Key Doctoral Level-Competencies Essential to Advanced Nursing Practice

Introduction

The Doctor of Nursing (DNP) is a multipurpose program that prepares nurses for roles
extending beyond the traditional clinical functions, such as recording patient symptoms and
medical histories, performing diagnostic tests, and administering drugs (Ahmed et al., 2018).
DNP nurses are equipped to conduct strategic planning, analysis and measurement of health
outcomes, decision-making and information management, design and management of quality
improvement programs, mentorship, problem-solving, administration, professional collaboration,
and team building, research and scholarship, and use of recent research and evidence-based
practices to make informed decisions. The DNP program also equips nurses with executive
leadership skills to serve as Chief Executives or departmental leaders. DNP nurses must have
several core competencies bundled by the American Association of Colleges of Nursing into
eight Essentials to fit into all these roles. Specific competencies are often considered a priority or
crucial to specific nurse settings, meaning that community nurses should possess certain skills
while geriatric nurses should have a different set.
This discussion will explore three doctoral-level competencies considered a priority for a
DNP-prepared nurse working in the ED (emergency department) clinical settings, including
Essentials III, IV, and VI. The third, Essential IV, focuses on Information Systems/Technology
and Patient Care Technology for the Improvement and Transformation of Health Care. Essential
VI focuses on Interprofessional Collaboration for Improving Patient and Population Health
Outcomes, while Essential III is about Clinical Scholarship and Analytical Methods for
Evidence-based Practice. Specifically, the paper will provide a brief description of the ED
clinical setting and why the selected essentials are a priority for the emergency department and

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examples demonstrating the application of each essential, including how the competencies will
support a change at the systems level. The final parts will examine how the three DPN
competencies can help the DNP-prepared nurse influence the health outcomes of people involved
in ED care (patients and clinicians) and the skills for DNP-prepared nurses to collaborate with
the interprofessional healthcare team.
A Brief description of the Practice Setting (Emergency Department) and Why the Selected

Essentials are a Priority for this Setting

The emergency department (ED) is a very sensitive and critical division because it admits
and treats patients suffering from severe medical conditions, including trauma and injury,
especially those requiring urgent treatment. Examples of conditions that warrant patient
admission to ED rooms include heart attack, joint dislocation or bone fracture, suicide attempts,
drug overdose, and baby delivery. The ED department also attends to patients that require urgent
surgeries due to life-threatening conditions, such as appendicitis. In most instances, admission to
ED rooms is unplanned and requires interprofessional collaboration to stabilize unconsciousness,
excessive bleeding, and breathing difficulties. Besides, the emergency department needs to have
technologies, frameworks, and support systems to help them make quick and informed decisions.
Each second or minute can separate between saving and losing a patient. Most importantly,
nurses must assure patient accountability of the safety and quality of care in these emergency
scenarios.
Therefore, the three selected competencies (III, IV, and VI) are a priority for the
emergency department because of their ability to guarantee that clinicians can make quick and
sound decisions supported by evidence and the type of care patients receive is safe and of superb
quality. For example, Essential III (Clinical Scholarship and Analytical Methods for Evidence-

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Based Practice) is appropriate to the ED because it assures that DNP graduates remain
accountable for patient safety and care quality. It also ensures that nurses have the requisite skills
to examine ethical dilemmas and make correct decisions backed by evidence, especially during
emergencies that require quick but accurate thinking (AACN, n.d.).
Essential VI (Information Systems/Technology and Patient Care Technology for the
Improvement and Transformation of Health Care) is also critical to the emergency department
because it arms ED clinicians with the up-to-date technologies and information systems required
to make pressing and informed decisions (AACN, n.d.). DNP-prepared nurses must know about
critical information systems that support clinical decision-making, such as electronic health
records (EHRs). As of 2017, HealthIT.gov estimated that about 86 percent of office-based
physicians had implemented any electronic health records, and roughly 80 percent had rolled out
a certified EHR.
Finally, Essential VI (Interprofessional Collaboration for Improving Patient and
Population Health Outcomes) is a priority for the ED because it prepares DNP nurses to head
interprofessional teams to assess the multidimensional system and practice issues through
practical collaborative and communication skills (AACN, n.d.). Classically, this competency
emphasizes the fundamental role of interprofessional collaboration in the delivery of care. For
the Emergency Department, interprofessional collaboration is a requisite practice that brings
ambulance paramedics, nurse practitioners, physicians, care coordinators, registrars, interns, and
allied health professionals, including pharmacists, occupational therapists, physiotherapists, and
mental health emergency team. It also incorporates emergency diagnostic technicians, such as
radiologists, sonographers, and radiographers. DNP-prepared nurses are endowed with the
requisite effective communication and teamwork skills to lead these interprofessional teams.

