Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Patricia Thomas PhD, RN, FAAN, FNAP, NEA-BC, ACNS-BC, CNL

Second Advisor

Ann Gosselin DNP, RN, CEN

Third Advisor

Dianne Slager DNP, RN, FNP-BC,


Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to nonchildren’s hospitals (1.62 [1.01–2.60]); urban facilities 0.35 [0.24–0.52], or lower-volume hospitals (0.73 [0.64–0.84]). Rural pediatric patients are an average of 68 miles from the nearest children’s hospital compared to 12 miles for non-rural children. The hospital where the Doctor of Nursing Practice (DNP) student scholarly project occurred is no exception. Hospital X has identified a trend of interfacility transfers, largely due to absent resources and provider care delivery confidence. To address this, a clinical improvement project identified common pediatric transfer conditions and developed high-volume, condition-specific clinical pathways to systematize care approaches for Hospital X. The effectiveness of the quality improvement (QI) project focuses primarily on improving nurse confidence in care for these high-volume pediatric conditions by comparison of pre and post nurse survey results, with a long-term goal to decrease pediatric transfers and improved patient outcomes.

Available for download on Sunday, May 08, 2022