136chapter FOUR
Refl ective Response 2
Karen Kaufman
Drs. Montgomery and Byrne provide a thought- provoking analysis of the differences
between doctoral- level and master’s- level practice roles. The personal stories and ex-
periences they relate are powerful reminders that nurses with practice doctorates, with
their advanced knowledge and strong commitment, are making enormous contribu-
tions to the nursing field and to health care in general. Most importantly, the authors
point to the distinction between the MSN degree, which “allows you to be part of the
change,” and the Doctor of Nursing Practice (DNP), which equips you “to be [ sic ] the
change.” In other words, MSNs are qualified to carryout important, necessary changes
in the practice of health care, while DNPs are the people with the knowledge and re-
sponsibility for actually driving that change.
The gulf between these two roles is vast. Our experience working with Drexel
DNP students suggests that no book, seminar, or dissertation is sufficient to transform
the DNP candidate from a nursing practitioner into a health care leader. Indeed, two
highly respected former Drexel professors, Smith Glasgow and Lachman (2010) docu-
mented that at least half of the DNP candidates in the Drexel DNP program did not
truly see themselves as future leaders, nor did they understand the connection between
their unique personality preferences and the role requirements of a leader.
Effecting such a transformation does indeed require advanced knowledge, skills,
and experiences, and it also requires a significant change in one’s self- image— which
is the first and most important step in persuading others to see you differently as
well. Even the best doctoral programs, because of their academic nature, have diffi-
culty affecting this kind of personal transformation in their students. As a result, most
DNPs do graduate with the knowledge to address complex patient care challenges
and to improve the efficiency of health care delivery. Where they often have difficulty,
though, is in mastering the leadership skills required to enlist others in the effort— to
implement real and lasting improvement in the nursing profession and health care in
general. In short, to be the change— which, after all, is the key reason for obtaining a
DNP degree in the first place. As one second year Drexel doctoral residency student
said, “Karen’s ability to empower us into transformational leadership is very valu-
able. We need to transform and elevate our role. We have had the role of clinicians for
years. Now we are moving to the executive level which requires a different type of
training.”