Successful collaboration among nurses with PhD and Doctor of Nursing Practice (DNP) degrees is important for advancing the nursing profession in knowledge generation and its translation to practice (Murphy, Staffileno, & Carlson, 2015). The Institute of Medicine's (2010) Future of Nursing report recommends doubling the number of nurses with doctoral degrees by 2020. It also calls for transforming nursing education to emphasize inter- and intraprofessional collaboration. Promoting collaborative endeavors during graduate education may promote a mutual respect and understanding of each other's knowledge and skills, and engender a culture of collaboration that extends beyond graduation. This article describes an innovative collaborative experience that paired PhD and DNP students together to complete dissertation and capstone projects at a school of nursing during their program of study. The role of the PhD-prepared nurse is establishing scientific knowledge for the discipline through research, and the focus of the Doctor of Nursing Practice-prepared (DNP) nurse is translating research into practice (American Association of Colleges of Nursing [AACN], 2010). DNP-prepared nurses practice at the most advanced level of nursing and create evidence-based strategies to improve practice and health care (AACN, 2006). Both nursing degrees aim to advance the profession and improve health outcomes (AACN, 2014; Bednash, Breslin, Kirschling, & Rosseter, 2014).
Intraprofessional collaboration is the partnering of two disciplines from the same profession (Bainbridge & Nasmith, 2011). By working together, PhD- and DNP-prepared nurses can ask important questions, conduct useful research, and further the development and use of knowledge in the nursing profession (Edwardson, 2010). Collaboration allows for synergy by optimizing skills and knowledge; however, the partnering of PhD- and DNP-prepared nurses may be challenging due to a lack of understanding of each other's roles and unique contributions. A lack of understanding of the DNP-prepared nurse's role has been found to exist in both academic and practice settings (Mancuso, Udlis, & Anbari, 2016; Melynk, 2013). This may be a result of the DNP degree being fairly new to nursing and the variability that exists in DNP program curricula (Udlis & Mancuso, 2015). With that in mind, collaboration that begins during graduate education can provide a better understanding of the skills and knowledge of each doctorally prepared nurse and lay the foundation for future partnerships among PhD- and DNP-prepared nurses (Edwards, Rayman, Diffenderfer, & Stidham, 2016).
The University of Washington school of nursing is an ideal environment for those with backgrounds in nursing and allied health sciences who envision themselves as leaders within the nursing world. Each year, 15 to 20 PhD students and 100 DNP students are accepted into their respective programs. The PhD and DNP students do not have any joint required coursework, and collaboration opportunities have not been established as a formal part of their graduate education. Informal collaboration is supported but not required.
PhD students at the University of Washington school of nursing are expected to develop their own unique research questions, built on a foundation of their life experiences, program of study, partnerships with colleagues, and mentorship by faculty. Dissertations must represent original scholarly work, reflect a mastery of research techniques, contribute to nursing science in the student's major field of study, and be disseminated in publications.
The University of Washington school of nursing's DNP students develop a personal program of study with a focus on appraising evidence, making recommendations to adapt clinical guidelines to the unique population or characteristics of a specific health care setting, disseminating the latest evidence, and implementing changes or evaluating the effects of changes in practice or new protocols. DNP capstone projects are systematic investigations of questions about practice that evaluate and translate evidence into practice. Most often, each DNP student will be engaged in only one phase or step of translating evidence into practice, and the DNP students' work can overlap with PhD students' research. Intraprofessional collaboration among PhD and DNP students on dissertation and capstone projects requires them to share knowledge of similar interests and goals.
Two University of Washington's school of nursing faculty members—one PhD-prepared and one DNP-prepared—had identified that they were advising PhD and DNP students with similar research and clinical interests. One of the goals for both groups of students was the mastery of a defined set of clinical or research skills focused on pain and pain management. The PhD students were to develop skills in grant proposal writing and conducting pain research, whereas the DNP students were to further their clinical scholarship and analytic methods for evidence-based pain management (EBPM) practice. Both faculty members felt strongly that encouraging the students to collaborate on dissertation and capstone projects would result in synergy, while building on the students' strengths and experience. In addition, students would come to better understand the different perspectives and roles of PhD- and DNP-prepared nurses. Finally, the students' scholarly activities of publication and presentation could also be facilitated through collaboration.
