In 2004, the American Association of Colleges of Nursing (AACN) issued a position paper intended to transform advanced practice nursing education into a practice doctorate. Doctor of Nursing Practice (DNP) curricular content with essential areas for development and validation of expertise through a project were defined (AACN, 2004, 2006). In 2015, an AACN task force clarified that DNP projects should be conducted in settings to improve a system, population, or outcome, or to evaluate a process or outcome to validate the essentials.
A recent national survey found that DNP programs were challenged to find settings to conduct DNP projects (Dols, Hernández, & Miles, 2017). Thus, the purpose of this article is to describe the formation of an academic–practice partnership between a college of nursing in a public university and a large health system to increase the number of DNP project placements. There is a great need to ensure that DNP programs have curricula that include a project in a practice setting find placements so that advanced practice nurses are prepared to address the needs of our nation (AACN, 2019; Auerbach et al., 2015).
Academic–practice partnerships are collaborative agreements between a nursing program and health care organization that create a mechanism for students to use the knowledge and skills learned during their education (Howard & Williams, 2017; Williams & Howard, 2017). A review of the literature regarding academic–practice partnerships in general is beyond the scope of this article; however, one key point is reported. Collaboration, leadership support in both organizations, and engagement by program coordinators, faculty, and staff along with frequent communication enhance academic–practice partnerships (Harper, Selleck, Eagerton, & Froelich, 2015). There is a paucity of literature regarding academic–practice partnerships to conduct DNP projects. One DNP academic–practice partnership found that a contractual agreement, an evaluation plan, and courses that designed projects congruent with health system goals led to increased collaboration, project placements, and a strong partnership (Howard & Williams, 2017; Williams & Howard, 2017). Thus, a case study of our partnership is described in this article.
A descriptive qualitative case study methodology, based on the constructivist paradigm, was used to describe and understand the partnership over time (Harrison, Birks, Franklin, & Mills, 2017; Mills, Bonner, & Francis, 2006). The academic–practice partnership in its entirety acts as the case in this study. Internal review board (IRB) approval was not required for a case study. Specific aims were to describe each partner's role in relation to the partnership, to monitor partnership components, and to report the number of DNP projects conducted in the health system prior to and after the study.
Setting and Sample
The academic setting was a school of nursing with 125 DNP students in three specialties (adult/older adult and child/adolescent nurse practitioner and health system leader). The practice setting was a Magnet® health system with 14 acute care hospitals and 184 primary care offices. The organizations are located a block apart in an urban area in the Midwest. The sample included PhD- and DNP-prepared faculty in the academic setting and a PhD-prepared health system research nurse (HSRN) in the practice setting.
Measures and Analytic Strategy
Faculty collected data in field notes during meetings, telephone calls, e-mail, and other interactions between the faculty and the HSRN from December 2016 to April 2018. Analysis of data followed a systematic case study methodology and included a review of data under various possible interpretations, such as a search for patterns, seeking linkages between activities and outcomes, drawing tentative conclusions organized by issue, and a review of data to deliberately confirm or disconfirm findings (Stake, 1995). Techniques to establish trustworthiness of the findings included multiple investigators involved in analysis, partnership engagement, dense description, and rechecking of the results (Krueger & Casey, 2000).
The partnership formed in a meeting between one faculty and the HSRN in December 2016, when the question was asked: “How can we work together to mutually benefit both organizations?” Discussion clarified the benefits for each partner.
The identified practice partner benefits included:
- Expanding the capacity to solve “wicked” problems in the health system.
- Assessment of the health system and identified problems to understand the improvements needed.
- A literature review to identify evidence-based solutions.
- Formation of an evidence-based improvement plan (e.g., implementation strategies, intervention).
- An evaluation of the implementation strategies (uptake) and intervention (outcomes).
- Provision of statistical support.
- Development of sustainability plan.
The identified academic partner benefits included:
- Placement sites for DNP student projects.
- Knowledgeable and highly skilled health system mentors.
The HSRN proposed a group meeting between faculty, mid-level health system nursing leadership, and students to identify project topics and mentors. The PhD faculty recruited a DNP faculty member to the team to ensure that DNP essentials were addressed during the project enactment.
Initial Faculty, Health System Nursing Leadership, and Student Meeting
The HSRN chaired a 2-hour meeting in February 2017, which included faculty, five DNP students, and four health system nurse leaders. The HSRN presented the partnership benefits and faculty reviewed the DNP project purpose, objectives, and time line. Students were introduced and reviewed their interests (e.g., cardiac care, palliative care). The HSRN provided support as the leader for DNP projects and discussed potential project topics and mentors. The group standardized the workflow to reduce the burden on the health system and ensure partner needs were met without creating barriers to project completion. This included the health system–required IRB training and application process, communication mode, how to schedule mentor meetings, and tracking project topic and mentor confirmations. The HSRN was charged with contacting five health system mentors regarding overseeing a DNP project. Within 3 weeks, the HSRN confirmed five placements with faculty.
