The DNP Healthcare Leader: Transformation of Practice

1. The DNP Healthcare Leader: Transformation of Practice Elizabeth F. Ellis DNP, RN, FNP-BC Chief of Advanced Practice Memorial Hermann Texas Medical Center Assistant Clinical Professor University of Texas Health Science Center at Houston-School of Nursing October 10, 2008 Doctor of Nursing Practice Conference Memphis, TN

2. Objectives • To discuss the implications for utilizing DNP graduates as clinical Leaders • To identify the role and responsibilities of the DNP clinical leader • To identify the challenges and lessons learned of a practicing DNP Clinical Leader

3. Creating the Transition • Practice doctorate needed in nursing • DNP becomes the highest level of advanced nursing practice • DNP creates clinical experts and leaders • DNP begins to impact practice change

4. HealthcareChallenges • National concern for patient safety • Transforming care at the bedside • Need for translational research • Development of evidenced based practice • Interdisciplinary practice models • Patient care across the continuum

5. DNP Education: The Right Choice • Structured clinical experience • Broader evidenced based scope of practice • Translational Research • Array of analytical, theoretical, philosophical and evaluative processes

6. Partnership Created • Impacted by patient satisfaction • Increased gaps in patient care • Required new models of care • Increased efforts to improve patient safety • Improved core measure outcome • Improved documentation

7. Chief of Advanced Practice • As far as we know this is a national first • Places DNP at level equivalent to Chief of Medicine • Transform patient care and APN/PA practice • Strengthens bridge between MHH, SON and Med School • Innovative Practice Model • Signifies nursing at the highest clinical level

8. Role of Chief • Leader in clinical, academic, administrative, community and institutional policy making arenas • Change agent-new models of care • Support and create scholarship opportunities • Foster Relationships • Sustain APP program

9. Lessons Learned • Establish Chief title and level of hierarchy from start • Define distinct department of Advanced Practice Providers • Identify NP administrator as major champion • Identify lead NP, PA, and CRNA

10. Lessons Learned • Establish MD Champion from start • Defined Budget prior to start • Defined inpatient clinical practice for the Chief • Service Line MD Champions

11. Where Are We Going • DNP Hospitalist model • DNP Intensivist model • Inpatient billing model • Sharing the model

12. References • Accreditation Council for Graduate Medical Education.(2002) Report of The ACGME work group on resident duty hours. Retrieved May 7, 2008 from http://www.acgme.org/DutyHours/dutyHoursCommonPR.asp •  Buppert, C. (2006). Billing physician services provided by nurse practitioners in specialist’s office, hospitals, nursing facilities, homes, and hospice. Bethesda, MD: Law office of Carolyn Buppert.  • Ellis, E., Mackey, T. Buppert, C., & Klingensmith, K. (2008). Acute Care Nurse Practitioner Billing Model Development. Submitted For Publication. • Fuchs, J. & Ellis, EF. (2008, June). Advanced Practice Nursing Clinical Leaders Special Interest Group. Presentation conducted at the conference of the American Academy of Nurse Practitioners, Washington, DC.  • Lake, D. (2007).UT School of Nursing and Memorial Hermann Hospital creating new TMC partnership with Chief of Advanced Practice position. Retrieved May 7, 2008 from http://publicaffairs.uth.tmc.edu/media/newreleases/nr2007/sonpartnership.html.

13. References Cont. • Larkin, H. (2003) The case for nurse practitioners. Hospitals & Health Networks [Internet] 2003, August [cited 2007, April 17]; Retrieved April 17, 2007, from http:www.hospitalconnect.com.  • Mundinger, M., Kante, RL., Lenz, ER, Totten AM, Tsai WY, Cleary PD, et al. (2000). Primary Care Outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAM, 283(1):59-68.  • Safriet, B. (1992). Healthcare dollars and regulatory sense: The role of advanced practice nursing. Yale J Regulation, 9:417-88.  • Todd, B., Resnick A, Stuhlemmer, R, & Mullen, J. (2004). Challenges of the 80-hour resident work rules: Collaboration between surgeons and nonphysician practitioners. Surgical Clinics of North America; 84:1573-1586.