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Interprofessional collaboration in the ED is necessary for delivering quality, safe, and timely care
(Dreher-Hummel et al., 2021).
Examples of How the Three Essentials Apply to the ED and Support Change at the

Systems Level

There are multiples ways in which competencies III, IV, and VI apply to the emergency
department and support change at the systems level. For example, Essential III guarantees that
clinicians always use critical thinking to quickly place a patient admitted to the emergency
department with breathing problems on an oxygen support machine. Specifically, Essential III
ensures that ED nurses and physicians run several approved tests to diagnose the breathing
concern accurately, such as peak flow, gas transfer, bronchial challenge, respiratory muscle
strength, spirometry, bronchodilator tests, and fractional tests exhaled nitric oxide test. All these
measures are centered on providing safe and quality care to patients.
There are myriad ways in which Essential IV has improved the use of information
systems and other technologies in the emergency department. Electronic health records (EHRs)
are the most widespread systems applied in the ED. Typically, EHRs are archetypal information
systems that embody technology in clinical healthcare settings, including the emergency
department. Typically, EHRs are patient records created, stored, and shared by clinicians and
patients through secure networks. They are the digitized version of the paper-based patient
charts. Implementing EHRs can guarantee that clinicians access accurate and updated patient
information for an emergency department, such as medication histories, allergies, blood groups,
and laboratory test results. For emergency care, this information is crucial as it guarantees that
physicians and nurses can access correct patient data quickly (Ward et al., 2014).

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Equally, competency VI (interprofessional collaboration) is widely used to make many
critical decisions in the emergency department. For example, DNP nurses sometimes require
other’s perspectives (such as physicians, radiologists, mental specialists, and care coordinators)
to make triaging decisions. Triaging patients to the ED is a fundamental practice determining the
patients admitted to the emergency department and those that have to wait a little longer.
Accurately triaging patients requires collaborating with specialists in specific practice areas, such
as mental health, radiology, pharmacy, or bacteriology, depending on the conditions of the
patients to be triaged. Any wrong decision in triaging can disproportionately predispose patients
to adverse health outcomes, including mortality. Therefore, interprofessional collaboration is a
critical competency that allows DNP-prepared nurses to create value-based care outcomes
(Moss, Seifert, & O’Sullivan, 2016).
How the DNP Competencies can Assist DNP-Prepared Nurse Influence Health Outcomes

of the ED Patients

DNP-prepared nurses can leverage the three competencies to influence healthcare
outcomes in emergency departments in the most profound way. Usually, nurses’ responsibility is
to stabilize patients’ conditions, and patients are eased to other ‘ordinary’ wards to open space for
others. Nurses can apply competencies III, IV, and VI in different ways to influence healthcare
outcomes in these clinical settings. For example, Essential III can assist nurses in ensuring they
remain committed and accountable to delivering safe and quality care in the ED amidst the
anxiety and urgency that often accompany care in the emergency department (AACN, n.d.).
Also, the competency requires that nurses critically examine all the ethical dilemmas and
challenges inherent in emergency departments using advanced evidence-based technologies.
Equally, competency VI guarantees that nurses have a deeper understanding of all the

