Doctor of Nursing Practice
The DNP Proposal and Defense Process
"I was referred to Brian by a DNP colleague and was not disappointed. I found him to be an excellent resource for taking away any confusion and tension in his work with me by providing clarity and clear direction for success in the evaluation and data analysis of my DNP quality improvement project. I highly recommend Brian as he is worth the investment!"
Dr. Tonye P., DNP Graduate, Chamberlain College of Nursing
"A colleague referred me to Brian a couple of years ago. He helped me complete the major tasks associated with Brian is accessible, prompt and professional. I would not have been able to complete my DNP if it were not for his guidance and knowledge about statistical analysis, the DNP proposal IRB process."
Dr. Bridgette J., DNP Graduate, Chamberlain College of Nursing
"Brian worked with me and provided direction and emotional support throughout my DNP practicum. He was instrumental in explaining statistical methods and data analysis for DNP project evaluation. He is resourceful and dedicated to his clients."
Dr. Yvette R., DNP Graduate, Chamberlain College of Nursing
"I just completed my DNP dissertation and could not have done it the expert help and guidance from Brian. He was so motivating and made me feel great about the direction of my project. Brian was extremely helpful, patient, kind and ethical. Brian did a marvelous job at coaching me and helping me to understand the statistical side of my proposal. I am confident this is how he will be with all clients. You need to know that he is timely in getting back to you with questions you have as well as the work that he does. The turn around time is fantastic. What was to be the most difficult part of the dissertation turned out to be the easiest and gave me confidence in my project!"
Dr. Katie C., DNP Graduate, Chamberlain College of Nursing
YOU NEED to start writing your DNP proposal, or you need to analyze your data and prepare for your defense; you know this, but you have been hesitating or feel uncertain
Knowing and doing are two very different states, and I understand that getting your DNP’s Introduction chapter going can be the most challenging aspect of the entire writing process and so can the final steps needed in finishing the DNP degree.
“It’s not just you! Writers as a whole have struggled with this very problem for at least 4,000 years, all the way back to Greek, Mesopotamian and Roman writers.”
Important Questions we can Help you to undo that Writer's Block!
How do I begin?
How do I write a PICOT?
What statistics will I use?
What is an EBP-Intervention or practice change?
How do I collect data and what do I put it in?
What do I do now that my data is collected?
How do I do a data analysis?
How do I put this all together and prepare for my defense?
I offer these basic services and more for the DNP students!
DNP Proposal Services
- PICOT Refinement;
- Understanding your project's design and comparisons;
- Choosing Measures and learning about Reliability and Validity;
- Help with Choosing and writing up the Statistics for your PICOT;
- Database Entry File Created for you in Excel or SPSS;
- Power Analysis and full write-up;
- APA style Tables and Figures;
- Proposal Refinement;
- Go over and consult GoToMeeting.
DNP Project Defense Services
- Create Excel or SPSS Spreadsheet for you to enter your data;
- Analysis of descriptive data such as demographics or study variables of interest;
- Analysis of the data and interpretation in relation to your PICOT;
- Easy to understand modules (1 page) to understand each statistic used;
- Understanding level of measurement (nominal, ordinal, ratio, interval);
- Annotated or full APA style write-up of the results;
- Creation of APA Tables and Figures;
- Revisions (1 time) and GoToMeeting consultation going over the results;
My Consultation Hours:
Central Time Zone (US)
Monday and Wednesday 9:00 am to 7:00 pm
Tuesday and Thursday 9:00 am to 6:30 pm
Friday 9:00 am to 5:00 pm
PICOT stands for:
- Population/Patient Problem: Who is your patient? (Disease or Health status, age, race, sex)
- Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications)
- Comparison: What is the alternative to your plan? (e.g., No treatment, different type of treatment, etc.)
- Outcome outcome do you seek? ( symptoms, no symptoms, full health, etc.)
- Time: What is the time frame? (This element is not always included.)
Your PICOT question will fall under one of these types:
“ Practice (EBP) is the integration of the best research evidence with clinical expertise and patient values.”
We can develop your APA formatted DNP Proposal and Defense Sections!!!!
Sample DNP Template:
The paragraph or two that follows the title on the first page of your text is assumed to be your introduction. Your introduction follows the title of your paper (note that it is not in bold). You should start your introduction with a powerful statement or two to stimulate interest. You should identify the purpose of your paper and provide a preview of what the paper will include. Remember that formal papers are in person so no I, me, we.
Significance of the Practice Problem
Start this section with of the practice problem. This section should also answer the question “why is this important?” You should address the significance to the patient/client (e.g., pain, suffering, quality of life, impact on income potential, etc.), the family, health care system (e.g., impact on cost or delivery systems), and society (e.g., cost of care, need for health care policy). Discuss the number of patients affected in the US and include the financial impact if at all possible. You might discuss of stay, readmission, home health care requirements, and mortality. Also, you should address any quality, safety, legal, and ethical implications. This discussion must be substantiated by citations from professional literature.
This section should include your PICOT question but also should provide thorough descriptions of your population, intervention, comparison intervention, outcome, and timing (if appropriate to your question). This section contains, in essence, your operational definitions of the variables in the question. If you use definitions from the literature be sure to cite them.
