6: REFLECTIVE RESPONSE ■ 179But what about the difference between the PhD and the DNP? We appreciate the
distinction in why nurse leaders choose different programs. If nurse leaders did not con-
tinue to contribute to our ongoing body of knowledge, we would have less substantive
backing in the application of that knowledge. Both of these graduates (the DNP and the
PhD) see the macroscopic perspective, but they see it through a different lens.
PhD programs tend to be more similar than varied. The same is not true for DNP
programs. The range of what comprises the DNP programs is between high- level
application and final scholarly project consisting of work we might call intense qual-
ity improvement and, at the other end, considerable theoretical perspectives and final
scholarly project, some projects that would be difficult to differentiate from disserta-
tions. As is always true in nursing, our diversity is one of our greatest benefits and one
of our greatest liabilities. On the positive side, there is a greater flexibility with tailoring
the DNP to the local needs. Program variability can also be viewed as a negative when
curricula are varied and there is a lack of consistency and sometimes rigor in the final
scholarly project. Until we have some better description of what best comprises a DNP
program, it is difficult to compare that type of programming with other degree pro-
grams. We anticipate this programmatic variability to decrease in future years in part
because of individual programs’ endeavors and in part because of the work of AACN to
make clear the expectations of final scholarly project experiences.
One final point about the value or preference for a PhD or a DNP, or for that matter
between the DNP and one of the master’s programs: The numbers of nurses prepared
at the master’s and doctoral levels continue to be relatively small in comparison to the
3.1 million registered nurses. Rather than worrying about which is better, we should
worry about how we move nurses toward graduate education more quickly and con-
sistently. As the authors point out, “Organizational performance during this turbulent
time in health care will be contingent on the effectiveness of the leadership team” (see
Supply, Demand, and Preparation of a Clinical Executive—Why Is it Important?).
This chapter addresses the advanced role of the clinical executive with a focus on
those positions that head nursing services in clinical agencies. Yet, many DNP programs
have students enrolled in the leadership component who are in other roles, such as
informaticist and clinical educators (professional development). DNP programs that are
inclusive of these leaders have the potential for great impact because today’s health care
truly does “take a team.”
The authors pose several excellent questions related to DNP education for nurse
leaders. As more DNP graduates emerge from the expanding number of programs,
major medical centers and systems will likely expect that the chief nurse executive hold
a doctoral degree. In those organizations, many others will likely be prepared at that
level. However, we know from past studies about the profile of nurses in clinical lead-
ership positions; they are often prepared at the baccalaureate, or less, level. This fact
suggests that we are unlikely to quickly advance a new educational expectation for
nurse leaders. That said, we would be remiss if we did not strongly encourage increased
education for nurses at every level.
Two key points resonate for us. One is that nurses are not invited to the table
based solely on clinical insight; those extending invitations today look for those who
are capable leaders. The second point is that ongoing development is critical for anyone
in a leadership position. Whether a nurse is prepared with an MSN or a DNP is not the
critical question. The question is, What is the plan for ongoing professional develop-
ment to remain relevant to the rapidly changing world? Thus, if we are not learning and
improving, we no longer are standing still. We are falling behind.