US Air Force Utilization of the DNP: A Quality Improvement Evaluation

This project is a quality improvement evaluation of the United States Air Force's transition to the Doctorate of Nursing Practice (DNP) as the entry-level degree for advanced practice nurses (APRN) practicing in clinical settings. In 2004, the American Association of Colleges of Nursing (AACN) released a policy statement based on the seminal quality publications from the Institute of Medicine (IOM) that began with To Err is Human. That policy recommended the transition of the APRN entry-level degree from a Masters (MS) to a DNP level. The notable changes to DNP abilities are evidenced by the eight DNP essentials for education. In alignment with this policy, the military health care systems began converting APRNs positions to the DNP as the entry-level degree. However, a 2014 Research and Development Corporation report on the transition to the DNP by 2015 showed slow adoption of the DNP in both the nursing profession and health care system-wide. The report stated that the value of the DNP is, "almost universally agreed upon," however, studies are still needed to demonstrate clearly the significance of the added DNP education to help stakeholders understand the true benefit and effectiveness of DNP prepared nurses. This project adds to the body of literature in support of DNP preparation. This will assist stakeholders in making quality decisions about the promotion of DNP education, clinical care, and leadership. Highlighting the impact of DNP prepared nurses within the Air Force health care system is one way to show a change in clinical care and health care leadership. This quality improvement evaluation identified the impact of the DNP degree on the behaviors of some APRNs within the Air Force health care system. Air Force APRN CVs were gathered and a comparison of pre- versus post-graduation behaviors was completed. The behaviors were compared using the DNP essentials as benchmarks. This evaluation found DNP APRNs show a positive change in the number of professional behaviors aligned with the DNP essentials post-graduation. This indicates DNP APRNs are engaged in higher quality, professional practice. It was identified that some limitation of the DNP scope may be occurring when DNPs fill roles traditionally held by MS level providers. It was also indicated that certain DNP essentials are not fully addressed in Air Force DNP APRN practice. The findings and recommendations to expand DNP role to the full scope of abilities has been presented via submission of an article to a military health care journal. The IOM articles on the quality of health care identified gaps and named nurses as uniquely poised to meet those needs within the health care system. "Practice-focused doctoral programs prepare graduates for the highest level of nursing practice beyond the initial preparation in the discipline". This move allows APRNs to meet the identified quality improvement needs of the US health care system. The US Air Force transitioned to the DNP as entry-level for APRNs as of 2015 per the AACN recommendation. This project identified improvements in professional practice since that transition. The Air Force is experiencing improved APRN practice through DNP education and can implement further changes to continue to maximize the DNP contribution to their health care system.