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NP-led practice improvement

A novice takes the leap

Brown, Marie-Annette, PhD, ARNP, FNP-BC, FAAN, FAANP

doi: 10.1097/01.NPR.0000554089.79900.2b
Department: Commentary

Marie-Annette Brown is a professor of family and child nursing and a primary care NP at the University of Washington, Seattle, Wash.

The author has disclosed no financial relationships related to this article.

The DNP degree is centered on pushing the edges of our professional foundation, expanding our spheres of influence outside the clinic exam room. The power of DNP projects to ignite meaningful NP-led practice improvement activities is gaining momentum alongside the growth of the DNP degree itself. Around the country, NPs are creating superb exemplars of varying sizes and scopes to enhance the quality and safety of practice in our clinics and agencies.

Busy practitioners often can easily identify problems that require a change in practice at the clinic or system level that cannot be solved by simply “trying harder.” Yet given the demands of today's fast-paced clinic operations, the idea of developing, implementing, and evaluating even the smallest practice change can seem unrealistic. Many of us have not had the opportunity to gain expertise in quality improvement (QI) curricula. I remember how I needed a deep dive into the ocean of QI information while I spearheaded development of the University of Washington School of Nursing DNP program in 2003.

Systematic approaches to practice change, along with QI metrics, were not part of my doctoral education or continuing education as an NP. Even today, deep expertise in these areas is scarce among nursing faculty. Despite that, we created practice change opportunities for students, making this the basis of our DNP project. In contrast, some DNP programs may have avoided taking the same risk and instead have kept traditional research as their final DNP projects.

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Implementing practice change

For over a decade, I have coached DNP students on facilitating and participating in practice change. I watched students thrive and accomplish small but powerful changes that their agencies celebrated, yet I had never led a practice change project myself. When a practice change opportunity emerged at the clinic where I practiced primary care, I took the risk to learn and lead.

Although I had no expertise in hypertension and was a novice at practice change, my clinic colleagues were pleased. An NP had led a practice improvement in my facility. I agreed to lead our interprofessional team in enhancing aspects of care for our patients with elevated BP. A full description of this practice change project and its results is forthcoming.1

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Learning from our colleagues

Despite having practiced in my clinic for almost 25 years, I came away with a new appreciation and depth of understanding of my clinic's colleagues and the specific dimensions of their roles and challenges. In turn, the clinic's RNs, medical assistants, receptionists, and internal medicine physicians learned about BP therapeutics from an NP's perspective and our approach to leading systematic, holistic change. With the newly garnered respect I felt from my colleagues for my leadership, I felt empowered to develop a vision of what could be and how even small changes could nudge the process along. From our work, we created a framework for NPs and practice change novices to apply in their organizations.

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The next generation

The practice change projects highlighted in this issue of The Nurse Practitioner provide inspiration for all advanced practice registered nurses. Along with collegial support and teamwork, NPs can seize the opportunity to further demonstrate their contributions to their clinics with value-added leadership, help improve their clinical environment, foster their own growth and creativity, hone their expertise to inspire change, and lead the profession into the next generation of practice change.

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1. Brown MA, Foster-West B. An Exemplar for the Practice Change Novice: It's Hard, But Not as Hard as You Think. Under Review, 2019.
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