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information systems and leverage technologies to scrutinize programs that affect decision-
making and outcomes in the ED. For example, the competency can furnish DNP-prepared nurses
with all EHR user functions and requirements, such as reporting, general documentation, patient
access, order entry, clinical charting, scheduling, billing, and appointments (Kabukye et al.,
2018). Knowledge on the proper use of EHRs can lower medication errors, improve patient
safety and quality of care, and reduce the length of stay in the ED. Finally, competency VI can
help nurses acquire the leadership skills to lead an interprofessional ED team in analyzing
multidimensional and complex systems and practice issues. It equips them with adequate
collaborative and communication aptitudes.
Analyze the Skills for the DNP-Prepared Nurse to Effectively Collaborate with the

Interprofessional Healthcare Team

In the emergency department, communicating and collaborating with interprofessional
teams is a prerequisite to assure that patients are triaged accurately and those admitted receive
quality and safe care supported by evidence. The emergency department comprises multiple
teams often working in harmony to ensure patients arrive safely to the facility, get treated, and
released when they are out of danger. This includes ambulance paramedics that perform
emergency clinical procedures like First Aid, provide advanced life support and ferry patients
that need urgent care to the ED. The other team comprises medical staff, such as emergency
physicians, hospital medical officers, registrars, interns, care coordinators, psychiatrists, nurse
practitioners, occupational therapists, pharmacists, and physiotherapists. There is also the
diagnostic team comprising of technicians like radiologists, sonographers, and laboratory
analysts. DNP-prepared nurses must coordinate and connect with all these professionals to

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deliver care. They must have the requisite leadership skills and competencies to effectively
communicate and lead these multidimensional and diverse teams to achieve a shared goal.
For instance, DNP-prepared nurses must have practical communication skills, both verbal
and non-verbal. Specifically, they must be able to communicate openly and precisely to foster
understanding in the ED. Clarity during communication is an important attribute that can prevent
medication errors, especially considering that the ED team often works under pressure and is
time-constrained. The DNP nurse must also have cultural awareness and diversity skills to build
strong relations with all team members from different backgrounds based on race, sexual
orientation, gender, or religious affiliation. Cultural awareness ensures that DNP nurses
understand and appreciate the values, beliefs, practices, and viewpoints of other teammates. It
also means that DNP nurses comprehend the interprofessional diversity inherent in clinical
settings. Most importantly, DNP leaders need to exhibit accountability, sound decision-making,
and problem-solving skills and respect others (Ahmed et al., 2018).

Conclusion

DNP-prepared nurses must have a broad range of competencies and skills to operate in
demanding clinical settings like the ED. Essentials III, IV, and VI are the top three priority
competencies necessary for the ED. Essential III assures that DNP graduates remain accountable
to patient safety and quality of care, VI arms ED clinicians with the up-to-date technologies and
information systems required to make informed decisions quickly, and VI prepares DNP nurses
to head interprofessional teams involved in the assessment of multidimensional systems and
practice issues through practical collaborative and communication skills.

References

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AACN. (n.d.). DNP Essentials: The essentials of doctoral education for advocacy nursing
practice (2006). https://www.aacnnursing.org/DNP/DNP-Essentials
Ahmed, S. W., et al. (2018). DNP education, practice, and policy: Redesigning advanced
practice for the 21 st century. Springer Publishing Company.
Dreher-Hummel, T., et al. (2021). The challenge of interprofessional collaboration in emergency
department team triage – An interpretive description. Journal of Advanced Nursing,
77(3), 1368-1378. doi: 10.1111/jan.14675
HealthIT.gov. (n.d.). Quick stats. https://www.healthit.gov/data/quickstats
Kabukye, J. K., et al. (2018). User requirements for an electronic medical records system for
oncology in developing countries: A case study of Uganda. AMIA Annual Symposium
Proceedings Archive, 1004-1013.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977730/
Moss, E., Seifert, P. C., & O’Sullivan, A. (2016). Registered nurses as interprofessional
collaborative partners: Creating value-based outcomes. The Online Journal of Issues in
Nursing, 21(3). doi: 10.3912/OJIN.Vol21No03Man04
Ward, M. J., et al. (2014). The effect of electronic health record implementation on emergency
department operational measures and performance. Annals of Emergency Medicine,
63(6), 723-730. doi: 10.1016/j.annemergmed.2013.12.019