Case Study

Responding to Peer 1

Hello,

This is a great post. It has brought forward two major roles that a DNP-prepared nurse can play: bridging the gaps in evidence-based practice and implementation in a clinical setup. I most appreciate your work’s emphasis on nursing informatics and medication reconciliation. Expanding on your post, other expectations for DNP-prepared nurses involve the roles of leaders in promoting health equity in partnership with communities (Azar, 2021): Case Study.

The DNP-prepared nurse is better positioned to implement the SDOH, working in concert with community-based organizations to improve access to preventative care and programs to manage chronic diseases. For instance, interventions that target underrepresented populations, such as health literacy strategies, provide a plan for assuring that evidence-based practices meet the needs and reach the intended vulnerable groupings (Meherali et al., 2020). This meets the call of the DNP Essentials in Population Health and Interprofessional Collaboration. It is inspiring to see your focus on policy and quality improvement, and extending such efforts to encompass health inequities can only serve to further your impact as a future DNP leader.

References

Azar, K. M. J. (2021). The Evolving Role of Nurse Leadership in the Fight for Health Equity. Nurse Leader, 19(6), 571–575. https://doi.org/10.1016/j.mnl.2021.08.006

Meherali, S., Punjani, N. S., & Mevawala, A. (2020). Health literacy interventions to improve health outcomes in low- and middle-income countries. HLRP: Health Literacy Research and Practice, 4(4), 251–266. https://doi.org/10.3928/24748307-20201118-01

Responding to Misti Aleta

Hello,

Thank you for your post.  You have provided reflective insight into your career journey and thoughtfully compared the different doctoral tracks. Another role of DNP-prepared nurses that aligns with your interests in education is mentoring and developing leadership skills in the next generation of nurses. The DNP Essentials emphasize the preparation of graduates to influence nursing education through evidence-based teaching practices and leadership in curriculum design (Beeber et al., 2019).

Your example of the dual-nurse system in narcotics management exemplifies your identification and addressing of practice gaps, the core competency of DNP-prepared nurses. Transposing this skill to online nursing education may make you an innovator in designing virtual simulations or evidence-based online curricula for nursing students (Sim et al., 2022). While teaching in an online classroom is often associated with research-focused doctorates, DNP-prepared nurses bring a unique, practice-oriented perspective that enriches the learning experience for students. Your journey toward this decision is inspiring.

References

Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of Doctor of Nursing Practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354–364. https://doi.org/10.1016/j.outlook.2019.02.006

Sim, J. J. M., Rusli, K. D. B., Seah, B., Levett-Jones, T., Lau, Y., & Liaw, S. Y. (2022). Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis. Clinical Simulation in Nursing, 69(69), 26–39. https://doi.org/10.1016/j.ecns.2022.05.006

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Personal Motivations and Goals in Pursuing the DNP Degree

My motivation to pursue a Doctor of Nursing Practice (DNP) degree stems from a deep seated desire to influence patient outcomes, drive quality improvement initiatives, and shape the future of healthcare delivery. With over a decade of experience in nursing practice and informatics, I have witnessed firsthand the challenges that health care organizations face in closing gaps between evidence-based practices and actual clinical implementation. The DNP program offers a pathway to gain advanced knowledge in leadership, policy development, and clinical practice to bridge these gaps(Graves et al., 2021).

Additionally, my passion for mentoring the next generation of nurses aligns with the DNP’s focus on clinical education and transformational leadership. My ultimate goal is to utilize my DNP education to advocate for policy changes that support equitable healthcare, foster interprofessional collaboration, and implement innovative strategies to improve patient outcomes at the organizational and community levels.

Expectations and Role of a Nurse with a Practice Doctorate

The role of a DNP-prepared nurse is distinct from that of a nurse with a research focused doctorate (PhD). While PhD-prepared nurses primarily focus on generating new knowledge through research, DNP-prepared nurses emphasize translating existing research into practice to improve clinical outcomes and healthcare delivery systems.

The DNP-prepared nurse’s role is multifaceted, encompassing leadership in quality improvement, policy advocacy, and advanced clinical practice. For example, a DNP prepared nurse might lead initiatives to reduce hospital readmissions by implementing evidence-based interventions, whereas a PhD-prepared nurse might conduct a study to understand the underlying causes of readmissions.

Another critical distinction lies in the emphasis on systems-level thinking. The DNP prepared nurse is expected to analyze and address organizational challenges, ensuring that healthcare delivery aligns with the latest evidence and meets population needs.

This role requires competencies in interprofessional collaboration, technology integration, and ethical decision-making, as outlined in the AACN’s The Essentials of Doctoral Education for Advanced Nursing Practice. Through these competencies, DNP prepared nurses become agents of change, capable of leading teams and influencing policy at local, state, and national levels.

Addressing Quality Improvement Needs Through Practice Change
As a DNP-prepared nurse, my vision is to address quality improvement needs by identifying and closing gaps in practice. One area of focus will be leveraging my expertise in nursing informatics to improve clinical decision-making and patient outcomes. For example, implementing clinical decision support systems (CDSS) can reduce medication errors and enhance guideline adherence (Shahmoradi et al., 2021b).
My informatics background positions me to lead such projects by integrating technology with clinical workflows and ensuring that staff are adequately trained.

