Practice scholarship satisfaction and impact as perceived by DNP-prepared nurses.

BACKGROUND: Today's health systems are complex and are challenged to strive for high-quality care that leads to optimal health outcomes. Doctor of Nursing Practice (DNP)-prepared nurses have the necessary competencies to influence health systems and delivery, that lead to safe and effective practice, by implementing practice scholarship, the translation of science to transform health care delivery, and clinical inquiry to improve practice. PURPOSE: The purpose of this study was to determine DNP-prepared nurses' satisfaction with their frequency of engagement in practice scholarship, and the relationship between the satisfaction and perceived impact of practice scholarship. METHODS: In this cross-sectional study, DNP-prepared nurses (n = 309) were recruited from a U.S. national membership organization and were asked to complete an online survey. RESULTS: Usable data findings (n = 269) revealed that 81% of participants reported feeling very, or moderately, satisfied with time spent engaging in practice scholarship or clinical inquiry in the areas of quality improvement, translation of research, and evidence-based practice; however, 19% expressed minimal satisfaction or dissatisfaction. There was a significant, moderate positive correlation between impact and satisfaction with time spent engaging in practice scholarship. CONCLUSIONS: Unclear roles and the lack of objective data measurement of practice scholarship are hindering the ability of DNP-prepared nurses to work to the full extent of their education and scope of practice. IMPLICATIONS: Further studies to develop processes and tools to measure the value and impact of DNP-prepared nurses on quality and safety, health care policies, systems, and population health are recommended.

Entrustable Professional Activities in Clinical Education: A Practical Approach for Advanced Nursing Education.

BACKGROUND: Competency attainment is foremost in the ethos of this project that provides a practical guide to implementing entrustable professional activities (EPAs) as one approach to competency acquisition in the clinical education component of a health care program. EPAs are units of work that provide evidence of required competencies for the clinical education component of a program of study for educators, preceptors, and students. PROBLEM: The American Association of Colleges of Nursing has raised the importance of competency-based education and need for a practical approach to assess clinical competency challenges (eg, EPAs) in nursing education. APPROACH: The implementation of EPAs in the clinical component of advanced nursing education is detailed as an example in this article. Prioritizing a systematic approach, the Knowledge to Action framework, was chosen to guide the process. CONCLUSION: Nursing must act now to put in place a robust competency acquisition and validation system.

Impact of Practice Scholarship as Perceived by Nurses Holding a DNP Degree.

OBJECTIVE: The aim of this study was to explore the perceived impact of practice scholarship among DNP-prepared nurses and the relationship of impact to primary work role and years since graduation. BACKGROUND: Healthcare organizations continuously seek ways to improve health outcomes and reduce cost. Doctor of Nursing Practice-prepared nurses are educated with essential competencies to lead healthcare reform initiatives based on their practice scholarship contribution. METHODS: A cross-sectional design was used to administer a self-report online survey to a convenience sample of 306 DNP graduates currently in practice. RESULTS: The highest impact of practice scholarship was perceived on patients, populations, quality of care, and the profession. The impact on policy, cost, and cost savings was significantly lower. No significant difference was found on practice scholarship impact based on role or between years of experience since graduation. CONCLUSION: Doctor of Nursing Practice competencies support practice scholarship outcomes. Organizational resources are needed to support the impact of practice scholarship.

Sickle Cell Disease: Considerations for Acute Pain Management in the Hematology-Oncology Ambulatory Setting.

Owing to the lack of specialized care and the unpredictable nature of acute pain episodes in adults with sickle cell disease (SCD), emergency departments have been largely used to provide care for these patients. The lack of specialized care for patients with SCD portends higher healthcare costs and lower health-related quality of life. Although study findings have shown that using multiple models for SCD care is feasible and cost-effective, nurses' awareness of evidence-based guidelines and care models for acute pain management in ambulatory settings is lacking.

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

BACKGROUND: Nearly 15 years after the introduction of the doctor of nursing practice (DNP) degree, stakeholders anticipate practice scholarship outcomes from graduates. PURPOSE: 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSIONS: 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. IMPLICATIONS: This is a call to action for DNP graduates, academia, practice, and the nursing profession to support and value practice scholarship.

Drivers for seeking the doctor of nursing practice degree and competencies acquired as reported by nurses in practice.

