204 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
Nurses ranked below all other groups (government, insurance, pharma and health care
executives, doctors, and patients). Neither physicians nor nurses were viewed as influ-
ential in the reform process, despite their being viewed as having the most credible
health care– delivery system information. The top barrier to nurses’ assuming this lead-
ership role was the perception that physicians, not nurses, were the key decision makers
in health care (RWJ- Gallup, 2010).
Survey respondents may not have viewed nurses as having a great deal of influ-
ence on health care reform; however, they did view them as having a significant influ-
ence on improving the quality of health care. This included reducing medication errors
and increasing patient safety. Respondents also wanted nurses to have significantly more
influence than they currently had in all areas queried. These opinion leaders, who have
significant political influence, clearly valued the nursing profession’s knowledge, skills,
credibility, and respectability; yet, they seemed to be saying that clinical expertise alone
is not enough to conceptualize and implement widespread health care reform.
Despite being 5 years old, these findings are congruent with the American
Association of Colleges of Nursing’s (AACN, 2015) white paper on implementing the
Doctoral of Nursing Practice (DNP). AACN (2015) stressed the importance of the DNP
role in strengthening the skills and competencies needed by advance practice nurses
to impact health care at all levels. The doctoral advanced practice registered nurses
(DAPRN) roles focus on providing evidence- based practice in primary and specialty
care settings and leading continuous quality improvement (QI) at the individual and
system levels (Dreher & Smith Glasgow, 2011). The executive DAPRN focuses on devel-
oping, implementing, refining, and leading effective and cost- efficient health care deliv-
ery models. These are clearly the skills needed to fill the perceived gap in nursing’s
ability to lead health care reform as noted in the Institute for Healthcare Improvement’s
(IHI, 2008) report on meeting a Triple Aim.
Established by the IHI (2008) and adopted by many as goals for health care
reform, the goals of Triple Aim are of (a) simultaneously improving population health,
(b) improving the patient experience of care, and (c) reducing per capita cost. These
three aims became the organizing framework for the U.S. National Quality Strategy
(NQS; Agency for Healthcare Research and Quality [AHRQ], 2012). AACN’s vision of
competencies for a DNP aligns perfectly with the skills needed to lead practice- based,
organizational, and national initiatives that would support achievement of these impor-
tant goals. Overcoming the barriers within the DNP educational programs and practice
sites are the first and most vital challenge for the nursing profession. Implementing the
clearly defined competencies for DNP graduates through consistently applying these
DNP educational standards within DNP programs will go a long way toward meeting
the mandate for nursing to assume leadership in health care reform.
The competencies described in the AACN’s (2006) Essentials of Doctoral Education
for Advanced Nursing Practice combined eight essential competencies with role- specific
competencies established within specialty or functional areas of focus. These eight
competencies serve as the core curriculum for BSN– DNP and post- master’s DNP pro-
grams. These courses vary by program and most often include content areas focused
on: translating evidence- based practice; interprofessional, organizational, and systems’
leadership; patient education and health information technology; analytical methods
including program evaluation, QI methods, and epidemiology; population health and
clinical prevention; and health care policy. Details regarding the specific approaches
to achieve these broad competencies are left to the faculty developing these courses.
Textbooks and other resources provide support as they develop the depth needed
in each content area to prepare DNP graduates to meet the stated competencies and
assume their leadership roles.