The two faculty members developed a pilot project to facilitate the development and implementation of dissertation and capstone projects through collaboration among PhD and DNP students. The five-stage process model of collaboration (Gitlin, Lyons, & Kolodner, 1994) was used by those students who partnered on dissertation and capstone projects. This model is based on core concepts from team-building literature (French & Bell, 1999) and social exchange theory (Emerson, 1976). Social exchange is a fundamental tenet of collaboration and includes negotiation and evaluation of the benefits of collaboration (D'Amour, Ferrada-Videla, Rodriquez, & Bealuieu, 2005). The model was built specifically to pair academic faculty and health care providers to work as collaborative research or educational teams in developing and implementing research or educational projects in older adults (Gitlin et al., 1994). For this pilot project, it provided a systematic approach for students by delineating the stages of effective collaboration:
- Stage 1: Assessment and goal setting.
- Stage 2: Determination of a collaborative fit.
- Stage 3: Resource identification and reflection.
- Stage 4: Project refinement and implementation.
- Stage 5: Evaluation.
In addition, the model clarified for students that open communication, negotiating roles, and establishing an environment of trust are key to working with each other. The faculty provided guidance to students on using the model.
The two faculty members required the six PhD and six DNP students who were interested to attend monthly 1-hour group meetings for 1 year. Students were in either the second or third year of their programs. Meetings provided opportunities for DNP students to give feedback on the PhD students' dissertation plans, including suggestions for how best to access study participants, achieve entry into a health care organization, and create buy-in with staff for participating in a research project. PhD students provided feedback to the DNP students on research instruments that might benefit a capstone project and how to conduct investigations. In addition, all of the students completed instruments that they planned to use in their dissertation or capstone project. This enabled the students to learn which items might be difficult for study participants to understand and how long it would take to complete a particular instrument. Students also worked together on critical reviews of the literature and evidence. The meetings enabled students to support each other when faced with challenges during their program of study. Students could ask faculty questions, which often benefited others in the group.
The students also participated in a twice-monthly writing group where they focused on developing manuscripts and abstracts for presentation under the guidance of a professional editor. At the end of the year, students were asked to reflect on their experience and provide feedback to the faculty.
The meetings were well attended, with most of the 12 students present at all of the meetings during the 1-year period. The group meetings were viewed favorably, as indicated by this quote from one DNP student:
Meeting with students who are working on similar projects allowed us to brainstorm and work as a team, whether it was related to a literature review or project development/methodology related to projects/research.
Voluntary attendance at the twice-monthly writing groups was also high. Partnerships among the 12 PhD and DNP students resulted in seven publications in journals such as the Pain Management Nursing, the Journal of Pain, and the Journal for Nurse Practitioners. Six of the publications were authored by at least one PhD student and one DPN student; the seventh publication was authored by three PhD students. Six students presented six posters at the Western Institute of Nursing Research annual conference.
Collaboration of a PhD and DNP student on their dissertation and capstone projects occurred six times during the pilot project. The following case example provides the results of one partnership using the five-stage process model of collaboration (Gitlin et al., 1994).
Case Example of Intraprofessional Collaboration
Stage 1: Assessment and Goal Setting. Mutual interests and goals of the dissertation and capstone projects were explored and discussed to reach a better understanding of the potential for collaboration during the first group meeting. In addition, a capstone needs list was created. This list included the project's topic, what help was being requested, the time frame, and the time commitment. After learning about group members' interests and the goals of different students' dissertation and capstone projects, a PhD and a DNP student determined that they had similar interests. The PhD student's focus was on evaluation of oncology nurses' EBPM practices, and although the DNP student's training was in family practice, her interest was in evaluation of pain management documentation in the electronic health record (EHR).
Stage 2: Determination of a Collaborative Fit. After the PhD and DNP students had identified a mutual interest, they met after the initial group meeting to determine whether their skills complemented each other and whether the collaboration was feasible. The PhD student's dissertation research methods included surveys of nurses' attitudes and beliefs about evidence-based practice, qualitative interviews about EBPM practices on the inpatient oncology unit, and quantitative measurement of EBPM practices. It became apparent that the DNP student's capstone project of pain management documentation evaluation dovetailed with this dissertation project. The PhD student had already established connections at two medical centers and was beginning to work on the institutional review board (IRB) application.