Theoretical (Conceptual) Framework
This section should include the theoretical (conceptual framework) which supports your project and a change model. Describe a theory and change model to serve as the foundation for your project. This may be a nursing theory or a theory from another discipline if pertinent and applicable.
Synthesis of the Literature
Synthesize at least 10 research studies and/or systematic reviews, not summary articles. This is all about the evidence rather than someone else’s opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a systematic review. The studies in this section must relate directly to your PICOT question. Address the similarities, differences, and controversies.
So, using available evidence, what is the answer to your question? This section is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a summary statement, and give a recommendation for practice change. This section should include the recommendation for practice based on the evidence. Perhaps you have found that one subset of your population does fair better with the intervention but the rest of the patients do just as well with the standard practice that you used as your comparison. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice and you recommend reinforcement and education regarding this best practice.
Project Mission, Vision, Objectives
This section should include the mission, vision, and objectives of your project. Describe the setting for your project and discuss the congruence between your project’s mission and vision statements and the mission and vision of the organization where the project will be conducted. Include of short-term and long-term objectives of the project.
Project Evaluation Plan
This section should begin with a description of your change model and why it was selected as the model for this specific change. You should learn about the model from a primary source (i.e., do not cite a textbook). The model that you select should be appropriate to the change that you are recommending (i.e., individual change or organizational change). You may use a change model or an EBP model which describes the process of implementing an EBP change. Use that model to describe the practice change that you recommend even if that is reinforcement and education regarding the status quo. Your change process should be specific to your setting. You can make each step of the model a level 2 heading (title case and flush left) and then describe how you would implement that step of the change in your selected setting. Your change process must be specific to your question and the answer that you found through your literature review and your setting. It should be a well thought-out process using the model as a guide. Describe the setting for your project. Include of stakeholders, barriers, facilitators, risks, unintended consequences, and your SWOT analysis. Include your activities in the form of a schedule or a Gantt chart. You should address the time frame for the change process and the evaluation keeping in mind that this project needs to be achievable within your o practicum courses. Include resources required for your project and a budget. Include your role in the project and the leadership qualities and skills that will be utilized for successful completion of the project. Discuss how you will protect human rights and ensure of health information.
Evaluation and Data Analysis
This section must include how you are going to evaluate the planned change project including formative and summative criteria for evaluation and time points for the evaluation. Remember that you must evaluate the outcome(s) identified in your PICOT question. Describe and include any tool(s) that are to be used in your project evaluation and discuss the reliability and validity of the tool(s). Discuss planned analysis of your evaluation data.
Dissemination of Project Results
This section should include your plan for sharing the results of your project within the institution and within the professional community. Discuss who would be invited to the presentation of results at the institution and your plan for how you will present the information. Also, discuss your plans for presentation at regional or national meetings and/or publication. If is planned, discuss what journal you will submit your manuscript to and why.
The conclusion should start with a statement regarding the intention of the paper and your achievement toward that intention. Also, it should briefly say what was included in the paper. Remember that the introduction is a preview and this section should contain a summary.
Remember that this is a reference list rather than a bibliography. A bibliography is everything you read to prepare the paper but a reference list is only what you cited. If there is not a citation for a reference, it should not be here. PLEASE make sure that your references and your citations throughout the paper are in APA format. You can go from an A paper to a B paper on APA errors alone. Take the time to make sure that they are correct. We have already formatted the paper for you with this template.
So, you’ve done your research, and you’ve found a gap in the literature that needs to be addressed. Even more impressively, you have designed a study that can fill this gap. So what do you do now? The obvious answer is to actually conduct your study, but before that can happen you have to overcome the roadblock of attaining Institutional Review Board (IRB) clearance. Unfortunately, for many students, the IRB application presents a particular challenge because it is written for a different target audience than the rest of the dissertation. However, just as with the other chapters you will write as you work through this process, the IRB application can be broken down into a few key components, and by focusing on meeting these requirements you can greatly simplify the process. To put it simply, the purpose of the IRB proposal is to answer four key questions of why your research is important, how you intend to conduct the research, who will take part in your study, and how you will manage experimental data once you have collected it. Adequately addressing these four key components will give your IRB confidence in your ability to proceed with the study in a safe and ethical manner.
Why is your research important?
I. Your IRB will want a simple explanation of the purpose of your study. While completing the Introduction and Literature Review chapters of your dissertation certainly positions you as an expert in your field, your IRB committee has quite possibly never heard of your topic. As such, it is important to provide a brief description of the state of the field, as well as to identify where the gap in the literature exists and how your study will help fix this issue. Perhaps more importantly, you should also identify why your research is important to the wider population. Since your IRB committee members may be from an entirely different field than you, the most important thing to remember is to be concise and accessible. Your description of the study purpose should be straightforward and should be written in layman’s terms to ensure that your readers can readily understand why they should approve your study.
How you intend to conduct the research?
