The Doctor of Nursing Practice (DNP) graduate is expected to acquire and synthesize knowledge and competencies to improve health care outcomes through a culminating DNP project. In March 2020, a global crisis and national state of emergency was proclaimed because of the COVID-19 pandemic, which disrupted all aspects of people's lives and livelihood, including the education system, research, and scholarship. During the COVID-19 pandemic, DNP programs have been particularly affected by barriers to implementation of practice scholarship projects. With both community and acute care practice settings prioritizing management of COVID-19 patients, student access to practice sites at all levels was paused. This delayed progress toward the implementation and approval of DNP projects by institutional review boards (IRBs) and/or nursing research councils. Despite the challenges to implement DNP projects over the past decade, the arrival of the unprecedented COVID-19 pandemic created new challenges for DNP students and educators. The purpose of this article is to identify barriers and strategies to support DNP students to be successful in implementing DNP projects during a global pandemic. This article focuses on inspiring educators to prepare learners to become leaders in health care issues and trends.
Barriers to Implementing a DNP Project During a Pandemic
Research related to the rigor and quality of the DNP projects indicates that the DNP project provides a foundation on which to base future practice scholarship for the learner. Historically, one of the major barriers to DNP project implementation has been garnering support from a practice organization, including the support of nurse leaders to instill the integration of current best evidence into organization practice. Prior to COVID-19, “most of the schools (76 of 91) cited challenges maintaining clinical sites or capstone programs” (Auerbach et al., 2015, p. 33). DNP program “directors articulated the need for detailed processes that determine whether IRB approval is needed or streamlined IRB processes, which allow a nonresearch application-specific review process, documentation, and approval mechanism for QI [quality improvement]-type projects” (Dols et al., 2017, p. 89).
Strategies to Reenvision DNP Projects to Meet Organizational Goals
Nurse educators can support and promote DNP students to conduct a rigorous scholarly project within the context of a pandemic crisis by exercising innovation, flexibility, and the ability to pivot to meet challenges and address the barriers to implementing DNP projects. Strengthening academic practice partnerships can pave the road to success.
Needs Assessment of Organization Priorities During a Pandemic
DNP students can be guided to conduct a needs assessment of the practice organization to include a review of the organization's strategic plan to identify organizational priorities, as well as analysis of the organization's mission, vision, and values. If physical access to the practice site is denied during a pandemic, a needs assessment may be conducted virtually through website review, telephone calls, and live virtual connection sessions. Interviews with organization leaders, providers, staff, and potential stakeholders will reveal strengths, weaknesses, opportunities, and threats to implementing a DNP project. The needs assessment may reveal shifting organizational priorities during the crisis that will inform DNP project evolution.
DNP students should be encouraged to engage in a practice change project that meets the most pressing needs of the organization at the time. Aligning the aims of the DNP project with the organization's strategic plan engages stakeholder buy-in, provides project traction, and can accelerate the project progress. Agreement on outcome measures to be evaluated between the practice site and the DNP student is needed. Access to human and material resources within the organization must be assessed, evaluated, and secured to ensure successful outcomes of the project. Discussion with quality officers, informatics specialists, access to the electronic health record, and access to staff via staff meetings and council meetings are important ways to leverage the project.
Reenvisioning DNP Project Types
Faculty may need to reenvision DNP projects to add greater flexibility, including the implementation method, time line, and scope of the project. A flexible and adaptable process for collaboration with colleagues is necessary to promote successful DNP projects and demonstrate outcomes to stakeholders. Engaging mentors from the practice site to serve on the DNP project committee can lead to success. Reenvisioning DNP projects to focus students on selection of one of four types of DNP projects is one successful strategy to address challenges during a pandemic.
Faculty guidance toward one of four types of DNP projects that do not involve human subjects research has proven to be successful in addressing barriers and time challenges: (a) translation of current best evidence into practice, (b) quality improvement, (c) program development and evaluation, and (d) policy analysis projects, all of which may be most beneficial to practice partners. Moran et al. (2020) stated, “The importance of a tight project that aligns the scientific approach with the appropriate study design, data collection, and evaluation cannot be understated” (p. 155). Creating pathways for defining projects, implementing changes in practice, and measuring and evaluating outcomes need to be clearly outlined for each type of project.
A flexible approach to selecting a population and an implementation method may be critical during a pandemic. For a translation of evidence into a practice DNP project, improving the use of screening tools for cervical cancer may not be feasible at a time when well visits and screening examinations are being deferred. Pivoting the project to education of providers and risk mitigation efforts to improve providers' follow-up of select patient populations may be successful for both the practice setting and the student.
A quality improvement project originally conceived to improve self-care management of patients with diabetes through small-group patient education sessions may need to be converted to a virtual connection with electronic educational modules accessible during a pandemic. Telehealth visits may be a new implementation for follow-up and individual sessions provided. Inadequate access to resources for patients may be revealed and need to be addressed in this project to provide equitable care.
For a program development and evaluation DNP project type, redesigning the focus and reframing the scope of the project can be beneficial. Broad-based redesign of orientation of nurses new to an acute care setting may not be the top priority in the organization during a pandemic. However, designing a just-in-time training to allow medical–nursing staff to quickly adapt to higher acuity level units within the organization may meet the staffing needs during a pandemic and become a sustainable model for staffing in the future.
The COVID-19 pandemic provides a window of opportunity for policy analysis and recommendation for policy change concerning the provision and reimbursement of telehealth visits. This could have potential policy implications at the local, regional, or national levels and can be addressed in a DNP project designed to seek and provide access to adequate resources for patients. Reimbursement of providers can also be addressed.
IRB Review and Determination of Human Subjects Research
IRB reviews may be slowed during a pandemic and present a barrier to DNP project success. Academic and practice process innovations to shorten time frames for DNP project approval might include the implementation of a worksheet for the determination of human subjects' research to alleviate the burden on practice site research councils and IRBs. If a quality improvement project is designed to meet the organization's needs, it may not involve human subjects research that is generalizable to a population beyond the scope of the organization or system. Implementation of a worksheet for the determination of human subjects' research can help to alleviate the burden on practice site research councils and IRBs.
Educators must prepare DNP graduates to serve as leaders in health care in the context of current health care issues and trends. During a pandemic, the ability to pivot and create an innovative DNP project that is relevant to practice organizations ensures success. Pivotal strategies to overcome barriers to DNP project implementation include finding projects that align with practice organizational goals, identifying and demonstrating practice outcomes to stakeholders, implementing one of four different types of DNP projects that do not entail human subjects research, and demonstrating flexibility in the selection of population and scope of the DNP project.
- Auerbach, D., Martsolf, G., Pearson, M., Taylor, E., Zaydman, M., Muchow, A., Spetz, J. & Dower, C. (2015). The DNP by 2015: A study of the institutional, political, and professional issues that facilitate or impede establishing a post-baccalaureate Doctor of Nursing practice program. Rand Health Quarterly, 5(1), 33.
- Dols, J. D., Hernández, C. & Miles, H. (2017). The DNP project: Quandaries for nursing scholars. Nursing Outlook, 65(1), 84–93 doi:10.1016/j.outlook.2016.07.009 [CrossRef] PMID:27667699
- Moran, K., Burson, R. & Conrad, D. (2020). The Doctor of Nursing Practice scholarly project: A framework for success (3rd ed.). Jones & Bartlett Learning.