The doctor of nursing practice (DNP) degree is a clinically focused, terminal degree that prepares NPs and other advanced practice registered nurses (APRNs) to improve healthcare delivery and health outcomes.1 DNP curricular design ensures NPs acquire the knowledge and skills needed to provide high-quality care through integration of evidence-based practice (EBP) and organizational leadership.1
Since 2006, DNP programs in the US have continued to grow. Between 2017 and 2018, more than 32,000 students were enrolled in DNP programs and over 7,000 students graduated.2 The growing number of DNP-prepared NPs in the workforce are using their education to improve healthcare systems and patient outcomes. Studies have found that DNP graduates and their employers acknowledge that DNP-prepared NPs are change agents who influence organizational leadership and integrate EBP and quality improvement into patient care.3,4
DNP-prepared NPs are ideal mentors and preceptors for DNP students. They're knowledgeable about DNP educational requirements and have experience as clinicians and healthcare leaders. Although students often find mentors at their place of employment or through their academic programs, leaders of professional NP organizations can also mentor DNP students. NP organizations can complement academic programs by providing DNP students with experiential learning and mentorship in areas such as leadership, policy, and advocacy.
This article describes a novel mentoring experience with DNP students and leaders of a local NP organization. Through this mentorship initiative, students gained valuable leadership experience and the organization was energized with growth and innovation.
Literature review
DNP education. DNP programs are available for postbaccalaureate and postmaster's students. The American Association of Colleges of Nursing (AACN) identifies eight competency outcomes for DNP program graduates.5 The Essentials of Doctoral Education for Advanced Nursing Practice outlines these outcomes, which include:5
* scientific foundation of practice
* systems and organizational leadership
* translation of research into practice
* health policy and advocacy
* incorporation of technology
* prevention and population health
* interprofessional collaboration
* advanced nursing practice.
The Essentials reflect the foundational skills and knowledge needed to provide advanced healthcare to improve outcomes and influence the healthcare system. Educational programs use coursework, clinical experiences, and a scholarly project to help students achieve these competencies.6
DNP students are required to complete at least 1,000 postbaccalaureate clinical hours in their educational program.5,6 Postmaster's DNP programs can include verified master of science in nursing (MSN) clinical hours in these 1,000 DNP hours, thereby reducing the number of clinical hours required in the DNP program.6 Through experiential learning, students incorporate didactic content into clinical practice and leadership, implement their DNP scholarly project, and achieve DNP competencies. They also have the flexibility to arrange clinical experiences that align with their personal goals and interests, such as partnerships with community health organizations, service learning, clinical practice settings, and their place of employment.7-9
An often-challenging area for DNP students is inclusion of experiences in policy and advocacy. de Cordova and colleagues investigated graduate students' policy education and found that the content was primarily didactic in standalone policy courses or integrated into other courses; most assignments focused on policy analysis. A notable finding was that 85% of DNP students hadn't participated in legislative advocacy efforts.10
Nursing faculty members may not be engaged in policy activities, which adds to the challenges of policy education. Staebler and colleagues investigated policy education and found barriers such as a lack of faculty involvement in policy and policy not being perceived as a high priority in some educational programs.11 If academic institutions and healthcare organizations have limitations on employees' political activities, students may benefit from policy experiences outside of their programs.
Professional NP organizations. The American Nurses Association Code of Ethics for Nurses with Interpretive Statements and AACN's Common Advanced Practice Registered Nurse Doctoral-Level Competencies encourage participation in nursing organizations to promote solidarity and advocate for healthcare and the nursing profession.12,13 NPs can belong to local, state, national, and international organizations. Some represent all NP professions, whereas others represent a specialty area.14 Organizational goals may include advancing the profession, providing education, and participating in policy initiatives.14 Belonging to a professional organization can also provide personal benefits for members, such as professional and leadership development, education, networking, mentoring, volunteerism, advocacy, engagement, and friendship.14
DNP students should be encouraged to join NP organizations to network and learn from NP leaders. Because of their involvement in policy initiatives for professional issues and healthcare advocacy, NP professional organizations can expand students' vision beyond the traditional healthcare system or academic focus. Many professional organizations are actively engaged at the local, state, national, and international levels, allowing diverse policy experiences for students. Membership in professional organizations has been associated with political engagement.15
In addition to policy and advocacy engagement, professional organizations have members who are expert clinicians and organizational leaders. Their expertise can be shared with DNP students through clinical experiences and mentoring.
