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kimberly foxworth

Kimberly Foxworth, UNLV Nursing Doctoral Student and ACNO in Las Vegas

Apr. 21, 2022

By Joseph Gaccione (UNLV School of Nursing Associate Director of Communications)

Spring 2022 is a historic semester for UNLV School of Nursing, as it will graduate its biggest class of students from the doctor of nursing practice program.  This semester, 19 students successfully defended their doctoral projects on topics as diverse as increasing awareness for HPV and enhancing genetic test rates to better spot breast and ovarian cancer in women.

A Doctor of Nursing practice degree is similar to a Ph.D. in the realm of advanced nursing, but a DNP focuses more on the clinical practice side. Nurses on this track find and improve health care outcomes in the clinical setting through policy changes and enhanced leadership.

As graduation approaches, DNP students and faculty share what being part of this class means to them, how their research is changing healthcare, and what their advice is to future nurse leaders.

Measuring Success - Kathleen Thimsen, DNP, MSN, ET/WOCN, FNS, Professor, DNP Program Director

Professor Kathleen Thimsen became program director of UNLV’s DNP program in 2021. While she’s excited about how many of her students are graduating this semester, she’s quick to say she’s more interested in the quality and depth of the research. “The projects are directed to high-level systems thinking, which is where DNP programs nationally are focusing education: systems thinking and systems science,” she says. “I see this level of richness in a lot of these projects, and that excites me because we're producing clinically relevant projects that create high level impact.”

The core of reviewing a DNP student’s research is how effectively the student identified a problem and how they developed a proper intervention through evidence-based practice. “I [ask], ‘What were their measures? Were they rigorous or were they kind of low hanging fruit in terms of what and how they're evaluating their impact?’ The efficacy is another component of that,” she says. “I'm trying to pull that out in the students I'm working with, [asking], ‘Tell me what's the impact of this? This was your perceived impact, did that happen?’ I want them to identify the serendipitous findings, because that's your springboard to the next trajectory of your project. That's where you build your body of work that may become your career focus.”

Thimsen looks not only at how each student hopes to improve patient care and clinical ability, but at the bigger picture, seeing all the areas it could impact, even if it’s not strictly nursing.  She calls it the ecological perspective. “You're looking at it comprehensively and then drilling down to focus the project on something that is manageable, that is based in the literature in terms of sound science or approaches or program designs,” she explains. “It may not be something from nursing. It may be from engineering; we use a lot of engineering frameworks. It might be from biomechanics or from a business model.”

Looking at all the facets of a student’s research is critical to add credibility to their specific work and the work performed by practicing nurses.  So far, Thimsen is happy with the results she’s seen so far, saying, “We want to make sure these projects are impactful and meaningful. I don't see any that are not meeting those criteria.”

Setting the Vision of Nursing - Kimberly Foxworth, MSN, BSN, RN, CCRN, RCIS, CPHQ, NEA-BC

Kimberly Foxworth is the Assistant Chief Nursing Officer at Desert Springs Hospital. Her DNP Project revolves around cutting down on the amount of central line-associated bloodstream infections in the Critical Care Unit.  These infections are known as CLABSIs. Three years ago, Foxworth moved into the ICU and noticed too many hospital-acquired infections, a trend that can irreparably harm a patient. "It increases morbidity and mortality," she explains, "and it also increases the length of stay [for] patients because now they have a hospital-acquired infection you have to give antibiotics for that they didn't have before."

So Foxworth began investigating the causes of these infections and how to correct the processes they had in place.  After enrolling in UNLV's DNP program in Fall 2020, she realized this could be an even bigger topic to research and improve. For three months, Foxworth and her team emphasized educating the nurses in the ICU on CLABSIs, hand hygiene and how to manage central lines in patients properly.  "The most important thing you can do before you access a line is to make sure your hands are clean," Foxworth explains. "When you're placing a central line catheter, you want to make sure you're using the evidence-based protocols of utilizing chlorhexidine cleansing and practicing sterility before placing a central line in a patient." Beyond the health practices, Foxworth helped enhance communication, prioritization and escalation among the nurses. "We discussed central lines in our nursing huddles; we addressed the importance of maintaining central line dressing, following the CLABSI bundle protocol, and escalating blood culture orders to the charge nurse," she says. "Central lines have to be monitored closely and with great intentionality. We want to make sure our patients are safe, and we have a responsibility to ensure patient safety as nurses." Foxworth adds educating the nurses was critical because some nurses were unaware of the potential consequences of central line-associated bloodstream infections. She asserts, "It's that consciousness of saying, 'If we don't understand how to manage central lines appropriately, these infections have the potential to cause our patient's great harm.'

Foxworth's efforts made significant progress.  The number of CLABSIs dropped from 15 in one year (pre-intervention) to zero, and that number still stands months after her DNP research ended. Even Foxworth was surprised by the effectiveness of her implementation methods. "My DNP project plan was to decrease CLABSIs by 10%," she admits. "Then we reached a 100% decrease, and it was just amazing. The team was fully engaged in this project. Once they knew this was important to the organization and we were making a difference, they put a tremendous amount of focus on implementing processes that decreased CLABSIs. The nurses were committed to improving the overall care of our patients, and it showed."

