4: HOW DOCTORAL-LEVEL ADVANCED PRACTICE ROLES DIFFER ■ 123and patient safety expertise (AACN, 2006). Practically simultaneously, Mary
O’Neil Mundinger, dean of the Columbia School of Nursing, pioneered the first
DrNP program to revolutionize the nursing profession and prepare the nurse
clinician for more sophisticated and complex advance nursing practices (Yox,
2005). At this juncture, a debate ensued that has really not abated. If the master’s
degree is still filled with rigor and produces capable and competent APRNs,
why are some left asking for “more?” Why go for the DNP?
Before the DNP/ DrNP degrees evolved, many passionate APRNs found
themselves in PhD programs, not exactly certain what their role would be if
they completed the PhD. Typically, APRNs who seek a doctoral nursing termi-
nal academic degree still identify strongly with the clinician role (Bloch, 2005;
Chism, 2009). The DNP program “requires competence in translating research
in practice, evaluating evidence, applying research in decision- making, and
implementing viable clinical innovations to change practice” (AACN, 2006,
p. 6). In addition, a strong DNP curriculum should prepare the APRN clinician
to become an integral part of a research team. In our program, and perhaps in
some DNP programs, the graduate is also prepared to competently spearhead
research initiatives, especially those deeply grounded in practice.
The expert APRN’s journey into the DNP curricula is definitely not an easy
one, Then again, is any doctoral program designed to be navigated effortlessly?
For the clinician accustomed to being “on top of her game” in the clinical world,
rejoining a very different academic world will often result in frustration. Being a
doctoral student mentally means experiencing challenging workloads designed
to reprogram the APRN’s view of the world, the very same view that was accus-
tomed to confidence and security in both judgment and performance (with a
master’s degree). In order for the APRN to attain the DNP, an extremely chal-
lenging metamorphosis needs to occur. These programs are designed to infuse
a deep- rooted understanding of the multifaceted aspects of evidence- based
practice, research skills, leadership, administration, and policy into the pol-
ished practitioner. The lens from which clinical practice was previously viewed
is reinforced, but also changed so that a new broader landscape perspective is
seen. The DNP clinician possesses newly acquired skills, which fortify critical
thinking about the care provided and empower the nurse to authoritatively and
credibly question the standard of care and to participate actively in the revision
of current standards to improve patient care.
In my case, my quest to find something “more” and stay true to my clinical
roots allowed me to build on my master’s- level training. I was truly at the point
in my professional career where I was no longer satisfied with doing the “how
to,” but I craved the “why” and the “why not” in order to improve “how to” learn-
ing. In this quest, my doctoral education encouraged and challenged me to find
novel and creative ways to improve the care I deliver and enable me to make a
greater impact on the lives of not only the patients I encounter but also the future
generations of patients and providers through the dissemination of my clinical
scholarship.
(continued)■ CASE STUDY I: A Women’s Health NP
Who Continues to Want “More” (continued)