II. Once you have explained why your research is important, it’s time to move onto detailing how you plan to perform your study. This aspect of your proposal should cover all of the specifics around what you will do to prepare for, and actually conduct, your study. As such, this portion of the proposal should begin by informing the review committee of the basic details of the study, including the setting and the personnel who will be conducting research activities. Specifically, you should provide a complete list of any individuals who will be assisting with data collection or interacting with participants. Additionally, it is important to note all locations where data collection will take place, particularly if this will occur off of your campus. This section must also cover the specific experimental protocol that all participants will take part in during the study, which many consider the most important part of this section; therefore, handle this part with great care. Importantly, a proper protocol should describe all details of the participant’s experience, from the moment they are recruited to when they walk out the door. This will include a description of all study activities and questionnaires or surveys (which should also be attached to your IRB application) that the participant will complete, as well as the methods you will use for obtaining consent and debriefing the participants. In short, it is vital that you provide a clear description of this process, as the details of the study protocol can often be a sticking point in the IRB review process.
Who will take part in your study?
III. You will need to include information about who will take part in your study. One of the primary goals of the IRB is to ensure the safety of research participants, so providing details on how you plan to recruit and treat these individuals is a critical part of any IRB application. To fulfill this requirement, you will need to identify the population of interest for the given study. In doing so, it is important to note what factors will lead to individuals’ inclusion in, or exclusion from, the study and how you will screen potential participants to ensure that they are eligible to take part in research activities. You will also need to specify whether individuals from at-risk populations will be allowed to participate. At-risk populations include individuals who may not be able to make informed decisions for themselves (e.g., individuals younger than 18 years of age or those with mental handicaps) or those populations that may be taken advantage of due to their circumstances (e.g., prisoners or economically disadvantaged individuals).
After identifying who will take part in the study, you will need to provide information regarding how participant rights will be upheld. One of the key components of this is the inclusion of an informed consent form which you must provide to participants prior to their inclusion in the study. This document should inform participants that they have no obligation to take part in the and that they can withdraw at any time without penalty. Finally, you will need to include information regarding the risks and benefits of participation in your study. This will include any physical, emotional, or social risks that the participant may encounter, no matter how unlikely. Additionally, you should note what measures you have taken to prevent any negative outcomes for your participants. Furthermore, you will also need to disclose any benefits or the participant may receive to ensure that this value is not so high that it can be seen as coercive. By discussing all of these aspects of who will participate in your study, you allow the IRB committee to feel certain that you have taken all of the necessary steps to ensure the safety of your research participants.
How manage experimental data once you have collected it?
IV. Following these components, you will need to prove to your IRB that you have adequately thought through the aspects around what you will do with your data once you’ve collected it. Essentially, your IRB knows that the goal of any experiment is to acquire data; they simply need the details around how you will handle data management and participant confidentiality. In discussing your plans for data management, you should note specifically how you will store any study materials. This often entails noting that data will be stored digitally on a computer, but you should also specify security measures that will be put in place to protect the data. For example, if you plan on using a password-protected computer, which you will store in a locked office, this is the place to note that. It is also important to state how long you intend to keep any study materials. Many institutions have set guidelines for how long data should be kept after the conclusion of the study, so make sure to check with your school to find what they recommend. This component of the IRB application should also contain details of how you will protect your participants’ confidentiality. In doing so, you will need to specify whether data will be anonymous, de-identified, or if it will contain identifying markers, and how you will ensure participant confidentiality in light of this information.
By addressing these four aspects of your IRB application, you should be well prepared to address any concerns that might arise during the IRB review of your study. However, we understand that gaining IRB approval is a complex and difficult and that you may still have questions.
The American Association of Colleges of Nursing DNP 2017 Fact Sheet
On October 25, 2004, the member schools affiliated with the American Association of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing. This decision called for moving the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate-level by the year 2015. This endorsement was preceded by almost four years of research and consensus-building by an AACN task force charged with examining the need for the practice doctorate with a variety of stakeholder groups.
INTRODUCING THE DOCTOR OF NURSING PRACTICE
- In many institutions, advanced practice registered nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse-Midwives, and Certified Registered Nurse Anesthetists, are prepared in programs that often carry a credit load equivalent to doctoral degrees in the other health professions. AACN's position statement calls for educating APRNs and other nurses seeking top leadership/organizational roles in DNP programs.
- DNP curricula build on traditional master's programs by providing education in evidence-based practice, quality improvement, and systems leadership, among other key areas.
- The DNP is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs. DNP-prepared nurses are well-equipped to fully implement the science developed by nurse researchers prepared DNS, and other research-focused nursing doctorates.
WHY MOVE TO THE DNP?
- The changing demands of this nation's complex healthcare environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. The Institute of Medicine, Joint Commission, Robert Wood Johnson Foundation, and other authorities have called for re-conceptualizing educational programs that prepare today’s health professionals.
- Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of patient care; national concerns about the quality of care and patient safety; shortages of nursing personnel which demands a higher level of preparation for leaders who can design and assess care; shortages of doctorally-prepared nursing faculty; and increasing educational expectations for the preparation of other members of the healthcare team.
- In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with this call to action.
- Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology () all require or offer practice doctorates.
- The District of Columbia. States with the most programs (10 or more programs) include California, Florida, Illinois, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, and Texas.
SUSTAINING MOMENTUM FOR THE DNP
- After a two-year consensus-building process, AACN member institutions voted to endorse the Essentials of Doctoral Education for Advanced Nursing Practice on October 30, 2006. Schools developing a DNP are encouraged to use this document, which defines the curricular elements and competencies that must be present in a practice doctorate in nursing.
