The Doctor of Nursing Practice leadership program at Case Western Reserve University was designed to prepare nurses for advanced practice and leadership roles. The program is delivered off-campus, in a hospital setting. This delivery model allowed for a more intimate learning experience, as well as the opportunity to learn from and work with experienced nursing leaders. The Doctor of Nursing Practice leadership cohort model is an effective way to train future nursing leaders. It allows for a more intimate learning experience and the opportunity to learn from and work with experienced nursing leaders. During the coronavirus disease 2019 pandemic, this delivery model proved to be advantageous. The Doctor of Nursing Practice students were able to work closely with nursing leaders who were on the front lines of the pandemic response. They gained valuable firsthand experience in leading a team of nurses during a crisis. Additionally, they were able to take what they learned back to their own hospitals and apply it to their own responses to coronavirus disease 2019.
Key Points
- •Coronavirus disease 2019 was challenging but also spurred needed changes in the nursing profession.
- •The Doctoral of Nursing Practice degree prepares nurses prepares nurses to assume leadership positions.
- •The Doctoral of Nursing Practice leadership cohort model allows nurses to advance their knowledge and skills while working full time in their current positions.
Nurses who are encouraged to further their education are empowered to pursue leadership positions in which they can utilize evidenced based practices that will result in improved quality care for patients, increased ability to work collaboratively with other health professionals, and advances in the nursing profession.
Impact of Coronavirus Disease 2019 on Nursing Practice
The coronavirus disease 2019 (COVID-19) pandemic created many challenges for health care professionals. A 2020 Medscape survey of 10,424 nurses (49% RN’s) indicated that the major concerns during the pandemic were transmitting the virus to family members (66%), fear of infection (47%), having to wear extra personal protective equipment (PPE)/discomfort of PPE (38%), lack of PPE (37%), loss of income (25%), and higher patient loads/patient acuity (23%).
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About a third of RN’s (35%) were less satisfied with their careers and 33% wanted to pursue new paths in nursing. Slightly over a third (37%) of RN’s felt burned out or very burned out compared to 12% who felt burned out prior to the pandemic. The pandemic has also impacted mental health in terms of increased levels of psychological distress, depression, anxiety and post-traumatic stress disorder, burnout, and exhaustion.- Stokowski L.A.
- Bastida D.
- McBride M.
- Berry E.
Medscape nurse career satisfaction report 2020.
https://www.medscape.com/slideshow/2020-nurse-career-satisfaction-6013455
Date: 2020
Date accessed: October 23, 2022
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On an organizational level, the pandemic exacerbated the nursing shortage, made it difficult to retain nurses, and affected morale.International Council of Nurses
Mass Trauma experienced by the global nursing workforce.
Mass Trauma experienced by the global nursing workforce.
https://www.icn.ch/news/covid-19-effect-worlds-nurses-facing-mass-trauma-immediate-danger-profession-and-future-our
Date: 2021
Date accessed: October 24, 2022
On the other hand, the pandemic also created an opportunity for nursing leaders to step up and make a difference. It was noted that the health crisis spurred change within the profession and altered expectations for nurses.
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The COVID-19 pandemic highlighted the need for nursing leaders who are able to think critically and act quickly. In many cases, these leaders have been able to make an impact by using their nursing education to inform their decisions. For example, when faced with a shortage of personal protective equipment, nursing leaders have been able to draw on their knowledge of infection control to develop safe protocols for its use. In addition, nursing leaders have also been instrumental in advocating for changes to policies that impact patient care. For instance, they have lobbied for changes in insurance coverage that would allow patients to receive the care they need without financial burden.
Nurses found themselves working in more collaborative environments where they could participate on collaborative interprofessional teams and where innovation and the exchange of ideas were valued.
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Nurses were presented with opportunities to take on leadership roles in program and initiatives, to influence decision-making and policy in their health organizations, and to advance their professional careers. Nursing leaders stepped up to the plate in a big way. They have taken on new roles and responsibilities in order to provide care for patients and families affected by COVID-19.Nurse leaders have also advocated for nursing education to be elevated to a doctoral level to better equip nurses to handle future pandemics and other health crises. Although there is no doubt that nursing leaders have had a significant impact during the COVID-19 pandemic, it is important to remember that they cannot do it alone. They need the support of the entire nursing profession in order to continue making a difference.
As the COVID-19 pandemic continues, nursing leaders have an opportunity to make a difference. With the right education, they can help to shape policy, advocate for change, and improve patient care. And, by elevating nursing education to a doctoral level, they can ensure that nurses are prepared to meet the challenges of the future.