BACKGROUND: The American Association of Colleges of Nursing introduced the Doctor of Nursing Practice (DNP) degree in 2004. To date, few publications examine the competencies and impact of nurses with practice doctorates. PURPOSE: The purpose of this study was to examine reasons for seeking a DNP degree, assess knowledge and competencies acquired from DNP programs, and to inform stakeholders about the skills acquired by nurses with practice doctorates. METHODS: A cross-sectional design was used to administer a self-report survey to a convenience sample of DNP-prepared nurses in practice, recruited from a national membership organization. The electronic survey was designed using constructs developed from the literature, national organization position statements, and standards of doctoral nursing education. RESULTS: A total of 306 participants responded to the survey, 270 were used after data review. The majority of respondents did not seek a DNP degree because it was required for a job, to gain additional supervised practice, or to receive additional training with a specialty population. The majority strongly agreed that they gained competency in translating and synthesizing research evidence into practice, designing and implementing quality improvement, and identifying, measuring, and evaluating outcomes. CONCLUSIONS: Primary reasons for seeking a DNP degree were seeking knowledge, skills, competencies, confidence, and job opportunities. IMPLICATIONS FOR PRACTICE: Doctor of Nursing Practice-prepared nurses hold unique, advanced knowledge, competencies and skills to affect health care across multiple settings. Study results suggest that highly skilled DNP-prepared nurses are equipped to lead quality improvement, engage in practice scholarship, and improve clinical outcomes.

The practice doctorate approach to assessing advanced nursing practice in Ireland.

AIM: To describe the practice doctorate scholarly approach to assess advanced nursing practice in Ireland to address healthcare and nursing policy initiatives. BACKGROUND: A global team from Ireland and the United States collaborated with stakeholders, using a practice doctorate approach to identify geographic healthcare needs, the current state of the education and the evolving roles of advanced nursing practice. In Ireland, current policy initiatives call for expanding the capacity for advanced nurse practitioners to meet healthcare needs in community settings. SOURCES OF EVIDENCE: Further assessment data were required from stakeholders to inform graduate nursing education to prepare advanced practice nurses to fulfil increasingly complex healthcare needs. The practice doctorate approach included review of literature, current policy and assessment with interviews, dialogue and the development of working relationships with policymakers, academics and practitioners. DISCUSSION: The current state and future vision of graduate nursing education are evolving. A force field analysis identified promoting and restraining factors to the desired state of development of the primary care advanced practice role. Relationship building with stakeholders and sharing of expertise was key to engage academia and policymakers to address identified restraining forces. Short-term outcomes included development of collaborative relationships between practice, academia and policymakers, curricular development for the primary care nurse practitioner and intentionally shared dissemination to promote community graduate nursing education. IMPLICATIONS FOR NURSING PRACTICE: This innovative practice scholarship approach was used to assess and promote advanced nursing practice impact and promote the nursing profession globally. IMPLICATIONS FOR POLICY: Successful collaboration between two global partners was achieved to promote policy objectives for both nursing and health care, with the ultimate goal of improving health outcomes and population health.

Improving guideline adherence: a randomized trial evaluating strategies to increase beta-blocker use in heart failure.

BACKGROUND: The dissemination of clinical practice guidelines often has not been accompanied by desired improvements in guideline adherence. This study evaluated interventions for implementing a new practice guideline advocating the use of beta-blockers for heart failure patients. METHODS AND RESULTS: This was a randomized controlled trial involving heart failure patients (n=169) with an ejection fraction < or =45% and no contraindications to beta-blockers. Patients' primary providers were randomized in a stratified design to 1 of 3 interventions: (1) control: provider education; (2) provider and patient notification: computerized provider reminders and patient letters advocating beta-blockers; and (3) nurse facilitator: supervised nurse to initiate and titrate beta-blockers. The primary outcome, the proportion of patients who were initiated or uptitrated and maintained on beta-blockers, analyzed by intention to treat, was achieved in 67% (36 of 54) of patients in the nurse facilitator group compared with 16% (10 of 64) in the provider/patient notification and 27% (14 of 51) in the control groups (P<0.001 for the comparisons between the nurse facilitator group and both other groups). The proportion of patients on target beta-blocker doses at the study end (median follow-up, 12 months) was also highest in the nurse facilitator group (43%) compared with the control (10%) and provider/patient notification groups (2%) (P<0.001). There were no differences in adverse events among groups. CONCLUSIONS: The use of a nurse facilitator was a successful approach for implementing a beta-blocker guideline in heart failure patients. The use of provider education, clinical reminders, and patient education was of limited value in this setting.