- In July 2006, the AACN Board of Directors endorsed the final report of the Task Force on the Roadmap to the DNP, which was developed to assist schools navigating the DNP program approval process. This report includes recommendations for securing institutional approval to transition an MSN into a DNP program; preparing faculty to teach in DNP programs; addressing regulatory, licensure, accreditation, and certification issues; and collecting evaluation data.
- Schools nationwide that have initiated the DNP are reporting sizable and competitive student enrollment. Employers are quickly recognizing the unique contribution these expert nurses are making in the practice arena, and the demand for DNP-prepared nurses continues to grow.
- The Commission on Collegiate Nursing Education (CCNE), the leading accrediting agency for baccalaureate- and graduate-degree nursing programs in the began accrediting DNP programs in Fall 2008. To date, 259 DNP programs have been accredited by CCNE.
CURRENT DNP PROGRAM STATISTICS
- 303 DNP programs are currently enrolling students at schools of nursing nationwide, and an additional 124 new DNP programs are in the planning stages (58 post-baccalaureate and 66 programs).
- DNP programs are now available in all 50 states plus
- From 2015 to 2016, the number of students enrolled in DNP programs increased from 21,995 to 25,289. During that same period, the number of DNP graduates increased from 4,100 to 4,855.
1. How will the transition to the Doctor of Nursing Practice (DNP) occur?
The AACN Board of Directors formed a Task Force on the to the DNP to study the full array of implications and issues resulting from this new direction in nursing education. The task force completed its charge to examine DNP program development, transition programs, regulations and licensure, reimbursement for advanced practice registered nurses (APRN) and other issues. The task force's final report was accepted by the AACN Board in July 2006. AACN will continue to work with an array of stakeholders, including APRN groups, the higher education community, and healthcare providers to determine the best ways of implementing the DNP.
2. How have stakeholders from education and practice had for input?
From 2004 through 2006, the AACN Task Force on the Practice Doctorate and the subsequent DNPEssentials and Roadmap Task Forces held a variety of forums and invitational meetings to collect input on the DNP from education and practice stakeholders. In December 2003, AACN and the National Organization of Nurse Practitioner Faculties (NONPF) jointly sponsored a forum attended by representatives from APN practice organizations. AACN hosted a number of meetings with the leadership of numerous organizations on this issue in order to ensure that their voices were heard. Further, since 2003, AACN held regular ongoing discussions with the 14 organizations affiliated with the Alliance for Nursing Accreditation about the potential for change in this arena. Beginning in Fall 2005, The DNP Roadmap Task Force, in conjunction with the DNP Essentials Task Force, held five regional meetings around the DNP in Boston, St. Louis, Atlanta, Houston, and San Diego. These meetings were open to any participants and stakeholders from education and practice settings. Participants provided feedback on the Essentials document and also discussed issues around implementing DNP programs. In total, there were 620 participants representing 231 different educational institutions and 18 from other agencies or institutions. Additionally, a national stakeholders' conference was held in October 2005 in which 65 leaders from 45 professional organizations participated. The president and executive director each organization were invited to attend. All feedback received at the regional and stakeholders' meetings was seriously considered. The clear and consistent messages from all feedback were incorporated into the final Essentials document and Roadmap report.
3. How will consistency be assured across institutions offering the DNP?
Academic institutions will determine the focus of their DNP programs, as is currently the case for all graduate nursing programs, while adhering to a consistent set of standards titled the Essentials of the Doctoral Education for Advanced Practice Nursing (DNP Essentials), which identify foundational curriculum content and outcome-based competencies essential for all students pursuing the DNP. The Commission on Collegiate Nursing Education (CCNE), the nation’s premier accrediting agency for baccalaureate and graduate nursing programs, has initiated a process for the accreditation of DNP programs that are offered by institutions of higher education.
4. What will be the career progression from entry into nursing and the DNP?
Multiple routes and mechanisms for career progression will be possible and ultimately decided by each educational institution. The proposed model allows for progression from the BS or MS or to the DNP.
5. Will the DNP diminish the need or support for programs?
There is no evidence that practice doctorates compete with programs aimed at developing nurse researchers. The specific type of program that doctoral applicants choose depends on whether their preferred emphasis is in the practice arena or in scientific investigation. The practice doctorate is designed for those in direct clinical practice and areas that support clinical practice-administration, organizational management and leadership, and policy. AACN will continue its work to expand the pipeline of nursing scientists prepared in programs. Research doctorates are a critical resource for supplying the evidence base for nursing practice.
6. How will the DNP differ from the or DNS in terms of curriculum content, research competencies, outcomes roles occupied?
The Essentials of the Doctoral Education for Advanced Practice Nursing presents the specifics of this education and role. DNP programs will incorporate the APRN content currently included in master’s programs. The DNP focuses on providing leadership for evidence-based practice. This requires competence in translating research practice, evaluating evidence, applying research in decision-making, and implementing viable clinical innovations to change practice. Considerable emphasis is placed on a population perspective, how to obtain assessment data on populations or cohorts, how to use data to make programmatic decisions, and program evaluation. If a DNP desires a more formal research role, additional preparation will likely be required—similar to completing a . and DNS programs are research intensive. In many graduates accept academic or governmental positions where research is a major expectation. The DNP graduates will likely seek practice leadership roles in a variety of settings—management of quality initiatives, executives in healthcare organizations, directors of clinical programs, and faculty positions responsible for clinical program delivery and clinical teaching would be appropriate.
