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Walking The Talk

DrNP grads put doctoral research to practical use

Nurses are masters of hands-on practice. But until now some practical obstacles prevented this continued hands-on for those who wanted to pursue education at a doctoral level. PhD programs often require fulltime study for 3 to 5 years. While these same programs traditionally prep graduates to teach or lead research programs, where do they leave a nurse who wants to continue nursing, without a multi-year break in practice?

“Philosophically, I disagree with the idea of anyone actively engaged in a nursing career having to take 5 years off,” said Susan G. Lorenz, DrNP, MSN, RN, one of the graduates in the inaugural class of a hybrid doctor of nursing practice (DrNP) at Drexel University, Philadelphia. “I feel I need to be out there, actively engaged in the practice of nursing. Five years later I might not only be unemployable, I wouldn’t have a realistic perception of what’s up-to-date and going on in the field.”

New Advanced Practice Nurse Has the Title ‘Doctor’

But Dr. Lorenz, chief nursing officer at Princeton Healthcare System, Princeton, NJ, and others found a “fit” in a DrNP program which began in 2005. It is designed to allow nurses – practitioners, educators, clinical executives or clinical scientists – to remain in practice throughout their studies. Lorenz, now with the title “doctor” as well as nurse, has wasted no time in putting her increased research skills to use.

“We are building a new hospital here in Princeton and embarking on setting up a live mock-up room,” said Lorenz. “We’re going to build it, test it, put live patients in it and do research on design features in the room. I can make sure the research is pure – not skewed by confounding variables – and make good decisions for my institution.”

Lorenz’s research on the new building components is being conducted in tandem with the health system’s CEO Barry Rabner as participants in the Pebble Project, a “think thank” initiative from the Center for Health Designs, which disseminates evidence-based design principles.

Her new degree has not only reinforced her relationship with her CEO, but with nurses as well. “It means something to nursing staff to have a doctorally-prepared nursing executive,” said Lorenz. “It’s walking the talk. I’m telling nurses we have to be certified, do the research at bedside, publish, present and promote findings. If I’m not doing any of this, I’m not a role model.”

As most hospitals are pushing to convert to all private rooms, Lorenz’s clinical doctoral dissertation was revealing. “Elderly patients have a 4 times greater risk of falling in a private room, compared to a semi-private room,” she explained. “All private rooms may not be the best way to go for all patients.”

‘Researching Professionals’

Drexel’s DrNP breaks with DNP degrees offered elsewhere, by requiring a dissertation, and steering graduates to become researching professionals, not professional researchers.

“Nursing has always been hamstrung by the lack of evidence-based practice for advanced practice,” noted H. Michael Dreher, PhD, RN, chair of the doctoral nursing department at Drexel’s College of Nursing and Health Professions and architect of the DrNP program. “And the only way to advance knowledge development is through research. Our degree requires a clinical dissertation, exploring a practice-oriented question. The PhD is a research degree; the DNP is a non-research, practice degree. Our hybrid DrNP degree fits right in the middle, combining clinical research and advanced practice.

“When designing the program, we did focus groups with nurses at two Philadelphia hospitals and with MSN adjunct faculty. We found they were interested in conducting research; ‘dissertation’ was not a dirty word to them,” said Dreher.

An Enhanced Seat at the Table

Several other DrNP grads are now carrying their newfound expertise into practice, and making a difference.

First to complete the program was Ann Townsend, DrNP, MSN, APRN-BC, RN, director of the outpatient heart failure center at Our Lady of Lourdes Medical Center, Camden, NJ. Townsend searched exhaustively for a program that suited her needs. “I was finding either education or research. But I’m a clinician,” she emphasized. “This degree has allowed me to conduct research applicable to the clinical area, bedside related. That’s where we [as a profession] have been lagging behind; that’s exactly where we need the research.”

Having a doctorate is just the beginning of a more expansive career, suggested Townsend. “I consider myself a beginning researcher. I’m actively trying to implement research into practice here at Lourdes. We’re doing a research project now on ambulation in hospitalized elderly with heart failure.”

Townsend herself is involved in a state project to reduce readmission for heart failure patients, and sits on a system-wide grants council to focus on underserved and underprivileged areas.

“I’m convinced the more doctoral-prepared RNs we have, the more we can ‘sit at the table.’ It’s a great leveler. This has empowered me to speak from an ‘expert’ point of view. After 30-some years in the field, I was already practicing as an expert. But now others recognize me in that way.”

The Value of New Perspectives

Nurse midwife Rose Marie Kunaszuk, DrNP, MSN, CNM, said she entered the DrNP program because, “In my clinical practice the knowledge and skills of being a researcher really help when trying to get people to change practice.”

Kunaszuk’s clinical dissertation focused on intimacy, postpartum depression and sexual health. She also surveyed men, saying, “Men are 50 percent of the postpartum couple. When you have depressed men, you will probably have unhappy women.”

The study has already proven useful in her midwifery practice at Neighborhood Health Services Center in Plainfield, NJ. “Just yesterday I had three conversations about sexual dysfunction,” she noted.

Now equipped to meet a professional goal to run a research study as principal investigator, Kunaszuk, who also works as a nurse at Hahnemann University Hospital, Philadelphia, reflected on the professional impact her studies have had. “In the DrNP program, I came together with people at my own academic level, with similar experiences viewed from a different perspective. There was another women’s health person, a neurology person, one from cardio, hospice and more. To be able to talk about the state of healthcare and where we each needed to be going within that group was an exceptional experience,” she avowed. “My practice has changed already in terms of thoughtfulness, and approach to patient care. I now look at the big picture and deal with patients holistically. I try to see the patient in terms of their whole family and their lives.”

Clinical Research Makes a Difference

As director of clinical services in the neurology division at Cooper University Hospital, Camden, NJ, Susan Baseman, DrNP, BSN, APRN-BC, said she considered herself first and foremost a clinician, so it was vital to her that a doctoral degree program would give her “…background and additional knowledge to look at real life, real time clinical problems.”

She wasted no time in finding that real-time application/connection. “My clinical focus is on improved systems of care for stroke patients. My dissertation was on the social aspects of recovery from stoke – how patients return to social roles in families, jobs and communities – and how that relates to their level of physical dysfunction.”

Through her research, Baseman has drawn important conclusions. “Most care provided to patients with stroke is geared toward the physical disabilities. In other words, we judge our success on the basis of functional recovery: Are they independent in activities of daily life? Can they walk 50 feet unassisted? But that’s not the total picture. For patients to truly recover, they need social recovery,” said Baseman.

“I’ve seen patients with minimal physical deficits who never get back into their roles within their jobs or families. And there doesn’t seem to be any good physical explanation. Where’s the disconnect?”

Now Baseman hopes to take that message further. “I’ve used this information to educate the nurses who care for patients on our stroke unit at Cooper. We know we need to look at other aspects beyond physical functional recovery, if we’re going to get the best outcomes for our patients.” 

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