6: THE ROLE OF THE CLINICAL EXECUTIVE ■ 173degree. Jones (2010) indicates that executives at the top level of nursing administration
are accountable for the executive level of patient services. She further states that execu-
tives will be expected to function at a macro level with decision making and actions
that impact patients and others within the organization. Mid- level managers have a
narrower focus and span of control within organizations and are more likely to func-
tion at a microlevel by virtue of the organizational chart and structure of organizations.
The nurse executive will work across both microsystem and macrosystem levels that
include groups both internal and external to the organization. As stated earlier, one
of the unique qualities of the DNP degree is its preparation of the nurse executive to
think and function on a macrosystem level. (c) Investigators must continue to monitor
the market and demand for DNP graduates. Many authors have noted the turbulence,
variability, and increasing complexity of the health care environment (AACN Fact
Sheet, 2010; Fasoli, 2010; New, 2010; Schaffner & Schaffner, 2009). All of these factors
continue to add momentum to the demand for preparation beyond a graduate level.
One other significant finding is that employers have quickly recognized the contribu-
tions that DNP graduates are making in the practice setting (Waxman & Maxworthy,
2010). This last point is further supported by early studies that show the DNP is per-
ceived as a viable advanced education option and enables students to make viable
contributions to the nursing profession (Loomis, Willard, & Cohen, 2006). In closing,
the supply is present and the demand continues to create a need for clinical executives
who are prepared beyond a master’s level. Based on the aforementioned data, the DNP
is necessary and should continue to be an option for nurses seeking a clinical executive
specialty in advanced nursing practice.
■ A PIONEER’S PERSPECTIVE: A GRADUATE FROM
THE NATION’S FIRST DNP PROGRAM
As the second author of this chapter (TT) and a member of the first DNP graduat-
ing class in the United States (at the University of Kentucky), I recall a moment in
time that I shall not forget. One of the members of my doctoral capstone commit-
tee asked me what was most beneficial about the DNP program. My response at
that time was that I had a better understanding of myself and my personal leader-
ship style. Although this may sound somewhat trivial, it was and continues to be,
for me, a profound realization. This realization continues to facilitate my personal
leadership journey and development, because I better understand what makes me
successful as a leader. It also illuminates and highlights what skill sets are neces-
sary to improve my leadership. Through reflection and my current practice, other
responses to that question would include the increased confidence and compe-
tence to create a culture of collaboration by navigating through departmental and
organizational borders by using focused evaluations, evidence- based practice, and
influencing others beyond the traditional boundaries of the nursing component of
health care. One could also say that health care today has an entirely different look;
it is something that stretches beyond the physical and sometimes human bound-
aries of the health care facility. Successful clinical executives must be willing and
equipped to see the new paradigm and context in which health care is practiced. As
a graduate of a DNP program (TT), I am able to see the difference and the shift in
the health care paradigm, and understand that it requires one to think and function
at a different, more advanced level.