Nursing leadership is vital to the success of any healthcare organization. By sharing their experiences, nurse leaders can provide insight and guidance that will help others to become nursing leaders in their own right. In this way, they can create a positive ripple effect that will benefit both the nursing profession and the patients they serve. Nursing leaders can inspire other nurses to become leaders in their own right, help to elevate the profession and make it more accessible to everyone. When nursing leaders lead by example, they show that nursing is a rewarding and fulfilling career that can make a difference in the lives of others. In doing so, they help to set the stage for a bright future for nursing.
Nursing leaders play an important role in shaping the nursing profession and improving patient care. By elevating nursing leadership, other organizations will be able to benefit from the nursing leader's example. The nursing leader can help improve patient care by providing guidance and support to other nursing staff. The nursing leader can also help to improve the nursing profession by developing new policies and procedures. By elevating nursing leadership, nursing leaders can help to improve the nursing profession and patient care.
The ability to have an impact on patient care is one of the many reasons why nursing leaders should consider pursuing a doctoral degree. With a doctorate in nursing, leaders will be equipped with the knowledge and skills they need to navigate the complex landscape of health care. They will also be able to better understand the needs of their patients and develop evidence-based solutions that improve care. In addition, a doctoral degree will allow nursing leaders to serve as faculty members at nursing schools, where they can educate the next generation of nurses.
Importance of Doctoral Level Training for Nurses
There has been strong support and encouragement via the Institute of Medicine for doctoral level programs in practice (the Doctor of Nursing Practice [DNP]) and research (PhD programs) for nurses with the aim of doubling of the number of doctoral level nurses.
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Doctoral level programs are beneficial for the health care system in that they enable nurses to collaborate more effectively with physicians and other health care providers and to take on leadership roles to reform the health care system. Doctoral level nurses can conduct research which adds to basic knowledge but also informs nursing science and evidence-based practices. The DNP degree prepares nurses for leadership positions in clinical settings, administration, teaching, quality improvement, and health policy.DNP programs have generated nurses that have contributed new skills and new knowledge to their inter-professional team and have improved the quality of patient care in the health care system.
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Furthermore, DNP programs have the potential to educate fellow nurses in designing nurse interventions and procedures via their competence in finding, synthesizing, and applying evidence appropriately. This would mean significant impact for the hospitals with these new acquired skills.5
In addition, DNP graduates can contribute enhanced knowledge to the health care systems through better understanding of policy issues and finance as well as professional leadership. These skills will lead to the redesign of the health care systems and train clinical leaders for evolving practice.5
Interdisciplinary collaboration is a crucial necessity in healthcare systems as the scientists are reported to be increasingly reliant on such teams to provide answers to complex issues in their field. There must be an increase in the generation of doctoral level nurses as they can be a vital addition to an interdisciplinary team where they can contribute to both didactic coursework and experiential research.
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Creating an interdisciplinary postdoctoral fellowship training program gives a chance to individuals to pursue their doctoral degrees knowing they will then be wanted in a team to work collaboratively as different medical professionals to generate effective and innovative research.6
It also important to note that pursuing doctoral degree is an enormous decision an individual can make. It can be quite overwhelming. As such, certain individuals may need more support to overcome obstacles in their doctoral journey. These are the underrepresented minority groups typically self-identified as African American, Hispanic, Asian/Native Hawaiian, American Indian, and Multiracial individuals.
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Doctoral prepared underrepresented minority (URM) nurse leaders can support and assist other URMs in their doctoral journey by providing mentorship and recourses and their experiences. Medical faculty members of any background must provide mentoring and support to URMs in a way that is reflective of antiracist and an inclusive environment.7
It is evident that nursing doctorate degrees can contribute major benefits to patient care which can lead to the overall improvement of health care systems. As such national support, funding URMs are needed for the generation of nurses with doctorate degrees.Development of the Cohort Program
The DNP program at The Frances Payne Bolton School of Nursing, Case Western Reserve University is a 34-credit program that is offered virtually (3 online courses) and through intensive in-person sessions. Intensive sessions are convened for 5 days on the Cleveland, Ohio campus. Other classes are offered offsite at various locations for 8 hours in January, May, and August. There are 18 credits of core classes, 6 credits of inquiry classes, 5 credits of project bases courses, and 5 elective credits in practice leadership, educational leadership, or executive leadership (See Table 1). The program duration is for 2 years.
