Flexibility, “Big-Picture” Thinking:
Just A Few of The Benefits of Earning Your DNP
According to the American Association of Colleges of Nursing (AACN), “Nurses with advanced preparation typically enjoy more opportunities to impact the overall design and implementation of care.” For Lensa Girsha, earning the DNP allows her to manage her own patient population. “In Indiana, DNPs collaborate with physicians, but don’t have to be supervised,” she said.
"It helps me ask the right questions that lead to improved patient outcomes."
Lensa Girsha, DNP, ANP, Internal Medicine Associates in Mishawaka, Indiana
Girsha, an Adult Nurse Practitioner (ANP) at Internal Medicine Associates in Mishawaka, Indiana, manages acute and chronic conditions, providing primary care to patients 18 and older. Her DNP degree has consistently come into play: “It helps me ask the right questions that lead to improved patient outcomes,” Girsha said. “I’ve also been able to generate significant cost savings for the practice.”
Girsha’s focus on finding solutions to vexing clinical questions began in graduate school. “My DNP project was based on how to effectively manage diabetes in a group setting while benefiting the patient, provider, and clinic,” she said. “We do a lot of teaching to diabetic patients about nutrition and other areas, but if you’re seeing, say, four patients per hour, that’s only 15 minutes with each patient, so you don’t have much time for interaction.” Girsha looked at what happened when providers saw a group of six diabetic patients for a full hour, instead of the individual visits. She followed the group patients’ blood work for six months and saw significant improvement over the individual treatment model. “We found that the longer group visit made more of an impact,” she said. “We were able to bring in a diabetic educator, who is a nutritionist, and really dig in to the issues.”
Girsha brings the lessons learned from her graduate studies into clinical practice daily. “The DNP has broadened my perspective and knowledge, helped me hone my leadership skills, and improved my critical thinking ability,” she said. “This degree really helps you understand the healthcare industry at large, and makes the interdisciplinary process much easier, which is crucial as healthcare moves closer to an integrated model.”
In addition to highlighting healthcare’s intricacies, the DNP offers degree holders the opportunity to practice in a wide variety of areas within the healthcare arena. “You aren’t limited to clinical practice, because you gain all the skills that allow you to understand the business of healthcare,” she said. “It’s such a flexible degree – you could go into education, public policy, public health, and those are just a few areas.”
What to Look For in a DNP Program
If you’re considering going back to school to further your nursing career, you’ve picked the right time. One-third of the nursing workforce will retire over the next 10 years, which has never happened before and will take a lot of knowledge out of the healthcare arena.1 Additionally, 70 million baby boomers will be retiring with multiple chronic and degenerative conditions, which will add to the complexity of care and increase the number of nurses needed to care for them.1 Add to that the looming physician shortage, and you have the perfect storm – and the perfect opportunity to step in and help shape the future of healthcare, as nurses will play a greater role in preventive care and patient education.
Nurses with a DNP will be best positioned to serve as leaders in the healthcare system, “working collaboratively with nurse researchers to implement new nursing science and practice innovations,” according to the AACN. Additionally, “Nurses with doctoral preparation typically earn six-figure salaries and often rise to the top of healthcare’s leadership ranks.” With a wide variety of DNP programs available, prospective students have a wealth of options at their fingertips.
"Brevity often sacrifices academic rigor..."
Tracy Anderson, DNP, Associate Professor of Nursing at Saint Mary’s College
The variety of options can be a double-edged sword, as there are many “drive-by” DNP offerings. It is important to search for programs that emphasize scholarship, are broad-based, and inform practice. According to Associate Professor Tracy Anderson, DNP, a strong program “will have enough scholarship and academic rigor to challenge the student to generate innovative and entrepreneurial opportunities for nursing as a whole.”
Additionally, the program should be broad-based, encompassing ethics, epidemiology, and theory-based evaluation, which explains the “whys” underpinning nursing practice. Be careful with the 13-month, full-time DNP program, which may lack scholarship: “The brevity often sacrifices academic rigor, because it takes time to absorb and learn,” Anderson says. “You may only get to do a handful of article reviews, and this ultimately won’t provide you with the same leadership and scholarship quality as other programs.”
Anderson also recommends searching for programs with an entrepreneurial focus, to prepare for the rapidly shifting landscape of healthcare. “In the future, nurses will be much more autonomous, especially when the provider shortages are as big as they’re predicting,” she said.
In terms of program structure, prospective students should determine whether an online or in-person format better fits their needs. Additionally, some online programs are completely virtual, while others feature on-campus components. Another consideration when exploring online programs is whether the program is approved by your state of residence, so make sure to call the school and ask them to check the reciprocity agreement.
1 Hospitals & Health Networks Online, “The 4 Forces That Will Reshape Nursing.” Laurie Larson. 8 September 2016.
How to Reduce Burnout
and Compassion Fatigue
Paradoxically, one of the characteristics of a stellar nurse can at times prove detrimental. Society has long viewed the nursing profession as synonymous with compassion and empathy, and due to the nature of the work, nurses may become extremely invested in the health and welfare of their patients. However, when nurses begin to “take on the emotions and suffering of their patients as their own,” 1 normal feelings of compassion and empathy begin to develop into compassion fatigue.
“Compassion fatigue ‘has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress.’’’ 1 When under ongoing stress from caring for severely ill patients, nurses may reach a point where they become burned out and unable to care for themselves or others, affecting their overall wellbeing.
"Do deep breathing, guided imagery, and just take a moment to yourself."
Jenna Bauer, DNP, Associate Professor of Nursing at Saint Mary’s College
Understandably, compassion fatigue is especially prevalent among nurses in the oncology unit. Along with working in an emotionally charged environment, “the intense and ongoing losses experienced in oncology care make oncology nurses very vulnerable to burnout. It can be especially difficult for nurses to deal with the loss of a patient that they have known and taken care of for a long time.” 1 Additionally, nurses working in the emergency department are prone to burnout, since they “see on average about 50 patients per shift compared to about four patients on a normal medical-surgical floor, which can be both physically and psychologically exhausting.” 1
So what can nurses do to prevent compassion fatigue – or at least minimize its effects? According to Jenna Bauer, DNP, associate professor of nursing at Saint Mary’s College, employing deep breathing and guided imagery techniques can go a long way toward alleviating symptoms. Bauer led fourth semester BSN students through an eight-week guided imagery stress reduction program, and found a clinically significant increase in students’ confidence levels in their ability to handle stress after the program, as well as an increase in feelings of control over unexpected events.
Another strategy to combat the onset of compassion fatigue is to create a space for relaxation. “If it ever gets to the point where it’s just too much, and you are able to step out of the situation, find a nurse who can watch your patients for a few minutes, go to an empty room and destress,” Bauer said. “Do deep breathing, guided imagery, and just take a moment to yourself.”
It’s important for stress-reduction initiatives to originate from the top levels of an organization. According to “Seven Strategies to Reduce Nurse Burnout,” 2 stress reduction programs frequently fail “because bedside nurses do not receive support for such programs from leadership.” Management should initiate and support nurse mentoring and stress relief programs to foster social support, which can alleviate stress, as well as encourage nurses to attend stress reduction classes and keep up-to-date with training, as nurses who feel competent in their jobs are less anxious and likely have a greater sense of mastery. 2
1 “Preventing and Managing Compassion Fatigue and Burnout in Nursing,” by Heidi Braunschneider, College of DuPage
2 “Seven Strategies to Reduce Nurse Burnout,” by Rebecca Hendren, HealthLeaders Media