There is a current shortage of primary care healthcare providers in the United States (US) and worldwide, as well as in future projections of both.1,2 The US Institute of Medicine’s 2011 report suggests that increased numbers of nurse practitioners/advanced practice nurses (NP/APN) could augment the limited number of primary care health professionals.3 Internationally, NP/APN roles are slowly gaining traction and, although unverified, an “estimated 70 countries have NP/APN roles or are exploring the possibility of introducing these roles."4 This expanding trend has the potential to ameliorate the universal healthcare provider shortage.
Perhaps responding to the opportunity, there has been a significant increase of US Doctor of Nursing Practice (DNP) students in recent years.5 The number of DNP students enrolled in programs increased from 11,400 in 2012 to 25,289 in 2017.6,7 Unfortunately, in tandem with this growth of DNP students, a serious shortage of nursing PhD-prepared and DNP-prepared faculty exists.7 Institutions find it difficult to attract and retain faculty for the burgeoning DNP student population.8 Faculty are charged with bearing the onus in meeting the high volume teaching need. Compounding faculty stress is the likely lack of workload credit for DNP project participation. In a study by Minnick et al. in 2013, almost half of the DNP programs surveyed did not allocate Faculty workload credit for DNP project participation.9 More recently there has also been the complaint of a lack of writing proficiency and reporting in DNP projects.10 Understandably, DNP program administrators are searching for innovative ways to maximize the use of DNP faculty, mitigate stress to retain existing faculty, and assure high standards for student products.
To answer these needs a unique program was conceived and instituted by a very large, predominantly online DNP program with both US and some international students. A national pool of nursing DNP and PhD professionals, meeting the high expectations of competence established by the university, audits manuscripts independently from the usual review by the chair and committee. This innovative system allows expanded use of faculty as well as an additional rigorous, formal, external academic quality review (AQR) of manuscripts by experienced, doctorally-prepared nurse professionals with the potential of enhancing the quality of the student product.
Methods:
The university hired a national online marketing company to advertise for experienced doctorally-prepared nurses to evaluate DNP manuscripts. After meeting stringent requirements and completing initial orientation and training, the diverse, nationwide group of almost 50 AQR reviewers serve as adjunct faculty for the DNP program. An AQR manager supervises and trains external reviewers, conducting ongoing webinars and individual training sessions to ensure consistency of manuscript evaluation. The manager uses a collaborative team approach with external reviewers, committee chairs and committee members, and students, reviewing the quality of each manuscript prior to return to the student.11 To ensure comments/edits by the external reviewer are incorporated in the paper, the DNP student is required to complete an AQR revision worksheet listing each reviewer item with proposed student revision or rationale for no modification. The chair assigns a due date for completion of revisions and works closely with the learner to ensure successful progression in the program.
Currently a blinded survey of DNP learners, AQR reviewers, chairs, and committee members is underway to capture satisfaction and effectiveness of the new program as well as suggestions for streamlining or improving the process. A random sample pre-AQR and post-AQR manuscripts will be scored and compared to evaluate increased quality of manuscripts.
The Community of Inquiry Conceptual Framework provides an effective means to facilitate student achievement of doctoral goals.12 The framework has been extensively used throughout the world, validated, and is seen as an influential model for analyzing and researching online learning.13
Results:
The unique AQR external-faculty-reviewer method of evaluation is ongoing. Survey results will be shared with outcomes, quality indicators, and future recommendations.
Conclusion:
The innovative creation and use of a national pool of external adjunct faculty alleviates some DNP faculty strain, ensures a more effective use of doctorally-prepared faculty, and supplements chair/committee/student manuscript evaluation with the promise of increasing the caliber of DNP manuscripts. Accommodating an increased number of national and international DNP students with a high-standard US education has the potential to alleviate the healthcare provider shortage both in the US and internationally.