Research and Theory for Nursing Practice: An International Journal

Research and Theory for Nursing Practice: An International Journal, Vol. 26, No. 1, 2012

6 © 2012 Springer Publishing Company http://dx.doi.org/10.1891/1541-6577.26.1.6

EvidEncE-BasEd PracticE

On the Doctor of Nursing Practice (DNP)

Doctoral degrees in nursing fall into two categories. The first is the research-focused doctorate, the Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNSc or DNS); and the second is the practice doctorate or Doctor of Nursing Practice (DNP). Nurses who graduate from research-focused doctoral programs are or should be prepared to generate new evidence for the profession. Nurses who graduate from the practice-focused doctorate are or should be prepared to be experts in advanced nursing practice and leaders in applying the best evidence to improve nursing practice, whether it be clinical, academic, or administrative. The authors should indicate our bias upfront. We believe that the DNP degree is meant to prepare leaders to improve practice and thus the focus of the degree should be on implementing practice change that improves outcomes for patients, nurses, and/ or students. Thus there should be a strong evidence-based practice (EBP) compo- nent in the curriculum, and the capstone in these programs should be on evidence synthesis and/or practice improvement projects (which can also be administrative or educational in nature), not research.

The DNP degree has continued to blossom since the American Association of the Colleges of Nursing (AACN) released their Position statement on the Practice Doctorate in Nursing in 2004. There are currently 153 DNP programs in the United States with an additional 160 nursing schools planning similar programs (AACN, 2011). Existing DNP programs follow either a clinical, educational, or adminis- trative track to prepare leaders in each of these areas. All DNP programs are expected to include in their curriculum the seven Essentials of Doctoral Education for Advanced Practice Nurses developed by the AACN (2006). Included in the Essentials is the edict that DNP graduates be able to “ . . . demonstrate refined assessment skills and base practice on the application of biophysical, psycho- social, behavioral, sociopolitical, cultural, economic, and nursing science as appropriate in their area of specialization” (AACN, 2006, p. 16). The DNP degree was conceived as an educational program to prepare graduates to be experts and leaders in evidence-based practice. The DNP clinician is ideally prepared to improve healthcare outcomes by facilitating the translation of current, best evidence into clinical practice.

Evidence-Based Practice 7

The DNP is proposed by AACN as the terminal degree for advanced practice nurses. DNP graduates may continue to work in the same practice environments with other nurses with different educational levels as well as other health care disciplines. Many organizations are still trying to determine how to utilize the DNP graduate within their practice environments. With pending health care reform, the threat of reduced reimbursement for poor outcomes, and the ongoing shortage of primary care providers, it is crucial for current best evidence to be quickly translated into clinical practice to improve outcomes for the patients and communities we serve. In addition, many healthcare organizations are applying for Magnet status, a recogni- tion program developed by the American Nurses Credentialing Center (ANCC) for high-quality nursing care. Magnet hospitals must demonstrate their contribution to generating knowledge, innovations, and improvements for the professions through the translation and application of existing evidence and by identifying areas where new research is needed (ANCC, 2011).

Despite the Institute of Medicine’s (2011) challenge for nursing to reconcep- tualize the role of nurses while developing innovative solutions to care delivery, many barriers to full implementation of evidence-based practice still exist. Nurses continually report lack of time as the most common barrier to applying evidence- based practice approaches to clinical practice (Bertulis, 2008; Brown, Wickline, Ecoff, & Glaser, 2009; Pravikoff, Tanner, & Pierce, 2005). Other barriers that have been reported include the difficulty accessing resources, poor computer skills, poor understanding of statistics and research technique, inadequate preparation to critically appraise research, lack of support from administration and other staff, and a disbelief that evidence-based practice can improve outcomes (Bertulis, 2008; Brown et al., 2009; Pravikoff et al., 2005).

There is a misconception among many nurses about the value of research in practice. Nurses follow clinical practice protocols developed by their agencies, many of which are not based on the best and highest levels of evidence but are instead based on expert opinion and tradition. When a practice question needs to be answered, many nurses turn to a colleague rather than search for answers in current research. Melnyk and Fineout-Overholt (2002) called for the development of an evidence-based practice mentor, an advanced practice nurse with in-depth knowledge and skills in evidence-based practice and organizational change. This is part of the foundation of DNP education. The DNP graduates need to be prepared to challenge these barriers to evidence-based practice by becoming a role model for integrating evidence-based practice into their practice setting.

