Addressing the elephant in the room: Differentiating the AACN Essentials levels of competency within advanced practice.

While the 2021 AACN Essentials, "The Essentials: Core Competencies for Professional Nursing Education", provide a framework for educational preparation, academia is challenged to navigate through the muddy waters of competency attainment at the advanced level (L2). The aim of the new Essentials is to serve as a curriculum guide and provide a clear vision of the profession to community and stakeholders, while those within the profession struggle to thread this vision through redesign, specifically differentiating competency in L2 for master's and doctoral level preparation. This perspective article challenges educators to expand the definition of competency attainment to one of innovation based on the history and evolution of Doctor of Nursing Practice (DNP) education, competency-based education (CBE), and the achievement of milestones as advanced practice moves to entry level as DNP.

Shifting Culture by Creating Synergy and Equity Through the Unification of Tenure Criteria.

BACKGROUND: Tenure requirements within universities vary; however, most focus on excellence in teaching, service, and scholarship. Within our university, faculty with either research or clinical doctorates were on both tenure and clinical tracks, with reported marginalization from clinical track faculty. METHOD: A task force was convened in 2018 to develop a unified single track that included a single set of criteria for all College of Health Professions faculty to obtain tenure. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) Roadmap was used to guide the work of the task force. RESULT: The implementation of a single track has influenced discourse around previous notions regarding what is considered "tenure worthy" and has opened the door to contractual equity among faculty. CONCLUSION: Internal structures, such as implementation of a single track, can support cohesion and productivity that facilitates collaborations among faculty of all ranks and degree backgrounds, promoting a culture that continues to embrace intellectual discourse and unity. [J Nurs Educ. 2022;61(8):455-459.].

Strengthening DNP Business Acumen: An Educational Intervention.

BACKGROUND: As reflected in the literature, business acumen for Doctor of Nursing Practice (DNP) students is lacking. Foundational business concepts and applications in the curriculum necessitate the understanding of core business requirements in health care applicable toward DNP leadership roles. METHOD: Course pedagogy used evidence-based materials as well as activities that included the development of business innovation proposals, stakeholder presentations, and business plans, as well as practicum hours. RESULTS: Successful course delivery increased DNP students' knowledge and skills related to business acumen. In addition, students fully grasped the need to sustain and have fully developed scholarly projects that consider the clinical and financial aspects of health care. CONCLUSION: Development of a business course strengthens the needed skills and acumen toward quality and financial performance critical in the DNP leadership role as well as in contributing toward institutions' growth. [J Nurs Educ. 2021;61(4):201-204.].

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.

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.

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.

Brilliant at the Basics: An Academic Practice Partnership to Build Nursing Management Expertise.

This article describes the importance of building academic and practice partnerships, and the process in developing and implementing a successful leadership academy in transforming emerging nurse leaders. In addition, this article highlighted the value on the evaluation and outcomes of the educational program pertaining to positive changes in the workplace. In its initial phase, the health system conducted a needs assessment that provided vital information to enhance nursing management development skills through the initiation of a leadership training academy for nurse leaders. The vital information obtained in the needs assessment was used as a framework in working on topical outline and content objectives developed as a joint initiative between the university-based school of nursing and health professions and the health system that shared a similar mission, vision, and goals. Thus, "Brilliant at the Basics" nursing leadership academy was formed. [J Contin Educ Nurs. 2021;52(3):136-141.].

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.

Hospital Admissions for Malnutrition and Dehydration in Patients With Dementia.

Dehydration and malnutrition are commonly experienced by patients with dementia and can result in hospitalizations and decreased quality of life. The purpose of this study was to explore and describe retrospectively, the incidence and correlations of variables that may precede hospitalizations for dehydration/malnutrition in the community-dwelling patient with dementia. Data from the Outcome and Assessment Information Set (OASIS) Start of Care (SOC) on 44 patients served by a Michigan home care agency were retrieved for analysis. This study did not reveal any single or collection of variables that would predict risk for hospitalization for dehydration/malnutrition. With the lack of specific predictors of hospitalization related to dehydration and malnutrition, clinicians need to place high priority on risk-lowering strategies and preventive education for patients, family, and caregivers.