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Just Care: Learning From and With Graduate Students in a Doctor of Nursing Practice Program

Abstract: In 2010, Fairfield University, a Jesuit Carnegie Masters Level 1 University located in the Northeast, established its first doctoral-level program: the Doctorate of Nursing Practice (DNP). In a developing program such as the DNP, some of the most pressing concerns of current rhetoric and writing in the disciplines align and interact with the education of clinical nurse leaders—questions of transfer, ethical practice, reflection, assignment design, and community engagement. Clearly, nursing scholar/practitioners and writing scholar/practitioners have much to offer and to learn from each other. In this article, we trace the initial action-research undertaken by the School of Nursing, the Writing Center, and the Center for Academic Excellence to document, reflect upon, and support the reading and writing experiences of DNP graduate students as they negotiate the new curriculum.

Introduction

The theme of enculturation cuts across many of the articles in this collection, and with good reason: As our colleges and universities respond to the ever more rapidly changing demands (economic, political, cultural), we educators struggle to anticipate and address the needs of our changing student populations. At our own university, these demands include expanding educational opportunities for graduate students, strengthening existing graduate programs, and developing new ones. The question of what happens when graduate student writers come to college is in many ways an open one, though as Fredrick et. al. point out in their chapter "The Space Between: MA Students Enculturate to Graduate Reading and Writing," it is informed by the long history of inquiry related to developmental and first-year writers (to name only a few well-researched cohorts). When we set out to understand and improve the experiences of graduate students writers in our very first doctoral program, the Doctor of Nursing Practice (DNP), we too sought to support transfer across and within discursive practices, while making those practices as transparent and accessible as possible to ourselves as well as to our students (Fredrick et al., n.p.). In this process, as in other studies in this collection (Adams, et al., Keith et al., La France and Corbett) we find ourselves taking on new roles and identities, becoming teacher/ learners, expert/novices, in short, co-learners with our students. This article traces our initial efforts in this regard.

Background

The DNP is an educational degree that prepares nurses to be leaders who will maintain the highest educational standards, safeguard the quality of patient care, lead and implement practice innovations, and contribute to policy decision making. At Fairfield, the first class of DNP students was admitted in the fall of 2010; the program received full board accreditation from the Commission of Collegiate Nursing Education in 2012. Beginning this project, we were conscious of our role in developing healthcare leaders for the 21st century, as we were also aware that our incoming students were already nursing professionals who could draw on years of experience in clinical settings.

The Fairfield University School of Nursing DNP curriculum, in keeping with the mission of this Jesuit University to develop "men and women for others," builds on a tradition of innovation and commitment to excellence in education, scholarship, social justice, service, and leadership. Ignatian pedagogy, which focuses on Experiential Learning, Critical Reflection, and Thoughtful Action, is foundational to our own and our students' educational experience. This strong, comprehensive Jesuit and nursing framework provides a solid foundation for building excellence in professional practice. Ethics, social justice, care of vulnerable populations, and reflective practice are incorporated into course objectives and content throughout the DNP curriculum. These concepts are consistent with the goals of the University's strategic plan to integrate Jesuit values in graduate and professional education and serve as lifelong tools to achieve the highest levels of practice accountability, leadership, and advocacy for optimal health care of all members of society. Additionally, the centuries-long Jesuit educational heritage at Fairfield University includes a focus on extensive training in all the language arts across disciplines at all levels. This immersive transdisciplinary education has served the aim of "eloquentia perfecta," that is, forming students intellectually, morally, and ethically to use their "erudition" and "eloquence" to be mindful, effective citizens and leaders (Gannett & Brereton, forthcoming).

