Running head: RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 1

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1 Running head: RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 1 Research Proposal: Return on Investment for a DNP Jennifer Cavallaro National University

2 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 2 Research Proposal: Return on Investment for a DNP Introduction Following the Institute of Medicine s (IOM) recommendation to double the amount of doctoral prepared nurses by , American Nursing schools and Universities have experienced a rapid proliferation in Doctor of Nursing Practice (DNP) programs over the last decade. Accredited programs expanded from eight in 2004 to 52 in 2011 with a further 69 seeking accreditation 2. Given that the need for doctorate level nurses in academia, leadership, research, and primary patient care roles is well documented 1-3, subsequently enrollment in DNP programs has increased significantly. To date there is little data discussing the benefits to the individual of pursuing a DNP; this study will explore the return on investment of pursuing a Doctorate in Nursing Practice (DNP). The American Association of Colleges of Nursing reports that 1,595 students graduated nursing doctoral programs in 2011 and in that same year, 9,094 students enrolled in DNP programs 3 an increase of 28.9% over the previous year. A further increase to 11,575 enrollees in 2012 was reported 4. The average doctoral course preparation time is 4 to 6 years past baccalaureate degree with graduate salaries ranging from $58, to $96, for academic positions and higher for administrative positions. These figures do not compare favorably to median salaries of $81, to $144, earned by master s degree nurses with advanced practice certificates, a degree only requiring up to two years preparation past baccalaureate degree 1. A literature review shows there are certainly benefits to society of having an increased amount of doctorate level nurses primarily, the lower cost of seeing a DNP verses an MD. In

3 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 3 most clinical situations DNP s work alongside and under the license of an MD, keeping the price of health care at an affordable level. Another benefit is patient accessibility to DNP s, particularly in community and public health centers, long-term care facilities, home health care, and rural areas where fewer MD s practice 1,5. Research falls short identifying if there is a return on investment to the nurse him/herself for the length of time spent in school and financial cost involved in attaining a DNP. The IOM s call to double the amount of DNP s by 2020 has already produced 28.9% of DNP program enrollees by 2011, little data is available at this time related to whether the employment market will be able to handle such a rapid increase of qualified individuals. Purpose Statement As previously stated the doctoral prepared nurse commonly works alongside physicians in primary care, in administrative and leadership roles, academia, and research. The intent of this two-phase sequential mixed methods study is to explore pre and post DNP graduation expectations. In the first phase, quantitative research questions or hypotheses will address the relationship of achieving a DNP and obtaining improved employment opportunities with increased autonomy, responsibility, and associated financial compensation such as those previously mentioned with graduate students at National University. Data collected from this first phase will be explored further in a second qualitative phase. In the second phase, qualitative interviews will be used to probe significant answers by exploring aspects of the participants expectations with the same cohort of students post-graduation from National University s DNP program. The reason for following up with qualitative research in the second phase, is to better understand and explain the quantitative results, and explore the differences.

4 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 4 Questions & Hypotheses The first stage of the study will test the hypothesis that students entering a DNP program have defined professional and/or financial expectations post-graduation. To test this hypothesis the following research question is posed: What expectations if any do students have for post-graduation? Other data gathered will look at the level of education upon entry to the DNP program and why the students chose a DNP program. The second phase of the study seeks to answer two research questions Were the graduates able to find employment in their field of choice? Do they consider the time and money it takes to attain a DNP worthwhile? These questions will test the hypotheses that, rapid growth of DNP graduates result in lack of available positions, and students do not realize a personal return on investment for attaining a DNP. The qualitative data will be used to explore any differences between the study participants pre-graduation expectations and post-graduation actualities. Study Design and Methods This study will use an explanatory sequential mixed method to investigate the association of achieving a DNP and realizing pre-graduation expectations. The population for this study will be a cohort of DNP students at National University. In this two phase study, the first phase will collect quantitative data in the form of a seven question web-based survey to be included in orientation to the DNP program. The survey will collect demographic data, nursing background information, in addition to exploring why the participants chose to pursue a doctoral degree and their expectations upon graduation. The themes from data collected from the first phase