Initial Student–Mentor–Faculty Meeting
Each student scheduled a 1-hour meeting with faculty and the health system mentor. During the meeting, the faculty explained the DNP project, time line, and mentor responsibilities. In response, the DNP faculty asked, “What problems are keeping you up at night?” Mentors reported then discussed six to 10 “wicked” problems, taking into account the academic requirements and time line, as well as health system needs, until a project topic was mutually agreed on. Faculty asked the mentor how the student could obtain data to assess the problem, if there were barriers or facilitators, if strategies were previously tried, and what strategies were suggested to improve the problem in order to prepare the student for starting. Faculty met with students immediately following the mentor meeting and formulated a plan to complete the required paperwork in order to establish the project team and submit the IRB application. Every week, the faculty e-mailed the HSRN regarding the initial meetings.
IRB approvals were obtained for each project prior to obtaining data for an analysis of the problem for the organizational assessment. The health system IRB process was new to faculty, so guidance was required from the IRB on streamlining applications, which reduced the time period of obtaining IRB determinations from 6 weeks to 2 weeks. In July 2017, the HSRN, a member of the health system IRB, asked to approve project protocol prior to IRB submission. This modified the standardized workflow and further reduced the amount of time from application to determination.
Partnership Support for the Organizational Assessment
Guided by the health system mentor, students were immersed into the site and problem. The mentors introduced the students to other health system staff (e.g., pharmacist, quality assurance department) to obtain data on the problem. Students also collected data to complete an organizational assessment. For example, the organizational assessment was conducted through observed transitions of care that were documented in field notes, a staff-completed survey following daily rounds, and workflow standards and creation of a checklist in order to observe enactment. A strength–weakness–opportunity–threat analysis was completed by the student and reviewed with the health system mentor to ensure accuracy.
Literature Review to Support Project Plan
Students conducted a literature review simultaneous to the assessment, which informed factors to examine in the health system, deepening the assessment. On two occasions, the mentor and/or HSRN provided articles on a specific topic (e.g., falls, infections) to enhance the review. Results were shared with the mentor and HSRN to guide development of the improvement plan and were appreciated, as most reported a lack of time to conduct the reviews.
Project Data Analysis
The HSRN facilitated obtaining quality improvement department data, which took longer than expected for one project. Six months into the partnership, the HSRN set up a folder on the health system internal drive to store project data. Each student was assigned a folder, and health system staff members on the project were provided with access. The HSRN and information technology department facilitated use of statistical software for analysis, and students, faculty, and the statistician met in the health system library to conduct analyses.
Dissemination of Project Results
The HSRN held a poster day in the health system to disseminate project findings, and 325 health system staff viewed the posters. A formal project defense included the provision of project findings to the site mentor, and the health system chief nurse officer was invited to attend. The chief nursing officer invited a student to present at the executive council and to nurse leaders.
The faculty and HSRN agreed on a communication plan. The faculty reported student project progress to the HSRN biweekly via e-mail (e.g., initial meetings, IRB determination). Over the year, the faculty contacted the HSRN via telephone two times in order to facilitate projects.
Health System Research Council
The HSRN asked faculty to be research council members and to present on projects at each meeting. The HSRN invited a student to present her project in December 2017 to reduce the prescribing and use of opioids; she was warmly received by the 20 committee members, was asked to distribute the literature review, and was welcomed to become a member of the health system opioid committee. In February 2018, the research council established a process to review project ideas and identify mentors to ensure alignment with health system goals. Between meetings, three members agreed to review projects to ensure student progression.
Expansion of Student Placements
By October 2017, the HSRN requested three additional students for a project, which was her first experience as a mentor. The health system advance practice provider vice president requested a literature review of the value of being a mentor in order to prompt placements, which faculty provided. The following year, 28 projects were identified, and 24 placements occurred. Faculty are routinely invited to attend health system meetings to facilitate placement.
Discussion and Conclusions
Summary of Academic–Practice Partner Roles
Partners had mutual respect regarding both practice and academic goals and communicated often, remaining focused on health system needs and student progression. The HSRN role included the following:
- Engaged health system nurse leaders to identify project topics and mentors.
- Facilitated IRB determination, access to, and storage for data.
- Defined and refined the standardized workflow.
- Problem-solved issues that arose until resolution was attained.
- Appointed faculty to the health system research council.
The faculty role included the following:
- Facilitated communication between the HSRN, departments, and mentors.
- Ensured that data collection and management occurred as required by the health system IRB.
- Ensured that students completed projects on time and in a scholarly manner.
In 2018, the findings were disseminated at two national conferences and several manuscripts were planned.