Consistent with our Jesuit mission, the DNP degree was designed to develop what Donald Schon, an early advocate for action research, has described as "reflective practitioners" and an awareness of what Iris Marion Young calls our "responsibility for justice" (Schon, 1984; Young, 2013). As the nature and form of health care undergoes dramatic social and technological changes, the DNP will need to prepare graduates for diverse flexible leadership roles in healthcare and professionals who will advocate for the underserved. The DNP program presents the potential for internal and external interdisciplinary partnerships in areas such as ethics, business, community engagement, communication and patient education. In order to prepare students for these roles, new and even more advanced oral and written communication skills need to be developed: DNP students are required to write in multiple academic and workplace genres, literature reviews, grant proposals, paper and poster presentations, policy briefs and quality improvement proposals. Most importantly, as doctoral students, DNP students are expected to prepare a publication-ready manuscript by the end of the program. In the broadest context, academic excellence, one of the hallmarks of Jesuit education, has been an essential component of the conscientious development of the DNP curriculum, reflecting professional standards as measured by specific individual and aggregate student outcomes.

University-wide initiatives supporting graduate-level writing remain uncommon; often, the decentralized nature of graduate programs, even within a single institution, complicates efforts to address these needs comprehensively. As Simpson writes, "The problem with graduate-level writing support is that it does not fit neatly into any university department as currently conceived. Or, to flip this statement, university systems often do not account for the fact that graduate students might still have a lot to learn about writing" (Simpson, 2012, p. 97; See also Berkenkotter et al., 1991). This statement is certainly true at Fairfield, where no mechanism exists in program development guidelines at any school or university level for ensuring that resources are in place to support writing-intensive initiatives or that faculty with expertise in writing have been consulted during the process of program development. The initial development of the DNP program is one case in point. Despite the clear emphasis on oral and written communication in program documents, these materials reference "skills" throughout but demonstrate little evidence of how students are to acquire the complex discursive competencies, particularly in writing, interwoven throughout program objectives. With this our university's first doctoral program, we recognized the opportunity to develop a collaboration that could support this program and its students, while laying the foundation for a more visible and effective writing culture at our university.

Throughout the project, we have all deliberately positioned ourselves as both experts and learners, as novices to this kind of collaborative work, just as we have worked to understand the special complex rhetorical situation of our entering graduate students in the DNP. This kind of open "inquiry stance" central to action-research projects led us to create our own collective literature review. So even as we set up our first consulting options, we began to ground our practical work in a scholarly context. The literature we surveyed reveals that our program is, in many ways, similar to most professional graduate and undergraduate programs: students are first educated in various academic discourses, and then, through advanced work, internships, and practica, learn to negotiate between and across workplace and academic genres (Bazerman & Paradis, 1991; Cox, 2006; Dias & Pare, 2000; Dias, Medway & Pare, 1999; Engstrom, 2001; Gannett & Cox, 2005; Odell & Goswami, 1985, Poirier and Dobie, 2001). However, DNP students, who are already in the workplace and immersed in professional genres, face a conundrum as they move back into a complex academic discourse community that will require both advanced academic work as well as ongoing development of new clinical areas of expertise. Many of our students have also been away from the academy for some period of time, so they must be re-acquainted with the current kinds of research and professional genres expected of health care leaders, genres to which they may not have been exposed in undergraduate education. And while the new DNP graduate students have considerable knowledge of the field of nursing, the graduate program requires them to acquire a whole new set of insights and understandings of the field from a leadership perspective. This professional development is embedded with their increasing mastery of the multiple knowledge domains of expert writers, as Beaufort (2007) has set forth: writing process knowledge, subject matter knowledge, genre knowledge, rhetorical knowledge, and the encompassing knowledge of the whole discourse community they are entering.

A Few First Steps

Matching Resources to Needs

All Writing Program Administrators (WPAs) know that they must match resources to needs, but this principle can be difficult to adhere to in practice; or, at the very least, it can be difficult to determine how best to match resources to needs, even if one knows one must do so. In our case, there is an anticipated growth of our graduate student population as part of our university's strategic efforts. To this end, graduate student enrollment has increased steadily over the past five years from 1,044 students in the year 2008 to 1,120 graduate students in 2012. This increase projects approximately 1% growth each year, which we expect to meet or exceed in the future. In response to this growth, a graduate assistantship in the Writing Center was funded for the first time in 2011-2012. Without a specific plan for outreach to and collaboration with graduate programs, however, we did not know much about the needs of graduate students writers or the expectations of the programs in which they were being prepared.

