The Nexus of Science and Systems: A Discussion of Two DNP Essentials

The Doctor of Nursing Practice (DNP) is a practice-focused terminal degree that prepares nurses for the highest level of advanced nursing practice. Rather than focusing on the generation of new scientific knowledge, the DNP’s purpose is to translate and apply existing research and evidence into clinical practice to improve health outcomes (American Association of Colleges of Nursing [AACN], 2006). This work is guided by a set of foundational competencies known as the DNP Essentials, which outline the knowledge and skills necessary for the DNP-prepared nurse to lead change and innovation. Among these, two essentials are particularly critical for professional practice: Essential I, Scientific Underpinnings for Practice, and Essential II, Organizational and Systems Leadership for Quality Improvement and Systems Thinking. When considered together, these essentials form a powerful framework that allows the DNP-prepared nurse to effectively identify and address complex healthcare challenges.

The first of these competencies, Essential I, highlights the scientific foundation of advanced nursing practice. This essential goes beyond simply understanding the biophysical and psychosocial sciences; it requires the integration of nursing science with other disciplines to serve as a basis for high-level practice (AACN, 2006). For the DNP, this means not only comprehending the “what” of patient care but also the “why” behind health phenomena and interventions. It involves using established nursing theories, models, and analytical methods to guide practice and improve outcomes. In my work area, a DNP-prepared nurse in a large, urban hospital system recently led a quality improvement initiative to reduce medication errors in the intensive care unit. Using a framework based on the Systems Theory, she first sought to understand the root causes of the errors, moving beyond individual nurse actions to analyze the larger system. This involved examining the unit’s workflow, the design of the electronic health record (EHR) medication ordering interface, and the availability of pharmacy support at different times of the day. By applying this scientific and theoretical lens, she was able to propose system-level changes, rather than simply offering a brief educational session for staff. As a result, she was able to apply scientific rigor to a complex clinical problem to identify a new approach that would better serve the patient population.

Building on this, Essential II, Organizational and Systems Leadership for Quality Improvement and Systems Thinking, provides the DNP with the skills to enact meaningful change. This essential emphasizes the ability to lead, manage, and evaluate care delivery approaches at a macro level, with a focus on improving patient safety and quality of care (AACN, 2006). It requires an understanding of business, finance, and policy, enabling the DNP to facilitate system-wide transformations. In the same hospital system example, the DNP-prepared nurse’s work on medication errors demonstrates this essential in action. After identifying the systemic issues, she had to navigate the organizational structure to secure buy-in and resources for her proposed changes. This included presenting a detailed proposal to the hospital’s quality improvement committee, demonstrating how the new EHR interface design could reduce errors and improve efficiency, thus providing a compelling argument for the financial investment required. Her leadership skills were crucial in collaborating with diverse stakeholders—including IT professionals, physicians, and frontline nurses—to design a new protocol and a more intuitive EHR interface. This collaborative, systems-level approach is what separates the DNP from other advanced practice nurses who may focus more on individual patient care (Zaccagnini & White, 2017).

Together, these two essentials enable the DNP-prepared nurse to function as a powerful agent of change. Essential I provides the foundational knowledge and the analytical tools to diagnose a problem scientifically, while Essential II provides the leadership and organizational skills to implement a solution. Without the scientific underpinnings of Essential I, the DNP’s leadership efforts might be based on guesswork or tradition rather than on evidence-based practice. Similarly, without the systems leadership skills of Essential II, the DNP would be unable to translate a scientifically sound solution into a sustainable, real-world change (Mielke, 2014). The medication error project exemplifies this synergy: the nurse used scientific theory to understand the problem, then employed systems leadership to implement a data-driven solution, ultimately improving patient safety and demonstrating the value of her DNP role. This combination of scientific rigor and systems-level leadership is what makes the DNP a unique and indispensable professional in modern healthcare.