Fostering Inclusivity as DNP Prepared Nurse Leaders
Presented by Metzler-Sawin, E., Argenbright, C., Buchanan, H., Lewis, E., & Mullen, L.
This presentation explores how Doctor of Nursing Practice (DNP) leaders can champion inclusivity within healthcare settings through specialized leadership simulation experiences designed to develop essential competencies in cultural humility and inclusive excellence.
Disclosures
Introduction to DNP Leadership Simulation
Leadership Excellence
Mastering inclusive team dynamics
Interdisciplinary Collaboration
Working effectively across professional boundaries
Competency Development
Building essential DNP leadership skills
The Challenge of Equitable Care
Core Professional Value
Inclusivity remains central to nursing practice across all levels, forming the foundation of equitable healthcare delivery and patient-centered approaches.
Standardized Challenges
Practicum site variations create inconsistent learning opportunities, making it difficult to ensure all DNP students develop comparable competencies in inclusive leadership.
AACN Essentials Requirement
Domain mastery is mandatory for all leadership graduates, establishing a clear need for structured experiences that develop these competencies systematically.
Leadership Imperative
DNP-Prepared nurses must lead efforts promoting healthcare equity, serving as champions for change within their organizations and broader healthcare systems.
Simulation Design Methodology
Evidence-based Design
Founded on INACSL Healthcare Simulation Standards of Best Practices (HSSOBPTM) to ensure validity and educational effectiveness
Standardized Patients
Live and pre-recorded interviews with trained actors providing consistent, realistic clinical scenarios
Guided Reflections
Structured personal reflection and group debrief sessions to enhance learning outcomes and promote critical thinking
Resource Preparation
Evidence-based materials provided before simulation to establish knowledge foundation
Strategic Implementation
Conducted in the second semester of a four+ semester DNP student practicum experience
Simulation Learning Objectives
Investigate Decision-Making
Examine key decision-making processes across different levels of a healthcare system to understand organizational dynamics
Assess Outcomes
Evaluate the consequences and impacts associated with various leadership decisions on patient care and staff experience
Synthesize Solutions
Integrate findings to develop comprehensive approaches to complex healthcare challenges
Implement Policies
Actively engage in the development and implementation of policies and regulations that promote inclusivity
Examine Collaboration
Analyze how interdisciplinary healthcare collaboration influences organizational decision-making processes
Simulation Overview
Organizational Context
Set within a large healthcare organization facing challenges in cultural humility implementation
Leadership Challenge
Tasked with integrating inclusive excellence into the professional identity of all staff levels
Precipitating Event
Recent incident raising concerns about depth of cultural humility among staff and leadership
Leadership Test
Scenario designed to challenge student's ability to promote cultural humility within healthcare institutions
The Simulation: Student Role
Chief Nursing Officer
Assume executive leadership position
Urban Hospital Setting
Navigate complex metropolitan healthcare environment
Diverse Patient Population
Address needs of multicultural community
The Simulation: Background
Cultural Diversity
Rich tapestry of cultural backgrounds within the community
Linguistic Variety
Multiple languages spoken by patient population
Traditional Practices
Various cultural traditions influencing healthcare expectations
Training Initiatives
Existing workshops and programs promoting cultural competence
The Simulation: Incident
Post-Surgical Patient
Rosa Ramirez recently underwent knee replacement surgery requiring inpatient care and rehabilitation support
Insensitive Encounter
Experienced culturally insensitive interaction with nursing staff that left her feeling uncomfortable during recovery
Emotional Impact
Mrs. Ramirez felt marginalized and disrespected following the interaction, affecting her overall hospital experience
The Simulation: Challenge
Community Concerns
Incident has sparked worries among staff and community members about cultural sensitivity
Initiative Effectiveness
Questions raised about whether existing cultural humility programs are substantive or merely performative
Professional Identity
Need to integrate inclusive excellence deeply into the professional identity of all employees
Organizational Culture
Challenge extends across all levels from frontline providers to executive leadership
Simulation Flow
Asynchronous Preparation
Students independently complete assigned readings, preview 3 pre-recorded interviews with involved personnel, and review materials to establish foundational knowledge about the event, cultural humility, health equity, and effective leadership approaches.