At the end of that first year, then, writing center staff considered the effectiveness of the open-ended approach to graduate student support and found that it limited the extent to which tutors could engage with writers in a sustained manner, particularly at advanced levels of practice in highly specialized fields. We wanted to encourage cross-programmatic sessions (with tutors and writers working across class years and schools, for example); we wanted to build shared capacity across the Writing Center staff (so that all tutors would have strategies for working with all writers, rather than devoting a particular tutor to a specific program); and we wanted our graduate assistant to have the opportunity to lead the work of identifying writing expectations at an advanced practiced level. In the first year, we knew this would mean allocating a significant portion of the graduate assistant's time to working directly on this project and to researching models for graduate student writing support across and within the disciplines.

With these factors in mind, the Director of the University Writing Center (Beth) and the Director of Core Writing and Faculty Writing Consultant (Cindy) together issued a call for expressions of interest from graduate programs across the disciplines for collaboration on graduate writing support, noting that our resources would allow us to advance one pilot program during the 2012-2013 academic year. The School of Nursing faculty responded quickly and enthusiastically. The thorough program design and review described earlier meant that they were well prepared to partner on this initiative. (Two other programs also expressed interest right away, suggesting that the need for this kind of collaboration and support is recognized across disciplines, and we are currently expanding our efforts to include them.)

Caring Among Colleagues

Through the fall and spring semesters, we met to develop and refine the project. Monthly meetings of the whole group provided an opportunity to reflect, plan, and assess. Weekly meetings between the writing center coordinator and graduate assistant, frequent check-ins between course instructors and the graduate assistant, and session feedback from graduate students themselves led to the re-shaping of writing center practice to meet emerging needs and to greater continuity with program objectives as well as the identification of areas for ongoing discussion.

The seven of us collaborating on this project, and on this writing, have had to consider—individually, in small groups, and collectively—how to share in this work. The Jesuit mission guiding our own institution privileges the role of companionship; and through this project, we have shared in the struggles, sorrows, and successes that the year has brought, as years will do, to each of us. Exciting challenges have emerged—Meredith has begun an MFA program, taking her well beyond her self-described "comfort zone" and opening up exciting new writing challenges, of which this article is one; after seven years in full-time central administration, Beth has returned to work in the Writing Center and is wrestling with writing into the emerging questions of the field, while Cindy has returned to campus after a year spent on sabbatical, deeply immersed in the history (and future) of Jesuit rhetorical traditions and eager to undertake more WAC/WID faculty development. Owen joined the project as a beginning graduate student, newly arrived in the U. S., and is now nearly done with his coursework; Mike, who coordinated the writing center for two years, is completing his dissertation. Our group is configuring and reconfiguring, as people move in, out, and through roles and programs. The work and relationships have been care-full and, at times, healing, professionally and personally.

Collectively, we share "service-oriented" professional backgrounds, and we are in many ways model university citizens. As such, we follow Michele Eodice, who writes, "Think of yourself—good citizen—arriving in the collaboratory to now generate theory about the many dimensions of your work, your service, your leadership, your teaching. An organic outcome of our interactions with tutors, student writers, faculty, and all members of our college communities should be this continual discovery of useful theory" (Eodice, 2003, p. 126-127). We participate, then, in the theory-practice/action-reflection relay in which our graduate student writers are engaged as we offer scaffolding for others, on and off our campus, for building the kinds of cross-campus partnerships Simpson (2012) describes.

