178chapter SIX
Refl ective Response
Patricia S. Yoder- Wise and Karen A. Esquibel
Wadsworth, Talbert, and Dennison pose some questions and insights related to the
Doctorate of Nursing Practice (DNP) preparation for clinical nurse executives. They
compare master’s preparation (in nursing and in business administration) with DNP.
Although they briefly address the PhD, they omit comparison of the DNP with the
PhD degree and how each of those degrees might contribute to the excellence of clinical
nurse executives. They also discuss briefly the position of the American Organization
of Nurse Executives and address its core competencies for clinical nurse executives.
However, they omit addressing the position of the American Nurses Association and
its scope and standards document governing nursing administration. These competen-
cies and standards are the basis of the American Association of Colleges of Nursing’s
(AACN) Essentials of Doctoral Education for Advanced Nursing Practice, Essential VIII: sys-
tems or organizations focused on advanced nursing practice competencies for improving
patient care processes and outcomes. The emphasis on “patient care” is vital to the future of
health care and the authors are clearly enthusiastic supporters of this degree.
Although this chapter focuses on DNP preparation, as it should, no mention is
made of the huge numbers of nurses in administrative positions who are not even pre-
pared with a baccalaureate degree in nursing. This diversity in the educational qualifi-
cations for someone who has the ultimate accountability for the nursing care of patients
creates an overwhelming challenge to address before the refinement of the question:
Should a nurse executive possess a master’s or doctorate? can be resolved.
Wadsworth, Talbert, and Dennison make an excellent case for why clinical execu-
tives need solid educational preparation. The idea that nurses in those positions have
“‘24/ 7’ accountability for processes, structures and outcomes” ( see Definition of a
Clinical Executive) and that these positions often encompass multiple professional
groups is an important consideration. The authors point out the value of the practica and
the final scholarly project in shaping the contributions the graduate can make. Although
these two experiences are similar to clinical intensives and capstone work at the under-
graduate level and the practica and thesis options at the master’s level, the richness of
the backgrounds that learners bring to the doctoral level study provides a higher level
experience. In short, every nurse learns through clinical experiences and focused work.
If an individual is learning to be a nurse, that level of insight differs greatly from what a
nurse, often with multiple years of experience, brings to doctoral level study.