involves learner-APN and mentor-APN self-evaluation of their role and performance within the QI project and evaluation of the outcomes associated with the QI project.19 Self-evaluation may involve specific knowledge and skill attained, quality of work, and barriers encountered with interventions implemented. Analysis of outcome data to determine the effectiveness of the practice, process, or system improvement should also be reflected upon.Methodical assessment of the learning process and the QI project is necessary to evaluate initial goals. Critique allows learner-APN views to be shared and acknowledged.19 Subsequently, the learner-APN is able to apply learned views to the revision of the QI project, resulting in an iterative process of improvement to both the learning process and the QI project.Dissemination of the QI project findings should take place within the organization and externally to achieve learner-APN knowledge translation and practice change. Internally, dissemination of the findings to organizational stakeholders, from unit leadership to hospital leadership, should take place. Externally, dissemination of outcomes can take place through presentation at professional meetings or publication within peer-reviewed journals to contribute to the current literature.Project-based learning is an innovative, evidence-based strategy by which learners are exposed to opportunities and challenges in the health care environment that may not be appreciated using other teaching methodologies. Project-based learning has been associated with improved learning outcomes, critical thinking and problem-solving skills, and competence by solving actual problems in an educational environment using dialogue between faculty and nursing students.20-25 Although little evidence exists regarding its use in the clinical practice setting in the nursing profession, PjBL specifically for QI has been shown to be an effective teaching strategy and increases knowledge and confidence in the academic setting.16,26 Current literature has demonstrated positive effects for PjBL on knowledge, critical thinking, problem-solving, and teamwork, among others.Project-based learning has been used infrequently by APNs in the clinical practice setting. Most QI learning tools offered in the clinical practice setting are executed through isolated didactic lecture rather than “learn by doing.” In contrast to the project-based, layered learning that takes place with PjBL, other QI tools for use in the clinical setting offer “micro-learning” in small, app-based segments.21 One example, BiteSizedQI, a mobile application developed for use by both clinicians and patients, offers small “sound bites” to provide the language and skills necessary for QI in clinical settings.27 Based on principles of Lean Six Sigma, the app shows a series of videos that build low-literacy, user-friendly questions and answers to reinforce content and evaluate learning. Similarly, the Institute for Healthcare Improvement web-based tools offer web-based skills development and online certification using learning modules and post-test quizzes.28 Unlike PjBL, these web-based programs deliver content and validate knowledge achievement without the added benefit of clinical context. Providing the clinical context adds meaningful learning and insight for APNs practicing in the clinical setting. Integration of PjBL into the clinical practice setting for APNs learning about QI should be a considered procedure to ensure accurate and standardized execution of QI can be achieved.Substantial evidence exists for the use of PjBL in the academic setting for teaching QI to nursing students; this experience may be applied in the clinical practice setting when teaching QI to APNs. Project-based learning is an effective teaching methodology for practicing APNs, in that it promotes the transfer of knowledge into clinical practice in a contextually and culturally meaningful way, addressing both the cognitive and psychomotor domains. Successful implementation of PjBL in the clinical practice setting engages the novice and expert APN together in QI and may be particularly advantageous for APNs pursuing clinical inquiry.

State of DNP education: Lessons learned from a novel academic fellowship in teaching and education.

We examine the gap between the current and desired state of Doctor of Nursing Practice (DNP) education from the perspective of postdoctoral (DNP) teaching and education fellows. In the assessment of the DNP Essentials framework, command of scholarly and scientific writing, ability to demonstrate critical thought, and significant variation in clinical experience among DNP graduates are top concerns. These inconsistencies are problematic to the professional and public value of this terminal degree in nursing.

Dissemination enhancement in Doctor of Nursing Practice students.

