Date of Conferral

12-17-2025

Date of Award

December 2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Barbara Niedz

Abstract

This Doctor of Nursing Practice project was a quality improvement (QI) initiative. Nephrologists were inconsistent in ordering iron studies and sometimes delayed the initiation of erythropoiesis-stimulating agents (ESAs) on admission to the inpatient site. These delays often led to suboptimal outcomes. The practice-focused question guiding the project asked whether a nurse-driven iron protocol would improve adherence to anemia management guidelines. The project’s purpose was to evaluate the impact of the evidence-based nurse-driven protocol. I used descriptive and inferential statistics for data analysis. Findings demonstrated a statistically significant improvement in the timely completion of iron studies and in intravenous (IV) iron administration; however, a reduction in ESA use at discharge did not change pre- to postimplementation. The results indicated a statistically significant association between the intervention and iron profile ordering, X² = 58.54, p < .001. The change was also statistically significant for iron IV administration (X² (1, N = 396) = 10.90, p < .001) and for increased ESA administration based on criteria in the nurse-driven protocol (X² = 9.62, p = .002). My recommendations to the project site included sustained use of the protocol, a unit-based dashboard, and policy changes for the protocol. The project’s implications for nursing practice include enhanced clinical autonomy, standardization of anemia care, and cost-effective resource to provide access to needed therapy for all patients with evidence of improved patient outcomes for a vulnerable patient population, a positive social change.

Download

Included in

Nursing Commons

Share

 
COinS