Submitted to the School of Nursing and Health Professions of Colorado Christian University Lakewood, Colorado in partial fulfillment of the requirements For the degree of DOCTOR OF NURSING PRACTICE Cerumen removal (ear wax removal) procedures are not minuscule tasks or rote routines. Cerumen removal tasks require specific skill sets, practical application, and theoretical education. It is imperative that registered nurses in the United States (US) are informed and educated on international groundbreaking advancements in cerumen removal. The aural microsuction technique for cerumen removal is an international groundbreaking advancement and much needed for registered nurses in the primary care setting. Currently, registered nurses in the US perform ear irrigations (a cerumen removal procedure) without prior education or training. Registered nurses in the US do not perform the aural microsuction procedure. Additionally, cerumen removal is a primary care level procedure. The Ear, Nose, and Throat (ENT) clinics in the US are overwhelmed with cerumen removal referrals from the primary care community clinics due to the lack of equipment and unqualified registered nurses within the primary care community setting. In the United Kingdom (UK), upon successful completion of an aural microsuction education and training course, registered nurses are currently, frequently, and commonly performing the aural microsuction technique in the primary care community clinics. Therefore, the Doctorate of Nursing Practice (DNP) Candidate introduced the groundbreaking advancement via the creation of an aural microsuction educational tool kit and examined the effect of an aural microsuction educational tool-kit on the knowledge and competency of registered nurses in a primary care community clinic.