Students in Doctor of Nursing Practice (DNP) programs graduate with a completed DNP Project focused on practice improvement utilizing evidence-based research. Despite the value in disseminating the DNP Project outcomes to an audience of interest, many DNP graduates do not pursue dissemination beyond conclusion of their project and graduation. The DNP Project didactic course and the DNP Project manuscripts were revised with active learning assignments designed to improve knowledge, skills, and confidence in professional writing and dissemination. A cohort of 26 students was invited to participate in informal focus groups to determine impact of the revisions. The program director tracked the number of students accepted for conference presentations or manuscripts post-implementation. Of those invited to the focus groups, 25 students provided feedback. The students reported a perceived increase in competence and confidence in their ability to submit a professional abstract or manuscript for presentation or publication. Faculty noted an increase in the number of students who proceeded with dissemination of their DNP Project. Capturing the momentum for dissemination by revising the DNP Project didactic course and DNP Project manuscripts proved valuable for enhancing graduates disseminating professionally thus contributing to the translation of evidence-based practice into healthcare.

Diving in: Using a "Shark Tank" approach to teach business skills to future DNP leaders.

Doctor of Nursing Practice (DNP) education prepares graduates to lead clinical improvement and innovation across practice settings. Advanced clinical knowledge, leadership skills, and the development of quality/safety competencies uniquely prepare the DNP program graduates to drive organizational change. Adding business and financial competencies to the skill set of DNP graduates strengthens the impact and value of their role on financial, quality, and operational outcomes. The Organizational Systems and Healthcare Financing course in a DNP program was redesigned to engage learners using an innovative approach to teach business and financial principles. This paper aims to (a) describe a novel "Shark Tank" approach whereby students develop and "pitch" their business proposals to a panel of healthcare executives; (b) share examples of impactful change projects by student teams; (c) report DNP course and program evaluations including students' satisfaction and perceptions of value and knowledge gained in business principles; and (d) report opportunities for bidirectional mentorship, faculty recruitment, and succession planning. The success of this innovative team-based approach for teaching business/financial skills better prepares future DNP leaders and has implications for other DNP programs. Using this teaching strategy created opportunities for faculty recruitment, succession planning, and bidirectional mentorship of DNP-prepared nurse leaders.

Practice scholarship engagement as reported by nurses holding a doctor of nursing practice degree.

Nearly 15 years after the introduction of the doctor of nursing practice (DNP) degree, stakeholders anticipate practice scholarship outcomes from graduates. To examine the frequency of engagement in practice scholarship, the relationship between the knowledge gained in DNP programs and the frequency of engagement in practice scholarship and the relationship between engagement in practice scholarship, work role, and years since graduation with a DNP degree, as reported by practicing nurses. This cross-sectional study recruited 306 practicing DNP graduates via a national organization and employed an electronic survey. Descriptive and inferential statistics, correlational analysis, and a one-way analysis of variance were conducted on demographics and outcome variables for 269 completed surveys. The practice scholarship activity reported most frequently was evaluation of current clinical evidence and least frequently was dissemination of policy papers. Reported knowledge gained from DNP programs and frequency of engagement in practice scholarship indicate a weak positive correlation. There was a significant difference in the direct care work role and practice scholarship engagement compared with other roles, and between those practicing greater than 10 years and those with less experience. Results highlight the underutilization of knowledge gained in DNP programs and engagement in practice scholarship. The study emphasizes the complexity of realizing practice scholarship outcomes of DNP-prepared nurses to influence patients, populations, systems, and policy as well as the advancement of the nursing profession. This is a call to action for DNP graduates, academia, practice, and the nursing profession to support and value practice scholarship.

Practice and Quality Improvement Leaders Survey of Expectations of DNP Graduates' Quality Improvement Expertise.

Input from practice leaders will improve how doctor of nursing practice (DNP) education is meeting the needs of the employer and improving patient outcomes. This article describes the expectations practice leaders have of new DNP graduates' ability to contribute to quality improvement (QI) efforts within health care organizations. A survey of practice leaders and QI experts investigated the importance and use of QI knowledge and skills. Practice leaders were also asked about the expectations of DNP graduates at the time of hire. The results of this study support the need for nurses pursuing a DNP in advanced nursing practice to have education and training beyond their area of specialization, specifically in QI methods and tools. Faculty need to provide DNP students education that includes concepts in QI and leadership to meet the expectations of future employers and the needs of a complex and changing health care system.

DNP-Authored Articles in Peer-Reviewed Journals 2012-2018.

