DNP Role SWOT Analysis
Define innovation? The Merriam-Webster dictionary (2018) defines innovation as: the introduction of something new, a new idea, method or device. The emergence and continued dedication to employ the Doctorate of Nursing Practice (DNP) has been fueled by the ever-changing health care reform agenda, the aging and multiplying population health of the United States, and its economic welfare. The Affordable Health Care Act, and visions of increasing the affinity of access to high quality, safe, effective, and cost effective health care, has intensified the calls for advanced practice healthcare providers of all respects. Mcsherry and Douglas (2011) summarize the definition of innovation specific to practice: as the utilization of a professional’s knowledge and skill to artistically create and develop new means of working, utilizing technologies, systems, models and theories with stakeholder input and collaboration to evaluate current practice and catapult it to the next level with means of evaluation and measurement based on evidenced based practice (EBP). Melynk and Fineout-Overholt (2011) define EBP as a lifelong commitment to clinical decision making using the best available evidence, coupled with an individual’s own clinical expertise, and patient centered values and preferences, to ultimately improve outcomes for patients, groups, communities, and systems.
At the heart of innovation to practice in the clinical setting are those that we care for: our patients, their families, our neighbors, and our loved ones. EBP inspires innovation and is essential as we work to attain improved patient outcomes and quality of care. Confusion and argument still exist as to whether or not the DNP is a role versus a credential, however, one can conclude that with the gained knowledge and skills upon obtainment of the DNP academia, DNP prepared individuals become excellent innovators. DNP prepared individuals serve in a wide variety of roles and positions, making relevant contribution to all healthcare lead initiatives (Terharr, Taylor, & Sylvia, 2016). This paper will emphasize the role of a DNP prepared nurse committed to EBP serving as the Director of Evidenced Based Practice in the acute care arena.
DNP Role of Interest: Director of Evidenced Based Practice DNP Leader
in the Acute Care Arena
The Director of EBP DNP leader is responsible for inspiring, cultivating, and sustaining organizational culture rich in EBP, within the acute care arena he or she serves. The vision and inspiration for this role is to improve the means of care delivery, knowledge attainment and utilization to improve practice and patient outcomes, increase collaboration and integration of disciplinary health professionals, and ultimately improve the image of nursing within the organization served and its community. Seated adjacent to and working in collaboration with the Chief Nursing Officer this position and its rank signifies the need for collaboration and commitment to providing evidenced based care, affecting both organizational and nursing strategic goals. This role demonstrates the importance of having a DNP leader committed to EBP in quantifying and signifying the impact and joint venture of what happens within administrative walls to that of how care is provided at the bedside.
In the acute care arena, the Director of EBP DNP leader collaborates, cultivates, and inspires evidenced based nursing interventions to influence health care outcomes within all avenues: direct patient care, education, management, administration, development and implementation of policy, outcome measure and evaluation. The Director of EBP DNP leader, serving in the acute care arena, has the affinity to transform health care across disciplines, inspire innovation, improve the context for which care is provided, and ultimately impact the trifecta of care: cost, quality, and safety. Melynk and Fineout-Overholt (2011) consistently report the influential value of bringing EBP to the forefront of care; leading to the highest quality of care, improved patient outcomes, reduction of costs associated with care delivery, expanding access, empowering providers and their roles, and reducing burnout and turnover in the profession.
The 2004 American Association of Colleges of Nursing (AACN) (AACN Position Statement on the Practice Doctorate in Nursing, 2004) position statement on the Practice Doctorate highlights the critical need to provide professional nurses whom serve in a multitude of leadership roles advancement in professional education. These leaders require enhanced knowledge and skill for clinical and administrative leadership in response to our nation’s current and forecasted health care dilemmas. The AACN (2004) also introduced several benefits to the practice-focused doctoral prepared nurse. Here are a few specific to leadership: enhanced skills to strengthen practice and health care delivery, enhanced knowledge improving practice and patient outcomes, collaboration and integration with other health professions, and ultimately improved image of nursing, affirming the professions high regard by the public.
