Good afternoon it is an honor to be here. Today is a special day, as it’s my 7 year anniversary as a nurse and so I’m thrilled to be sharing it with you all to talk about a dream come true which is pursuing my doctorate degree and what the benefits could be for you.

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Second Degree Nursing Student

Nursing is my second degree, but I always wanted to pursue a doctorate degree because I always wanted to be in a position with multiple options and where fewer people can tell me no. I started the part time BSN to DNP program at GWU in the fall of 2016. I graduated from the AGPCNP program in May of last year and then started the DNP program two weeks later. I spent the summer in class and studying for boards which I took and passed in August. I made the difficult decision to not transition into an NP job at this time to allow me the opportunity to devote my attention to the program full time, keep my current job which is very supportive and predictable, and to keep my stress level as low as possible. Additionally, I already have an established relationship with an organization when it comes time to work on my DNP Project which is a big part of the program.

The DNP is a Degree, Not a Role

Obviously I’m here today because I highly recommend that you all consider advancing your education as well, especially as a nurse and soon to be nurse practitioner. Any time you have more people on your team who can be change agents, your team becomes better at what they do and how they do it, which means they will be more effective, more efficient, more innovative and be able to do so at a lower cost.

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I want to start by saying, the DNP is a degree, not a role. Per the American Association of Colleges of Nursing, the DNP Essentials, and The Doctor of Nursing Practice textbook by Chism that is used in the DNP Residency course, the DNP is a terminal degree for advanced practice nursing (APN). The degree does not lead to specialization within itself, instead it builds upon the advance practice specialization obtained during the master’s preparation. Nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists are all examples of APNs (Chism, 2016; American Association of Colleges of Nursing, 2004). Additionally, since we are talking about education, it’s also important to point out that the DNP program and project should not be confused with the discipline of education which includes its own body of knowledge and competencies. Although DNP and PhD trained nurses obtain the expertise to serve as educators, DNPs are advised to obtain additional training (in the educator role and pedagogical methodologies) to effectively do so (see Recommendation 12 of the DNP Essentials) (American Association of Colleges of Nursing, 2004).

DNP vs PhD

We refer to ourselves as DNP graduates who have the ability to translate knowledge into clinical practice. This is opposed to PhD prepared nurses who generate new knowledge and typically work in research and academia. The program is designed to help you identify change, lead change, motivate others to change, and teach you about resources you can use to sustain those changes. You will attend class online with other NPs, clinical nurse specialists, nurse educators, and nurse executives. Both faculty and students alike come with an extensive array of credentials and experiences at the local, national and international level, many have and are currently working in top leadership positions of organizations you cite in your papers! I can’t stress enough what a privilege it is to learn from them and with them.

Inside the Program
So, what’s the program like?  A lot of it is what you are accustomed to, weekly sessions with group discussion boards, individual and group assignments which include written reports, PPT presentations, and Blackboard Collaborate presentations. Sometimes you are asked to reflect on your past experience with implementing change in the workplace either from the position of a subordinate or a leader using the current literature to apply theoretical frameworks to analyze the change initiatives and/or leadership styles. Other times you are asked to identify opportunities for improvement in your current work setting and then use the literature, various frameworks and change theories to develop strategic solutions you would implement as a leader that are more efficient, effective and at a lower cost.

You’re going to be asked to take a step back from the problems of delivering direct patient care, and look more broadly at the organization you work for to identify system level problems, solutions, key players, stakeholders, beneficiaries and the factors that influence positive and negative outcomes at the systems level. Then you are going to be asked to take another step back and look more broadly at the health care system where there are even more players, influencers, and structures impacting outcomes, costs, access, and quality of care.

Social Determinants of Health

When we take a step back to look at the health care system itself, we introduce social determinants of health and those upstream factors that impact the ability to provide and receive care that is efficient, effective, and equitable for all people of all ages, races, and socioeconomic statuses. We have realized those upstream factors of health directly influence direct patient care for both the provider and the patient, and our failure to address them has led to higher costs and lower outcomes in the United States compared to other countries. By upstream factors I am talking about things like housing, education, transportation, and food insecurity that impact whether someone shows up for their annual physical. So, in the program you will learn more about the social determinants of health and how important it is for nurses at all levels to be political advocates, speaking up on behalf of your patients, and the benefits of becoming a political leader.

Systems Level Thinking
At the health care systems level, we focus less on individuals and more on populations, and so you’ll just expound on the knowledge you’ve obtained in your NP program when it comes to population health, which is one of my favorite topics. At each level we talk about how NPs can use health information technology to gather data, analyze processes, disseminate knowledge and communicate with the public. Innovation is a large part of our society, therefore it has to be a part of the program because it’s a large part of our practice and it’s an excellent tool to promote patient engagement and self-management.

Program Insight

Each semester you gradually work towards understanding the requirements for the DNP Project which will take place at an organization you work for or have an agreement with. This can be tricky for new NPs who don’t know where they will be working when they start their DNP project. You will implement a change initiative based on their strategic values, stakeholders’ interests, and availability of resources. It’s advised to find an organization sooner than later, which depends on whether you are full time or part time. Full timers take up to 4 classes, I only take 2 and eventually I will only have 1 class a semester. Full timers who started with me are in the beginning stages of their DNP Project, I will begin in the fall. Many students are married, parents, and working full time. My hats off to them. The age range is wide, there are both men and women in the program, and we are located across the country. The only requirement that I know of that has to be in person is your DNP Project, so far I haven’t had any on campus or clinical requirements.

The program is heavily leadership focused, it doesn’t mean you have to stop being an NP who works directly with patients, it just means you’ll be more prepared to lead change from whatever position you find yourself using data. What we do is very data driven. You’re going to learn a lot about what NPs can actually do, it’s so motivating and so inspirational to hear how NPs have used data they have analyzed and collected:
-to identify gaps in care
-to use change initiatives to improve outcomes
-to provide support for their value in the workplace
-to help them create jobs that weren’t even in existence

The faculty is more than understanding and accommodating and it has always been my experience that they want to see you succeed and their actions reflect that. Only a handful of us started the DNP immediately after graduating the NP program, the rest of them had at least one year experience, and they tend to have had a less stressful transition into the program and better time management. In this program you are provided a blank canvas and given the tools to create whatever experience you want.

Practicing at the Highest Level

In closing I would like to remind you that nurses comprise the largest segment of the healthcare workforce. If you only see or work within the space of direct patient care, you are not working to the full scope of your education and expertise.

I hope I have said something today that inspires you to dream beyond your current state of imagination and understanding, and to pursue a journey to find out all that you are truly capable of achieving and becoming.  Of course here at GWU, we hope you pursue that journey in our DNP Program.

If you ever have any questions now or in the future, please don’t hesitate to ask. Thank you again for your time.

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Kimberly Madison, DNP, AGPCNP-BC

Kimberly Madison is a nurse practitioner with a passion for writing, entrepreneurship, education, and mentorship. I created this blog to share my journey as source of motivation and as a blueprint as you embark on your journey. Most importantly, I’m looking forward to increasing access to dermatology education and clinical training for aspiring and practicing nurse practitioners. I invite you to view the mission and vision statement on the homepage to see how we can best partner to make our dreams align.

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