Author ORCID Identifier

Date of Award

Spring 5-14-2019

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Regena Spratling

Second Advisor

Dr. Nora Colman

Third Advisor

Dr. Margaret Gettis



In a large urban pediatric hospital in the southeastern region of the United States, Pediatric Intensive Care Unit nurse practitioners (NPs) had difficulty transitioning to practice. Identified NP transition to practice barriers were arduous clinical reasoning and ineffective communication. Transition to practice barriers impact patient outcomes and healthcare cost due to patient care errors, delays in care, and NP turnover from poor practice perceptions. The goal of the Doctor of Nursing Practice project was to examine whether the Provider Bull’s-Eye Tool (PBT), a tool to guide clinical reasoning and communication for NPs, would decrease time to diagnosis and intervention selection, while simultaneously improving communication and perceptions of practice confidence in new NPs.


The PBT was evaluated using a two-group comparison. All pilot participants were volunteers, actively enrolled in a NP program or had less than or equal to two years NP experience. Project participants, N=17, were randomly divided into those who completed simulation in medicine education (SIM) evaluation prior to PBT education, and those who completed SIM evaluation post PBT education. During SIM, project participant time to diagnosis and interventions were documented using a validated checklist. After SIM, each participant verbalized a recorded handoff report to a transferring facility. Recorded handoff reports of both groups were analyzed for communication enhancements from PBT training. Once both groups concluded all project components, a Likert survey evaluating perception of practice confidence after PBT training was completed.


The PBT trained group was observed to be marginally slower during SIMS due to increased cognitive processing; however, they were more likely than the non-PBT group to diagnose and intervene appropriately in several areas. The PBT group also had more effective communication patterns during handoff reports than the non-PBT group. Further, PBT training increased perception of practice confidence in both groups.


Based on findings, the PBT is a promising tool that has the capacity to enhance NP clinical reasoning while simultaneously promoting effective handoff communication. Improving these skills increased perceptions of practice confidence. Combined, these improvements could result in decreased healthcare cost by reducing patient errors, delays, and NP turnover.