Problem Solved: DNPs Rise to Nursing's Greatest Challenges
Source Newsroom: Johns Hopkins University School of Nursing
Newswise — The map on the office wall of Mary Terhaar, DNSc, CNS, RN, remains a work in progress. She’s been sticking pins in all the towns where nurses are heading into workplaces armed with a doctorate in nursing practice (DNP) from the Johns Hopkins University School of Nursing.
The program, which Terhaar directs, will soon graduate its 100th student. Launched in 2008, it’s designed to give nurse practitioners and administrators the skills they need to take their practice to the next level. “They take a problem, they go to the evidence, they devise a solution, they translate it into practice, and they publish the results so other people can adapt it for their practice," Terhaar says. "That’s what’s so cool about this job, thinking about the impact our problem solvers are having out there in 100 different places.”
Leadership and communication skills are a strong focus of the Hopkins curriculum. Newly minted DNPs can come up with a bevy of problem-solving ideas, but those ideas won’t get anywhere if the DNPs can’t win buy-in from workplace stakeholders, whether that means colleagues on a unit or a CEO in the corner office. “That’s our brand here—we’re turning out leaders who can see and solve problems in ways that are good for patients and that work for institutions,” Terhaar says.
In her capstone, Lina Younan, MSN, DNP, nursing director at the 130-bed Labib Medical Center in Saida, Lebanon set out to close gaps in the way nurses at Labib handled patient “handoffs” between shifts. The procedures in place were vague and out of date, so Younan set up task forces in the medical, cardiac, and surgical units to develop new protocols. Each group included physicians and administrators as well as nurses. “I was thinking that if everyone is a part of establishing this new tool, then they would be less resistant to using it later on,” she says.
The intervention had four parts—a new checklist tool, the integration of that tool into the patient file, training sessions on communications, and an institutional effort to reduce interruptions—especially physician rounds—during handoff windows.
The data set Younan’s team developed came from audio recordings of actual shift changes, which were later evaluated for omissions. Omissions per handoff dropped from 4.9 to 2.3.
The most significant evolution in the Hopkins DNP program so far has been the development of an intensive focus on data management. When Martha Sylvia, PhD, MBA, RN, joined the faculty three years ago, she brought broad experience in analytics, data, and program evaluation from her work as director of Outcomes and Evaluation for Johns Hopkins Healthcare, which cares for about 300,000 patients through three insurance plans.
Sylvia insists that students work with data from the first semester through the last. The small class size of about 20 students allows her the luxury of a lot of one-on-one work. “As nurses, we have a lot of anecdotal information from patients, and that kind of information really drives us, especially emotionally,” Sylvia says. “It’s harder for us to think about things from a data standpoint. But we need those skills in today’s world. You’re not going to get stakeholders to buy into the idea that there’s a problem unless you can show to them that the problem exists—and that you can solve it.”
The quick immersion in statistics so unnerved Carrie Kairys, ARNP, DNP, that she confessed doubts to her 16-year-old son about whether she’d succeed at Hopkins. “He said, ‘Mom, what did you expect, something easy? You’re getting a doctorate!’” Kairys recalls. "And the funny thing is that data management turned out to be the most interesting and fun thing for me.”
Kairys is a nurse practitioner at a Department of Veterans Affairs facility in West Palm Beach, FL. Through most of its history, the VA has delivered care primarily to men, but the agency now finds itself caring for increasing numbers of younger women.
Kairys set out in her capstone to boost reproductive health services delivered to women returning from overseas. The intervention was integrated into the patient’s Electronic Health Record so that a series of four questions asked by a nurse generates an alert for her doctor. A combination of answers, for example, might signal that a woman is on teratogenic medications that could harm a fetus but is not using birth control.
The number of reproductive health screenings conducted went from 23 percent of cases to 71 percent after the intervention. The consulting firm Booz Allen Hamilton recognized the project as a VA “best practice.” The Office of the Inspector General cited it as a “facility accomplishment.”
Many Happy Returns
It’s only fitting that the DNP program should go through an evaluation process as rigorous as the one its students apply to their capstones. A grant from the Maryland Health Services Cost Review Commission enabled Terhaar to interview chief nurse officers around the state about their experiences with Hopkins DNPs.
“What they’re telling us is that the work of our graduates is characterized by a new level of scholarship and discipline,” she says. “They’re telling us that they’re very happy with our graduates, and that they’re getting even happier as the program evolves.”