Announcer: Welcome to the Doing Your DNP podcast from Premier Health. This episode is about the approval and regulatory issues of doing your DNP at Premier Health.
Holly Hall, EdD, RN, MSHA: Greetings. I am Dr. Hall. Welcome to the Nursing Evidence Based Practice Research Committee’s podcast. I will be today’s interviewer. I am a nurse researcher at Premier Health and an adjunct research chair. I have over thirty five years experience in nursing, including clinical and administrative roles. I am honored to be joined by Dr. Patricia O'Malley. Dr. O'Malley, please introduce yourself.
Patricia O’Malley PhD, RN, CNS: Good afternoon, Dr. Hall, and it’s very good to be here for this podcast today. I have been at Premier Health over forty years and have worked clinically as well as in the research program and work as a nurse scientist with Dr. Hall. We mentor and help students as they bring their projects forth and complete their doctoral work at Premier Health. So hoping this podcast today gives a little bit of assistance to you on your DNP journey on important issues that need to be addressed as you walk this journey to completing your project.
Holly Hall, EdD: Great. Okay. All right. The first question. Share with us, Pat, Premier Health’s experience with DNP education.
Patricia O’Malley PhD: Premier Health is honored that DNP students choose Premier Health as a site to implement their DNP project. Premier Health has welcomed many students from entry into the profession through post-doctoral work for over forty years from universities across Ohio, Indiana and Kentucky, as well as Arizona, South Dakota, Alabama, Kansas and West Virginia.
As the number of DNP programs increased, we have also experienced a significant increase in DNP students seeking to complete their projects at Premier Health. Each school is unique in that the expectations for the students and requirements for the DNP project vary. We have also experienced that many DNP faculty are new faculty with limited understanding of the requirements for hospital systems with regards to access to information, approval processes, protection of patients, and maintaining safe workflows. We’re here to help with that.
Holly Hall, EdD: That is quite impressive. Okay. Can you share how the DNP student and project is supported at Premier Health?
Patricia O’Malley PhD: The DNP project focus, as described in the twenty twenty one AACN Essentials, states that DNP projects may take various forms depending on the student’s specialty and role and institutional requirement. Project focus can include evaluation of current nursing interventions, evaluation of adherence to national standards, evidence translation to practice via education and data reviews, as well as systematic reviews of the literature.
Depending on the depth of the DNP project, some students have prepared clinical programs for possible implementation based on evidence translation. All of these are acceptable at Premier Health. However, Premier Health does not guarantee that all DNP program requirements can be implemented. For example, we may not be able to adopt a program that was successful during the project implementation of the student. However, we will support the student in their project as they complete their degree requirements.
Holly Hall, EdD: Okay, that’s pretty straightforward. All right. Next, can you tell us how projects are reviewed and approved at Premier Health?
Patricia O’Malley PhD: Thanks, Holly. We have a process that’s multi leveled and walks the student through each phase of the organizational and regulatory requirements. First, every DNP student must meet with the nurse scientist or the nurse researcher to discuss their project, the resources they need, and their projected timeline. Their faculty are welcome to participate in these discussions.
We, the nurse scientists and nurse researcher, work with the student to help facilitate the project approval process for the HIRC, or the Human Investigation Research Committee of Premier Health. Only Premier Health HIRC approval is required to allow a student to move forward with their project at Premier Health sites. So it is a requirement. It is very wise for the student to have their project approved by their faculty before seeking approval at the HIRC committee at Premier Health.
Holly Hall, EdD: Great. Okay. And now, can you tell us some of the reasons a project may not be approved by HIRC?
Patricia O’Malley PhD: Yeah, there are a few reasons, Doctor Hall. And part of our work here is to assist students with these issues for possible adaptation of their protocol in light of these issues.
Reasons for projects not being approved can include the project that was submitted to Premier Health is incomplete. The project as written disrupts patient and staff workflow, interfering with patient care. Safety concerns from the HIRC committee. Poor scientific merit. The project timeline is set too short. There’s a big issue here with expecting to complete a project rapidly when, in most cases, that is not possible.
Other issues that may stop approval include confidentiality risks for patient and staff, students expecting staff to do the student’s work, unnecessary burden added to workflow, or the project as written is not quality improvement and evidence based practice and needs to move to the Institutional Review Board approval process for human subjects research.
Although rare, depending on community demand and available resources, students seeking to complete a DNP project can also be turned away for these reasons.
Holly Hall, EdD: Okay. I have a question. What if my project is not approved? Would I get a letter from HIRC or what is that process?
Patricia O’Malley PhD: Yes. If there is non approval from HIRC, the student is notified as well as the nurse scientist or nurse researcher of what are the issues that are holding the project back from approval. So the student is able to respond to those issues and those things can be modified. Or we can make recommendations for other sites that they may want to consider for completion of their project.
Holly Hall, EdD: Okay. Can you share with us some of the regulatory requirements that influence the DNP project approval process?
Patricia O’Malley PhD: These issues that I just want to share with you are very important. First of all, students, whether you are employed by Premier Health or not, do not have access to the electronic health record, which is Epic, for their project unless they have written approval from the HIRC committee.
You may not access the electronic health record except by the processes that are given to you with your HIRC approval. You may not access the record at any time on an inpatient unit or area where patients are cared for for project purposes. The HIRC committee will provide for you direction after approval where you can obtain the information that you are requesting from Epic.
The Health Insurance Portability and Accountability Act, or HIPAA, of nineteen ninety six is a federal law which protects patient health information and establishes our standards for electronic health information access. HIPAA was passed by Congress in nineteen ninety six and the fines are steep when these regulations are not followed. We are required under federal law to protect health information and to limit access to those with only a need to know basis. That is why the HIRC committee oversight and approval is so important to keep us in line with our regulatory requirements.
Additionally, if you request data such as quality improvement data or other types of information that is collected as part of daily operations, this data is also under the HIPAA rules. With approval of the HIRC committee, data will be provided de identified for the project depending on the project approval and available resources that can obtain your data.
Any request to modify our electronic health record is usually not approved since the electronic health record is our record of care and storage of confidential information. Any modification of our record requires significant time for approval, construction, education and testing.
Patients as well as staff are considered vulnerable populations and also require protections. This includes confidentiality and the right to not participate in a student project. Consent is therefore required for both, and the nurse scientist, nurse researcher and HIRC committee can help provide guidance regarding meeting these consent requirements.
Holly Hall, EdD: Is there anything else you would like to share?
Patricia O’Malley PhD: We have shared a lot of information in this podcast and it seems kind of daunting at first. However, the process for approval within the organizational and regulatory guidelines is worth doing to provide a good foundation for a successful project. The nurse scientists and nurse researcher and the HIRC committee are here to assist you in this process, and we look forward to working with you.
Holly Hall, EdD: Thanks for your attention and thank you, Dr. O'Malley. And this concludes our podcast.
Patricia O’Malley PhD: Thank you, Dr. Hall.
Announcer: Have questions about the information presented in this podcast? Please contact Dr. Patricia O'Malley, nurse scientist, at pomalley@PremierHealth.com, Dr. Holly Hall, nurse researcher, at hhall@PremierHealth.com, or Dr. Tanya Trotter, nurse scientist, at tltrotter@PremierHealth.com. Thanks for listening.
