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Changing Clinical Practice via the DNP

by Julie Paul, CNM, DNP

After about 5 years of practicing as a full-scope certified nurse-midwife (CNM), I started to notice things I wanted to change in practice, but I had no idea how to accomplish them. It is a very frustrating feeling, not knowing the next steps to take to make a positive change. I would sit at the hospital obstetrical (OB) departmental meetings and hear buzzwords such as low patient satisfaction, high epidural rates, and increased cesarean delivery rates. I remember thinking that all of these could be improved if only the hospital would employ midwives. This frustration prompted me to seek more information about the doctorate of nursing practice (DNP) degree versus the PhD. The DNP is a degree for practicing advanced practice nurses who want to make changes in clinical practice (utilizing existing research), whereas the PhD is a degree that focuses on original research. Based on my personal goal to add midwives to the hospital setting, I concluded that the DNP was the way to go for me.

I chose the DNP program at Frontier Nursing University (FNU) in March 2010. At first I wanted to start a laborist program at the hospital. A laborist program is similar to a hospitalist program, however this model would utilize midwives to help run the birthing unit. I thought if midwives were in this role they could improve satisfaction with care, decrease the epidural rate by educating nurses at the beside, and potentially reduce the cesarean delivery rate. While FNU thought this was a worthwhile goal, they also thought it was too big of a project to complete in 15 months. So I decided to start with having a dedicated CNM in the obstetrical triage unit. My goal was to improve satisfaction with care and reduce the length of stay in the triage unit.

While I was in the DNP program, I was taught how to do a complete literature review of the topic, develop a Needs Assessment; create a GANNT chart (a chart that looks at goals and timelines) and SWOT analysis (this looks at the strengths, weaknesses, opportunities, and threats to a project); submit my project to the IRB (Internal Review Board) at both FNU and the clinical site; implement my project; and finally analyze the data obtained from this project. The results demonstrated statistically significant results of improvement in both client satisfaction with care and reduced length of stay in the obstetrical triage unit.

The process was very satisfying and worthwhile. The lessons I learned while in this program will be invaluable to me as I continue as a CNM. My project at the clinical site, South Shore Hospital in Massachusetts, was very well received. After presenting the results to the OB department, I was asked to join a task force to help improve the flow of the OB department and find ways to improve patient satisfaction. I was able to participate in this project with confidence and with practical suggestions that I would never have thought of prior to this process. It has now been 1 year since I’ve completed my DNP and while the hospital has still not formally adopted the project, they have recently submitted a proposal to the board requesting midwives as well as laborists in triage.

Editor’s note: Curious about ACNM’s views on the DNP? Check out ACNM’s newly revised Position Statement Midwifery Education and the Doctor of Nursing Practice (DNP).

Posted 7/3/2012 11:43:37 AM



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