5 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 5 quantitative survey will be used to form the second phase qualitative data collection instrument. Using the same population the second phase of the study will collect data from the DNP cohort one year post-graduation. This qualitative data will be in the form of a seven question interview to be conducted in person, via phone or other electronic media such as Skype the questionnaire will compromise demographic questions and open-ended questions asking if the participants realized their pre-graduate expectations. The findings from the qualitative data will be analyzed to evaluate how accurate the participants expectations prior to graduation were and to understand any differences. Analysis Plan For the first phase of this two phase study the sample size will be dependent upon the number of students enrolled in the participating DNP cohort. The quantitative data will be organized into frequency distribution tables for descriptive analysis of each variable. A statistical t-test will be used to test the first phase hypothesis; identifying the participants expectations, if any, post-graduation. The t-test is used to measure the independent variable; DNP student against the dependent variable; post-graduation expectations. In the second phase the qualitative data will be organized and prepared for analysis by transcribing any recordings and notes taken from interviews. The data will be read and any themes will be identified, and then coded into areas of focus. The coded themes will then be related back to the research questions to discuss the findings, interpret results, and form theories to address issues found, as needed.

6 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 6 Biases/Threats to Validity/Ethical Concerns As the first phase of the study will be taken as part of the DNP orientation it is expected that the whole cohort will participate, the sampling of the second phase could be a challenge and will be biased to those from the cohort who chose to participate. Using only one school in this study will result in a bias to the students from that school. Threats to the validity of the study can include inadequate follow up on appropriate quantitative results in the qualitative phase and, contradictory questions in the two phases.

7 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 7 References American academy of nurse practitioners; nurse practitioners provide solutions to the healthcare crisis. (2011). Obesity, Fitness & Wellness Week 5, Retrieved from d=25320 IOM (Institute of Medicine) The Future of Nursing: Leading Change, Advancing Health. 1 Washington, DC: The National Academies Press. Retrieved from Feeg, Veronica, PhD, R.N., F.A.A.N., & Nickitas, Donna M, PhD, RN, N.E.A.-B.C., C.N.E. (2011). Doubling the number of nurses with a doctorate by : Predicting the right number or getting it right? Nursing Economics, 29(3), , 125. Retrieved from d=25320 Rosseter, R. (2013). DNP fact sheet 3. Retrieved from Rosseter, R. (2013). New AACN data show an enrollment surge in baccalaureate and graduate programs amid calls for more highly educated nurses 4. Retrieved from

8 RESEARCH PROPOSAL: RETURN ON INVESTMENT FOR A DNP 8 Appendix Cohort Survey. Pre-graduation 1. Sex Male ( ) Female ( ) 2. Age ( ) ( ) ( ) 51+ ( ) 3. Years of Nursing 0-5 ( ) 6-10 ( ) ( ) ( ) 31+ ( ) 4. Level of Nursing Education ADN ( ) BSN ( ) MSN ( ) PhD ( ) Other ( ) 5. Current Position Bedside Nurse ( ) Clinic/school Nurse ( ) Education ( ) Nurse Specialist ( ) Management ( ) Administration ( ) Research ( ) Other ( ) 6. Why did you choose to pursue a DNP? Advance Education ( ) Research ( ) More Nursing autonomy ( ) Administrative/Leadership Role ( ) Academic Role ( ) Other ( ) 7. Post-graduation Expectations None ( ) Increased employment opportunities ( ) Research opportunities ( ) Increased income ( ) Other ( ) Cohort Survey. Post-graduation 1. Sex Male ( ) Female ( ) 2. Age ( ) ( ) ( ) 51+ ( ) 3. Have you completed the DNP program? Yes ( ) No ( ) 4. Where you able to obtain the type of employment you expected? If No Explain. 5. How long did it take to find a position? 6. Has your salary increased? 7. Do you consider the investment of time and money for a DNP worthwhile? Explain.