To illustrate further the impact of DNP prepared nurses, Udlis and Mancuso (2015), conducted a qualitative study exploring 340 professional nurses, all with various experiences and academia, assessing their perceptions surrounding the role of the DNP prepared nurse. They reported that to some degree the perception by all survey participants concluded that the DNP prepared nurse is better adapted to assume enhanced complex leadership roles and responsibilities and 84% of the DNP prepared survey participants agreed that their academic accomplishments further prepared them for academic leadership roles.
Background and Significance
The Institute of Medicine has evolved from its means of identifying quality and safety of patient care to further acknowledge the need for 21st century reform. Reform brings a shifting platform of focus from review and analysis of negative outcomes to a focus on conceptual qualities of care. Demanding quality care that is safe, effective, patient centered, timely, efficient, and equitable (Mitchell, 2008). Professional nurses play a fundamental and critical role in providing quality care to those they serve, with the use of consistent evidenced based research and practice implementation. Inconsistencies, lack of standardization, and failure to utilize EBP at the bedside have been identified within all clinical settings. Bernazzani (2017) reported events associated with preventable harm or adverse events accountable for nearly 1,000 deaths per day. These events such as hospital acquired infections (HAI), surgical errors, medication errors, hospital acquired pressure injuries, and falls increase mortality, decrease patient outcomes, and increase length of hospital stay. Coincidently, cost per incident of preventable harm is nearing $59,000 per occasion (Bernazzani, 2017).
The Director of EBP DNP leader, in an acute health care arena, fosters EBP through philanthropy, development, implementation, and sustainability of an organizational culture engrained and committed to safe, quality, and cost effective care. EBP, coined as the gold standard of care, (Melynk and Fineout-Overholt, 2011) now calls for organizations to prioritize resources to affect care both at the bedside and in collaboration with those whom serve in administrative offices.
Literature Review and Synthesis of Sources
In order to further understand the impact of the role of the Director of EBP DNP leader one must discuss the similarities and differences found in literature regarding the nurse leader, EBP, and nursing excellence. Through accessing Northern Kentucky University’s library and choice of all worldwide libraries, search limiters were utilized to limit the study date to a minimum date of 2008. These search terms: nurse leader, nursing excellence, evidenced based practice quickly resulted in the 4 articles to be presented. All four articles address the importance of a nurse leader’s role in creating a culture of patient safety committed to use of EBP and in turn cultivating nursing excellence (Grindel, 2016; Melnyk, 2016; Sammer & James, 2011; Xiaoshi, 2008). Melynk (2016, p. 3) stated, “Without a culture and environment that supports EBP, evidenced-based care by clinicians is not likely to be consistently implemented and sustained.” This statement made by Melynk (2016) emphasizes the importance of the nurse leader’s ability to promote professional competency in assuring safe quality care, and the need for nurse leaders to take ownership in a culture centrally focused on patient safety (Grindel, 2016; Sammer & James, 2011). Two articles specifically discussed the importance of nurse leaders in influencing the implementation of EBP along with collaboration of direct bedside providers through the design and implementation of policies, protocols, and pathways, standardizing practice and ultimately influencing change in practice and outcomes (Grindel 2016; Sammer & James, 2011). Xiaoshi (2008) was the only article that directly discussed the correlation of EBP and nurse leader responsibilities impacting that of organizational strategic goals and objectives.
All four articles acknowledged the nurse leaders’ skill and competency in influencing a framework and platform to drive initiatives in employing patient safety measures through the use of EBP (Grindel, 2016; Melnyk, 2016; Sammer & James, 2011; Xiaoshi, 2008). Sammer and James (2011) mentioned that measurement of improvement processes may serve as the “tipping” point to nursing excellence and superior patient care. Melynk (2016) and Xiaoshi (2008) both presented a barrier to the use of EBP, directly related to the resistance of use by nurse leaders and managers, and a lack of leadership, motivation, vision, and strategy to support EBP central to practice. Grindel (2016) introduced leadership competency skills including, but not limited to, clinical expertise, emotional intelligence and the 3 C’s: communication, collaboration, and coordination. These skills were also mentioned in a manner of means in the other three articles but not quite as deliberate as this author (Melnyk, 2016; Sammer & James, 2011; Xiaoshi, 2008). Sammer and James (2016) introduced the application of theory to practice in means of guiding leaders to become strong foundations and change agents in promoting EBP and improving patient outcomes.