Foxworth's successful implementation and doctoral defense epitomize a passion fueled by her vow to her sister, who died of pancreatic cancer.   "Before she passed away, she said to me, 'I want you to make me the promise that you will terminate your nursing degree,' she recalls. "I said to myself, 'I will fulfill this promise. I don't care how long it's going to take me,' and it literally took me about 20 years because life happens, and sometimes life can get complicated. However, I never lost sight of the promise." She embraces what she admits is the only profession she has ever had and remains passionate about the practice of nursing. "I take it seriously. I want patients to have positive outcomes," Foxworth says. "In nursing, that's our role, to advocate for patients, make sure that we're not doing harm, and get them to a place where they can be healthy and live long lives."

Despite her achievements, Foxworth is adamant about advancing as a health care professional. "I want to be able to set the vision for nursing," she says. "That's what I've been trying to do in every leadership position I have had. As an LPN, as an RN, I always wanted to lead by example and grow." She strongly urges young nurses to heed her words as motivation for brighter futures. "Lead by example and commit to lifelong learning," she maintains. "You have to advocate for your patients, and the only way you can be an advocate is to continue to learn and put evidence-based processes into your practice. As nurses, we must commit to lifelong learning by advancing our education by acquiring degrees or certifications, which will lead to improvements in our clinical practice and the nursing profession."

Transforming Nurse Leadership - Tanya Haight, MSN, RN, NEA-BC

Tanya Haight is Executive Director for Oncology, Surgery and Cardiovascular services at Providence Holy Cross in California. COVID-19 inspired the subject for her DNP Project, which targeted nursing leadership skills in online environments. During the height of COVID, Haight realized fellow nurse leaders were not effectively introduced to online meeting technology like Microsoft Teams, which was her facility’s primary software. This included both the technical aspects, like program features, but also how to demonstrate leadership in an online setting. “A lot of the connection you have with your team as a leader is lost in the virtual environment," Haight explains. "Nonverbal communication, communication nuances, and the engagement of team members tends to drop off a little bit.” She also described other common practices that became challenging to deal with when interacting online. “A lot of people hide behind their avatars, so you have this meeting, and you just see avatars and you don't actually see people's faces or expressions," she says. "There's online etiquette and that was never anything that was covered as well. I don't know if you will ever have the full measure of engagement online that you do in person, but there's certainly a lot more that could be done to improve that online engagement and connection with people.”

Speaking with her peers, Haight learned this lack of orientation had long-term impact and should be addressed as to adapt to remote engagement during the pandemic.  She says, “There was a need for some training in the form of an educational intervention to teach nurse leaders not only how to use teams in all of its different functions to have engaging interaction, but also how to be effective leaders in the online environment.” At the time, Haight struggled to find comparable research based on the existing literature on how to act as an online leader through virtual technology, so she found similar competencies that she molded towards online settings. These competencies included areas in leadership, communication and behavioral management.

Haight’s multi-faceted approach aimed to educate nurses on a wide range of online behaviors she argues tend to drop on the wayside, like meeting mechanics, assigned roles, and adhering to an agenda. But most importantly was enhancing nurse leader development, a topic Haight stresses immensely. “Transformational leadership style is a core pillar of any organization that understands that nurse leaders are critical to their success, because they are the ones that motivate the nursing workforce towards the patient outcomes and excellence in care," she says. "Nurse leaders are sometimes under-recognized for the role they play.” She adds, “When you equip nurse leaders with the skills they need and give them the tools to lead their teams, they will do that. But without that, they really struggle.”

Through her research, Haight noted 60% of the nurse leaders in her project saw improved knowledge and confidence in using Teams technology.  Improvements were also noticeable in areas like behavior and conflict management and communicating with teams. “Those things are really intangible, in a sense," she explains. "They're hard to do online: how to coach or counsel someone online, or how to encourage them. It was good to see improvements in those domains.” Her organization also indicated it wants to disperse her education modules to other hospitals in their network. Haight already presented her findings at the 2022 Western Institute of Nursing Conference.  She plans to submit her research to multiple nursing journals.

Similar to Kimberly Foxworth, Tanya Haight was motivated by family to become a nurse, though her path started later in her life as a non-traditional student. She enrolled in nursing school in her 30s after years of raising her son until he became more independent. “I was a single parent at a young age, and it was the 90s. It wasn't like you could log on to online programs: they weren't available. School was in-person attendance, and my son was young and just wasn't the right time.” But though her path started later, she credits that added toughness as a key reason she succeeded academically and professionally. “I thought I was beating myself up for being behind all of my peers when it came to education," she admits, "but I found the life experience and the resiliency I had as a single parent really helped me in the program. I think people who are getting into nursing, at any age, they bring valuable life experiences that not only helps them in the program, but that they can share with others, too.”

Looking ahead to graduation, Haight is proud to see so many fellow doctoral students walking across the stage with her. “There is a lot that doctorate prepared nurses can do in healthcare and in nursing," she asserts, "not only to advance the profession of nursing, but to influence policy and the way we are delivering healthcare.” For younger nurses still honing their craft, Haight emphasizes the impact of transformative nurse leadership on others, from having the emotional intelligence to connect with a team, to collaborating outside the realm of nursing, to never forgetting their nurse upbringing. “We need nurse leaders who are still nurses at heart," Haight says. "They understand the challenges of the clinical environment. I think we need to work to change that perception that nurse leaders are far removed from the day-to-day challenges that nurses are experienced. They understand them well, we need to articulate them better.”

 

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