DNP graduates in the advanced practice clinician role have a unique perspec- tive on evidence-based practice due to their direct patient care role in the practice setting. Within their clinical roles, DNP graduates can evaluate current practice and develop clinical questions relevant to their practice. Evidence-based practice can then be integrated and implemented to directly improve care. By becoming a role model, coach, and teacher, while creating an environment that encourages evidence- based practice, the DNP clinician can empower other staff. Melnyk and colleagues (2004) demonstrated that nurses who have a mentor that facilitates evidence-based

8 Evidence-Based Practice

practice are more likely to practice within an evidence-based framework. Levin, Fineout-Overholt, Melnyk, Barnes, & Vetter (2011) tested this proposition in a pilot study and validated the need for nurses to engage in an evidence-based practice project with a mentor to achieve significant gains in evidence-based practice beliefs and implementation behaviors.

The DNP graduate should be primed to take on a formal or informal mentorship role. As a leader of practice improvement in the clinical area, the DNP graduate also needs to take on the role of educator to teach the skills necessary to effectively utilize evidence-based practice to frontline clinicians. The DNP graduate can also promote evidence-based practice through journal clubs where current research is appraised and encourage nurses to ask questions at the point of care. Evidence- based answers can then be sought, critically appraised, implemented, and evaluated in practice as part of unit-based performance-improvement projects to improve healthcare outcomes for consumers and promote professional development for health care providers, whether in indirect or direct roles.

As the number of DNP graduates entering practice continues to grow, these indi- viduals need to be promoted as practice experts and leaders in their field. By being a champion for evidence-based practice, promoting an environment that fosters clinical inquiry and critical thinking, nurses and other members of the health care team will see that the integration of current best evidence is an integral component of their everyday practice.

REFERENCES

American Association of the Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Retrieved, from http://www.aacn.nche.edu/dnp/position- statement

American Association of the Colleges of Nursing. (2006). The essentials of doctoral education for advanced practice nurses. Retrieved, from http://www.aacn.nche.edu/dnp

American Association of the Colleges of Nursing. (2011). The doctor of nursing practice fact sheet. Retrieved, from http://www.aacn.nche.edu/media-relations/fact-sheets/dnp

American Nurses Credentialing Center. (2011). Magnet Recognition Program® Model. Retrieved, from http://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet- Model.aspx

Bertulis, R. (2008). Barriers to accessing evidence-based information. Nursing Standard, 22(36), 35–39.

Brown, C. E., Wickline, M. A., Ecoff, L., & Glaser, D. (2009). Nursing practice, knowledge, atti- tudes, and perceived barriers to evidence-based practice at an academic medical center. The Journal of Advanced Nursing, 65(2), 371–381.

Institute of Medicine (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

Levin, R. F., Fineout-Overholt, E., Melnyk, B. M., Barnes, M., & Vetter, M. J. (2011). Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: A pilot test of the advancing research and clinical practice through close collaboration model. Nursing Administration Quarterly, 35(1), 21–33.

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Melnyk, B. M., & Fineout-Overholt, E. (2002). Putting research into practice. Reflections on Nursing Leadership, 28(2), 22–25.

Melnyk, B. M., Fineout-Overholt, E., Fischbeck Feinstein, N., Li, H., Small, L., Wilcox, L.,et al. (2004). Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing, 1(3), 185–193.

Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. nurses for evidence- based practice. American Journal of Nursing, 105(9), 40–51.

Correspondence regarding this article should be directed to Rona F. Levin, PhD, RN, 1 Scarsdale Rd. – Apt. 408, Tuckahoe, NY 10707. E-mail: rlevin@pace.edu

Jason slyer, DnP, rn, FnP-BC Montefiore Medical Center, New York, New York

rona F. levin, PhD, rn Consultant in Evidence-Based Practice and Practice Improvement

Professor Emeritus, Felician College, Lodi, New Jersey

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.