Doctoral Nursing Students Make Improvements in Health Systems through Projects

The Doctor of Nursing Practice (DNP) program prepares students to lead healthcare innovation at the highest organizational level and influence policy while allowing students to focus on a particular specialty area. Students Rachel Coumes, Dawn Byrne, and Jill Richmond applied their research knowledge to analyze healthcare practices and policies, translating this knowledge quickly and effectively to benefit patients and healthcare systems. With the motivation to help their teammates, improve patient care, and become stronger leaders, the graduate students’ final projects focus on enhancing health policy and legislation, communication, and patient outreach within hospital systems.

Rachel Coumes’s project, “Nurse Error and Criminal Punishment: A Policy Analysis,” explored which policies might be the best suited for the uptake of legislation in more states. Coumes’s experience as a certified professional in patient safety (CPPS) and interest in the legislative side of patient safety have inspired her to delve deeper into the subject of medical error. To gain a deeper understanding of the policies in place, Coumes conducted a formal policy analysis examining the variables associated with the criminalization of unintended medical error. After discovering that only one state in the US had passed legislation, she conducted a descriptive qualitative thematic analysis of nurse interviews to learn more about nurse perceptions and awareness of the criminalization of unintended error. In order to inspire change, Coumes reviewed her research and suggested policy recommendations as well as indicated action, “To pass legislation, patients and legislators have to understand why the legislation is important. It will be successful if we can have more public support to pass.”

Dawn Byrne’s project, “Glycemic Control in Hospitalized Adults: Improving Quality and Outcomes,” successfully improved the communication systems of hospital staff by implementing a desktop-to-phone app called “Mobile Heartbeat,” designed to send a broadcast message to all staff in the building. This system would replace the previous method of individual phone calls, which resulted in longer wait times and miscommunications. The dietary staff was trained to use Mobile Heartbeat to communicate simultaneously to the entire nursing unit on their clinical smartphones, alerting them to new formations and events, such as food tray delivery timing, to better manage insulin. Using this new system decreased turnaround time from 55-60 minutes to 15-25 minutes. As a result of the new system that Byrne implemented, 92% of patients were getting their blood sugars and insulin administrations properly. 

Jill Richmond’s project, “Decreasing The No-Show Rate in a Multi-Clinic Organization of Federally Qualified Health Centers,” aims to reduce no-shows by implementing a predictive modeling tool and targeting outreach interventions based on the tool’s prediction. The model was engineered to examine numerous (30+) demographic variables, such as social determinants of health and patients’ history of no-shows. Then it generates a predicted probability for no-shows. “It's the combination of innovative technology in predictive modeling with the old-fashioned but significant personal outreach that some patients appreciate,” said Richmond. The project was implemented at 19 sites and was built using the Institute for Healthcare quality improvement framework, utilizing plan-do-study-act (PDSA) cycles. The first month resulted in a decrease in no-shows from 15% to 11%. The project concluded with a 20% relative change, resulting in 2,500 more visits preserved and $582,000 in preserved revenue. 

Coumes, Byrne, and Richmond may have completed their projects, but the conversations and systems they developed are continuing to be refined and practiced. The students hope to foster more discussion surrounding their projects and continue to ease the stresses of healthcare through innovation. The graduate students felt inspired and supported throughout the program. They acquired valuable skills that provided them with a broader perspective on all aspects of nursing practice. “The program has the most inspiring group of women that I have learned so much from around doctoral nursing practice that we have globally; whether it’s policy, community, clinical practice, or executive presence. This program has been incredibly supportive in shaping me to become a more well-rounded leader for my organization or anywhere else I choose to practice,” said Byrne. Moving forward, the students continue to flourish alongside their innovations.