[Steven Watson]

Hi Avery,

I like your question because it is one I asked myself a lot before deciding to go back to school. I think everyone should do an honest cost-benefit analysis for the options in their situation. This topic is not limited to advanced practice either as nurses starting out have many options. For example, my sister once found a job as a licensed nursing assistant which paid only $3/hr less than my Bachelor’s degree with 5-6 years experience, granted our scope of practice was quite different.

I found an interesting comparison on Michigan State University’s website between their MSN & DNP programs. Both curriculums take the same core classes and 4 classes in diagnosis & management with the DNP track adding a 5th class in diagnosis and management and 3 classes for the DNP project. The written description of the DNP track included the statement “The program develops practitioners who design, implement and evaluate high quality and cost-effective health care services for diverse populations including the disadvantaged and underserved.” If I am reading between the lines correctly, that means the MSN track does not include all aspects of design, implementation, and evaluation. This leads me to believe that MSN-prepared APRNs may be restricted in their role to implementing the evidence-based practices which the DNP’s design and evaluate, based on the research of Ph.D. prepared nurses. If this is right MSN prepared APRNs may have difficulty when seeking positions that require program development and evaluation.
As for the pay…

[Steven Watson]

This is called team nursing, or at least a version of it. I enjoyed listening to this video, the presenter brought out many good points. One of the most clinically significant points is the decreased risk for cross-infection by fewer persons crossing the infection barrier. The presenter mentioned a moral objection to the use of international nurses where this would leave one country with fewer nurses. As an international nurse, I can say this topic is much more complex than presented. Mass recruitment from other countries doesn’t deal with the issue of the clerical burden being presented.

The clerical burden on nurses is a combination of low perception of nurses by the public (and other health professionals) and the sense of self-worth of nurses. As mentioned in the video others may view nursing as an entry-level position and therefore not necessitating a secretary. Nurses, on the other hand, are trained to be highly sensitive to minute details which should be considered holistically, as such we are reluctant to give up any aspect of our role.

There is only so much we can do/control, especially in crisis situations. Team nursing is an idea borrowed from other disciplines where it has been successfully implemented. Henry Ford famously streamlined car production by introducing the production line where individuals sequentially performed tasks repetitively resulting in high quality and efficiency. This task-focused model of team nursing traditionally has not been executed well. When various assessment tasks are divided it results in the inability to easily consider the patient’s whole situation.

Team nursing can work well when duties are well allocated, like the proposal given by the presenter. This assessor/documenter form of team nursing works well in given situations, like isolated patients, recovery, and precepting new nurses for example. This form uses the TeamSTEPPS closed-loop communication tool by the assessor calling out (or dictating) assessments and the second person reading back (documenting) what is called out completing the closed-loop. The proposal in the video suggests that this second person does not need to be a highly trained RN. This process reduces the number of times a nurse goes between the patient and the recording station, improving efficiency and reducing cross-contamination.

This form of team nursing is not ideal in all situations but could definitely be expanded beyond the situations I mentioned above. The interesting part for DNP’s and Ph.D.’s will be defining the cost-benefit tipping point for this model and obtaining buy-in from nurses and administrators alike. Of course, we should also deal with the other part of the clinical burden equation by promoting the perceptions of nursing among the public and other professionals.

PS. Please don’t connect more than one patient to a ventilator, it will end up under-inflating the person with stiffer lungs and hyperinflating and potentially injuring the other.

[Steven Watson]

Hello, and thank you DNP Inc. and Dr. Linda Roussell for making this information available, I especially appreciate the article Quality Improvement Primer. I am just starting my DNP education and have previously been trained in 6 Sigma Process Improvement methods. I found this interesting and a good refresher though from a different perspective. One thing in the article that jumped out at me was the table differentiating measurements for research and measurements for learning and Process Improvement. I am currently learning about the history and development of Advanced Practice RN’s and their journey through various academic preparation. Some of the differences between a research-focused Ph.D. and a practice-focused DNP are really highlighted in that one table, and it has reinforced the type of data, measures, and outcomes I should be utilizing moving forward. I also liked the 9 points to developing a measurement plan, it is very clear and an important step in the planning process of any PI project. Defining the types of outcomes, and suggesting the measurement of multiple outcomes to demonstrate the project’s effect on the system I think was a very good idea also. After all, if you can’t measure it and demonstrate results, either way, that doesn’t fit the definition of Evidence-based. I will definitely be sharing some of these suggestions for QI/PI projects with my colleagues.

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