Table 1Outline of the Curriculum for the DNP Program
| Executive Leadership Program (34 credits) |
|---|
| Core Courses (18 credits) |
| NUND 450 (3 credits): Applied Statistics (online) |
| NUND 510 (1 credit): Informatics (online) |
| NUND 610 (3 credits): Translating Evidence into Nursing Practice (online) |
| NURS 508 (3 credits) Health Policy Development and Implementation |
| NUND 506 (3 credits) Leadership In Organizations and Systems |
| NUND 504 (3 credits) Theories for Nursing Practice and Scholarship |
| NUND 611 (2 credits) Practicum (No-formal class sessions-arranged with the advisor and preceptor/s) |
| Inquiry Courses (6) |
| NUND 540 (3 credits) Practice-Focused Inquiry I |
| NUND 541 (3 credits) Practice Inquiry II |
| Project Based Courses (5 credits) |
| NUND 619 (2 credits) Proposal Development (No-formal class sessions arranged with the advisor) |
| NUND 620 (3 credits) Scholarly Project (No-formal class sessions arranged with the advisor) |
| Executive Leadership Track Electives (5 credits) |
| NUND 512 (2 credits) Advanced Leadership and Management in Health Care Organizations |
| NUND 612 (3 credits) Transformational Leadership in Executive Nursing Practice |
Nurses enrolled in the DNP program learn nursing science and theory, organizational and systems theory to address quality improvement and systems thinking, evidence-based practice, information system/technology and informatics, health care policy and advocacy, interprofessional collaboration, and how to utilize scientific data on clinical prevention and population health to reform health systems and improve health. Students learn about the nursing profession on a regional, national, and global level. For example, DNP candidates have opportunities to learn about and engage in global initiatives such as the International Council of Nursing, an organization comprised 130 national associations devoted to nursing and established to advance the nursing profession, advocate for sound workforce competencies and practices, and ensure the growth of knowledge, quality nursing care and comprehensive health care policies. Participants were able to visit the United Nations and legislative bodies to observe nursing bills being introduced and voted upon.
Students must maintain a minimum average of 3.00 in all classes. The capstone of the degree is the DNP project focused on addressing an issue that will improve patient outcomes. The DNP student designs the project with assistance from a 3-member committee and Program Director, implements the project as a thesis or publication, obtains feedback from the committee and defends the final project orally to the committee, faculty and other students. Once approval is obtained the degree is awarded.
Program Design
The Bassett Health Care System comprised 6 hospitals, 107 community, 26 school-based health centers, 2 skilled nursing facilities, and affiliated health care providers provides services to residents of Central New York who live in 8 counties.
Denise Robinson, DNP, MPH, WOCN, Senior Vice President Chief Nurse Executive, negotiated with the Bassett Health Care System to offer nurses with masters degrees the opportunity to pursue higher education with 100% reimbursement. The Bassett Health Care Network would cover the cost of the executive program which would allow nurses to work full time while completing their online coursework and inperson intensive sessions. Nurses had to agree to continued employment at the health care facility for 2 years postdoctoral degree.
Dr. Robinson outreached to nurses in leadership positions who met the program criteria and explained the DNP program. This was followed by a virtual meeting conducted via zoom with Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, who serves as the program ambassador, director, preceptor, mentor and advisor. An administration assistant helped with the onboarding and registration process. Potential candidates were then interviewed by a program advisor. Dr. Robinson set up the tuition payment special accounts with our accounts payable.
Description of the Cohort
Twelve students were recruited for participation in the program; 2 did not complete the program. One nurse took a job with a different health care system and another was concerned about the reimbursement process.
Thus, 10 nurses employed by the Bassett Health Care network became part of the cohort of the Doctoral of Nursing Practice Program at Case Western Reserve University, the Frances Payne Bolton School of Nursing.
The majority of the cohort were women and worked in a variety of departments including trauma, critical care, education, and quality care. Four members of the cohort were currently managers or directors.
Program Impact
Qualitative and quantitative evaluation strategies were used to assess program implementation, impact on the participating nurses, and the project’s effects on the Health Care Network.
All 10 of the participants completed the program. Seventy percent of the cohort will graduate in May 2023 and program effectiveness has led to 2 additional cohorts.
Participants showed a growth in leadership skills and self-esteem and their supervisors noted their enhanced contribution to their departments. The program which provided leadership and mentoring increased the morale of the participants. Nurses were provided with a professional incentive to stay with the health care system and this leads to retention during the pandemic. The program’s emphasis on clinical as well as management skills enabled nurses to change their roles, take on leadership positions, and practice in a different way.
When asked to reflect on the professional impact of the DNP program and whether being a member of the cohort was a positive or negative experience, nursing directors in the DNP program responded as follows:
“The DNP program has reignited my passion for learning and helped me look at the profession through a more global lens. I am truly appreciative of our cohort because it provided an opportunity for knowledge sharing and encouragement that we can accomplish this together.”