Live Patient Interview
Students conduct an asynchronous interview with a standardized patient (SP) portraying Rosa Ramirez, gathering information about her experience and practicing therapeutic communication skills in a challenging scenario.
Synchronous Group Debrief
Faculty facilitate a structured group discussion where students reflect on their experiences, share insights, analyze their approaches, and develop comprehensive strategies for addressing similar situations in future practice.
Simulation Preparatory Activities
Simulation Preparatory Activities: Videos
Nurse Manager Interview
Students viewed a pre-recorded interview with the unit's nurse manager discussing leadership perspectives on cultural sensitivity and team dynamics within the department.
Bedside Nurse Interview
A frontline nurse provided their perspective on the incident, offering insights into unit culture, workflow challenges, and typical patient interactions.
Provider Interview
The attending physician shared their observations on interdisciplinary collaboration and perspectives on cultural humility within the broader healthcare team.
Simulation Patient Interview
Interview Format
20-minute Zoom interviews with standardized patient
Students created their own Zoom links for the interview
Sessions were recorded for evaluation and reflection
Recordings submitted through learning management system
This virtual format allowed for flexible scheduling while maintaining the integrity of the simulation experience, providing students with authentic practice.
Simulation Patient Interview
Standardized Patient Preparation
The standardized patient portraying Rosa Ramirez underwent thorough training to ensure consistent portrayal of the patient experience across all student interviews. This included:
Simulation Reflection: Written Component
Root Cause Analysis
Identify underlying factors contributing to the incident
Solution Development
Create actionable strategies to address identified issues
Cultural Integration
Plan for embedding cultural humility in daily practice
3
Concise Documentation
Summarize findings within 500-word limit
Following their standardized patient interview and before the group debriefing session, students individually completed a written reflection. This assignment required them to analyze the scenario, identify root causes, and develop a comprehensive action plan addressing both the immediate incident and long-term cultural humility integration.
Simulation Debrief: PEARLS Healthcare Debriefing
Setting the Scene
Faculty welcomed the students and set the goals and tone of the debrief.
Emotional Check-in
The session began with an emotional temperature check, asking students to provide a single word describing their feelings during the simulation, shared through a chat waterfall technique to capture immediate reactions.
Objective Description
Faculty guided students to establish shared understanding of the objective events in the case, asking them to summarize key occurrences from the videos and their patient interviews without interpretation or judgment.
This initial phase established psychological safety for the discussion while ensuring all participants had a common understanding of the case facts before moving into deeper analysis.
Simulation Debrief: Analysis
Understanding Bias
Students explored personal and systemic biases potentially affecting patient care, identifying how these might have contributed to Mrs. Ramirez's experience
Communication Effectiveness
Analysis of verbal and non-verbal communication strategies used by healthcare team members, evaluating their impact on patient experience
Cultural Competence
Identification of specific areas for improvement in providing culturally sensitive care within the organizational context
The analysis continued with examination of team collaboration dynamics, assessing how interdisciplinary communication affected care delivery, and discussing specific strategies to ensure patients from all cultural backgrounds feel respected and heard throughout their healthcare experiences.
Simulation Debrief: Application/Summary
Chronicle Documentation
Students integrated their simulation experience into their ongoing professional development chronicle, connecting it to their broader learning journey
Experience Evaluation
Completion of detailed survey providing feedback on simulation
Competency Connection
Reflection on how the experience developed specific DNP leadership competencies related to inclusive excellence
Practice Integration
Consideration of how insights would translate to current or future leadership roles
The self-reflection components encouraged students to internalize their learning and consider how they would apply these insights in their professional practice, moving beyond theoretical understanding to practical application of inclusive leadership principles.