Mentoring. The AACN encourages intra- and interprofessional mentorship for DNP students.6 Mentoring is a process of pairing a mentee, or novice, with an experienced individual who serves as a mentor to facilitate professional and personal growth as the mentee moves into new areas of responsibility.16 Mentors invest time and resources to support and guide mentees in this process.
Attributes of mentors and mentees can influence the success of the mentoring process. Mentors build trust through confidentiality, sensitivity toward others, and empathy. They should have knowledge and skills to support their mentees' professional development. Mentees should be enthusiastic, receptive to learning and feedback, and active participants in the mentoring process.16 Both parties must have time to invest in the relationship.
In graduate nursing education, nursing faculty and preceptors often mentor DNP students in academic and clinical settings.17,18 DNP graduates can also mentor DNP students. DNP-prepared NPs understand the requirements of the program and the challenges students may face. Because many graduates are using DNP skills in their practice, they can inspire students by helping them see the relevance of DNP competencies in clinical practice. Studies investigating the benefits of DNP graduates mentoring DNP students found that both groups viewed the mentoring experience as being personally beneficial.19,20
Mentoring for policy and advocacy is an area well suited for NP organizations. Mentoring for policy has been recommended to increase skills and comfort level with policy activities and is associated with internal political efficacy.21,22 Mentoring and membership in professional organizations are motivators for political activity.21 When NP organizational leaders mentor DNP students, the organization provides access to leaders outside of students' academic and clinical settings, allowing for diversity in experiences. NP organizations can provide leadership opportunities for students who don't have leadership roles in their workplace. Most important, mentorship through professional organizations invests in individuals who are the future of the NP profession.
Mentoring DNP students through a regional NP organization
In 2018, the president of a regional NP organization spearheaded an initiative for the organization to mentor DNP students by inviting students to join the leadership board. This experience provided students with opportunities to develop leadership skills and help them achieve competency outcomes; it also had a positive effect on the organization.
Located in a metropolitan area with over 200 members, this organization is a regional council of the state NP organization. Its goals are to promote policy, advocacy, and education for APRNs in the region. These goals align with the DNP Essentials of organizational and systems leadership for quality improvement and systems thinking, healthcare policy for advocacy in healthcare, and advanced nursing practice.
The governing board includes the president, president-elect, past president, secretary, treasurer, and committee chairs. Many board members have DNP degrees and bring diverse expertise as NP business owners, entrepreneurs, organizational leaders, DNP faculty, global health leaders, and international nursing faculty. To facilitate achievement of DNP competency outcomes, these leaders provided mentorship and clinical experiences to four postmaster's DNP students from two DNP programs. The students served as committee chairs for education, government relations, student representation, and nominations and awards.
Each student was mentored by a DNP-prepared board member who previously held the position or was familiar with the responsibilities. Students attended board meetings and monthly membership meetings, and communicated regularly with their mentors by phone or in person. Students were responsible for contacting their program faculty members to determine how these hours and experiences could count for clinical hours for their programs.
A unique benefit for the DNP students was that they were actively engaged in leadership. With support from their mentors, they established short- and long-term goals and budgets for their specific committees. Students were mentored in strategic organizational planning to achieve goals for policy, advocacy, and education. The development of a formal leadership mentoring program was invaluable for the students who didn't have leadership opportunities in their workplace or their DNP clinical sites.
Because healthcare delivery is continually changing, the organization is committed to providing education for members to stay abreast of new healthcare practices. To meet this objective and provide experience for the advanced practice competency, the chapter president mentored the education chair on innovative ways to establish a successful inaugural pharmacology conference that was attended by 100 NPs. The conference included a session on opioids because the state had recently added a requirement of opioid education for NP prescriptive licensure. Additionally, the pharmacology continuing-education credits could be applied to NP licensure and certification requirements. This conference provided funding for MSN and DNP student scholarships and charitable contributions.
Based on its success, the next conference will include an advanced practice clinical skills workshop developed by one of the DNP students. Participants will learn suturing, splinting, foreign body removal, and incision and drainage. Having the ability to perform procedures can increase access to care. When providers don't have these skills, patients are often referred to EDs, which increases healthcare costs and requires transportation. It can also be a barrier for patients in rural and underserved communities.