“The value of the program – the connectivity and mentorship of nurses throughout the world and country by being in the program is immeasurable. The value of doing a cohort with peers – the emotional, mental support coupled with ‘no man left behind’ culture is spurring us through..even in difficult times. If I was doing this solo…like my MSN.. not sure if I would be as successful.”
“The connections, support and open doors that I have received through this DNP program have been forever life changing.”
“I could go on and on! The DNP program has completely opened up my mind to all of the national and global possibilities in nursing. I have a much broader lens of what my responsibility as a nurse leader is and how I can apply what I have learned to make a difference. Thank you for bringing this to us.”
“The DNP program has been and epiphany into the true meaning of professionalism in nursing and nursing leadership. Belonging to the cohort has fostered collegiality and cohesiveness among team members.”
The participants are eager to pursue additional opportunities for career advancement and are considering enrolling in The Nurse Leadership Academy at the Frances Payne Bolton School of Nursing, Case Western Reserve University which was created was by Marian K. Shaughnessy, DNP, RN, a renowned nursing leader, and opened in May 5, 2022. Nurses can be involved with transforming health care by using leadership skills to develop and implement policy and to design, plan, manage, and deliver quality care. Through “education, scholarship, research, and faculty development” (https://case.edu/nursing/nurse-leadership-academy/components-of-leadership), nurses can acquire the knowledge and skills to be effective change agents at the local and national level.
Conclusion
In my tenure as a Senior Vice President/Chief Nurse Executive, one of the most important things I have worked on is getting support to pay for 12 nursing directors to complete their doctorate in nursing practice. This was no small feat, and it took a lot of hard work and dedication to get the support we needed. It was worth it. These nurses are now leaders in their field, and they are making a real difference in the lives of their patients. They are also setting an example for other nurses who are considering pursuing their own doctorates. I am proud of what we have accomplished, and I know that this cohort of nurses will continue to make a positive impact on the nursing profession for years to come.
Nurse leaders have the unique opportunity to lead by example and inspire others to do the same. When we set ourselves as an example of what it means to be a nursing leader, we elevate the profession and show others what is possible. Nursing leaders can elevate the professional practice and become a role model for other organizations. Nursing leaders have the unique opportunity to influence the nursing profession at large by demonstrating excellence in nursing care and promoting best practices within their organizations. When nursing leaders set the example of providing high-quality patient care and continuously improving nursing practice, they inspire other nurses to do the same. This, in turn, elevates the nursing profession as a whole and sets a positive example for other health care organizations. By continuing to develop nursing leaders who are role models for excellence in nursing care, you can help to ensure that the nursing profession continues to make a positive impact on the health of individuals and communities around the world.
References
- Medscape nurse career satisfaction report 2020.(Available at:)https://www.medscape.com/slideshow/2020-nurse-career-satisfaction-6013455Date: 2020Date accessed: October 23, 2022
- Mass Trauma experienced by the global nursing workforce.(Available at:)https://www.icn.ch/news/covid-19-effect-worlds-nurses-facing-mass-trauma-immediate-danger-profession-and-future-ourDate: 2021Date accessed: October 24, 2022
- COVID-19: impact on nurses and nursing.Am J Nurs. 2021; 121: 19-21
- Nurses in the United States with a practice doctorate: Implications for leading in the current context of health care.Nurs Outlook. 2015; 63: 124-129
- Impact of Doctor of Nursing Practice education in shaping health care systems for the future.J Nurs Educ. 2013; 52: 423-427
- An interdisciplinary postdoctoral fellowship model: opportunities for nurse PhDs.J Nurs Educ Pract. 2020; 10: 33
- Pursuing a doctorate in nursing: Implications for underrepresented minority nurses.J Prof Nurs Official J Am Assoc Colleges Nurs. 2022; 39: 117-121
Biography
Dr. Denise M Robinson, DNP, MPH, WOCN, is Coldiron Fellow 2022, Miller Fellow 2021, Marian K. Shaughnessy Nurse Leadership Academy, Frances Payne Bolton School of Nursing, Case Western Reserve University and Adjunct Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University. She can be reached at [email protected]
Article info
Publication history
Published online: December 05, 2022
Footnotes
Note: Thank you to Dr. Joyce Fitzpatrick, , PhD, MBA, RN, FAAN, FNAP and Linda Everett, PhD, RN, NEA-BC, FAAN, FAONL for their expertise, leadership, mentorship, and support. This submission did not receive any specific grant from funding agencies in the public, commercial or not-for profit sectors.
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2022 by Elsevier Inc. All rights reserved.
