75chapter TWO
Refl ective Response
Sheila P. Davis
Does the role of a more highly educated advance practice nurse result in improved
patient outcomes as compared to the traditional master’s- prepared advanced practice
nurse? These and other questions are posed by Dreher and Uribe in an attempt to de-
scribe evolution of the advanced practice role. Does the public more clearly understand
and embrace us now that we have introduced the doctoral role? How are the 20 minutes
of care provided by the doctoral advanced practice nurse (DAPN) significantly different
from the care provided by the physician, master’s-level advanced practice nurse, and
the physician assistant? What is the value added by the DAPN? We are reminded that
since 1965, the American Nurses Association (ANA) position statement called for all
RNs to be educated at the baccalaureate level. Fifty years have passed and in the United
States, the majority of RNs are still educated at the associate degree nursing (and) level.
Since that time, the ANA reaffirmed its position and, recently, the Institute of Medicine
report, The Future of Nursing: Leading Change, Advancing Health , recommended 80% BSN-
prepared nurses by 2020. Given the progression of our past compelling mandates, one
has to wonder if current recommendations will translate into practice policies. Perhaps,
it is time to study the politics that feed the ADN movement. Although we may recom-
mend, the reality is that we fall short in legislating. Consequently, DAPN are tasked
with carving out a place in the practice community where, in many instances, there is
not only confusion, but resentment to the title of doctor. How can one be the “thing” that
they are educationally prepared to be without acknowledgment of the title? The title is
the first step in acknowledgment of the role, in my opinion. To give a personal example,
I became a family nurse practitioner after having had the doctorate of philosophy for
more than 20 years. Hence, I am very accustomed to the title doctor. Well, one day while
attending a staff meeting in the clinical setting, before long, I realized that the meeting
was about me. The physician’s assistant expressed his extreme discomfort with me be-
ing called doctor. I explained that I always introduced myself as a nurse practitioner
with a doctorate. In most instances, patients referred to me as “their doctor” even if I
did not refer to myself as doctor. What’s in a name? I submit that as we seek to advance
the role of the doctorate advanced practice nurse, the discussion and ownership of the
name has to be paramount.
Small wonder, as alluded in the chapter, more role strain is being experienced
by the DNP graduates. For this and other reasons, I agree with Dreher and Urbide