How does the Director of EBP DNP leader commit to EBP? A great example of the application of a DNP leader committed to EBP is that of an organization that has achieved Magnet Recognition. Nurse Leader Insider (2017) presents the nature of organizations that have achieved the American Nurses Credentialing Center (ANCC) Magnet Recognition as an organization with EBP nurses directly impacting patient care and outcomes. Hallmark to Magnet Recognized organizations is the culture surrounding EBP as a “need to have” culture (Nurse Leader Insider, 2017). In order for any organization to achieve Magnet Recognition, multiple quality indicators, nursing practice, and outcomes are appraised for distinction. The Director of EBP DNP leader is committed to guiding EBP through advocating, supporting, and creating a professional environment that embraces practice excellence. The value in a DNP leader guiding the journey to attainment of Magnet Recognition and its sustained recognition is a prime example of how the DNP degree is more than a degree.
SWOT Analysis
The SWOT analysis below presents an effective means of identifying the strengths, weaknesses, opportunities and threats that a Director of EBP DNP leader should consider in order to commit to identifying opportunities for impact and growth and overcoming potential barriers and challenges.
| Strengths EBP practice knowledge and skill central to point of care providers, leaders and organizations committed to safe, effective, quality care Increased culture focused on Patient Safety, Quality Outcomes, and Cost Containment Disciplined educated, knowledgeable, and skilled leader in guiding culture and sustainability Increase teamwork and collaboration Increase communication and transparency Influence ownership and accountability (Xiaoshi, 2008) Empower patient care provider’s confidence (Xiaoshi, 2008) Commitment to lean processes reducing waste in the workplace (Grindel, 2016) Position organization as hallmark to excellence ensuring effective care attractive to communities served (Grindel, 2016) | Opportunities Standardization Nurse driven care protocols, pathways, and practices central to evidenced based practice driven and guided by the DNP prepared Nurse Leader (Grindel, 2016) Decreased health care costs and costs associated to adverse events/preventable harm, suffering, and disability (Sammer & James, 2011) Promote continued learning and academia Recognition of Gold Standard commitment to care central to EBP (Melynk & Fineout-Overholt, 2011) Decrease burnout and turnover amongst providers (Melnyk & Fineout-Overholt, 2011) |
| Weaknesses Lack of understanding EBP as a direct pathway to improving quality and outcomes (Xiaoshi, 2008) Negative attitude towards research (Melnyk, 2016) Nurse leader and manager resistance to EBP Lack of resources and access to EBP and mentors (Xiaoshi, 2008) Lack of tools and appropriate resources used in research findings and practice (Melnyk & Fineout-Overholt, 2011) | Threats Perception of adopting EBP care (Melnyk, 2016) Outcomes in trials do not reproduce same results in real world clinical settings (Melnyk, 2016) Lack of standardized tools for assessment of organizational culture, readiness, and framework supporting culture (Xiaoshi, 2008) Overwhelming volume and variability of information (Xiaoshi, 2008) Nurses tendency to rely on experienced based care rather than evidenced based care (Xiaoshi, 2008) |
PEST Analysis- Begins Part 2 of paper
A PEST analysis has been completed to predict how the role of the Director of EBP DNP leader will resound within the organization and its constituents. A PEST analysis addresses factors that are external and out of direct control by this leader, it inquires consideration of political, economic, social, and technological factors that are common to affecting overall performance (Post, 2017).
