122 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
■ CASE STUDY I: A Women’s Health NP
Who Continues to Want “More”The first author of this chapter is a 50- year- old, well- seasoned practicing APRN.
My 20- year practice, specializing in women’s health in both clinical and academ-
ic arenas, centered on achieving success at providing empathetic, comprehensive
care to my patients and was focused on health promotion and disease preven-
tion. Each office day was packed with a full complement of patients with an ar-
ray of issues ranging from the normal annual well visit to the extremely complex
and potentially life- threatening disease situations. Booking an appointment with
me typically necessitated a 6- month wait. My collaborating physicians’ operat-
ing room schedules were also booked with referrals stemming from my robust
practice. In addition, the number of my pregnant patients delivering with the col-
laborating physicians greatly contributed to the income of the practice. Needless
to say, I successfully cultivated a large and loyal patient volume through ded-
ication and hard work, and earned the respect of the medical community and
my peers through my practice— my ideal clinical APRN professional career goal
attainment.
However, as the years passed and as each professional milestone was
attained, my office hours began to get longer and more mundane. Challenges
were fewer and farther between. I did not feel as though I had to put much
thought into providing high- quality, effective, and efficient care. I did, however,
become more frequently frustrated by existing policies that were incongruent
with high- quality health care options. Somehow, invisible to my patients and
initially without my own complete self- awareness, I was intellectually stunted.
But what grew out of this discomfiture was a gnawing desire to seek the
unknown— to find “more,” whatever that was. I thought about taking the Law
School Admission Test (LSAT) for law school admission, but my unwavering
self- identification and dedication as a nurse clinician halted that option. I also
explored avenues in forensic nursing, defense law expert for nurses, and even
medical school. However, my zest for my specialty and my profession contin-
ued to overpower my “wandering eye” into other career areas, until I found the
practice doctorate, the DrNP.
In response to another IOM report (2003), Health Professions Education: A
Bridge to Quality , the AACN interpreted the document’s policy recommenda-
tions as supportive of more advanced nursing education, and thus the early
planning and politicking toward a practice doctorate degree alternative to the
PhD was underway. Many master’s- level nursing programs had revamped
their existing curricula by requiring an expansion of the already challenging
and complex credit loads to deal with the IOM’s requests. Some thought the
MSN degree already conferred this advancement and was almost equal to simi-
lar entry- level health profession doctorates. Was nursing about to abandon its
history of failed clinical doctorate models in favor of a new practice doctorate
degree? The AACN ultimately indicated the new DNP degree was created to
meet the demands of the present- day fragmentation of services and system fail-
ures in health care by preparing nurse clinicians (and later clinical executives)
for practice with interdisciplinary, information systems, quality improvement,(continued)