Understanding the process helps ensure a successful project.
The final doctor of nursing practice (DNP) project provides students with the opportunity to systematically translate the best current evidence into practice. However, variability in how projects are implemented exists among programs. In response, the American Association of Critical Care Nurses (AACN) commissioned white papers from two internal task forces: the Implementation Task Force (ITF) and the Advanced Practice Registered Nurse Clinical Training Task Force. The ITF’s white paper, The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations, describes and clarifies the characteristics of DNP graduate scholarship (including the DNP project), efficient resource use, program length, curriculum considerations, practice experiences, and collaborative partnership guidelines. The Advanced Practice Registered Nurse Clinical Task Force white paper, Re-envisioning the Clinical Education of Advanced Practice Registered Nurses, explores how APRN education can adapt to include more simulation opportunities, academic-practice partnerships, competency-based assessments, and nontraditional APRN clinical education models, such as technology or informatics. However, the AACN doesn’t make specific recommendations with regard to the final DNP project, pointing instead to the DNP Essentials to explain the project’s scope and depth.
This article discusses the issue of project variability, then explores DNP project fundamentals to help eliminate ambiguity and confusion and broaden students’ understanding of the project’s significance. Before initiating a DNP project, several key elements—mentoring, time management, organizational and academic support, potential institutional review board approval, and planning for dissemination—must be in place. (See 8 steps to completion.)
DNP project variability
With the increased volume of new programs and growing interest in the DNP degree, the profession must clarify the scope of the final project, including implementation, impact on system and practice outcomes, extent of collaborative efforts, dissemination, and degree of faculty mentorship and oversight. Some universities require students to complete a practice improvement project over the span of a course, whereas others require students to initiate an evidence-based practice (EBP) innovation project when they begin the program and continue it through the final semester.
Despite projects’ various forms, many elements—including planning, implementation, evaluation, and sustainability—must be consistent across programs. Without concrete guidelines, programs have employed several interpretations, including portfolios, case studies, systematic reviews, and writing projects. (See Project dissemination variability.)
Reasons for variability include:
- lack of faculty familiarity with quality improvement (QI) and EBP methods
- strain on faculty capacity and time commitment for project completion
- lack of faculty expertise in DNP education
- inability to find clinical sites that allow students to implement projects
- lack of DNP faculty resulting in programs led by PhD faculty
- lack of graduate-level writing skills
- differing student education levels (for example, BSN-DNP, MSN-DNP)
- time constraints within the iterative process requiring multiple revisions of written work.
Although some program variability is expected, concern about the lack of adherence to the DNP Essentials exists. In response, the AACN is committed to enhancing program congruency. To ensure consistency, post-master’s and post-baccalaureate DNP students (who begin their doctoral programs with different education and practice backgrounds) should graduate with the same comprehensive skill set as described in the DNP Essentials.
The DNP project, previously called the capstone project or the scholarly project, should demonstrate translation of acquired knowledge into clinical practice and exhibit the student’s growth in clinical knowledge, expertise, and use of the DNP Essentials and DNP Tool Kit. (See DNP Essentials and Tool Kit.)
Projects can focus on QI, executive outcomes management, or an EBP change initiative aimed at strengthening healthcare. (See DNP project examples.)
While working on their projects, students learn to build strong, collaborative partnerships with stakeholders and mentors.
DNP programs throughout the United States require students to conduct various types of projects, which contributes to ongoing confusion about DNP preparation and role. However, all projects should reflect the DNP Essentials in a single, cumulative work that evolves as the student progresses through the program. In addition, this scholarly synthesis should serve as a platform for future scholarship after graduation.
According to the AACN DNP Tool Kit, all projects should:
- focus on a change that impacts the outcome of healthcare through direct or indirect care
- have a systems (micro-, meso-, or macro-level) or population/aggregate focus
- demonstrate implementation in the appropriate practice area
- include a plan for sustainability (it should take into account financial, systems, or political realities, not only theoretical abstractions)
- include an evaluation of processes and outcomes (formative or summative).
Frequently, a project is the outcome of a student’s identified need for improvement in clinical practice or patient outcomes guided by the spirit of inquiry. The project results are a compendium of graduate education immersed in nursing leadership, education, health policy, or clinical practice.
All DNP projects should emphasize positive change that advances quality outcomes, attention to systems thinking, strategies for sustainability with an appraisal of processes and outcomes, and a structure for future practice. The expectation is that DNP-prepared nurses will contribute to the body of knowledge in nursing practice by sharing their work with others so that they can apply it to their practice roles. Platforms for dissemination include social media, peer-reviewed journals, presentations, professional conferences, brochures, posters, policy briefs, organizational team meetings, media interviews, academia, and press releases. Many programs require students to summarize their projects for publication in a peer-reviewed journal.
The final requirement of the DNP project is a student’s presentation before their institution’s doctoral panel. In this venue, students deliver elemental details about their project’s processes and impact, including purpose, evidence synthesis, project design, data analysis, frameworks, and dissemination.
Be a trailblazer
DNP students’ final projects reflect the culmination of their educational journey and prepare them to share their work with others to benefit patients, the healthcare system, and the nursing profession. The result is a body of information that bridges the gap between research theory and clinical practice. As trailblazers, DNP-prepared nurses can empower other professionals to improve patient outcomes and achieve benchmarks for practice change supported by collaborative endeavors.
The following authors are DNP graduates from the University of Texas at Tyler in Tyler: Barbara Chapman is a family NP with the INTUNE Mobile Unit and assistant clinical professor in the school of nursing at The University of Texas at Tyler. Chiquesha Davis is department head of post-licensure programs, graduate programs, and assistant professor at Tarleton State University in Stephenville, Texas. Sonya Grigsby is a critical care NP at CHRISTUS Mother Frances Hospital in Tyler, adjunct nursing faculty at University of Texas at Tyler, and locum NP at OSF St. Francis Medical Center in Peoria, Illinois. Cyndi B. Kelley is a nurse manager in the special care nursery and chair of the doctoral collaboration council at Texas Health Presbyterian Hospital of Dallas and adjunct faculty in the ADN-to-BSN program at Grand Canyon University in Phoenix, Arizona. Rebecca Shipley is a family NP at CHRISTUS Trinity Mother Frances Health System. Christian Garrett is a DNP student at the University of Texas at Tyler, a family NP at CHRISTUS Trinity Mother Frances Hospital, and an adjunct professor in the school of nursing at The University of Texas at Tyler.
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