For many older adults living with dementia in long-term care facilities, antipsychotic medications are often prescribed to manage behavioral and psychological symptoms. While these medications can be necessary, when used inappropriately or without ongoing evaluation, they carry serious risks, including falls and sedation.
After years of working in behavioral health and long-term care and seeing these challenges firsthand, Randall Bartnick, Doctor of Nursing Practice ’26, saw an opportunity to address the issue through his final DNP project.
“As I gained experience as a nurse practitioner, particularly in geriatric mental health, I began to recognize that my impact could extend beyond individual patients,” Bartnick said.
Bartnick earned his Family Nurse Practitioner and Emergency Nurse Practitioner degrees from Samford University’s Moffett & Sanders School of Nursing in 2022 and was impressed by the quality of education and mentorship he received from faculty. He later returned to pursue his Doctor of Nursing Practice with a psychiatric mental health nurse practitioner focus.
“I was surrounded by compassionate leaders who helped me reach my potential,” Bartnick said. “This degree was about positioning myself to make a greater difference for patients, families, health care organizations and the communities we serve.”
An important component of the DNP program is the final evidence-based quality improvement project, which requires students to identify a clinical problem, implement an evidence-based solution and evaluate its impact on patient care and health care systems. Its goal is to prepare clinicians to lead change and improve care at the systems level.
For Bartnick, the project focused on improving care for older adults through targeted quality improvement work.
Building on his experience in geriatric mental health, he developed and implemented a Gradual Dose Reduction Committee within a skilled nursing facility. The goal was to reduce unnecessary use of antipsychotic medications and ensure they were only used when truly needed.
“Too often, antipsychotic medications are continued without clear documentation of why they are needed or whether they are still appropriate,” Bartnick said. “In many cases, these medications are started during a hospital stay and then continued without reassessment once the patient’s condition stabilizes.”
The project created a consistent process for reviewing these medications, identifying when doses could be safely reduced and improving how those decisions are documented. It also encouraged the use of nonmedication approaches when appropriate.
“My goal is to foster a mindset that values ongoing reassessment, individualized care and thoughtful prescribing practices,” Bartnick said. “I want to reduce unnecessary prescribing and improve safety and quality of life for residents.”
Throughout the process, Bartnick said faculty challenged him to think critically, evaluate evidence and focus on measurable outcomes and sustainable change. Their mentorship strengthened both the project and his approach to complex health care challenges.
“I am grateful for their guidance and support, which helped shape my growth as both a clinician and a leader,” Bartnick said.
Looking ahead, Bartnick hopes to expand this work to other long-term care settings and continue promoting a more intentional approach to psychotropic medication use. He said the degree prepared him to take on greater leadership responsibilities while continuing to work directly with patients.
“Every resident deserves care that recognizes them as an individual, not simply a diagnosis,” Bartnick said. “If this work helps improve safety, preserve dignity and encourage more thoughtful care, then it has made a meaningful impact.”
