SPIN: Stimulating Practice Innovation Mary Terhaar, DNSc Krysia Hudson, DNP Carolyn Fowler, PhD

Martha Sylvia, PhD, MBA, RN

Inst

itute

Resources

Colla

bora

tion

Coaching

Have to compete

for funding

Struggle to repeat the cycle

of research

Have difficulty getting

published

Need to find collaborators

& build relationships

Asked to teach but

may not have learned to do

so

Mock, Nolan, Allen et al (2008)

Newly Prepared Doctorates Struggle

Strategies

1. Assessment DNPs Employers

2. Annual Institute

3. Online Community & Resource Center 4. SPIN Fellows Program

5. Enterprise-Wide DNP Council

Inst

itute

Resources

Colla

bora

tion

Coaching

ASSESSMENT Describe & Promote Outcomes

DNP Outcomes

Projects

CNO Survey

Employer Survey

Scholarly Work

Grad Surveys

Anecdotes

Assessment - DNPs

• What are DNPs doing?

• What challenges do DNPs experience?

• How can we mitigate barriers & threats?

• How can we be helpful?

Practicing DNPs

First Credential

0 2 4 6 8 10 12 14 16

AD

Diploma

BSN

43

Role

0 2 4 6 8 10 12 14 16

CNS Admin

Educator Informatician Public Health Health Policy

Safety & Quality Home Care

Care Management Other

43

NP Certification

0 1 2 3 4 5 6 7 8

Acute Care

Adult

Family NP

Family/Psych

Gero

Peds

Neonatal

Safety & Quality

Pedi Acute Care

26

CNS Certification

0 1 2 3 4 5 6

Acute care

Adult

Adult/Psych

Child & Adol Psych

Gero

Peds

Other

11

Location of Practice

0 5 10 15 20 25 30

Maryland

Virginia

New York

Pennsylvania

Kansas

Florida

Delaware

North Carolina

California

Puerto Rico

44

Publication After Graduation

0 5 10 15 20 25 30 35 40

Submitted

Acdcepted

Published

Book Chapters

Book Chapters

Other

Presentations After Graduation

0 5 10 15 20

None

One - two

Three or Four

Five or Six

Seven or more

Accomplishments • JHH Nursing Publication Award **** • Shirley Sohmer Award ** • MNA Pathfinder Award • Think Swiss Award • Assistant Professor Appointment ****** • Program Director **** • NLN Nurse Educator Certificate • Director of Nursing • CNO *** • Physician Collaboration Award • National Committee Chair ****

Compensation for Performance

YES 82%

NO 18%

33

Place of Employment

0 5 10 15 20 25 30

Academe

Hospital

Joint

Private Practice

Government

Other

Changed Employers

YES 23%

NO 77%

44

Promotion Post Graduation

YES 42%

NO 58%

43

New Title

0 1 2 3 4 5 6 7

CNO

Director

Assistant Professor

Lead NP

Cant Share

19

Reason for Changing Position

Opportunity 68%

Responsibility 16%

Relocation 5%

Prepare for Future

Promotion 11%

20

Teaching

Classroon 32%

Clinical 21%

Hospital 19%

Not Teaching 28%

43

New Responsibilities

• None

• EBP • Increased leadership • Publication • Translation Projects • Program Development • Precept DNP Students • Policy Development • QI

• Research

Very Often to Always

8 Advocate for colleagues 3.48

7 Advocate for patients 3.33

3 Provide organizational leadership to increase quality 3.30

18 Impact practice in your facility 3.25

1 Apply science to improve outcomes 3.23

2 Demonstrate organizational leadership (systems) 3.23

Very Often to Always 9 Use evidence to change policy 3.20

11 Collaborate with other disciplines to improve outcomes 3.20

5 Apply analytics to decisions 3.10

4 Demonstrate doctoral level clinical scholarship 3.0 5

10 Change policy to impro ve o utco mes 3.0 5

12 Lead collaborations between disciplines 3.0 5

14 Impact health in your facility 3.0 0

Occasionally

6 Apply information systems solutions to raise quality 2.8 3

13 Lead collaborations focused on prevention 2.75

15 Impact health in your community 2.55

16 Impact health nationally 2.0 8

19 Impact practice locally 2.6 8

20 Impact practice nationally 2.28

Almost Never

17 Impact health globally 1.8 3

21 Impact practice globally 1.9 5

Barriers

• Competing priorities 1.97 • Lack of funding 2.00 • Lack of time 2.03 • Lack of administrative support 2.31 • Lack of executive sponsorship 2.60 • Lack of statistics assistance 2.87 • Lack of IT resources 2.79 • Lack of data 3.21

The lower the score, the greater the difficulty

What organizational support would help?