The Doctor of Nursing Practice (DNP) nurse is recognized as a practice scholar in nursing and leadership; moreover, the volume of published scholarship from DNP authors is expanding. The aim of this research was to quantify and analyze DNP-authored peer-reviewed journal publications from 2012 through 2018. This was a descriptive analysis of DNP graduate publications found in the WorldCat database from 2012 through 2018. Nearly 2000 (n = 1903) DNP-authored, peer-reviewed journal publications were extracted. Doctor of Nursing Practice-authored publications increased 136% from 2012 to 2018, including 1059 (56%) with DNP authors as first authors and 494 (26%) from DNP graduate solo authors. There were 1179 collaborative and interprofessional publications (62%). The findings in this research demonstrate an increase in the number of DNP-authored scholarly publications since 2012. Scholarly publications by DNP authors expand the dissemination of knowledge and offer an avenue to improve health outcomes nationally and globally.

Doctor of nursing practice students' perceptions of professional change through the DNP program.

This thematic analysis study examined how post master's Doctor of Nursing Practice (DNP) students described personal and professional growth in their views of self, healthcare, and clinical practice that evolved as a result of the curriculum and experiences in the DNP program. The purpose of this thematic analysis was to describe and discuss perceptions of graduating post master's DNP students regarding personal and professional development that occurred during the DNP program to identify how DNP graduates saw themselves change and grow during the course of the DNP program. A thematic analysis method was used to code, categorize, and summarize data from 42 reflection papers of post master's DNP students into a thematic framework based on the eight DNP Essentials which are the framework upon which DNP programs build their curriculum and design student experiences. The authors systematically analyzed the statements from each student paper and drew interpretation of the students' statements into themes that were congruent with the eight DNP Essentials and one stand-alone category. Data analysis yielded 15 themes that were aligned within eight categories of the DNP Essentials and one stand-alone category. The eight DNP Essentials provided a framework for the themes which reflected professional growth attributed to the journey through the DNP program. A ninth category entitled Personal Advancements described students' perceptions of their personal and professional development. These dimensions are proposed in the new DNP Essentials currently in development. Increasing understanding of the DNP students' journey serves to inform DNP curriculum development and program experiences, and informs faculty of the influence they have on molding students into a more robust professional role.

Modifications Needed: Additional Strategies to Transform DNP Projects into Publishable Manuscripts