Stage 3: Resource Identification and Reflection. The PhD and DNP students did not commit to working together until they both had time to reflect separately on whether or not collaboration was what they wanted. Within several days of their first meeting, each made the decision to collaborate on their projects. Their negotiation included a time line for completing tasks and authorship decisions for manuscripts resulting from their collaboration. It was recognized that both students would need to get permission and training to access the EHR at the two medical centers.
Stage 4. Project Refinement and Implementation. The PhD and DNP student met weekly to review the details of their collaboration and begin project implementation. The DNP student conducted a literature search to identify instruments for evaluating EBPM documentation. She shared her findings with the PhD student and recommended an instrument. After discussing the psychometrics of the instrument and whether it captured the essentials of the two medical centers' pain management policies and procedures, it was mutually determined that the instrument was appropriate for data collection. The DNP student developed a data collection plan, and the PhD student submitted the IRB application. After the research protocol was approved by the IRB, the DNP student collected data from one medical center's EHR, and the PhD student collected data from the other medical center's EHR. The students worked together to evaluate inter-raterreliability of EHR data abstraction. Next, the PhD student entered data from the instrument's paper copy into SPSS® Version 21 software and conducted data analysis. The two students then met to review and interpret the findings.
The DNP's capstone project found that key elements of EBPM documentation were missing from the EHR. These findings were shared with the nursing staff with recommendations for evidence-based strategies to improve documentation quality. The DNP student presented her capstone project as a graduation requirement, wrote a manuscript with the PhD student as a co-author (Song, Eaton, Gordon, Hoyle, & Doorenbos, 2015), and presented a poster at a research conference. The capstone findings were integral to the PhD student's dissertation work. Through a mixed-methods approach that included statistical analysis of the documentation data, the PhD student was able to identify the facilitators and barriers to EBPM practices among an academic and community medical center. Findings were disseminated through the student's dissertation defense, podium and poster presentation at three research conferences, and two publications (Eaton, Meins, Mitchell, Voss, & Doorenbos, 2015; Eaton, Meins, Zeliadt, & Doorenbos, 2017).
Stage 5: Evaluation. At the completion of the dissertation and capstone projects, the PhD and DNP students together conducted critical reflection on the process, teamwork, and outcomes. This cumulative evaluation allowed for an examination of the entire process. Both students benefited from their teamwork and successfully completed their dissertation and capstone projects. The two students formally presented their experience to faculty and students at the school of nursing to educate others on how intraprofessional collaboration can be effective and to encourage others to do the same. Reflecting on the benefits of this collaboration, the DNP student stated that, “PhD students are great resources for DNP students throughout the capstone project.” The PhD student demonstrated her learning about the DNP role and practice, stating that “being respectful of each of our unique perspectives as a PhD and DNP was critical to our success in completing our dissertation and capstone projects.”
Although this is an example of successful intraprofessional collaboration, challenges were recognized and discussed by both students throughout the process. Because the DNP student had clinical commitments related to her graduate program, in addition to work and family responsibilities, it was a stressful time period. The PhD student recognized this but needed to keep the time line on target to meet her own, as well as her partner's, academic deadlines. She provided support and helped her DNP partner to determine how best to get the work done. Their decision-making and communication styles were compatible, which prevented problems from occurring during the collaboration.
The short-term goals of the 1-year pilot project were met. PhD and DNP students worked together when they had not in the past. Students increased their understanding of the training PhD and DPN students receive, as well as an understanding of their distinct skills and knowledge. This provided clarity in what each doctorally prepared nurse brings to the nursing profession. All of the students supported each other in the writing of manuscripts and abstracts, which may have added to their productivity. The case example demonstrated that synergy resulting from intraprofessional collaboration can further the evidence for nursing pain management practice and potentially influence practice through the dissemination of this knowledge. As a result of this pilot project, the school of nursing will be moving forward to establish further opportunities for intraprofessional collaboration as a formal part of its graduate education programs. A limitation of this project was that data were not collected postgraduation to evaluate whether collaboration continued among the participants. These data will be collected as part of the school of nursing's future intraprofessional collaboration activities.
Collaboration of PhD- and DNP-prepared nurses can advance the nursing profession through scientific inquiry of important practice questions and translation of findings to clinical practice. Under the guidance of faculty, successful partnerships can begin in graduate school through formal meetings and scholarly work. Based on the findings of this pilot project, other doctoral programs are encouraged to indoctrinate nurses to a culture of intraprofessional collaboration by promoting teamwork in the completion of dissertation and capstone projects and in the dissemination of findings through publication and presentation.
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