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The Post–Master’s Doctor of Nursing Practice as a Critical Strategy to Reduce the Time Lag to Implement Research in Clinical Care

McCorkle, Ruth, PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000659
DEPARTMENTS: Insights
Free

Author Affiliation: Yale University School of Nursing, West Haven, Connecticut.

The author has no funding or conflicts of interest to disclose.

Correspondence: Ruth McCorkle, PhD, RN, FAAN, Yale University School of Nursing, PO Box 27399, West Haven, CT 06516 (ruth.mccorkle@yale.edu).

Accepted for publication August 20, 2018.

As a researcher in cancer nursing for the last 40 years, my primary focus has been to design studies to test the role of the advance practice oncology nurse on patient and caregiver outcomes.1 I have been successful in securing funding to conduct 7 clinical trials with patients with multiple types of cancer and at different stages across the cancer trajectory. My dream was to demonstrate the needs of patients and benefits of posthospital care delivered by advance practice oncology nurses in the home to meet those needs. However, even with evidence-based outcomes, my team and I were not able to influence the home care industry in the United States to employ master’s degree–prepared clinicians in oncology to manage patients. We were told the costs were prohibitive. We believe the needs of these patients are complex and warrant careful monitoring by specialty-trained and skilled clinicians. Consequently, I refocused and taught the advance practice providers in our specialty clinics to deliver the intervention through our ambulatory services.2 My experiences underscore what others have written: there is at least a 17-year delay in getting research findings into practice at the bedside.3

As rewarding as research is, especially when we have success in demonstrating significant differences in symptoms, functional status, and even survival, it is frustrating if we cannot impact systems of care. However, a major change in my thinking occurred 5 years ago. My teaching allowed me the opportunity to see another way to influence practice in a more rapid and efficient way.

With the untimely death of Donna Diers in 2013, I was given the opportunity to teach in the Yale School of Nursing Doctor of Nursing Practice (DNP) program. In the DNP program, I have encountered a renewed commitment to implementing research into practice and changing care. Yale School of Nursing’s DNP is a post–master’s degree program designed for midcareer nurses who wish to become innovative healthcare leaders through building on their previous education and experience. It is offered as a hybrid program, part-time to be completed in 3 years. Combining Yale on-campus experiences with online coursework, the program is tailored for nurses who already have major professional and work experiences. Students are required to come with a clinical question they intend to develop into their DNP project.

For 3 years, I have taught the first core course, Evidence, and for 5 years, the seminar on developing project proposals. Unlike my experience with PhD students, who study with me in my areas of expertise, DNP students pose a range of questions that I have little or no expertise with. I have learned this is often an advantage because they must convince me of the importance of their projects.

They are an exciting group of mature students to work with because they come as the experienced expert on the topic they are studying.4–9 They are passionate, committed, and driven to make a difference. Our faculty gives them the skills and knowledge to review and summarize the evidence to support their clinical questions. They present their project proposals early in their second year, and once approved, they move forward to implement their methods and evaluate the impact. My experience mentoring PhD students has been invaluable in teaching the methods to help DNP students expedite the implementation of their projects into their clinical settings. Along with the DNP faculty, the students establish collaborative relationships with mentors associated with their work environments. This is an invaluable step in the process of implementation because together they provide oversight to the clinical arena they want to change. Because most of them have influential positions in their organizations, they have obtained buy-in from the necessary key stakeholders. These DNP students can garner support to bring about change in systems of care.

We accept 15 to 16 students a year, and as of May 2018, we have graduated 58 students representing 4 cohorts. I have observed firsthand the changes our graduates have made and the potential long-term effects these transformative nurse leaders will have. I was not an advocate for the DNP program when it was first proposed at Yale School of Nursing, but today, I have become one of its biggest champions. Donna Diers had the vision that experienced nurse leaders in practice settings are powerful change agents to ensure that healthcare is evidence based and that patients benefit. Nursing has an opportunity to impact how care is delivered, its quality, and most importantly patient outcomes. The post–master’s degree DNP is a critical strategy that we can add to our efforts to reduce the time lag to implement significant research findings into clinical practice. It is also a strategy that could be attractive to nurses around the world who are leaders and want to change practice. We have many foreign-born nurses who study in the United States each year. The skills and knowledge of how to find evidence and use it will help to prepare them to return to their countries as change agents. This is an exciting time in nursing. The opportunities are vast for those who want to make a difference in healthcare today, especially in cancer care.

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References

1. McCorkle R. A program of research on patient and family caregiver outcomes: three phases of evolution. Oncol Nurs Forum. 2006;33(1):25–31.
2. McCorkle R, Jeon S, Ercolano E, et al. An advanced practice nurse coordinated multidisciplinary intervention for patients with late stage cancer: a cluster randomized trial. J Palliat Med. 2015;18(11):962–969.
3. Slote Morris Z, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–520.
4. Daniels RG, McCorkle R. Design of an evidence-based “second victim” curriculum for nurse anesthetists [review]. AANA J. 2016;84(2):107–113.
5. Blumenthal NP, Petty MG, McCorkle R. Missing domains of lung transplant patient selection. Prog Transplant. 2016;27(2):90–97.
6. Feld A, Madden-Baer R, McCorkle R. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care. Home Health Care Serv Q. 2016;35(2):53–68.
7. Magpuri AT, Dixon JK, McCorkle R, Crowley AA. Adapting an evidence-based pediatric acute asthma exacerbation severity assessment tool for pediatric primary care. J Pediatr Health Care. 2018;32(1):10–20.
8. Fox K, McCorkle R. An employee-centered care model responds to the triple aim: improving employee health. Workplace Health Saf. 2018;1:2165079917742663.
9. Acal Jimenez R, Swartz M, McCorkle R. Improving quality through nursing participation at bedside rounds in a pediatric acute care unit: a pilot project. J Pediatr Nurs. In press.
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