Since the Doctor of Nursing Practice (DNP) degree was introduced by the American Association of Colleges of Nursing (AACN) in 2004, 348 programs have been established with more than 32,000 students enrolled.1, 2 As a practice-focused doctorate, DNP programs prepare graduates to enhance health outcomes through the critical appraisal and application of scientific findings. This goal is achieved through evidence-based practice (EBP) and quality improvement (QI) initiatives, many of which will make significant contributions to the nursing literature by addressing gaps in practice. However, Rousch and Tesoro4 investigated the rigor of DNP projects and identified some substantive problems including unsupported conclusions, lack of data collection, and flawed methodology, among others. So, how can authors, faculty, advisors, reviewers, and editors ensure that quality DNP projects are published? This article offers practical strategies to assist graduates in transforming a scholarly academic project into a manuscript appropriate for publication in a peer-reviewed journal. Faculty and advisors often encourage graduates to publish their work. At first glance, transforming an academic project into an appropriate publication for a peer-reviewed journal may seem like an easy feat. However, there are key differences between academic papers and quality manuscripts ready for publication that authors must consider. Academic papers, such as DNP student projects, are written to satisfy course or program requirements. These works meet specific assignment guidelines and are evaluated with course/program rubrics. Conversely, publishable manuscripts have a narrow focus, are targeted to a specific journal, and present new information or a new perspective about a particular topic and are intended to improve practice. These manuscripts are reviewed by professionals in the discipline and must meet established journal criteria. Table 1 provides some other key differences between academic papers and journal manuscripts that authors should consider. As DNP projects primarily represent EBP and QI activities, it is important to understand the common frameworks frequently used by journals when reporting QI initiatives and use them to guide manuscript development. For consistency and quality across disciplines, most healthcare journals require that authors use reporting guidelines recommended by the EQUATOR Network.3 The EQUATOR Network is an organization of editors and researchers, among others, who have identified reporting guidelines for various study types that can assist to increase accuracy, completeness, and transparency when reporting about health topics.3 Recognizing that DNP projects are primarily EBP and QI initiatives, the EQUATOR Network recommends that these initiatives be reported using the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0.5 The SQUIRE 2.0 guidelines include 18 sections that describe why the initiative was implemented (introduction), what was done (methods), what was identified (results), and what the results mean (discussion). Click here to read a downloadable table that includes all 18 elements with descriptions of each item. Many DNP programs have embraced the SQUIRE 2.0 guidelines for student reporting of their work so you may be familiar with this document. Either way, using the SQUIRE 2.0 guidelines may ease the transformation of an academic paper into a publishable manuscript. Authors should follow the advice previously published in the literature that offers traditional strategies for publication success. Many helpful articles have been published in Nurse Author & Editor and provide further assistance with these writing basics. There are several other practical strategies that DNP graduates can use to possibly increase the likelihood of publication. The first step is to identify an appropriate journal for QI or EBP projects. To do so, think about the topic and journals that are related to your specialty. For example, nurse practitioners may consider submitting a manuscript to The Journal for Nurse Practitioners while a nurse leader may consider submitting a manuscript to the Journal for Healthcare Quality. It is also helpful to identify journals that embrace EBP and QI articles. The SQUIRE 2.0 website provides a non-encompassing list of journals and serves as a good starting point for possible journals to consider. Reviewing one's own DNP project reference list may further identify potential publication options. As with the preparation of any manuscript, it is essential to review the author and manuscript guidelines for selected journals. Some authors find it useful to print the author and manuscript guidelines to use as a reference while writing and use it as a checklist before submitting an article. The next strategy for transforming an academic paper into a publishable manuscript involves reviewing manuscripts in the selected target journals to get a sense of the format and approach used for these types of projects. This valuable step will provide examples of how to present information, section length, headings, format, and overall manuscript length. As you begin writing and editing consider items that you may need to modify from the original project. In general, manuscripts submitted for publication have much shorter literature reviews than academic papers may require. So, think about what are the essential references that contribute to the article. As you transform the academic paper, consider what was unique about the project? What new information was gleaned? Think about why readers will be interested in the topic and why this is important to share. What are the main takeaway points from your manuscript? Incorporate these answers into your writing. When describing the project, make sure that you have provided sufficient details about the rationale, problem, and methods. Thoroughly describe the impetus for your project and the specific intervention(s) so that readers can understand what was done and can replicate your work. When discussing the findings, it is helpful to present baseline data, evaluation metrics, and how the intervention influenced patient outcomes or organizational effectiveness. You should also address pertinent barriers, facilitators, financial considerations, plans for project sustainability, and lessons learned. Writing clearly and succinctly can be a challenge for many writers. One effective strategy to overcome this challenge is to utilize the SQUIRE 2.0 checklist while writing. This checklist provides a framework for each of the 18 SQUIRE 2.0 sections. You may also find it helpful to have someone outside of your specialty read your work and provide feedback utilizing the SQUIRE 2.0 checklist. This external review can provide valuable insight on the overall flow, presentation of crucial information, and implications for nursing practice while also ensuring that all key SQUIRE 2.0 components are addressed. It pains us to say this, but we would be remiss if we did not include this piece of advice: not every project meets a standard necessary for publication in a journal. Sometimes the number of people who participated in the project is too small to draw meaningful conclusions or the impact of the initiative is too specific to the local setting to be of interest to a wider audience. You need to be honest with yourself on this point, or heed the advice of mentors or colleagues, who are perhaps telling you something you don't really want to hear. Rather than spending a lot of time pursuing publication unsuccessfully, it might be wiser to begin work on your next project, thinking carefully about what you need to do to make the project a success with outcomes that will merit publication. When DNP scholarly projects such as QI and EBP initiatives are successfully converted into publishable manuscripts, they can offer journal readers useful information that can advance nursing practice. However, these manuscripts need to follow the appropriate format for reporting and meet publication standards. Using the guidelines provided above should assist students and graduates to convert their academic projects into works that may be suitable for publication. Aaron M. Sebach PhD, DNP, MBA, AGACNP-BC, FNP-BC, FHM is an Associate Professor and the Doctor of Nursing Practice Program Chair in the College of Health Professions at Wilmington University, New Castle, DE. He is an experienced nurse practitioner and educator. He regularly presents and publishes content related to the Doctor of Nursing Practice degree. Contact Aaron by email: aaron.m.sebach@wilmu.edu Teresa Shellenbarger PhD, RN, CNE, CNEcI, ANEF is a Distinguished University Professor and the Doctoral Program Coordinator in the Department of Nursing and Allied Health Professions at Indiana University of Pennsylvania, Indiana, PA. She is an experienced nurse educator and author. She currently serves as an Author-In-Residence for Nurse Author & Editor and regularly contributes articles about writing. Contact Teresa by email: tshell@iup.edu.