Through the unfolding School of Nursing/Writing Program collaboration, we have begun to see in our own and in our writers' experiences growth in what Beaufort identifies as the multiple knowledge domains of expert writers: writing process knowledge, subject matter knowledge, rhetorical knowledge, discourse community knowledge, and genre knowledge. (For a summary of these domains, see Beaufort, 2012). In our small group meetings, we anticipated that students would be encountering certain genres for the first time—the Evidence-Based Practice paper, for example—but we could not have predicted the ways that their subject matter knowledge would interact with these other domains, nor the role it would play in forming a community of writers who could support, challenge, and extend these knowledge domains for and with each other. The same has been true for us as colleagues and co-authors.

We identified participants for an initial working group, including colleagues with various ranks (graduate student, affiliate faculty, tenured and pre-tenure faculty) and from various locations (nursing, English, education). Together, we recognized the need for ongoing program research and evaluation and also for a regular discursive space where we could reflect on our efforts-in-process. Thus began what would become an action research project with collectively increasing levels of investment, multiple connected pedagogical interventions, various forms of data gathering from the students and faculty participants alike, and clearer, more productive pedagogical questions to investigate in the next cycle. As LaFrance and Corbett (this volume) insist, we needed to be ready for serendipities and small "instructive failures," and be willing to understand and adjust our project accordingly. Very much like Ignatian Pedagogy, action research is a form of practitioner inquiry, a kind of "systematic and intentional inquiry carried out by teachers" (Cochran-Smith & Lytle, 2009, p. 40-41). The practitioners themselves are researchers, rather than outside "objective" experts. Action researchers undertake their inquiry within their specific and local contexts, often in collaboration with other stakeholders, setting and revising their own questions from the direct experience of teaching and learning, undertaking active interventions informed by current research or scholarship, and assessing the consequences of their "actions." This is usually a recursive process, as data from the first cycle informs the next kind of pedagogical action to be undertaken. While it is both intentional and systematic, unlike many social scientific paradigms, action research is not restricted to any one single methodology, and "assumes relationships of knowledge and practice are complex and non-linear" (Cochran-Smith & Lytle, 40-41).

Gathering Artifacts

Our own "complex and non-linear project" took shape as we began to search the literature in this area. We came to agree more on what it was we were gathering (or able to gather) and how these pieces of information related to each other. We decided to compose collaboratively and we developed a sense of the collective project through the possibility, even the need, to contribute to a developing area of inquiry, as Gordon Wells has described in his work (2009, p. 57).

Much as our DNP students need to immerse themselves in the literature of new and interesting fields, we too found ourselves searching the literature for articles focused on collaborations between university writing centers and nursing, healthcare communication, action research and genre theory, WAC/WID and writing center scholarship, and the scholarship of teaching and learning. As noted earlier, none of us felt expert in all (or in some cases any) of these areas, resulting in several thought-provoking discussions about scholarly norms and practices.

Because DNPs are relatively new (though growing) degree programs, we identified no scholarship specifically taking up the question of supporting writers in DNP or other graduate nursing programs. Most WAC/WID scholarship focused on writing in nursing considers the needs of undergraduate writers developing these discursive competencies (Cowles, Strickland, Rodgers, 2001; Poirier and Dobie, 2001, Inman and Inman, 2002; Sitler, 2001; Sorrell, 2001). Conversely, in writing center scholarship, when graduate students are broken out as a separate population, the literature tends to imagine them as either tutors or administrators (or, more likely, both), not as writers. Notable US exceptions include Snively (2007) and Snively, Freeman, and Prentice (2006). (For an excellent overview of graduate students working as tutors and administrators in writing centers, see Nicolas [2008].) International research literature on graduate student writing development and tutorial support for graduate students in journals like the Journal of Academic Writing (The Journal of the European Association for the Teaching of Academic Writing) is expanding, though the instructional context is often quite different. Literature in the Scholarship of Teaching and Learning focuses largely on a getting-the-writing-done model (and not without reason, given graduate program completion rates), typically in conjunction with a large project (such as the dissertation), rather than with a portfolio-based, practice-oriented advanced degree like the DNP. (Bolker, Single & Reice, 1998).

