1. Rhodes, Marilyn MSN, BSN, RN, CNM

Article Content


This presentation will examine the results of research that explored the introduction of the doctor of nursing practice (DNP) into a system of systems from leadership and effects-based perspectives.



In October 2004, the American Association of Colleges of Nursing endorsed its vision to establish the DNP as the sole entry-level education for advanced practice nurses by 2015. Nursing, medical, and educational disciplines responded to this initiative, introducing new variables and questioning potential results.



Introducing change into a system creates variables and outcomes that may be uncontrollable. The military introduced Effects-Based Operations to understand the achievement of military and political objectives and evaluate outcomes. The term effect refers to the "full range of outcomes, events, or consequences that result form a specific action"(p31) (Mann et al, 2002). Adapting this military leadership concept, effects-based reasoning (EBR) is defined by the researcher as a method to explore and analyze effects of an action. Effects-based reasoning considers first, second, and third orders of effects.



The researcher used a qualitative case study method, triangulating data from organizational documents, pertinent professional literature, and interviews, to demonstrate effects of the DNP initiative.



The author identified outcomes, uncontrollable variables, and potential outcomes of the DNP initiative. Such outcomes include the initiation of more than 60 DNP programs and the publication of position statements on the practice doctorate by advanced practice nurse organizations (first order). A second-order effect is demonstrated by individual state higher education associations controlling the number of programs allowed in public institutions. The introduction of Resolution 211 by the AMA may lead to further fragmentation of the healthcare team, strained communication among healthcare professionals, and unfavorable patient outcomes (third order).



This research identified effects-based outcomes resulting from the introduction of the DNP into the system of systems: the national healthcare system.


Implications for Practice:

Effects-based reasoning assists nursing leaders in guiding the effects of the DNP initiative. Effects-based reasoning examines actual and potential effects in the planning, execution, and assessment of organizational objectives. Utilizing EBR can exemplify contributions and outcomes of clinical nurse specialist practice from a systems perspective.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.