College adoption of the DNP Discussion

College adoption of the DNP Discussion

College adoption of the DNP Discussion

There has been much controversy about the adoption of the DNP as the entry to practice for Advanced Practice Nurse role.

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1. What is your opinion about the rationale for the DNP as the entry to practice for the Advanced Practice Nurse roles? Cite evidence for your position either for or against.

1. What are your thoughts about the clinical doctorate (DNP) as opposed to a research doctorate (PhD)?

Available online at www.sciencedirect.com Nurs Outlook 65 (2017) 94e102 www.nursingoutlook.org Determinants for effective collaboration among DNP- and PhD-prepared faculty Beth A. Staffileno, PhD, FAHA*, Marcia Pencak Murphy, DNP, ANP-BC, FAHA, Elizabeth Carlson, PhD Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University Medical Center, Chicago, IL article info abstract Article history: Received 14 June 2016 Revised 8 August 2016 Accepted 21 August 2016 Available online August 28, 2016. Background: Uncertainty exists surrounding collaborative relations among Doctor of Nursing Practice (DNP)- and Doctor of Philosophy (PhD)-prepared faculty. Purpose: This qualitative study explored the attitudes and determinants for effective collaboration among doctoral-prepared nursing faculty. Methods: Focus groups were conducted using a convenience sample of doctoral faculty who taught in either/both DNP or PhD programs. Focus group questions were derived to identify interpersonal, organizational, and systemic determinants of collaboration. Data were transcribed and content analyzed using Kruger and Casey methods. Results: Four focus groups included 41 faculty members from two metro area university medical centers. Five themes emerged: (a) DNP not well understood, (b) confusion surrounding research, (c) opportunities for collaboration, (d) lack of structural support, and (e) personal characteristics and attitudes. Discussion: Interpersonal relationships, organizational structures, and systemic impacts have both positive and negative influences on successful collaboration among DNP- and PhD-prepared faculty. Conclusion: Collaborative efforts are needed for advancing the profession.College adoption of the DNP Discussion

Keywords: DNP-PhD collaboration Doctoral faculty Determinants of collaboration Cite this article: Staffileno, B. A., Murphy, M. P., & Carlson, E. (2017, FEBRUARY). Determinants for effective collaboration among DNP- and PhD-prepared faculty. Nursing Outlook, 65(1), 94-102. http://dx.doi.org/ 10.1016/j.outlook.2016.08.003. Introduction The Institute of Medicine Report (Institute of Medicine [IOM], 2010) recommends doubling the number of nurses with doctoral degrees by 2020, and with increasing numbers of Doctor of Nursing Practice (DNP) graduates and DNP-prepared faculty, DNPeDoctor of Philosophy (PhD) collaboration is necessary to advance the profession, transcend the academic environment, and improve health care outcomes of the population (American Association of Colleges of Nursing [AACN], 2014; Bednash, Breslin, Kirschling, & Rosseter, 2014). Melnyk articulates the importance of DNPs and PhDs working in parallel “.to rapidly and effectively translate evidence-based interventions supported by research into clinical settings for the ultimate purpose of improving health care quality and patient outcomes” (Melnyk, 2013, p. 443). Furthermore, several national initiatives promulgate doctoral faculty collaboration. The recent AACN Task Force Report (2015) on the implementation of the DNP affirms the * Corresponding author: Beth A. Staffileno, Department of Adult Health and Gerontological Nursing, Rush University Medical Center, 600 S. Paulina St, 1080 AAC, Chicago, IL 60612. E-mail address: Beth_A_Staffileno@rush.edu (B.A. Staffileno). 0029-6554/$ – see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2016.08.003 Nurs Outlook 65 (2017) 94e102 importance of doctoral faculty collaboration to provide students a range of opportunities involving academicpractice partnerships. The Carnegie Initiative on the Doctorate (Golde, 2015; Golde & Walker, 2006; Walker, Golde, Jones, Bueschel, & Hutchings, 2008) recommends a collaborative academic environment. The Carnegie Initiative on the Doctorate further advocates a professorate that engages all faculty to promote research, teaching, and scholarly productivity (Golde, 2015). College adoption of the DNP Discussion

