Enhancing Doctor of Nursing Practice Students' Diagnostic and Clinical Reasoning Skills

Students entering Doctor of Nursing Practice (DNP) programs represent a diverse group of individuals with a wide variety of nursing experiences. Prior to beginning the DNP program, some students may have obtained a nurse practitioner (NP) degree and have years of nursing experience, whereas other students may enter the program with only a few years of experience because they recently completed their undergraduate program. Therefore, DNP faculty have the challenge of assessing each student's unique diagnostic and clinical reasoning skills to ensure all students obtain the necessary knowledge and clinical experiences to prepare them to be leaders who will help shape tomorrow's health care.

At one southeastern college of nursing affiliated with an academic health science center, NP faculty recognized they were missing an opportunity to maximize the benefits of the current clinical log system. Initially, the system was used for data collection to verify the number of patients NP students were seeing during their clinical experience. Several years ago, the curriculum underwent a detailed evaluation and course restructuring by a curriculum taskforce. Part of the work of the taskforce was to fully evaluate the clinical tracking system to determine its maximum capability. Olson and Fauchald (²⁰¹¹), who developed and implemented a NP clinical tracking system, acknowledged that faculty might have additional reporting needs and require more functions in the future beyond logging patient numbers. Finding this to be true, the taskforce recommended expanding the clinical log tool to take advantage of the systems' full potential. The DNP faculty subsequently began to use the clinical tracking system as an assessment tool to evaluate clinical and diagnostic reasoning.

The literature regarding how other DNP faculty have implemented improvements to clinical tracking systems in their programs is sparse. O'Brien et al. (²⁰¹¹) conducted a mixed-methods study among first-year medical students and found students endorsed clear guidelines for the clinical log requirements and requested a review and feedback process from faculty that helped them to recognize the importance of patient logs and how to maximize their use for learning. The medical students who participated in the study recommended that the requirements for the entries should align with the curriculum and that the entries should encourage students to review and reflect on patients and their...