A strength of mentorship with an NP organization is engagement in policy and legislative initiatives. The government relations chair provided legislative updates to the organization's members and encouraged them to contact their government representatives about relevant legislation. To further support development of policy skills, the organization provided funds for three mentored DNP students to attend a national NP policy conference. Students learned about policy resources, processes, and skills to advocate for NPs, patients, and communities. They commented that this experience changed their beliefs about the importance of policy, empowered them to engage with legislators and the political process, and ignited their passion to advocate for the NP profession. Their enthusiasm inspired members of the organization to engage in policy activities.
The student representative was intentional about engaging MSN and DNP students at all meetings. She recruited NPs to precept students enrolled in MSN and DNP programs. A new initiative for the organization was the establishment of preceptor recognition awards. Three tiers of awards included bronze for 100 hours, silver for 200 hours, and gold for 300 hours. Students and/or preceptors submitted the preceptor's name, students' names and university affiliation, and number of preceptor hours in the previous year. Five preceptors were recognized at a monthly meeting and given a gift according to the level of the award.
Finding preceptors is challenging, so the organization felt it was important to publicly recognize and thank NP preceptors. The nominations and awards committee chair was responsible for obtaining nominations for leadership positions and overseeing elections, as well as coordinating the selection process for MSN and DNP student scholarships.
Organizational impact
The regional NP organization's initiative was empowered with new leaders who brought innovative ideas and membership engagement. The students assisted in reorganizing the agenda for monthly membership meetings, which promoted a sense of community. Because of the pharmacology conference's success, the organization was able to increase the number of scholarships for MSN and DNP students.
To provide organizational information and highlight members, the president created a monthly regional newsletter and mentored students on the importance of disseminating information. Students helped with writing and editing. The newsletter provided a platform to provide detailed information about legislative changes that directly affect NPs locally and throughout the state. Other sections included membership, government relations, education, links for political action committee donations, public relations, volunteer opportunities, awards/nominations, and upcoming local and state events.
The newsletter provided a way for DNP students to share their experiences. The organization's members responded in overwhelmingly positive ways, with increases in membership and donations to the state political action committee.
Future plans
Based on the success of this mentorship initiative, the organization will continue to offer mentoring to DNP students. When board members mentor students, it provides a leadership succession plan and ignites the students' desire for increased leadership responsibilities; one student is now president-elect of the regional organization and another was invited to join the state NP organization's leadership board as a student mentor for public relations.
A future area for mentorship is evaluation and dissemination of clinical practice innovations. Organizations can provide mentorship for DNP scholarly projects and support after graduation for continued scholarly endeavors. Evaluation and dissemination of practice improvement projects is a skill developed through DNP education and should be continued in practice. By encouraging translation of research into practice and evaluation of outcomes, NPs advocate for their value as healthcare providers. Evaluating health outcomes is crucial to validate and support the care provided by NPs.
Implications for NP organizations
As NP education moves toward the DNP degree for entry into practice, students may not have the experiences and professional connections that postmaster's students bring to their DNP programs. Finding clinical experiences to meet competency outcomes may be challenging. However, because of their diverse experiences and the growing number of DNP-prepared members, NP organizations can provide mentoring and learning experiences for DNP students.
Professional organizations should consider offering mentorship to DNP students. Organizations can reflect on the unique strengths of their leaders and members to offer experiences that facilitate educational and professional success for students. By participating in organizational leadership, students learn important skills and the value of organizational membership.
Implications for DNP programs
Anecdotal comments by DNP faculty included appreciation of the organization's mentorship of DNP students. Students shared their enthusiasm for the unique opportunities provided by the organization. Mentoring allowed for meaningful and relevant experiences that contributed to achievement of DNP competencies.
All DNP programs should encourage students to seek mentorship in professional organizations to facilitate achievement of competencies, especially in the areas of policy, advocacy, and leadership. Because faculty members are role models, they should be active members of professional organizations. This demonstrates the value of professional membership and provides a connection for mentoring opportunities.
New energy and innovation
The NP organization found DNP student mentorship to be rewarding and beneficial. The students brought new energy and ideas that led to membership growth and engagement of members. DNP students received valuable experience to help them meet DNP competency outcomes and they were empowered with the knowledge, skills, and experiences needed to influence the healthcare system and improve outcomes.
With many competing interests in the healthcare arena, NPs must be skilled advocates for their profession and their role as vital members of the healthcare team. Through a powerful voice of unity, NP organizations champion their contributions in improving the health of individuals and communities. When NP organizations mentor DNP students, the organization and students are empowered with experiences to advance the profession, and organizations can be transformed through new energy and innovation.
INSTRUCTIONS DNP student mentorship
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