In my current practice, I addressed a gap in medication reconciliation processes within a skilled nursing facility. Errors in reconciliation often led to adverse drug events during patient transitions (Araya et al., 2023). By collaborating with an interdisciplinary team, I developed a standardized checklist and provided staff education on its use.

Within six months, the facility reported a 30% reduction in medication discrepancies. This experience reinforced the importance of data-driven interventions and interprofessional collaboration in addressing practice gaps.

As a future DNP graduate, I aim to scale such initiatives to a broader organizational level. For instance, by analyzing population health data, I can identify trends in chronic disease management and implement targeted interventions to improve care delivery (Mazzucca et al., 2021).

My ability to translate evidence into practice, coupled with strong leadership and policy advocacy skills, will ensure that I contribute meaningfully to advancing healthcare quality and equity. By addressing gaps in practice and championing evidence-based changes, I hope to leave a lasting impact on both patient outcomes and the nursing profession.

References
Araya, A., Thornton, L. R., Kwon, D., Ferguson, G. M., Highfield, L. D., Hwang, K. O., Holmes, H. M., & Bernstam, E. V. (2023). Medication Reconciliation during Transitions of Care Across Institutions: A Quantitative Analysis of Challenges and Opportunities. Applied Clinical Informatics, 14(05), 923–931. https://doi.org/10.1055/a-2178-0197

Graves, L. Y., Tamez, P., Wallen, G. R., & Saligan, L. N. (2021). Defining the role of individuals prepared as a doctor of nurse practice in symptoms science
research. Nursing Outlook, 69(4), 542–549. https://doi.org/10.1016/j.outlook.2021.01.013

Mazzucca, S., Arredondo, E. M., Hoelscher, D. M., Haire-Joshu, D., Tabak, R. G., Kumanyika, S. K., & Brownson, R. C. (2021). Expanding implementation research to prevent chronic diseases in community settings. Annual Review of Public Health, 42(1),135–158. https://doi.org/10.1146/annurev-publhealth-090419-102547

Shahmoradi, L., Safdari, R., Ahmadi, H., & Zahmatkeshan, M. (2021b). Clinical decision support systems-based interventions to improve medication outcomes: A systematic literature review on features and effects. Medical Journal of the Islamic Republic of Iran.https://doi.org/10.47176/mjiri.35.27

Case Study

Misti Aleta
Pursuing a DNP degree has been a goal of mine for the last 10 years. I completed my master’s degree in nursing education and landed a job teaching for a local community college in the clinical setting. As I continued to work in the clinical and educational settings, I realized that teaching was what I wanted to pursue.

My end goal is to be able to teach in the online classroom when I retire from the clinical aspect of nursing. I need to decide if I follow the Doctor of Nursing Practice tract, the Doctor of Education, or maybe move to the Doctor of Philosophy. Reviewing the differences between these degrees may aid in my decision-making.

“Historically, the PhD degree is research intensive and prepares the nurse for a career in education. The DNP degree prepares nurses to become clinical experts and leaders in healthcare innovation, influencing policy at the highest organizational level (Hartjes et al., 2019). The Doctor of Education is also focused on education and research.

Each degree expects to prepare nurses to become competent leaders in nursing and nursing education in the academic setting. According to Waxman et al.(2017), DNP-prepared nurses are expected to be leaders in evidence-based practices, cultures, and practice environments and experienced in leading change.

DNP competencies are outlined in the AACN’s Essentials: Core Competencies for Professional Nursing Education (AACN, 2021). The DNP-prepared graduate’s competencies will not always align with workplace expectations. Continued research is needed to be sure that the curricula expectations in the DNP programs will ultimately prepare advanced practice nurses to excel in the field. Many of the DNP programs have some form of overlap, and this makes it difficult for administrators to decide how best to use these nurses (Hartjes et al., 2019)

One reason I chose the Doctor of Nursing is due to a medication issue I had while working in a surgical center. While working at this facility, I discovered a gap in how narcotics were tracked and counted. We used liquid cocaine for sinus surgery and would remove all the bottles we needed for the day at one time in the morning. Only one nurse needed to remove them from the cabinet and complete the logbook.

During a review of the logbook, it came to the director’s attention that one bottle was missing and not logged. We reviewed all the charts for that day and discovered it was used on a patient but never logged into the book. After reviewing the policy, we decided that we needed two nurses to remove the narcotic from the cabinet, complete a count, and chart it in the log.

This was a positive change for our facility. While the Doctor of Nursing course is practice-focused, this may not be ideal in this situation, and it may not be the ideal tract for me to move into the online teaching environment.

I will continue to review the different DNP programs over the next few weeks and decide what tract is best for me moving forward. I love the clinical aspect of teaching and enjoy seeing the students grow, but as I get closer to my retirement, I want to work smarter and not harder. Online education is the normal progression for me.

Hartjes, T. M., Lester, D., Arasi-Ruddock, L., McFadden Bradley, S., Munro, S., & Cowan, L. (2019). Answering the question: Is the doctor of philosophy or doctor of nursing practice right for me? Links to an external site. Journal of the American Association of Nurse Practitioners, 31(8), 439–442. https://doi.org/10.1097/JXX.0000000000000273

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. Links to an external site.
AACN. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Waxman, K., Rousell, D., Herrin-Griffith, D., & D’Alfonso, J., (2017). AONE nurse executive competencies: 12 years later. Nurse Leader, 15 (2), 120-126