162 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
conclude that these demands comprise a new strain with a different genotype that is
placing new pressure on the preparation of those nurses in senior leadership positions
and on their level of preparation.
In this chapter, the following areas are discussed: an operational definition of
the clinical executive; the AACN’s Essentials of Doctoral Education for Advanced Nursing
Practice ; a comparison of the AACN’s Essentials for Master’s Education for Advanced
Practice Nursing with The Essentials of Doctoral Education for Advanced Nursing Practice ; a
comparison of the DNP degree with the master of science in nursing ( MSN) and master
of science in nursing and master of business administration (MBA); and the position
of the American Organization of Nurse Executives (AONE) regarding the DNP degree
requirement for nurse executives. The objectives of this chapter are to give readers the
opportunity to have a more in- depth view of the demand for a different level and type
of education beyond the master’s degree for clinical executive leadership; the results of
a DNP education; and the potential challenges of making the DNP a requirement for
nurse executives.
■ DEFINITION OF A CLINICAL EXECUTIVE
Webster (2000) defines an executive as, “capable of, or concerned with, carrying out
duties, functions... or managing affairs in a business or organization; empowered and
required to administer” (p. 497). One cannot fully respect the role of the clinical executive
without acknowledging the context in which it occurs. The clinical executive must over-
see all aspects of clinical practice in health care organizations. The nursing practice within
any organization is a “24/ 7” accountability for processes, structures, and outcomes of
care delivery (Fasoli, 2010). The responsibility of the clinical executive is ever changing
and growing, and the expectations on those in the role are greater. For the purposes of
this chapter, the authors agree that senior- level nursing leadership (chief nursing officer
[CNO], chief nursing executive, and vice president [VP] of nursing) in a health care setting
is a form of advanced nursing practice as evidenced by the differentiation option offered
by the DNP degree, which is the eighth option beyond the seven core essentials.
■ AACN ESSENTIALS OF DOCTORAL EDUCATION
FOR ADVANCED NURSING PRACTICE
The AACN (2006) identified seven core competencies for the DNP along with two addi-
tional differentiated competencies for nurses who choose to focus more on an advanced
practice administrative role (i.e., clinical executive role) or an advanced practice– focused
role (nurse anesthetist, nurse practitioner, midwife, clinical nurse specialist). The seven
core essentials are: (a) scientific underpinnings for practice; (b) organizational and sys-
tems leadership for quality improvement and systems thinking; (c) clinical scholarship
and analytical methods for evidence- based practice; (d) information systems/ technology
and patient care technology for the improvement and transformation of health care;
(e) health care policy for advocacy in health care; (f) interprofessional collaboration for
improving patient and population health outcomes; (g) clinical prevention and population
health for improving the nation’s health (8a— practice- focused) individual, family, and
population- focused advanced nursing practice competencies for improving patient care
processes and outcomes; and (8b— executive/ administrative) systems or organization-
focused advanced nursing practice competencies for improving patient care processes
and outcomes.