Executive Perspective on the DNP

Purpose:

To describe what Chief Nurse Officers who employ or intend to employ DNPs think about the education, the contribution and the potential of the DNP in their organization and in health care

Methods:

 Semi-structured interviews (60 – 90 minutes in length) were conducted, in-person or by telephone, by an impartial interviewer with a total of seven respondents. Five (5) Chief Nursing Officers, one (1) director of nursing research and practice, and one (1) designee participated. These respondents represented academic teaching institutions, magnet facilities, and community hospitals. All were recorded and transcribed with interviewee consent.

Interviewees were asked to describe their thoughts about the DNP degree; the skills they would expect all DNP graduates to have in the areas of leadership, quality improvement, translation and dissemination of research and practice evidence. Respondents were asked to identify the critical competencies and skillsthey believed indicate DNP education had been effective. CNOs were asked to describe their experiences working with DNPs; as well as how returning DNP graduates have been able to apply their education to improve practice, outcomes and organizational performance. 

CNOs were asked to describe how DNPs could benefit their organizations, with emphasis placed on identifying measurable outcomes. They were also asked to describe ways in which the DNP program could support graduates to increase the application and translation of educational outcomes. A final open-ended question invited participants to offer any perspective, suggestions or insight unique to the organization or their experience with DNPs.

Interview transcripts were analyzed by an evaluator and two faculty members blinded to the identity and practice setting of respondents.

Results:

Several themes were identified from analysis of the interview transcripts these include:

• DNPs are making important contributions in their organizations.  They are serving in traditional advanced practice roles (NP & CNS) and in assorted leadership roles as well (Managers, Directors, and Educators).  Some have assumed leadership roles in informatics, quality improvement, and interdisciplinary functions.
• There is considerable variability in the performance 0f DNPs from program to program and from one DNP to the next.
• Many DNPs are helping bring evidence to bear on practice.  Their approach is variable and so are the outcomes.
• Both graduates and programs are maturing and the outcomes are evident.  Early graduates were not comfortable working with the data required to evaluate outcomes.  More recently, graduates are comfortable and skilled with analytics. Likewise, early graduates were unsuccessful in efforts at dissemination.  More recent graduates are increasingly successful.
• Confusion surrounds the role.  Physicians and other disciplines are unclear about the purpose and contribution of the DNP.  Graduates need to be prepared to teach others about the potential of the role and to demonstrate value.
• The value for traditional scholarship and publication in peer-reviewed journals was mixed.  although the expectation that DNP graduates should be disseminating lessons-learned widely (through teaching in the hospital or at conferences, presentations at meetings, development of best-practices or policy guidelines, etc.) was unanimous. Participants believed these presentations should begin during the DNP program.
• Participants encourage collaboration between DNPs and PhDs, both during their training and upon graduation.
• All participants recognized and valued the DNP graduate’s experience and expertise finding and reviewing evidence.  They observe and report that many graduates use these abilities effectively to improve clinical practice and outcomes..
• Without exception, all interviewees suggested that more attention be given to the screening of potential DNP students, consideration of their baseline in critical skills areas (such as leadership and writing), establishing an expectation that planning for translation of learning should happen at the start of the DNP program, and increased focus on mentoring. All respondents expressed appreciation for the current evaluation that is fully engaging key stakeholders: DNP graduates and the CNO’s who will employ them.

Conclusion:

Some are concerned that DNP education may be more effective in the preparation of Advanced practice nurses than nurses administrators or executives.

The competencies most valued by participants include: ability to adopt a broad systems-perspective to quality improvement; political “savvy” to understand how to lead strategic change; tactical expertise specific to the rapidly evolving health care setting; experience with inter-professional initiatives; ability to motivate teams at all levels through expert communication and teaching of evidence-based practice concepts mastered in the DNP; the ability and discipline to envision and implement translation projects proactively; at least an intermediate knowledge of evaluation and how to demonstrate effectiveness; a commitment to life-long learning; willingness to seek out and partner with academic institutions for research or quality improvement projects; strong leadership skills; the ability to take carefully considered and monitored risks; and viewing themselves as a change agent. The need for academic writing skills was emphasized.

Concern was expressed about the rigor of projects required in the early DNP cohorts. All respondents knew many changes had been made to increase the level of rigor. Respondents also commended the program for its commitment to quality and responsiveness to evaluation.

Work in progress that rsulted from this evaluation includes the following

1. An on-line survey is being deployed to employers of graduates and to nurse Executives across the state.
2. A DNP council has been established to provide support and opportunities for collaboration across the enterprise.
3. Participants endorsed the development of a forum in which graduates.  We could continue to interact with each other and possibly other experts.