Describing the Challenges Faced by Newly Prepared DNP Graduates in the Acute Care Setting

Since the development and introduction of the doctor of nursing practice (DNP) degree in 2004, the number of doctoral-prepared nurses has increased dramatically. The purpose of this article is to review the current challenges faced by DNP-prepared nurses as they enter the acute health care setting, and to share strategies we are exploring to enhance and showcase DNP practices and outcomes. In collaboration with our doctor of philosophy nursing colleagues, it is critical that we conduct studies that document the impact that DNP graduates have on health care organizations and, most importantly, patient outcomes. Since the development and introduction of the doctor of nursing practice (DNP) degree in 2004, the number of doctoral-prepared nurses has increased dramatically. The purpose of this article is to review the current challenges faced by DNP-prepared nurses as they enter the acute health care setting, and to share strategies we are exploring to enhance and showcase DNP practices and outcomes. In collaboration with our doctor of philosophy nursing colleagues, it is critical that we conduct studies that document the impact that DNP graduates have on health care organizations and, most importantly, patient outcomes. Ruth Labardee, DNP, RN, CNL, NEA-BC, is the director of health system nursing quality and evidence-based practice at The Ohio State University Wexner Medical Center (OSUWMC) in Columbus, Ohio, and assistant professor of clinical practice at The Ohio State University College of Nursing. She can be reached at [email protected] Jacalyn Buck, PhD, RN, NEA-BC, FAONL, is the chief nursing officer at University Hospital, Ross Heart Hospital, Brain and Spine Hospital and Dodd Rehabilitation Hospital at OSUWMC, and assistant professor of clinical practice at The Ohio State University College of Nursing. Rebecca Coffey, PhD, MSN, CNP, is a nurse practitioner for the Burn Center at OSUWMC. Kerry Dhakal, MAA, MLS, is an assistant professor, and research and education librarian at The Ohio State University. Deborah Francis, DNP, RN-BC, APRN-CNS, is a medical surgical clinical nurse specialist at OSUWMC. Deborah Seeling, DNP, RN, APRN-CNP, FNP-C, is a family nurse practitioner at The Ohio State University Hospital East, and an assistant professor of clinical practice at The Ohio State University College of Nursing. Esther Chipps, PhD, RN, NEA-BC, is a nurse scientist at OSUWMC and associate professor of clinical nursing at The Ohio State University College of Nursing.

Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track

BackgroundIn 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. PurposeThe purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. MethodsDeans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. FindingsThis paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. DiscussionThis paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

Reports of three organizations’ members about doctor of nursing practice project experiences and outcomes