Conferences and listservs also proved invaluable resources in shaping our practice at critical moments. Several conference sessions and professional contacts contributed to our developing frameworks, each moving us along a bit farther in our thinking: a session entitled "Graduate Writing Groups: Providing Specialized Writing Support Outside of the Writing Center," given by colleagues from the University of California-Davis at the 2012 International Writing Centers Association Conference; a well-timed WCenter question about supporting DNP writers as well as shared resources from Salisbury University's Writing Center and its director, Nicole Munday; and a 2013 NEWCA presentation by the University of Connecticut writing center staff, entitled "Writing Support Across the Graduate Curriculum: Lessons from Year One of a Writing Center's Efforts."

We drew on both quantitative and qualitative methodologies as we worked through this project. Students were surveyed in both fall 2012 (early in program development) and spring 2013 (after completion of the first-year writing pilot). In the early survey, we asked students how the writing center could best help them. A total of 19 students responded with needs related to understanding the assignment (21.1%), developing ideas (36.8%), using sources (42.1%), organization/structure (78.9%), wording/style (47.4%), grammar and punctuation (52.5%). We asked students what types of course work the writing center could help with. We were especially interested in the tasks students were likely to seek Writing Center assistance with, so that our team could share information and discuss expectations in advance. The responses received are in table 1 below.

Table 1: Types of Coursework Writing Center may Help with

Projects N %
Course Papers 16 84.2
Case Study Presentations 7 36.8
DNP Portfolio Development 12 63.2
IRB Applications 8 42.1
Grant Applications 8 42.1
Manuscript Editing for Publication 10 52.6
Other 1 5.3

We also queried students in the first survey about how to time and structure our writing support, and we incorporated their suggestions in our scheduling. Additionally, students provided feedback in anonymous end of semester evaluations. Writing center staff wrote session reports and periodic directed reflections from fall 2012 through spring 2013.

Syllabi and course materials from two specific DNP courses were collected and analyzed: Advanced Nursing Roles and Reflective Practice and Research Methods for Evidence-Based Practice. These courses were selected because they are foundational, introductory courses for first-year DNP students, given across consecutive semesters. These courses are writing-intensive, with multiple scaffolded writing tasks: reflective writing assignments, role papers, literature reviews, and the Evidence-Based Practice (EBP) paper. The EBP paper is an essential artifact of the DNP portfolio (which also includes an IRB application, a grant application, case studies, a manuscript for publication, as well as others artifacts), as the student may choose to continue a focus of inquiry from the EBP paper while progressing through the DNP program. Therefore, the writing of the IRB application, grant application, manuscript, and some case studies may all stem from the EBP paper. We decided to integrate writing support in these two courses, then, in an effort to improve overall programmatic coherence and outcomes.

The Heart of the Matter

In this section, we explore four themes that recur in the various data sets we gathered for this project: 1) Shifting from individualized to collaborative practices; 2) Developing professional communities in and through writing; 3) Integrating knowledge domains; 4) Learning Lessons.

Shifting from Individualized to Collaborative Practices

Individualized conversations with writers have been the norm in our writing center, as in many writing centers, and we had expected (even if we had not articulated the outcome as such) that this principle would be foundational in our work with graduate student writers as well. However, we quickly began to rethink this principle, precipitated at least in part by necessity, which is the mother of invention in writing centers everywhere.