Today’s health care system is complex; therefore, doctoral faculty and students must be prepared to take on discriminant, but at the same time collaborative, roles to better serve and improve the well-being of the population (Melnyk, 2013). Background Collaborative relationships between DNP- and PhDprepared faculty continue to evolve as the landscape of doctoral education is changing. However, challenges hindering collaborative efforts between DNP- and PhDprepared faculty exist, in part, because the roles among DNP- and PhD-prepared faculty are diverse and not well delineated (Dreher, Smith Glasgow, Cornelius, & Bhattacharya, 2012; Redman, Pressler, Furspan, & Potempa, 2015; Smeltzer et al., 2014). This in turn is leading to uncertainty and tension among some doctoral faculty in relation to faculty functions and expectations, lack of traditional boundaries, misperceptions surrounding resources, and lack of respect. How then, do DNP- and PhD-prepared faculty address these key issues to better understand one another’s unique roles and to make an attempt to resolve this confusion and uncertainty? Our recent report summarized findings from three national surveys describing the current landscape among doctoral faculty (Staffileno, Murphy, & Carlson, 2016). In brief, Smeltzer et al. (2015) surveyed 554 doctoral faculty members teaching in DNP and/or PhD programs. Compared to doctoral faculty teaching in both programs, DNP-prepared faculty teaching only in the DNP programs are newer to the faculty role and teaching and more likely to be involved with clinical practice. A disparity was noted among these same faculty as they are less likely to advance in rank or be appointed tenure and less likely to be experienced with scholarly activities. Interestingly, unlike faculty teaching in both programs, DNP-prepared faculty teaching only in the DNP programs were less likely to perceive system-related support for their scholarship activities. Ulrich et al. (2015) surveyed 408 nurse scientists in doctoral programs and identified challenges with collaborative research in relation to differing expectations concerning authorship, poor communication, and roles and responsibilities not clearly defined. Standards of practice for collaboration were not uniformly done within academic organizations or among faculty, thereby adding to confusion among doctoral 95 faculty. Dreher et al. (2012) surveyed 624 doctoral faculty members teaching in both DNP and PhD programs. Their descriptive survey contained both closed and open-ended questions and was designed to seek faculty experiences. Survey questions focused on tenure status, rank, years in academia, teaching role, university type, administrative appointment, funding history, retirement plans, salary, views on doctoral education, job satisfaction, and succession planning and demographics. The open-ended questions pertaining to faculty views on doctoral education are most germane to our team.College adoption of the DNP Discussion

Five themes identified from the qualitative data include: (a) tensions rising among faculty as a result of the DNP-PhD controversy, (b) concerns the DNP may fail like previous clinical doctorate attempts, (c) concerns about generating new knowledge through research, (d) fear over competing resources and student enrollment, and (e) lack of respect among dual doctorate faculty. In addition to the aforementioned surveys, confusion and uncertainty about DNP and PhD roles are not limited to faculty. Brown and Kaplan (2016) conducted a qualitative study among 22 DNP graduates to describe their educational experiences in a newly developed DNP program. Interestingly, graduates commented about the nature of an evolving curriculum in which faculty and students were learning along the way. Faculty were seeking to understand the DNP program, sometimes struggling with the paradigm shift from traditional research to practice focused inquiry. Udlis and Mancuso (2015) conducted a quantitative study involving 340 nurses of varying educational levels to explore perceptions about the DNP role and identify areas of ambiguity. Survey findings were differentiated by degree, and results were dichotomized to agree and disagree. While there was overall support for the DNP as a terminal practice doctorate, confusion was noted surrounding faculty roles, research, tenure, and scholarship. Among DNP-prepared participants, 76% felt prepared to take on a faculty role whereas only 19% of PhD-prepared participants agreed that DNP graduates were prepared for the demands and rigor of faculty roles. With respect to research, 78% of the DNP compared to 18% of the PhD-prepared participants agreed that DNPs were prepared to develop knowledgegenerating research. Interestingly, 84% of DNP compared to 35% of PhD-prepared participants agreed that tenure criteria should be similar between the two doctorates. Confusion was also apparent with respect to scholarship as 97% of DNP-prepared and 40% of PhDprepared participants agreed that DNP graduates will contribute to nursing scholarship. While nursing and doctoral education is evolving, there remains confusion on how best to appreciate and optimize the blending of an intraprofessional discipline. As noted, the literature reflects concerns voiced by DNP- and PhD-prepared faculty members. While change is difficult, there is evidence that some initiatives are underway highlighting doctoral collaboration as a way to facilitate timely translation of research into 96 Nurs Outlook 65 (2017) 94e102 practice, enhance educational opportunities, drive positive change, and improve health outcomes of the population (Edwards, Rayman, Diffendefer, & Stidham, 2016; Murphy, Staffileno, & Carlson, 2015; NeSmith et al., 2013; Staffileno et al., 2016). College adoption of the DNP Discussion