BackgroundHolders of the Doctor of Nursing Practice (DNP) degree were envisioned to improve health and health care outcomes by implementing quality improvement initiatives, applying evidence-based practice changes (EBP), and influencing policy. Little is known about the nature of the DNP project experience and its relationship with subsequent experiences of graduates. Filling these knowledge gaps is important because of the investment of time, faculty and student effort, expense, and the projects' potential long-term effects on the organizations in which they were conducted. Purpose(1) Describe the impetus for foci, outcomes and activities of DNP projects and (2) determine the extent to which project foci are a part of post-graduation experiences. MethodsA cross-sectional descriptive survey design was used and a via mailed paper and online version was sent with return options to graduates of Doctor of Nursing Practice program. The sampling technique was designed to maximize the capture of DNP graduates. Three mailings were sent to 5,830 nurse members of three national organizations with memberships that included advanced practice registered nurses, nurse administrators and nurse educators. The 1,308 DNP prepared respondents were demographically and geographically representative of organizational members. FindingsMost (65.2%) reported the topic of the project was their own idea and they sought out an organization in which to conduct it. Twenty-five percent indicated not all aspects of the reorganization/initiative/policy change were completed by graduation. Five project foci emerged with the majority reporting an EBP initiative or an EBP project involving reorganization in the setting (57.7%) There was also a wide variation in the number, types and combinations of activities reported to be a part of the project. There was wide variation in the relationship of project foci and activities with reports of post-graduation experience by position title. Discussion/ConclusionFindings suggest potential avenues for innovations during the DNP project experience innovations. Long term effects of projects on organizations in which they were conducted and the relationship of project activities with post-graduation roles should be considered.

The DNP Degree: Are We Producing the Graduates We Intended?

This study addressed how recently graduated doctor of nursing practice (DNP) nurses describe their current practice, how their supervisors describe the DNP's current practice, and whether nurse and supervisor descriptions of the practices reflect the American Association of Colleges of Nursing (AACN) DNP Essentials and, if so, how? Introduced in 2004, the goal of DNP programs was to educate advanced practice RNs for effective leadership in complex healthcare environments. The value of the DNP degree for nurses in healthcare systems is evolving. We used conventional content analysis to inductively describe how DNP graduates from 7 different schools and their supervisors described the practice of the recently graduated DNPs. Interviews were reviewed to assess whether the AACN DNP Essentials were enacted in practice. The overarching theme was "becoming more: re-envisioning self as an agent of change." Results support the claim that DNP education prepares advanced practice nurses for leadership across complex healthcare systems. Evidence of the DNP Essentials is realized when graduates perceive themselves as equal to other leaders and capable of driving change using evidence and effective collaboration.

DNP Program Faculty and Graduates' Knowledge and Use of QI and Safety Processes.

Across doctor of nursing practice (DNP) programs, wide variation exists for DNP project expectations and curricular integration of Quality and Safety Education for Nurses competencies. This study examined DNP project characteristics and compared knowledge, skills, and attitudes about quality improvement (QI) processes between DNP program faculty and graduates. This descriptive study used a national convenience sample of DNP program faculty and graduates from multiple settings (N = 147) who completed an electronic survey of a modified version of the Quality Improvement Knowledge, Skills, and Attitudes Survey. Most DNP projects were QI/practice improvement (85.5%) and required interprofessional collaboration (65%) and implementation of a practice change (55.8%) with evaluation (65.5%). DNP program faculty (n = 73) and graduates (n = 30) had no significant differences in QI knowledge or skills; faculty reported less confidence in their knowledge (P = .002) and skills (P = .007) than graduates. Faculty development efforts to improve QI knowledge and skills for DNP program faculty are needed.

Examining the Roles and Competencies of Nurse Leaders, Educators, and Clinicians With a Doctor of Nursing Practice at an Academic Medical Center.

As the nursing profession has gained experience with Doctor of Nursing Practice (DNP) graduates, it is important to examine the integration, operationalization, and contributions of the DNP-prepared nurse within healthcare systems. Administrators and leaders must have a clear vision of how DNP graduates will contribute within and outside of their organizations. This article describes the outcomes of a workgroup comprised of DNP-prepared staff at a large academic medical center. The overarching goal of this group was to examine current practices of our DNP-prepared staff and make recommendations regarding roles and practice to the senior nursing leadership. A crosswalk comparing the current job descriptions of our DNP-prepared nurse leaders, nurse practitioners, clinical nurse specialists, and nurse educators with the core competencies of The Essentials of Doctoral Education for Advanced Nursing Practice as outlined by the American Association of Colleges of Nursing was completed. Strategies and tactics to enrich current practice and build leadership capacity were identified. DNP-prepared nurses must continue to document their contributions to the healthcare setting. DNP-prepared nurses in the health-care setting must work collaboratively with their senior nursing leaders to seek opportunities to increase their visibility within their organizations, and increase their scholarly output.