In his fall mid-semester reflection, for example, Owen writes of a session in which three writers showed up for what had originally been scheduled as a one-to-one session:

[T]he opportunity presented itself to work on some writing together. I had not prepared to confront the problem of how to transfer the practices usually confined to one-on-one sessions to the task of tutoring three students simultaneously, but in the event a hasty innovation allowed us to negotiate the problem and in fact produced a pleasing effect that encourages me to replicate it elsewhere. . . The three students concerned were far more open to this practice than I had expected: they were happy to take advice from their peers and from myself and seemed to derive a far clearer understanding of the aim of the introduction than they had from simply reading the assignment. Later in the session we had a reflective conversation on the unfortunate atmosphere in education and academia wherein students are unconsciously discouraged from mutual sharing of work and ideas by the stigmatizing effects of a competitive culture. We agreed that getting over the initial embarrassment of sharing one's work conferred huge advantages, and that ideally places of learning should function as communities and on the basis of mutual trust and respect among their members.

Technology also functioned as a great facilitator in this process, supporting the development of synchronous sharing and peer response.

While not typical of past practice in our writing center, adapting what had been our standard practice of offering only one-to-one sessions expands our field of vision, as Jackie Grutsch McKinney calls for in her book Peripheral Visions for Writing Centers, when she urges those of us who work in writing centers to be less invested in defining what it is we don't do and to be more interested (or at least as interested) in what we might do but are not yet doing. In this case, we considered together the goals for professional preparation through the DNP program, which support the development of an emerging professional learning community in both formal course and extra-curricular spaces (Pinkert, Adams et al.), one that renders both struggles and successes as natural and productive. (See Keith et al. and LaFrance and Corbett in this collection.)

Responding to the Spring 2013 survey question "How have your PEERS in the graduate nursing program helped you to improve your skills as a writer, one student writes, "Not as much as a writer, but mostly as reviewers of my research papers by pointing out specific areas that needed to be further explained." This response speaks to a growing awareness of the collaboration and social construction of discursive competence. It also addresses the important dialectic in writing center scholarship between the "generalist" and "specialist" tutor, a separate peace increasingly brokered through the co-existence of writing centers (frequently staffed with "generalist" tutors) alongside, though not necessarily integrated with, writing fellows programs (where tutors are much more closely aligned with disciplinary specializations). That this respondent views assistance with content development to function separately from writing support is telling, and we realize now that the question alone predisposes a writer to consider the tutor as providing separate, skills-based support. (For the foundational reading on this issue, see Kiedaisch & Dinitz, 1993)

Grutsch McKinney writes, "[A]nything that any center is doing is considered 'writing center work.' We do not limit ourselves to writing about what we share in common" (2013, p. 89). Perhaps what we do share in common is a broad principle indeed: a desire to work with writers in all the places, spaces, and ways in which writers work. We tried to listen deeply, to pay attention to what we were hearing and seeing about the limitations of our past practice, and to invent new ways of working. This is, as Grutsch McKinney suggests, properly writing-centered work.

Developing Professional Communities in and through Writing

Through this developing community of practice, we have been able to expand our vision for peer instruction in writing, and we have each had moments of recognizing places where our scope had been unnecessarily, if unwittingly, limited. We have revised how we present the writing center to students; we have reconsidered how we understand the relationship of the writing center to the classroom and to professionalization; we have explored how new affinity groups enlarge the possibilities of writing-centered work. Much of this reconsideration was prompted by the meta-cognitive work in which Owen and the DNP students were engaged through the writing center, such as that represented in this reflection:

These ideas [about the group's work] led us to discuss the Writing Center, and the role it could play in students' academic lives. . . Students seemed genuinely excited at the prospect of a place that allowed students to work together in non-didactic pairings or groups to talk about ideas and create or refine pieces of writing into effective vehicles for concise and clear thought. We talked about the importance of encouraging experimentation and imagination in the process of forming ideas, and the practical writing tools that can help to transfer such mercurial forces into a concrete piece of writing. . . I feel that in the work we were able to do together in a short time, and in the ideas that we exchanged during the course of the sessions, the communitarian philosophy of the Writing Center was well represented.

Owen's assessment is supported by student survey responses such as this one: "Nursing students have not had much experience with writing essays, literature reviews, etc. The writing center gives us a lot of ideas on how to pursue these papers. They are a HUGE help and really think outside of the box. Students at the writing center think very differently than nurses, and their feedback is incredibly important and valuable."