7. How are the Master's Essentials reflected in the development of the DNP?
The DNP Essentials are built on the content and competencies outlined in AACN’s Essentials of Master’s Education for Advanced Practice Nursing (1996), and subsequently the Essentials of Master’s Education in Nursing (2011). Graduates of programs based on Master’s Essentials will already possess much of the core knowledge needed to attain the end-of-program competencies delineated in the DNP Essentials. The DNP program will provide these graduates with the additional competencies and knowledge needed to practice at the highest level.
8. What is the link between the DNP curriculum model from the Essentials and specialty practice competencies? What role do specialty APN groups play in defining competency expectations?
The DNP Curriculum is conceptualized as having two components:
1. DNP Essentials 1 through 8 are the foundational outcome competencies deemed essential for all graduates of a DNP program regardless of specialty or focus.
2. Specialty competencies/content prepare the DNP graduate for those practice and didactic learning experiences focused on preparing the DNP graduate for a particular specialty.Competencies, Content, and Practica experiences needed for roles in specific specialty areas are delineated by national specialty nursing organizations.
The DNP Essentials document outlines and defines the 8 foundational Essentials and provides some introductory comments on specialty competencies/content. The essential components of the Core Essentials of the DNP curriculum are defined. The specialized content, defined by the specialty organizations, builds on and complements the areas of core content defined by The DNP Essentials and constitutes the major component of DNP programs. DNP curricula should include these two components as appropriate to the specific advanced nursing practice specialty being prepared. Additionally, the faculty of each DNP program has the academic freedom to create innovative and integrated curricula to meet the competencies outlined in the Essentials document.
9. How many institutions currently offer the DNP?
10. Who will teach DNP students since the role is considered advanced practice?
Many of those who currently teach in advanced practice programs will be involved in teaching DNP students, particularly at the beginning level. There will be components of the DNP which will demand doctorally prepared faculty. As programs move forward with development, arrangements will have to be made for joint appointments or articulation agreements. teaching in APRN programs will have the option to complete the DNP, enhancing their standing within the university and increasing the number of qualified to teach in the DNP program.
11. What about the opportunity for tenure and promotion for faculty with a DNP?
Though primarily an institutional decision, AACN is confident that a DNP faculty member will compete favorably with other practice doctorates in tenure and promotion decisions, as is the case in law, education, audiology, physical therapy, pharmacy, public policy, and administration, public health, and other disciplines. AACN data from 2011 show that doctoral students who also teach are just as likely to have a DNP as This indicates that graduates of both types of doctoral programs are finding teaching positions.
12. How will DNP graduates be prepared to assume the nurse educator role?
Though a doctorate is for a faculty role, the DNP program is not designed to prepare educators per se, any more than a does. Graduates from all doctoral programs ( or DNP) who wish to be educators should have that adds pedagogical skills to their base of clinical practice.
13. Will master's level nursing still exist? Should these programs be phased out?
Yes, master’s education will continue. The position statement on the DNP is a vision for the future of specialty nursing education. As specialty nursing education transitions to the doctoral level, the DNP Task Force recommends that institutions consider their master’s degree to prepare nurses for other essential roles. The Clinical Nurse Leader SM, a national demonstration project launched to introduce a new master’s level role into the healthcare system, is one model for master’s education. This change in master’s programs is consistent with the position statement endorsed by AACN members which states: “As the education of the generalist nurse is elevated to the master’s degree level, it is reasonable to assume that education and the education of those individuals prepared for the highest level of nursing practice would occur at the practice doctoral level.” The transition date of 2015 for the DNP was set far enough in the future to give programs enough time to make a smooth transition and address the role of master’s education.
14. How can we justify efforts to develop the DNP when we have an acute faculty shortage? Should we focus on increasing faculty salaries rather than the DNP?
Nursing cannot continue to have large numbers of faculty in full-time academic positions without doctorates. One of the frustrating aspects today's world of academic nursing is the fact that we have been so slow in moving this agenda forward. Nursing permits a culture which is accepting of limited educational credentials in a variety of settings. In it is increasingly difficult to develop the kind of clinical scholarship and maintain the kind of credibility necessary for programs without a higher level of education among our faculty. The faculty shortage is compounded by the fact that salaries in the academic setting have not kept pace with the service setting. We cannot expect improved salaries until we improve the educational level. The DNP will foster a more highly educated faculty workforce.
15. research demonstrated the need for a practice doctorate? Is there a gap in clinical practice?
Recent reports from the Institute of Medicine describe the challenge of health care and represent a mandate for change in the educational program for the health professions. Nurses are constantly working with individuals who have a higher level of preparation in their respective fields—physicians, pharmacists, and other providers. Nursing educational preparation and the time commitment ought to be analogous to other health professions e.g., PharmD, Physical Therapy, Occupational Therapy. The DNP provides a clinical option for advanced preparation in nursing practice that is more comparable to other. In addition, research from Drs. Linda Aiken, Carole Estabrooks, and others have established a clear link between higher levels of nursing education and better patient outcomes.
16. Does implementation of the DNP mean advanced practice nurses will no longer be permitted to practice without a doctorate?
