6: THE ROLE OF THE CLINICAL EXECUTIVE ■ 163The authors of this chapter strongly believe that the DNP degree offers an expan-
sive educational experience very different from that of the administrative tract of the
master’s of science degree. This belief hinges on some of the following benefits from the
DNP degree that includes extensive literature on leadership theory that encompasses the
process of leadership and more specifically leadership in health care; mentoring oppor-
tunities with other leaders in advanced practice roles as part of residency/ practicum;
the differentiated option to focus more on students’ desired specialization in the pro-
gram; and the capstone project, which is a work in progress throughout the program.
The capstone project serves as the student’s population focus. Throughout the program,
the chosen population focus will undergo several analyses that include cost- benefit
analyses/ return on investment, statistical analyses, utilization- focused evaluations, and
extensive literature reviews, especially if students have interventional studies as part of
their capstone projects.
■ THE DNP CLINICAL EXECUTIVE PRACTICA: A CRITICAL ELEMENT
Although all aspects of the DNP educational experience are important, additional focus
will be spent on the practicum experience and the capstone project. The practicum
experiences for each student are designed around the student’s choice for specializa-
tion (administrative/ executive or practice focused). The second author’s (TT) practi-
cum took place at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire,
with the VP of nursing. During the experience, the VP of nursing along with other mem-
bers of the senior leadership team undertook a restructuring of the organizational chart.
The change, as you can imagine, was enormous. It not only was going to impact the
hospital, but also had implications for change for other hospitals that were part of an
alliance with Dartmouth. The VP of nursing was able to articulate the communication
plan at every level of the facility and to those hospitals outside the physical boundaries
of Dartmouth. The ability to participate in this monumental event at that hospital was
vastly different from any of the clinical experiences in the MSN program experienced by
this author 10 years before the DNP program.
During the practicum at Dartmouth, as a doctoral student, the second author func-
tioned as a consultant and generated questions that might be posed by stakeholders
and various team members within and outside the organization. During the residency,
students are expected to exhibit critical thinking and participate in scholarly discus-
sions. The key objective during the residency hours (practicum) is that the students
drive the learning experience by being active participants who are not simply in an
organization solely to shadow their mentors. Each course has course objectives that
provide guidelines for students’ practicum experiences; however, the students also cre-
ate unique objectives for each practicum experience, which results in ownership of the
process and outcome of the residency. Although there were other practicum experiences
(see Figure 6.1 ), the Dartmouth experience demonstrated the practice of an effective
leader dealing with a very toxic change in a major health care organization. The overall
focus of this practicum therefore was on the process of leadership and leadership style,
and its effect on organizational culture.
A second practicum occurred at the University of Texas MD Anderson Cancer
Center in Houston, Texas, one of the top oncology health care facilities in the nation. The
focus of this residency revolved around my (TT) capstone project, which actually was a
quasi- experimental pre- and post- test design study that investigated psychological dis-
tress among patients undergoing hematopoietic stem cell transplants. During this time,