While we are pleased when students experience the writing center as a useful resource on campus, we are even more encouraged when they demonstrate an appreciation for the value of their developing peer professional networks, as Owen observes in the final line of his summative reflection: "[S]tudents spoke with great enthusiasm about this culture of free collaboration, about the way that exchanging ideas had improved their work, and about the confidence they had gained in expressing themselves, in speaking as much as in writing."

Our collective work on this project kept us in conversation about intersecting opportunities and expectations for writing support. Policy decisions affecting multiple stakeholders, too often made by one unit with little consultation, were put on the table for discussion, with needs of students, faculty, and programs all in consideration. As the year progressed, we made a number of adjustments to formalize the partnerships between the in-class and out-of-class writing support. Nancy, in particular, structured class visits by Owen, paired "writing partners" who could support each other through the development of their Evidence-Based Practice (EBP) proposal, and required attendance at a minimum of one group session.

The group sessions were generally very successful. Over a period of eight weeks, a total of twenty small group meetings were held. The largest session involved up to six students, with average attendance between two to four students. Students signed up for the sessions through the course management system (in our case, Blackboard). Due to student schedules (and their limited availability on campus), the preferred time for these sessions was either immediately before or immediately following classes. A large majority of students who attended did so more than once, and seven students attended three or more times. In addition to these group meetings with the writing assistant, students met individually, in pairs, and in groups with the nursing faculty to fine tune the scientific aspects of the proposals. Students also made individual appointments at the Writing Center, with the graduate assistant and with other tutors working there. The frequency of all types of meetings increased as the due date for the proposal approached.

Integrating Knowledge Domains

Much of the work of the early writing center sessions consisted of Owen working with writers on building confidence and successfully transitioning to writing for academic purposes: clarifying assignments, incorporating "feelings" (as one student observed) into reflections, gaining confidence in transferring their subject matter knowledge into novel genres and new settings. A comment from the student survey results supports the benefits of the collaborative process: "In group sessions, the tutor does a lot to provide examples and build off of each others [sic] writing skills. He does a great job differentiating who needs help where."

From the beginning, we were aware that our writing tutor would lack the clinical knowledge that students possessed and the advanced practice knowledge they were gaining. The facilitated writing group approach addresses this disparity across knowledge domains, as Owen notes here:

One student was very active in teaching another during this discussion, frequently I could take a back seat in the conversation and just let her go to work. One big contribution she brought was to identify that another student had used a generic term for the drug he would use; she argued with his [sic] as to why he needed to name the specific drug. This contribution was invaluable, as I would never have been able to spot such a gap in the question the student had put together, probably assuming that the generic term was the name of a particular drug.

Perhaps more importantly, the writers themselves demonstrate an increasingly ability to work across knowledge domains, such as in Owen's reflection below, which shows the writer successfully integrating subject matter knowledge and genre knowledge at a crucial moment in the writing workshop:

We reached Limitations and Delimitations. I asked if anyone was confident enough in their understanding of the terms to refresh our memories as to their meaning. One student stepped up and delivered what amounted to a five minute minilesson on the definitions of the terms, how they should be applied to the evidence based practice paper, and what information was essential to include in the sections.

In these examples, graduate writers enact what Blazer and DeCapua (in this collection) describe as "the process of developing disciplinary discourse knowledge [which] should be seen in terms of doing, knowing, and becoming since discourse is an ever-evolving set of socially constructed conventions and patterns created and used to carry out ever-evolving needs and interests of a given research and professional community" (np). We note this development appears to be facilitated by repeated engagement with group work: The more frequently students participated, the more aware they became of the ways to improve their own work and the greater the benefits of working with their peers. Students, over time, worked through the many challenges of a difficult assignment by building their knowledge across multiple domains, individually and collectively, as they proceeded through the first year of the DNP program. That is, they began to build and inhabit their new professional discursive identities.