However, this practice is not universally embraced. Since the advent of the DNP degree, collaboration among DNP- and PhDprepared faculty appears to be an expected outcome, yet why are so many barriers being encountered? The achievement of unity and inclusion has and continues to impact the full potential of our profession. Although empirical evidence indicates perceptions of confusion and ambiguity, the determinants for effective collaboration among DNP- and PhD-prepared faculty are unknown. This gap, and lack of understanding, needs to be examined, otherwise the expertise and skills of a collective professoriate will not be embraced and enable us to work in teams to address the needs of the population through practice and policy initiatives. Moreover, having an understanding of factors that influence collaboration will enable DNP- and PhDprepared faculty to better prepare students to work in collaborative teams to solve practice and policy issues. Therefore, the purpose of this study was to explore the attitudes and determinants for effective collaboration among DNP- and PhD-prepared faculty. The aims of the study were to explore the following: 1. What interpersonal determinants influence collaboration among DNPePhD faculty? 2. What organizational determinants influence collaboration among DNPePhD faculty? 3. What systemic determinants influence collaboration among DNPePhD faculty? Methods Study Design, Sample, and Setting A descriptive, qualitative study collected data through four focus groups. A convenience sample of doctoral faculty was eligible to participate if they: (a) taught in DNP and/or PhD academic programs, and (b) were employed at an academic institution offering both DNP and PhD degrees in nursing. With respect to sample size, the intent was to gather a sample of 5 to 10 participants per focus group. Focus groups were conducted at a large metro area university medical setting. This study received institutional review board approval. Determinants of Successful Collaboration Framework The focus groups enabled the investigators to elicit insights, attitudes, and beliefs of the participants. Aims of the study were developed from the literature and followed a model of determinants of successful collaboration as described by San Martı́n-Rodrı́guez, Beaulieu, D’Amour, & Ferrada-Videla (2005). They reviewed theoretical and empirical studies and identified three “determinants” of successful collaboration: (a) interactional includes processes at work in interpersonal relationships within the team, (b) organizational includes conditions within the organization, and (c) systematic includes the organization’s environment. These three determinants were used to formulate our aims and focus group questions. Nine questions were developed based on these aims and reviewed by a qualitative expert for face and content validity. A script served as a data collection tool for the focus groups.College adoption of the DNP Discussion

The script addressed the main aims of interpersonal, organizational, and systemic determinants that influence collaboration among DNPePhD faculty and contained the nine questions. Recruitment A recruiting email was sent to College of Nursing deans at three metro area university medical centers (two private and one public institution). This initial email described the rationale and purpose for conducting the study. The respective deans forwarded this recruiting email to DNP- and PhD-prepared faculty. Prospective faculty participants were directed to click on a Survey Monkey link to acknowledge their interest in participating, provide contact information, and select which focus group dates/times they would like to attend. In addition, age, degree, faculty rank, years as a faculty member, percentage of time of faculty responsibilities (teaching, research, clinical, administration), and estimated time of collaboration were obtained. A response email from the investigators was sent to confirm receipt of interest and provide information on the mechanics of the finalization of dates for the focus groups. After 2 weeks, a second email was sent to the three deans requesting them to forward this recruiting email to DNP- and PhD-prepared faculty. After a 4week recruitment period, four focus group dates were confirmed and email invitations were sent to participants with the focus group date, time, and location. Procedures for Data Collection Four focus groups were scheduled over 1 week to accommodate daytime and evening preferences. To provide greater opportunities for exploring attitudes and determinants of effective collaboration, separate focus groups were held for DNP- and PhD-prepared faculty. In other words, participants were integrated in groups by doctoral degree, irrespective of university affiliation. Three days prior to the focus group, a reminder email was sent and an electronic version of the consent form was available for participants to review. Focus groups were conducted in a classroom located in the academic building of the university medical center. The tables were arranged in a circular format so 97 Nurs Outlook 65 (2017) 94e102 participants could see each other. A brief overview of the study was provided, and informed consent was obtained. An experienced focus group facilitator, who was not one of the study investigators, led the discussion. Participants wore name tags, and introductions were stated.College adoption of the DNP Discussion

All focus groups were audio taped, and one investigator was designated as the scriber. The focus groups ran for 90 min, light refreshments were provided, and participants received a $25 Amazon gift card at the end of the session. Data Analysis and Interpretation The data generated by the focus groups were analyzed using the methods proposed by Krueger and Casey (2015). For consistency, the same investigator scribed notes at each focus group, reviewed the audio recordings, and transcribed verbatim. To protect confidentiality, no participant names were included on the transcription. The transcripts were arranged by degree, meaning that the two DNP groups were combined into one file and the two PhD groups were combined into a separate file. This arrangement was done to explore findings from both types of faculty. A classic approach for analysis was used that consisted of sorting and arranging the data by comparing and contrasting themes. As part of the initial-step coding process, two investigators, who did not attend the focus groups, sorted transcript comments by question. This was done to ensure consensus and to minimize the possibility of interpretation bias. The second step of the coding process was done by placing similar labels on similar comments, thereby establishing categories. The coded data were discussed among the three members of the research team to further ensure a consensus that coding was representative of the experience studied. As part of the third step of the process, coded comments were cut and placed under respective questions. This facilitated determining how much weight/emphasis to give to themes. Finally, prioritizing analytic themes was done by clustering comments with respect to: (a) frequencydhow frequent a concept was mentioned, (b) extensivenessdhow many people mentioned the concept, and (c) intensitydhow much passion or force was behind the comment (Krueger & Casey, 2015). Results Forty-three faculty members completed the Survey Monkey link indicating interest in participating in a focus group. Two faculty members were not eligible to participate: one did not have a doctoral degree and the other lived out of state. Of the remaining 41 faculty members, 25 (61%) participated in one of the four focus groups. A total of nine DNP- and 16 PhD-prepared faculty participated. College adoption of the DNP Discussion