Inst

itute

Resources

Colla

bora

tion

Coaching

Assessment - Employers

CNO Interviews - Methods

• Round 1: Survey refinement (respondent N = 1)

• Round 2: Survey administration and refinement (N=7)

• Round 3: Development of web-based CNO survey

• Round 4: Selected follow-up

CNO Interviews – Key Findings

DNP degree program is not well understood

“My greatest concern is the lack of understanding and appreciation of

what a DNP can bring to an organization. One of our greatest

challenges is educating the organization, and especially physicians,

about the DNP role and what advantages there are to the

organization”

CNO Interviews – Key Findings

DNP degree program is not well understood

“[A senior physician colleague] approached me in the hall and said:

‘I’m very concerned about nursing’s movement to produce all these

DNP’s. Nursing is better off having a few high-quality doctorally-

prepared students than an army of people with lesser qualifications’”

CNO Interviews – Key Findings Skills considered essential for DNP graduates working in

“I would expect them to be able to define leadership and know how to

assess [it] using various models.”

“[I expect them to be] able to operate at both a strategic and tactical

level.”

“They must be able to take on more complex system issues”

CNO Interviews – Key Findings Selected limitations of DNP training

“I definitely think there is a difference between the skills I would expect

them to have and what they are getting prepared for … because when I

looked at DNP programs … what they provide in leadership [training]

is very variable”

CNO Interviews – Key Findings

New themes

“They were shining stars before they did the DNP; they came back with

enhanced skills, and are even better than they were before.

The most successful had a crossover experience because she blended her

work and scholarly pursuit”

CNO Interviews – Key Findings

Selected limitations of DNP training

“I think it has been stronger in concept than in execution and I think it

has been stronger for nurse practitioners in advanced practice roles than

it has been for those going into executive or management roles”

CNO Interview Results

• Anticipation of DNPs contribution

• Desire to support DNPs

• Desire to put DNPs abilities to good work

• Connect DNP to mission & triple aim

Inst

itute

Resources

Colla

bora

tion

Coaching

Annual Institute

Provide all DNPs in Maryland the opportunity to

disseminate knowledge and increase

confidence so they will be effective in the

work of translation and innovation in practice.

SPIN

Initial

• 3 day program once a year

• Nice hotel

• Abstracts

• Un-conference

• Statistical Process Control

• Role transition

• N=50

Improved

• 2 day program twice yearly

• On campus

• Abstracts

• Un-conference

• Writing for publication

• Calculating ROI

• N=45

Inst

itute

Resources

Colla

bora

tion

Coaching

Online Community & Resource Center

• Develop and test social and professional network.

• Facilitate networking and collaboration among DNPs

across Maryland.

• Alpha testing by DNPs across Maryland in 2012.

• Refined in 2013.

Online Community

• In-House (JHU/JHH Community)

– Bubbler (JHED)

• State Wide

– Linked In

• Collaboration – Have we missed anyone?

Inst

itute

Resources

Colla

bora

tion

Coaching

DNP Council

• Establish a council at the Johns Hopkins Hospital – 40 DNPs across the Hopkins Enterprise

• Target practice problems • Design strategies to

– improve performance, – evaluate outcomes, and – develop careers

DNP Council

• Focus on strategic intent

• Collaborative efforts

• Collaborative publications

• Problem solving

• Identify and mitigate barriers

Your Thoughts?

Next Steps

• Collaborations

– Translation

– EBP

– Publications

– Consultations

Next Steps

• Planning for next conference…

• Use of social media

• Self Paced Learning Modules

This work was conducted with support of an NSP II award from the Maryland Health Services Cost Review Commission

IMPACT Start-up……

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