Learning Lessons

In many ways, our work together had barely begun at the end of our pilot year, and we identified a number of steps we took, and a few we didn't take but wish we had, to provide a solid foundation for this developing partnership:

Conclusion

DNP programs are designed to prepare nurse leaders who will improve the quality of patient care, implement practice innovations, and contribute to policy decision making. In order to accomplish this purpose, students must be able to show high levels of integrated competence in several domains of discursive knowledge. Through this pilot program, we learned from each other and from the scholarly literature about the DNP curriculum, genres of writing in this field, the research on effective ways to support graduate students, and the evolving needs of our new graduate students. We took this opportunity to implement a customized writing center program to meet the needs of DNP students. The success of this venture was evidenced by high student engagement and enthusiasm, and in well written, high quality papers. While fewer than 50% of students at the start of the pilot said they would use the writing center again, this number rose to 80% at the end of the year. In addition, students provided feedback in anonymous end-of-semester evaluations and through informal conversations with writing center staff. Students noted that meeting with the writing assistant and faculty contributed to their learning experience. Though the sample size is small and our project length was limited in duration, our surveys indicated that at least a core group of graduate nursing students identified improvements in their writing skills, and they correlated those improvements with the Writing Center assistance they received. Students noted that work with the Writing Center helped them to understand the genre of the comprehensive literature review and enabled them to craft projects that were more coherent and analytical overall. In addition to the successful student outcomes, faculty involved in the project also grew from the opportunity to develop a professional writing community. Broad faculty engagement in the program resulted in improved understanding of the relationship of the writing center and classroom education and we all benefitted professionally from engaging in writing-centered work.

We continue to explore a number of challenges, including different comfort levels with research/writing that create conflicting expectations and abilities: it is common for students to express anxiety about writing ("It's just not my thing!"). These concerns seem to be amplified when students come from a discourse community, like nursing, in which professional writing genres are often short, focused on quantitative information, and seen as purely instrumental. In order to manage the challenge of introducing a variety of new academic-professional genres in novel rhetorical situations, the writing center will be introduced during the student's orientation to the program, in order to highlight the importance of writing in the program as complex, developmental set of skills AND competences. The writing center can be understood early on, then, as a key partner with invaluable resources for DNP students to become expert writers.

Our plan for the future is to continue to promote a high level of interaction between the existing partners (the Writing Center, the Core Writing Program, and introductory DNP courses) while also reaching out to additional partners, such as the Library. We further plan to include engagement strategies during the formal introduction to the DNP program, by offering a scientific writing workshop before courses start. We will continue to introduce the writing assistant to introductory classes via a brief "in class" session in the beginning of each semester, and then schedule small group meetings as writing projects are initiated. The working group will periodically review student artifacts, as a part of the assessment protocol for the DNP program and the ongoing programmatic evaluation for this cohort. (Already, as a result of such review, we determined that classes requiring such intensive work were found to be too large [at 30 students each]. Future cohorts will be broken into two sections to facilitate greater individual and small-group attention.)

As DNP programs continue to evolve across the globe, the opportunity to assist students and faculty to meet outcomes through writing center engagement are vast. This article presented one successful such engagement. However, future writing center, WAC consulting, and nursing collaborations will likely develop further innovations and new questions which will prompt additional "reflective practice." We will work to enact the "just care" of graduate students learning to negotiate sophisticated new genres of writing, so that they can offer such care to improve patient care in the future.

References

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Complete APA Citation

Boquet, Elizabeth, Kazer, Meredith, Manister, Nancy, Lucas, Owen, Shaw, Michael, Madaffari, Valerie, & Gannett, Cynthia. (2015, August 25). Just care: Learning from and with graduate students in a doctor of nursing practice program [Special issue on graduate writing across the disciplines]. Across the Disciplines, 12(3). Retrieved from https://wac.colostate.edu/atd/graduate_wac/boquetetal2015.cfm