| Political Evaluation of current political agenda shaping cost, quality, access through efforts to promote EBP Changes and regulation of care based on EBP and care through federal, state, local, and private health insurance companies Increased demand for monitoring of data, outcome research, reporting, and reform due to shift in EBP | Economical EBP influence financing policy through reimbursement, authorization, and payment Elevate medical necessity for care and treatment Cost versus Quality Decrease mortality, decrease length of stay, decrease institutionalization and disability after care, decrease patient harm events Focus on cost minimization, cost utility, cost consequence, and cost effectiveness |
| Social Shift for education, knowledge, skill attainment based on EBP at the bedside Shift in increased autonomy and accountability of nursing providers Shift in trust of patients and communities in respect to trusted profession focus on a culture of patient safety and quality outcomes Increased collaboration and communication amongst providers, patients, and family/significant others Clarification of roles and responsibilities of all providers | Technological Use in technology to monitor and evaluate data and further imply improvement quality measures Validation of practice through use of modern technology, ability to gather and analyze data Ability to impact media and integrity of the nursing profession central to nursing excellence Increased knowledge and skill sharing and philanthropy of EBP through use of communication devices and resource access |
Implementation Strategies
Focused facilitation of implementing the Director of EBP DNP prepared nurse leader is essential in confronting the need to expand the roles and responsibilities demanded by trends in health care delivery. The Director of EBP DNP prepared nurse leader utilizes, EBP, as the yellow brick road, to improve quality and outcomes and decrease health care costs. Through guided inquiry, innovation, and the partnership of all providers, nursing accountability and autonomy can impress the importance of EBP to practice (Melynk, 2016). In further demonstration of the value of the Director of EBP DNP leader guiding EBP, please allow the discussion of influencing and changing an acute care arena’s organizational culture.
The first step would be to align with all stakeholders in defining a vision and goals. The conduction of a needs assessment, careful planning of education and development of programs to assist the goals and vision of the Director of EBP DNP prepared nurse leader, in conjunction with the organizational strategic plan are imperative (Xiaoshi, 2008). Motivating stakeholders further compels desired change that results in excellence of practice, sparking transformation and innovation. The Director of EBP understands that the key to transforming behaviors is in the ownership of the change (Melnyk & Fineout-Overholt, 2011). Collaboration with key change agents: mentors, experts, clinicians, direct patient providers and the administrative team is essential in the early stages of transformation and the Director of EBP becomes the main facilitator. The Director of EBP than steers engagement within the organization through forums such as; town halls, unit based councils, patient advisory boards, and leadership conferences to communally assist in the identification of barriers and challenges and strategies to overcome obstacles.
The Director of EBP further assists in the prioritization of clinical issues and serves as the lead resource to all organizational staff in research guidance, appraisal, and development of practice recommendations and the development and implementation of changes with appropriate valid and reliable evaluation measurement. Culture transformation requires time, resources, and facilities in order to ensure all are receptive to the change. Culture transformation is hallmark to EBP as the gold standard of care (Melynk & Fineout-Overholt, 2011; Xiaoshi, 2008).
Stakeholder Support
Support from all stakeholders is essential in encouraging open communication and collaborative decision making to support staff in the culture shift and promote the value and impact of the DNP nurse leader (Melynk, 2016). Implementation of this role must consider factors that influence performance of all whom are internal stakeholders. In identification of key stakeholders internal to the use of the Director of EBP DNP leader, one must consider all who serve in the organization. Sammer and James (2011) stressed the importance of a culture rich in patient safety emphasizing contributing factors specific to leadership, EBP, teamwork, collaboration, communication, learning, and patient centered care. From the top down, every individual serving in that organization must be committed to the mission, vision, and strategic plan, including but not limited to, the chief executive officer, chief nursing officer, providers and nurses, ancillary staff, educators, housekeepers, and volunteers. External stakeholders are those that the organization reports to such as the Joint Commission and local, state, and federal accrediting bodies along with consumer reporting agencies like Press Ganey to measure patient satisfaction and quality of care (Grindel, 2016). External stakeholders also include patients, families, and communities, who seek effective, safe and cost effective care, so that funds, whether private and/or public, such as Medicare and Blue Cross Blue Shield, are being utilized effectively (Xiaoshi, 2008). It is key to consider all internal and external stakeholders influence and interest in implementing the Director of EBP DNP leader to facilitate and ensure success.