A strong academic–practice partnership formed, standardized workflows were defined, and DNP project placements increased. Contrary to others (Dols et al., 2017), intentional development of our academic–practice partnership increased student placements for DNP projects. Intentional alignment of projects with health system goals increased engagement and satisfaction of health system leaders and may be a requisite to finding adequate numbers of project placements (Howard & Williams, 2017; Williams & Howard, 2017). Additionally, academic faculty were heavily involved in the projects, regularly attending meetings with health system mentors and maintaining full responsibility and oversight for the ensuring the academic program objectives. This minimized the work of the health system mentor in the project. If health systems can realize a benefit from DNP work, this can outweigh the time burden required to work with students, facilitating future placement.
Notably, DNP project alignment with health system goals ensured that students validated the essentials by improving the system, population, and outcomes and evaluating a process and outcome through completion of a project (AACN, 2015). This was not intentional in the design of this partnership, but rather a positive incidental finding. Not only did alignment with organizational goals leverage benefit to the system, it also enriched the student learning experience.
The academic–practice partnership described resulted in an efficient standardized workflow, IRB processes, and communication modes; identification of project topics and mentors; and design of enhanced student learning and on time assignment completion. Graduation rates and other metrics are reported elsewhere (VanderKooi, Conrad, & Spoelstra, 2018). Finally, similar to the findings of the literature (Harper et al., 2015), collaboration, engagement, frequent communication, and leadership support in both organizations enhanced the partnerships.
Academic settings that pursue formation of formal partnerships within practice settings are more likely to have an adequate number of placements for DNP projects. Building a relationship in an intentional manner to mutually benefit both partners can lead to a stronger academic–practice partnership. Standardizing workflow, communication modes, identification of project topics and mentors, and IRB processes that are codesigned by academic–practice partners ensure that attention is paid to alignment with health system goals while ensuring student progression.
Academic faculty members are encouraged to build relationships with health system leaders to facilitate DNP project placement. Faculty, as opposed to students, are in a better position to understand the aims and needs of the institution. Faculty who play a visible role in project placement and facilitation may be contacted for future student opportunities, as was experienced in this partnership. Both students and the health system benefitted from faculty involvement in project placement, decreasing the burden for all parties. The partnership described can serve as a model to ease the AACN project requirement for doctoral practice programs.
- American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Retrieved from https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Practice-Doctorate
- American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from https://www.aacnnursing.org/News-Information/Publications
- American Association of Colleges of Nursing. (2015). The doctor of nursing practice: Current issues and clarifying recommendations. Retrieved from https://www.aacnnursing.org/Portals/42/News/White-Papers/DNP-Implementation-TF-Report-8-15.pdf
- American Association of Colleges of Nursing. (2019). DNP fact sheet. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet
- Auerbach, D.I., Martsolf, G.R., Pearson, M.L., Taylor, E.A., Zaydman, M., Muchow, A.N. & Lee, Y. (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, 3.28083356
- Dols, J.D., Hernández, C. & Miles, H. (2017). The DNP project: Quandaries for nursing scholars. Nursing Outlook, 65, 84–93. doi:10.1016/j.outlook.2016.07.009 [CrossRef]
- Harper, D.C., Selleck, C.S., Eagerton, G. & Froelich, K. (2015). Partnership to improve quality care for veterans: The VA nursing academy. Journal of Professional Nursing, 31, 57–63. doi:10.1016/j.profnurs.2014.06.004 [CrossRef]25601246
- Harrison, H., Birks, M., Franklin, R.C. & Mills, J. (2017). Case study research: Foundations and methodological orientations. Forum: Qualitative Social Research, 18, 1–17.
- Howard, P.B. & Williams, T.E. (2017). An academic-practice partnership to advance DNP education and practice. Journal of Professional Nursing, 33, 86–94. doi:10.1016/j.profnurs.2016.08.010 [CrossRef]28363393
- Krueger, R.A. & Casey, M.A. (2000). Focus groups: A practical guide for applied research (3rd ed.). Thousand Oaks, CA: Sage.
- Mills, J., Bonner, A. & Francis, K. (2006). The development of constructivist grounded theory. International Journal of Qualitative Methods, 5, 25–35. doi:10.1177/160940690600500103 [CrossRef]
- Stake, R.E. (1995). The art of case study research. Thousand Oaks, CA: Sage.
- VanderKooi, M.E., Conrad, D.M. & Spoelstra, S.L. (2018). An enhanced actualized DNP model to improve DNP project placements, rigor, and completion. Nursing Education Perspectives, 39, 299–301. doi:10.1097/01.NEP.0000000000000384 [CrossRef]30096113
- Williams, T.E. & Howard, P.B. (2017). An academic-practice partnership model to grow and sustain advanced practice nursing. Journal of Nursing Administration, 47, 629–635. doi:10.1097/NNA.0000000000000558 [CrossRef]29135854