No, nurses with master's degrees will continue to practice in their current capacities. Recommendations are included in the Roadmap Task Force report on how to facilitate rapid transition to the DNP for nurses seeking this credential.
17. What are the factors that assure that nursing boards will accept this degree for APRN preparation? Will Nurse Practice Acts and regulatory language need changing?
Since the DNP programs will include content currently in master's programs to prepare NPs, midwives, CRNAs, and CNSs, there should be no major difficulties with licensure and certification. As DNP programs come forward to state boards of nursing for approval, changes in Nurse Practice Acts and regulatory language are being considered.
18. Is it the intent of the DNP to further expand the legal scope of practice for APRNs?
No, transitioning to the DNP will not alter the current scope of practice for APRNs. State Nurse Practice Acts describe the scope of practice allowed, and these differ from state to state. These requirements would likely remain unchanged. The transition to the DNP will better prepare APRNs for their current roles given the calls for new models of education and the growing complexity of health care.
19. What is the incentive for expert APRNs to go back to school, particularly since state laws and regulations allow practice with a master's degree?
Over the years, requirements for the profession of nursing have evolved, consistent with needs of the healthcare environment. The DNP is preparing for the practice. Transforming healthcare delivery recognizes the critical need for clinicians to design, evaluate, and continuously improve the context within which care is delivered. Nurses prepared at the doctoral level with a blend of clinical, organizational, economic and leadership skills will significantly impact healthcare outcomes. Until the time that state laws are changed, if a nurse desires an APRN education, and has a choice between a DNP or a master's preparation, it would be far more cost-effective to spend the additional time for the DNP and be prepared for future practice.
20. Will adding another credential only create more confusion about nursing degrees?
No, the DNP does not add "another layer"---just another doctoral focus. The plan will be that all practice doctorates will convert to the DNP designation to reduce confusion and differentiate those programs from research focused degrees (, DNS). All institutions that currently offer the Doctor of Nursing (ND) have chosen to become DNP programs. Those with an ND will need to contact their program about the possibility of a credential change.
21. Will doctorally-prepared nurses confuse patients and the public?
No. The title of Doctor is common to many disciplines and is not the domain of any one group of health professionals. Many APRNs currently hold doctoral degrees and are addressed as "doctors," which is similar to how other expert practitioners in clinical areas are addressed, including clinical psychologists, dentists, and podiatrists. In all likelihood, APRNs will retain their specialist titles after completing a doctoral program. For example, Nurse Practitioners will continue to be called Nurse Practitioners. Of course, DNPs would be expected to clearly display their credentials to that patients understand their preparation as a nursing provider, just as many APRNs, physicians, and other clinicians are required and currently do.
22. Will DNP programs prepare nurses to assume roles as physicians?
No. Nursing and medicine are distinct health disciplines that prepare clinicians to assume different roles and meet different practice expectations. DNP programs will prepare nurses for the highest level of nursing practice. Transitioning to the DNP will not alter the current scope of practice for advanced practice nurses as outlined in each state's Nurse Practice Act.
23. Does CCNE accredit DNP programs?
Yes, practice doctorates with the degree title DNP are eligible for accreditation by CCNE. Programs offering research doctorates (e.g. or DNS) will not be considered for accreditation. It is expected that specialty accreditation for programs preparing nurse midwives and nurse anesthetists will continue by their respective accrediting agencies. If one of these programs is housed in a non-nursing program, the decision regarding the credential will be determined locally. CCNE continues to collaborate with specialty accrediting bodies through the Alliance for Nursing Accreditation. Moreover, CCNE will continue to strive to assure congruence among the standards for accreditation nurse anesthesia, and DNP programs.
DNP GLOSSARY: QUALITY, SAFETY AND EVIDENCE-BASED PRACTICE (EBP)
Adverse Event: An injury resulting from a medical intervention. (Reason, 1990 and IOM, 2000. p 210) or An event that results in unintended harm to the patient due to an act of commission or omission rather than the underlying disease or condition of the patient. (IOM, 2004, p. 327)
Adverse Drug Event: An injury resulting from medical intervention related to a drug (IOM, 1999) or simply “an injury resulting from the use of a drug.” (Nebeker, Barach & Samore, 2004)
Aims for Improvement: Health care should be safe, effective, patient-centered, timely, efficient, and equitable. (IOM, 2001, chapter 2)
Bad Outcome: Failure to achieve a desired outcome of care. (IOM, 2000, p. 210)
Case-Control Study: A type of research that retrospectively compares characteristics of an individual who has a certain condition (e.g. hypertension) with one who does not (i.e., a matched control or similar person without hypertension); often conducted for the purpose of identifying variables that might predict the condition (e.g., stressful lifestyle, sodium intake)(Melnyk & Fineout-Overholt, 2010, p. 572)
Case Study: An intensive investigation of a case involving a person or small group of persons, an issue, or an event. (Melnyk & Fineout-Overholt, 2010, p. 572)
Cause Map: A visual explanation of why an incident occurred. It connects individual cause-and-effect relationships to reveal the system of causes within an issue. It identifies all of the causes and different options for solutions rather than focusing on one cause and one solution to a problem. It is one method of root-cause analysis. (Think Reliability, 2009)
Clinical Inquiry: A process in which clinicians gather data together using narrowly defined clinical parameters; it allows for an appraisal of the available choices of treatment for the purpose of finding the most appropriate choice of action. (Melnyk & Fineout-Overholt, 2010, p. 572)
Clinical Practice Guidelines: Systematically developed statements to assist clinicians and patients in making decisions about care; ideally the guidelines consist of a systematic review of the literature, in conjunction with consensus of a group of expert decision-makers, including administrators, , clinicians, and consumers who consider the evidence and make recommendations. (Melnyk & Fineout-Overholt, 2010, p. 572)
Close Call: An event or situation that could have resulted in an adverse event (or accident) but did not, either by chance or through timely intervention. Also referred to as a near miss or good catch. (U.S. Department of Veterans Affairs, 2002)
Cohort Study: A longitudinal study that begins with the gathering of two groups of patients (the cohorts), one that received the exposure (e.g., to a disease) and one that does not, and then following these groups over time (prospective) to measure the development of different outcomes (diseases). (Melnyk & Fineout-Overholt, 2010, p. 573)
Commission: The act of doing something.