Financial Implications
A cost-benefit analysis can be utilized as a tool to validate the importance and utilization of the Director of EBP DNP leader committed to nursing excellence. Zaccagnini and White (2017) attribute the benefit to this analysis through means of justifying commitment to solving the problem well worth the cost. While some benefits are difficult to quantify, such as the worth of an organizations culture, it is useful to illustrate the tangible benefits. Assisting in illustrating the tangible benefits of this role is four approaches: cost minimization, cost utility, cost consequence, and cost effectiveness (White & Zaccagnini, 2017). DNP EBP leaders have an affinity and basic understanding of operating expenses and revenues; they have the ability to help identify where care is driving cost. For example, practicing cost minimization through the evaluation of ineffective work processes, that in turn, increase a patient’s length of stay and increase nurse productivity related to incidental overtime, is an example of cost utility (Grindel, 2016).
DNP EBP leaders have the ability to prevent, predict, and evaluate, an example of cost consequence, through the use of EBP to prevent adverse events by identifying, acting, and eliminating threats to safety, such as lack of nursing knowledge and skill that could precipitate a medication error (Grindel, 2016). Another example of how DNP EBP leaders impact cost effectiveness is through the use of ensuring a culture free from toxic environments and unprofessional behaviors, promoting positive attitudes and improved patient care, and support of a healthy work environment, all factors that directly affect turn over and employee satisfaction and consequently patient care (Grindel, 2016). The financial implications of committing a dedicated and passionate DNP leader focused on EBP far outweigh the negative implications and potential cost effects of nurses not committed to EBP.
Evaluation and Measurement
Essential to determining the impact of the Director of EBP DNP leader is the ability to measure outcomes and provide evidence supporting successful improvements and changes. Finding valid and reliable tools provide credibility and compliance promoting continued action and stakeholder support. Evaluation should suit the design of the role and its projected outcomes. One method of evaluation and measure of the role of the Director of EBP DNP leader is to measure the culture of an organization and its readiness for EBP. Melynk and Fineout-Overholt (2011, p. 559) present an example instrument that utilizes 18 questions focused on EBP to assess an organizations present culture and readiness for a system wide integration and culture shift of focusing on EBP. Other tools of measure and validation are also introduced and exampled by Melynk and Fineout-Overholt (2011, p. 560-561), such as EBP Belief Scales and Implementation Scale. Another method of evaluation and measure is to track data specifically related to nurse sensitive indicators correlated with patient harm, such as hospital acquired pressure injuries and patient falls through use of databases such as the National Database of Nursing Quality Indicators (NDNQI) (Nursing Quality, n.d.). Accurate data can be a critical tool in the reporting, action planning, and intervention, central to the process of quality improvement and pursuit of performance of nursing care at the highest level. These are only a few means of measuring the impact of having a skilled, knowledgeable, committed DNP leader who lives and breathes EBP and a commitment to make changes directly impacting patient care and outcomes and the professional future of nursing.
Summary
DNP nurses serving in leadership roles, both formal and informal, have the ability to govern and lead health care organizations and its stewards to stop, think, act, and review our current “status quo” experienced based care. Care that is safe, effective, patient-centered, timely, efficient, and equitable demands that health care is delivered by all disciplines in collaboration with EBP (Mitchell, 2008). DNP nurse leaders are catalysts for driving change, both at the bedside and within executive board rooms, through transformation of both their operational and clinical foregrounds. DNP nurse leaders create a vision, inspire inquiry and innovation, and continually engage all to seek measures that improve nursing quality and in turn patient outcomes. DNP nurse leaders have been called into action to master quality, improve safety, model professional nursing and credibility through the cross stitching of evidenced based knowledge and information into every day practice. DNP nurse leaders will someday be called the champions of transformation knowledge to practice with tangible proof of the lives saved, improved patient outcomes, and healthcare reform.
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