Date of Graduation

Fall 12-11-2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. KT Waxman

Second Advisor

Dr. Mary Lynne Knighten


Human trafficking is a multi-billion-dollar global industry, generating $150 billion annually (International Labour Organization [ILO], 2014), and driven by the exploitation of victims of all ages, primarily for forced labor or commercial sex. Victims endure frequent and prolonged abuse, suffering illnesses, and injuries. When accessing the health care system, they often go unrecognized by health care providers and nurses. Recognition requires training to raise awareness and the right tools to capture the information necessary to identify victims and address opportunities to improve their safety, care, and support. The aim of this Doctor of Nursing Practice (DNP) evidence-based change project was to improve the recognition and identification of victims of human trafficking by emergency department and labor and delivery clinicians through (1) participation in a standardized training program built on the provision of victim-centered, trauma-informed care, and (2) the creation and use of a screening tool template in the electronic health record (EHR). An important secondary goal included increasing the number of referrals made for community services on the identified victims’ behalf.

Unexpectedly, the global pandemic disrupted the project plan and timelines, prompting a re-evaluation of the project and the need to create contingency and collateral workstreams. Activities were re-prioritized, and the Phase II initiative became the Phase I interventions.

Three-module training programs for clinical staff were developed: (1) Human trafficking 101: Dispelling the myths, (2) Trauma-informed patient care and services, and (3) PEARR: Five steps to victim assistance in health care settings. Each module included comprehension questions, and a score of 80% was required to complete each learning module successfully. Due to a moratorium on non-essential training during the height of the pandemic, these modules were not assigned to clinicians for completion until September 1, 2020. Clinicians in the emergency departments (ED) of three Dignity Health acute care facilities in southern California were assigned the modules and given 30 days to complete them. Comprehension improved from 87.1% (n=307) at baseline to 91.5% (n=302) for those modules completed by September 30, 2020; the 5.05% improvement (p=.6018; 95% CI) was not statistically significant. It may be clinically significant because these clinicians now have greater knowledge and awareness to recognize victims of human trafficking who present to the ED and then take action to offer services.

The benefit-cost ratio for the learning modules was 2.47 based on estimates of the “soft” benefits or intangible benefits to victims and society, indicating this project was feasible and beneficial to the organization. However, to fully measure the benefit-cost ratio of the DNP project, data are needed to determine if clinicians who receive standardized training can better identify victims of human trafficking. Data collection and analyses will be extended beyond the timeframe of this project and compared to the baseline. Additionally, the project plan for creating and implementing the standard screening tool in the EHR was modified to relaunch in the mid-calendar year 2021, pending the status of the COVID-19 pandemic.

In summary, human trafficking is a public health crisis and one of the most lucrative crimes in the world (ILO, 2017). Standardized tools and training are needed to aid clinicians in screening and identifying victims. The executive nurse leader can effectively lead change during a global pandemic by using change management theory, nursing theory, demonstration of leadership competencies, and a strong understanding of project management principles. In doing so, care delivery can be improved, even for those most vulnerable and hiding in the shadows.

Included in

Nursing Commons