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February 2009
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HOW the DNP Delivers

After 26 years of nursing, a doctorate student finds new inspiration at St.Kate's.


EVERY fourth Thursday afternoon, Michelle Spadoni leaves behind her home nestled in a pine forest on the outskirts of Thunder Bay, Ontario, along with her "very patient" husband and their Newfoundland puppy. She also leaves behind her job teaching nursing students and becomes a nursing student again, driving nine hours to the College of St. Catherine, where she is in the first class of the inaugural Doctor of Nursing Practice (DNP) program.

St. Kate's DNP program, only the second in Minnesota, lasts 24 to 27 months. It was launched last September with 15 students. Students meet monthly on Friday evenings and Saturdays, and engage often in online discussions and clinical applications that supplement the face-to-face classes.

Spadoni, 46, worked in clinical practice for 22 years before becoming a full-time lecturer at Ontario's Lakehead University School of Nursing four years ago. She describes herself as a perennial student. She commuted in 2000 to the College of St. Scholastica in Duluth, Minnesota, to become a clinical nurse specialist. And she'll commute for the next two years to St. Kate's to earn her DNP.

No DNP degree is offered through Canadian universities. Her goal is no less than to improve long-term nursing care, so she's willing to risk that her university may not recognize her doctoral degree.

As a student and as a nursing professional, Spadoni is dedicated to resolving the colliding issues of an aging population and a scarcity of long-term care healthcare professionals. She continues to administer end-of-life care for patients while teaching undergraduates and arranging clinical experiences for 178 first-year students — on top of working on her degree at St. Kate's.

The France-sized province of Ontario houses 600 long-term care facilities with some 75,000 patients. Yet nurses are reluctant to work in long-term care because of the intense and complex work involved. At times just one registered nurse is responsible for a facility's entire patient population and healthcare staff.

"With people living longer, so many patients have so many complex health problems," Spadoni says. "The patients are fragile, and caregivers need to give to the full ability of their experience and education."

An agent for change

Spadoni has already proven to be a change agent. Formerly an oncology nurse, she helped develop the first antibiotic kits for patients undergoing chemotherapy far from home. The kits allow cancer patients from northern Canada to return home between treatments. Some of Ontario's northern residents live in areas so remote they have no physician, nurse, pharmacy or navigable roads in winter.

Northern nurses now can administer the medication in the kits should the patient get a cut or sore, which, if infected, could be dangerous because of a weakened immune system.

Spadoni wants to educate the next generation of nurses to retain the ideal of truly caring for patients despite the pressures of increasing patient loads and management responsibilities. And she wants to inspire existing nurses to reclaim their ideals as well.

A beacon of collegial support

"Coming to St. Kate's has given me a new breath of life," she says. "You see problems in healthcare and you wonder, 'Can I change this?'" St. Kate's has empowered her to answer yes, she says.

"Nurses in the DNP program at St. Kate's are experts in mental health, long-term care, pediatrics, administration. You have all these experts at the table," she says. These fellow students become colleagues who offer one another new perspectives as they journey together in a cohort through the program. In addition, she says, St. Kate's faculty have worked nationally and are leading writers and researchers in their respective fields.

"These women are leaders in the field. They have the potential to make a real difference."

— Associate Professor of Nursing Margaret Dexheimer Pharris
Having considered DNP programs throughout the United States, Spadoni chose St. Kate's because of its social justice mission and its focus on administrative leadership. The program has turned her attention back to the patient-centered care she embraced when she began her nursing career, and she's grateful.

"We're looking at some pretty philosophical, advanced theories, but they're always brought back to human experiences," Spadoni says.

For example, the first course in the DNP program is called "Underpinnings of the Discipline of Nursing," taught by Associate Professor of Nursing Margaret Dexheimer Pharris. DNP students discuss readings, sometimes in small groups — some that Pharris designed as "Ethics Cafés," replete with food and beverages. Pharris tries to pose the critical questions, and let the students grapple with the answers.

Students consider ways in which theories have come to life in their own practices. A book by Margaret A. Newman, Transforming Presence: The Difference That Nursing Makes, inspired Spadoni to consider the importance of patients' life experiences in treating them. Upon reflection, Spadoni could easily find examples in her own work.

For instance, she recently cared for a critically ill woman who was told by her doctor that she'd have to trade in her high heels for athletic shoes so she didn't fall and hurt herself. Proud of her grooming, the woman was devastated. Spadoni was challenged with getting her to comply.

So, she and her undergraduate nursing students mounted pictures of the older woman on the wall wearing her favored sweater sets and pearls. The students styled the woman's hair. Then they entertained her with an emceed style show exhibiting current fashions — all with athletic shoes in a rainbow of colors to help her feel more stylish. It worked. The woman had her daughter buy her athletic shoes in an array of colors. "Long-term care is about creating dignity and comfort," says Spadoni.

Practical research

All DNP students are required to complete practice-improvement projects to earn their degrees. Spadoni plans to analyze and improve professional accountability in Ontario's long-term care environment.

She calls her project "Reframing Nursing Accountability in Uncertain Times," and her Lakehead University colleagues have urged her to write a grant to the Ontario Ministry of Health and Long-Term Care to get funding for her study. If she receives the grant, the funding will allow her to suspend her teaching and focus on her research for three years.

As part of her project, Spadoni hopes to help long-term care professionals learn to work more in collaborative teams. She says that in long-term care, licensed practical nurses, registered nurses, nurse practitioners and clinical nurse specialists all work with patients and families. They can be confused about where their roles intersect. Communication often breaks down. As a result, professionals become distressed about their inability to consistently deliver quality care, and patients and their families may feel lost in the system.

Understanding adult learners

Although her task looms large, Spadoni is not one to let challenges overwhelm her. Unless, she says with a smile, it's the challenge of being an adult student asked to write papers again. But that's one of the reasons she chose the DNP program at St. Kate's.

"My professors understand the balance of work and academic life, and they are patient with adult learners who want to get things right," she explains. "I've been working for so long in environments where there's a demand to write and speak clearly that I want to do well and grasp the material. When I was younger I didn't appreciate educational opportunities like I do now."

Pharris says students like Spadoni make the first class of DNP students truly remarkable. "We had more than double the number of applicants we could take, and there were outstanding applicants to choose from," Pharris says. "These women are leaders in the field. They have the potential to make a real difference."

Each Saturday that Spadoni drives back to Thunder Bay she feels energized, eager to share with her colleagues what she's learned. The drive also gives her a chance to reflect on what she can do with her new information.

"I can empower students to look at the big objectives in nursing," she says. The harder challenge, she concedes, will be inspiring overworked healthcare staff who have grown complacent or cynical about the way things are. She won't be one of them. St. Kate's has inspired her to continually ask herself, "Is this good nursing care?"

Elizabeth Child is a freelance writer and communications consultant in Northfield, Minnesota.

Michelle Spadoni

Michelle Spadoni