Critical Inquiry: Theoretical perspectives that are ideologically oriented toward of and emancipation from oppressive social arrangements or false ideas. (Melnyk & Fineout-Overholt, 2010, p. 573-574)
Culture: Shared knowledge and behavior of people who interact distinct social settings and subsystems. (Melnyk & Fineout-Overholt, 2010, p. 574)
Data and Safety Monitoring Plan: A detailed plan for how adverse effects will be assessed and managed.
Electronic Medical Record (EMR): A collection of a patient’s medical information in a digital (electronic) form that can be viewed on a computer and easily shared by people taking care of the patient. (Used interchangeably with Electronic Health Record although the EMR is a subset of HER – The electronic medical record is often just one health care system’s record rather than the entire health record for an individual.) (National Cancer Institute, 2009)
Error: The failure of a planned action to be completed as intended (i.e., of execution), and the use of a wrong plan to achieve an aim (i.e., of planning) (IOM, 2000). It also includes failure of an unplanned action that should have been completed (omission). (IOM, 2004, p. 330 & IOM, 2004, p. 360)
Evidence: Scientific evidence is a replicable and generalizable observation that can be experienced nearly identically by independent people from different places and at different times. (IOM, 2004, p. 330) see Levels of Evidence.
Evidence-Based Practice (EBP): The integration of the best research evidence with clinical expertise and patient values. (Sackett, et al, 2000, p. 1)
Evidence-Based Practice Model: The LCC nursing program has adopted the Melnyk & Fineout-Overholt seven step evidence-based practice model:
Cultivate a spirit of inquiry.
- Ask the burning clinical question in PICOT format.
- Search for and collect the most relevant best evidence.
- Critically appraise the evidence.
- Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a decision or change.
- Evaluate outcomes of the practice decision or change based on evidence.
- Disseminate the outcomes of the EBP decision or change. (Melnyk & Fineout-Overholt, 2010, p. 11)
Expert Opinion: Recommendations from persons with established expertise in a specific clinical area often based on clinical experience; not considered a research method because systematic (or critical) inquiry is lacking. (Kruszewski, 2009)
Generalizability: The extent to which the findings from a study can be generalized or applied to the larger population. (Melnyk & Fineout-Overholt, 2010, p. 576)
Good Catch: See close call or near miss.
Hand-Off: The process of moving patients and their information from one provider or site to another. (IOM, 2007).
Harm: When risks outweigh benefits. (Melnyk & Fineout-Overholt, 2010, p. 576)
Hierarchy of Evidence: A mechanism for determining which study designs have the most power to predict cause-and-effect. The highest level of evidence is systematic reviews of RCTs, and the lowest level of evidence is expert opinion and consensus statements. (Melnyk & Fineout-Overholt, 2010, p. 576)
Informatics: How data, information, knowledge, and wisdom are collected, stored, processed, communicated, and used to support the process of healthcare delivery to clients, providers, administrators, and organizations involved in healthcare delivery. (Melnyk & Fineout-Overholt, 2010, p. 577)
IOM: Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. Found at http://www.iom.edu/. (IOM, 2000)
Latent Error: Errors in the design, organization, training, or maintenance that lead to operator errors and whose effects typically lie dormant in the system for lengthy periods of time. (IOM, 2000, p. 210)
Levels of Evidence ranking of evidence by the type of design or research methodology that would answer the question with the least amount of error and provide the most reliable findings. Leveling of evidence, also called hierarchies, vary by type of question asked. An example is provided
Level I that is generated from systematic reviews or meta-analysis of all relevant randomized controlled trials or evidence-based clinical practice guidelines based on systematic reviews of randomized controlled trials; the strongest level of evidence to guide clinical practice.
Level II Evidence generated from at least one well-designed randomized clinical trial (i.e., a true experiment).
Level III Evidence obtained from well-designed controlled trials without randomization.
Level IV Evidence from well-designed case-control and cohort studies.
Level V Evidence: Evidence from systematic reviews of descriptive and qualitative studies.
Level VI Evidence: Evidence from a single descriptive or qualitative study.
