Healthcare organizations may possess untapped resources that could be leveraged to become or remain a high reliability organization. This article aims to explore the skills nurses holding a Doctor of Nursing Practice (DNP) degree bring to the organization and offers strategies to capitalize on their talents to help achieve high reliability, accomplish organizational goals, and address the Quadruple Aim.
High reliability organization are those that consistently achieve high standards of safety, quality, and efficiency by focusing on: 1) sensitivity to operations – a heightened awareness of the state of systems/processes; 2) reluctance to simplify work – accepting that healthcare is complex and can fail in unforeseen ways; 3) preoccupation with failure – viewing near misses as opportunities to improve; 4) deference to expertise – prioritizing insights from staff with the most relevant knowledge; and 5) practicing resilience – training for potential systems failures.
Hidden Organizational Treasures
The DNP-prepared nurse is highly skilled in bridging the gap in clinical practice through enhanced competencies in quality improvement, systems thinking, evidence-based practice (EBP), and leadership. Nursing leaders developed the DNP degree over 2 decades ago in response to the increasing need to address the complexities of practice and achieve the Quadruple Aim. Therefore, DNP-prepared nurses are uniquely equipped to drive organizational change that leads to improved patient outcomes and reduced errors with:
- Enhanced patient-centered care – by developing quality improvement initiatives that integrate EBP and lead to the improvement of patient protocols/practices; advancement of clinical practice guidelines; the design and evaluation of new care delivery models; and the development, implementation, and evaluation of policy. These efforts drive system change focusing on the care experience and propel innovation and technology integration forward.
- Reduced costs – using financial acumen skills to streamline workflows, reduce waste, and ensure efficient use of resources.
- Population health – designing and implementing programs related to disease prevention, health promotion, and chronic disease management; implementing strategies to address social determinants of health and diversity, equity, and inclusion.
- Improved provider experience – leading interprofessional collaboration and mentoring efforts.
However, if the unique DNP skillset is unrecognized or underutilized in organizations, the opportunity to capitalize on this desired expertise is limited. In a recent study by Kesten et al. (2024), of the 87 organizational leaders who hire or work with DNP-prepared surveyed, over half reported that DNP competencies were integrated into job descriptions; although, almost half reported providing no time for these types of activities.
Strategies to Maximize the Talents of DNP-Prepared Nurses
To leverage the skillset of the DNP-prepared nurse, it is necessary to become familiar with the Essential Competencies for advanced level nurses. When assigning the DNP-prepared nurse or student to an improvement project, it is strongly recommended to establish performance expectations that align with these competencies to achieve the desired outcome(s).
- Peer support and mentor programs may be exceedingly helpful in increasing the comfort level and proficiency with one or more competencies. This support might also be necessary to ensure interfaces with the appropriate stakeholders, often decision-makers, who can advance the work.
- Academic Practice Partnerships (The Guiding Principles for Academic-Practice Partnerships) may not only provide an opportunity to connect academicians who possess these competencies to clinicians who require assistance with their application, but also serve as a pipeline for recruitment of DNP-prepared nurses.
- Lessons learned from the Toyota Production System (TPS) (A3 Problem-Solving - A Resource Guide | Lean Enterprise Institute) may be helpful in framing and justifying the problem that is being solved by those closest to the work, specifically the A3, within the context of a professional governance structure. This includes many of the data elements that must be considered and reflects the knowledge and skills honed by the DNP-prepared nurse and encourages inclusion of content experts such as finance leaders who can best articulate financial implications.
- The development of innovative models of care delivery can lead to reliably safer and higher quality care at reduced cost while enhancing the experience of care for both the clinician and the patient/significant other. This includes the integration of technology such as virtual encounters, robotics, and/or the prudent use of artificial intelligence as adjuncts or doing more with less, but effectively.
- Dissemination of findings regardless of favorability is a critical professional developmental activity that not only serves as a summation of the work but also reinforces the professional responsibility of the DNP-prepared nurse to contribute to the discipline’s body of knowledge.
Conclusion
DNP-prepared nurses are essential drivers of healthcare transformation and the key to sustaining high reliability organizations. Their advanced competencies in leadership, evidence-based practice, quality improvement, and systems thinking make them uniquely positioned to help healthcare organizations meet their strategic goals and achieve the Quadruple Aim. By improving patient outcomes, reducing costs, enhancing population health, and fostering a supportive work environment for healthcare professionals, DNP nurses reveal their value and contribute to the overall success and sustainability of healthcare organizations. However, to live into their potential, DNP-prepared nurses need organizational support.