Implementation Timeline Over Two Cohorts
1
Initial Design
Development of simulation based on AACN Essentials Domains, establishing clear alignment with required DNP competencies
2
First Cohort Implementation
Initial implementation with 8 DNP students, providing baseline experience and identifying improvement opportunities
3
Refinement Phase
Adjustments based on student feedback and faculty observations, enhancing simulation design and delivery
4
Second Cohort Implementation
Improved simulation delivered to 10 DNP students, incorporating lessons learned from first iteration
This iterative implementation approach allowed for continuous quality improvement of the simulation experience, with each cohort benefiting from refinements based on previous outcomes and feedback. The development process maintained strong alignment with educational standards while enhancing practical effectiveness.
Key Results and Observations: Faculty Perspectives
Student Hesitation
Faculty observed that some DNP students exhibited noticeable discomfort when leading difficult conversations about health equity. This hesitation revealed an important growth opportunity within the program, highlighting the need for structured practice in navigating sensitive topics.
Preparedness Variation
Debriefing sessions revealed varying levels of student readiness for addressing care disparities effectively. Some students demonstrated advanced understanding and approach, while others needed additional support developing comprehensive strategies.
Cohort Differences
During the second year implementation, faculty noted increased student engagement with the topic
Effective Simulation
The simulation provided a safe environment for students to develop these crucial communication skills, with faculty guidance supporting their progress through challenging scenarios.
Key Results and Observations: Student Feedback
1
Safe Learning Environment
Students consistently expressed appreciation for the non-punitive simulation context that allowed them to practice leadership skills without fear of negative consequences
2
Directional Guidance
First-year participants indicated a need for clearer instructions, prompting faculty to enhance directions for standardized patient interviews and assignment sequencing
3
Timeline Adjustment
Feedback led to shortening the interval between patient interviews and debriefing from one month to approximately one week, maintaining learning momentum
4
Practical Relevance
Students highlighted the simulation's direct applicability to their current or anticipated leadership roles in addressing real-world inclusivity challenges
Key Results and Observations: Competency Development
Students demonstrated progressive improvement in their ability to address inappropriate variations in patient care throughout the simulation experience.
The most significant competency gains occurred following the structured debriefing sessions, highlighting the importance of guided reflection in consolidating learning from experiential activities.
Educational Impact
The simulation experience demonstrated significant educational value in preparing DNP students for their future roles as inclusive healthcare leaders. By integrating theoretical knowledge with practical application, students developed essential competencies that will directly translate to improved patient care and organizational effectiveness.
Leadership Skills
Enhanced ability to guide interdisciplinary teams through equity challenges, developing practical approaches to complex situations
Communication Mastery
Improved confidence in navigating difficult conversations about cultural sensitivity and care disparities
Cultural Awareness
Deeper understanding of diverse patient needs and perspectives, recognizing how cultural factors influence care experiences
Systems Thinking
Strengthened ability to identify and address systematic barriers to equitable care within healthcare organizations
Future Directions
Expand Implementation
Extend simulation to additional DNP programs nationwide through creation of a standardized toolkit for faculty implementation at partner institutions
Formal Research Protocol
Develop structured study measuring simulation effectiveness with validated tools evaluating DNP competency development and real-world applications
MSN Adaptation
Modify simulation for Master of Science in Nursing students, creating developmental pathway for inclusive leadership competencies
These future directions will build upon the successful implementation with initial cohorts, expanding the impact of this educational approach to benefit nursing leadership development more broadly. The research protocol will provide valuable evidence regarding the effectiveness of simulation-based learning for developing cultural humility competencies in advanced practice nursing roles.
Questions & Discussion
Thank you for your attention to our presentation. We look forward to exploring how this simulation model might be adapted or enhanced for your specific educational context and student population needs.