Level VII Evidence: Evidence from the opinion of authorities and/or reports of expert committees. (Melnyk & Fineout-Overholt, 2010, p. 577)
Meta-Analysis: A process of using quantitative methods to summarize the results from multiple studies, obtained and critically reviewed using a rigorous process (to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific question and draw conclusions about the data gathered. The purpose of this process is to gain a summary statistic (i.e., a measure of a single effect) that represents the effect of the intervention across multiple studies. (Melnyk & Fineout-Overholt, 2010, p. 578)
Medical Error: Mistake that harms a patient. Adverse drug reactions, hospital-acquired infections and wrong site surgeries are examples of preventable errors. (Robert Wood Johnson Foundation, 2009)
Medication Error: Any error occurring the medication-use process. IOM, 2004, p. 360; Bates, 1995)
Misuse: Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of misuse. (Robert Wood Johnson Foundation, 2009)
National Guidelines Clearinghouse: A comprehensive database of up-to-date English language evidence-based clinical practice guidelines, developed in partnership with the American Medical Association, the American Association of Health Plans, and the Association for Research and Quality. Found at http://www.guideline.gov/. (Melnyk & Fineout-Overholt, 2010, p. 578)
Near Miss: An error of commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance (e.g., the patient received a contraindicated drug but did not experience an adverse reaction), prevention (e.g., a potentially lethal overdose was prescribed, but a nurse identified the error before administering the medication), or mitigation (e.g., a lethal drug overdose was administered but discovered early and countered with an antidote). Also referred to as a close call or good catch. (IOM, 2007, p. 332)
“Never-Events”: “Never-Events” are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a facility. Examples surgery on the wrong body part; foreign body left in a patient after surgery; mismatched blood transfusion; major medication error; severe ‘pressure ulcer’ acquired in the hospital; and preventable post-operative deaths. (National Quality Forum, 2009)
Omission: Neglecting to do something; failure to act; neglect of duty; and/or leaving something undone.
Overuse: Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes overuse. The potential harm includes adverse reactions to the antibiotics and increases antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures. (Robert Wood Johnson Foundation, 2009)
Patient Preferences: Values the patient holds, concerns the patient has regarding the clinical decision/treatment/situation, and choices the patient has/prefers regarding the clinical decision/treatment/situation. (Melnyk & Fineout-Overholt, 2010, p. 579)
Patient Safety: Freedom from accidental injury; ensuring patient safety involves the establishment of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur. (IOM, 2000. p. 211)
Peer Reviewed: A project, paper, study, etc. is reviewed by a person(s) who is a peer to the author and has expertise in a subject. (Melnyk & Fineout-Overholt, 2010, p. 579)
PICOT Format: A process in which clinical questions are phrased in a manner that yields the most relevant information; P = patient population; I = Intervention or issue of interest; C = Comparison intervention or status; O = Outcome’ T = for (I) to achieve the (O). (Melnyk & Fineout-Overholt, 2010, p. 579)
Primary Studies (literature): Studies that collect original data. Primary studies are differentiated from systematic reviews that summarize the results of primary studies. (DiCenso, Guyatt & Ciliska, 2005, p. 564).
: The statistical test of the assumption that there is no difference between an experimental intervention and a control. indicates the probability of an event, given the assumption that there is no true difference. By convention, 0.05 is considered a statistically significant result. (Melnyk & Fineout-Overholt, 2010, p. 580)
Quality of Care: Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (IOM, 1990; IOM, 2000, p. 211)
Quality Improvement: Process by which an organization improves or increases the quality of care in the institution and/or along the continuum of care. Improvements should be sought in the six areas described by the Institute of Medicine in the “Aims for Improvement.” (Hoover, 2009)
Quantitative Research: The investigation of phenomena using manipulation of numeric data with statistical analysis. Can be descriptive, predictive, or causal. (Melnyk & Fineout-Overholt, 2010, p. 580)
Random Sampling: Selecting subjects to participate in a study by using a random strategy (e.g., tossing a coin); in this method of selecting subjects, every subject has an equal chance of being selected. (Melnyk & Fineout-Overholt, 2010, p. 580)
Randomized Controlled Trial (RCT): A true experiment (i.e., one that delivers an intervention or treatment in which subjects are randomly assigned to control and experimental groups); the strongest design to support cause and effect relationships. (Melnyk & Fineout-Overholt, 2010, p. 581)
Reconciliation: Comparison of the medications a person is taking in one care setting with those being provided in another setting. (IOM, 2007, p. 361)
Root-Cause Analysis: An approach for identifying the underlying causes of why an incident occurred so that the most effective solutions can be identified and implemented. It’s typically used when something goes badly, but can also be used when something goes well. Within an organization investigation and root-cause analysis are all fundamentally connected by three basic questions: What’s the problem? Why did it happen? and What will be done to prevent it? (Think Reliability, 2009)
Secondary Literature: Sources that are not original studies or research but are a compilation or summary of primary studies. They usually follow criteria or rating system. Examples are clinical practice guidelines and systematic reviews. (Hoover, 2009)
Sentinel Event: An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response. (The Joint Commission, 2009)
Systematic Review: A summary of evidence, typically conducted by an expert or expert panel on a particular topic, that uses a rigorous process (to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific clinical question and draw conclusions about the data gathered. (Melnyk & Fineout-Overholt, 2010, p. 582)
of Study Findings: Whether or not the results of a study were obtained via sound scientific methods. (Melnyk & Fineout-Overholt, 2010, p. 583)
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