Just two years ago, American Sentinel launched an innovative, online Doctor of Nursing Practice (DNP) degree with a focus on executive leadership. Now we’re proud to announce that the students in our first cohort have graduated on June 22. To earn the DNP, each student had to complete a Capstone project – an intensive, active learning project that demonstrates his or her ability to apply leadership, analytical, and interpretive skills to an area of their choosing. Because each project is tailored to the individual student’s professional goals, the results have been fascinating! Here are their stories.
Nursing Background: A specialty in nursing informatics
Ellen Harper, DNP, MBA, RN has an executive position with Cerner Corporation, one of the world’s largest providers of health care information technologies. She currently holds the title of chief nursing officer and works with clients, to help them with their vision for data-driven process improvement initiatives.
Before obtaining her DNP from American Sentinel, Ellen had already earned a bachelor’s degree in health care management and a master’s degree in business administration (MBA). She notes that while her employer wasn’t requiring a higher level of education, she really wanted a terminal degree in nursing. “I’m not a hospital CNO, I don’t take care of patients, so the DNP with a focus in executive leadership was perfect for me,” she says. Since American Sentinel’s program is designed to address the complexities of modern day health care, she found it easy to apply newfound knowledge to the high-tech field of informatics. “I used all of the course work from the DNP program in my professional work. There was no ‘busy work’ – everything was applicable. From the beginning, the classes built an infrastructure regarding the way I thought about nursing practice and policy,” she says.
The Capstone: An evidence-based nurse staffing tool
Ellen had identified what she saw as a gap in the IT industry’s collective offering of nursing solutions – she felt the industry was lacking a really world-class acuity tool to assist with nurse staffing. (These systems can help determine how many patients one nurse can care for, depending on each patient’s daily needs, which can change over the course of a patient’s hospitalization.) With the encouragement of both her American Sentinel faculty adviser and her employer, Ellen decided to embark on the research needed to develop an evidence-based staffing tool. Sheobtained administrative approval to perform an onsite study at a carefully chosen hospital, and this research formed the basis of her Capstone project. The goal was to create a new model for predicting nurse intensity, which can be defined as the total time and staffing mix of nursing resources used by an individual patient across an episode of care.
Nurses represent the largest proportion of direct health care providers, Ellen points out, so under- or over-staffed units have major implications for quality of care, costs, patient satisfaction, and nurse job satisfaction. There’s a huge body of evidence pointing out the relationship between staffing levels and outcomes, both clinical and financial. Yet currently there is no consensus on the best way to determine nurse-to-patient ratios.
“I’ve always thought that nurses weren’t given the credibility they deserved, and that staffing levels were always being questioned. And I thought, if only we could find an objective tool that takes the emotion out of that. It’s been both a personal and professional goal to find the sweet spot between staffing and outcomes — both clinical and financial,” Ellen notes.
Ellen found that American Sentinel’s DNP program gave her all the tools she needed to tackle a complex problem and devise an evidence-based solution. She notes that one course was particularly useful to her. “It dealt with the contemporary use of health care IT, and it was the one that set the theoretical framework.. I did my research from a comparative effectiveness approach, which was stressed in my DNP coursework.”
Conclusions: Addressing a complex issue
The problem with existing staffing systems, Ellen found, is that they are not real-time or designed to consider variables – factors like the patient’s medical diagnosis, age, and co-morbidities; family demands; best practices research; and the skill set and experience of individual nurses on staff.
Ellen’s mixed-methods study used observation and data mining techniques to determine which care activities have the greatest impact on the amount of direct care needed for each patient. She notes that identifying these activities is not possible for a human – hunches are usually wrong and often reflect biases. “It’s incredibly complex, and that’s what computers are good at,” she says.
Another strength of Ellen’s study was that it involved using multiple sources and techniques for the data gathering process – including the admission, discharge, and transfer data collected from the electronic medical records (EMRs) of the patients on the nursing unit. She’s now working along with her employer to further refine the Clinical Demand Index (CDI), an algorithm that calculates the amount of staff needed to care for an individual patient. The CDI model can create a profile of nurse intensity, and the data can be used to predict the amount of patient care needed in real time. This in turn will more precisely determine the workload for nursing care hours.
Overall, these findings demonstrate that clinical data from the EMR can be abstracted and used to objectively calculate the nurse intensity expected for each unit, to evaluate shift-to-shift, hour-to-hour, and daily decisions regarding nurse staffing – so neither quality of care nor cost considerations are compromised. Ellen says. “It’s very exciting to think that this pilot study is the foundation to build an objective way of calculating nurse intensity.”
And it’s just this kind of forward thinking that American Sentinel’s has hoped to foster with its DNP program, as nurse leaders are faced with ever-increasing complexities and unprecedented challenges. Congratulations, Ellen, on a job well done!