427chapter EIGHTEEN
Refl ective Response
Irene C. Felsman
Donley and Kiraly provide a compelling argument regarding the importance of solid
preparation of the Doctor of Nursing Practice (DNP) level advanced practice regis-
tered nurse (APRN) to participate in policy development regarding advocacy for qual-
ity health care, based on Essential V of Doctoral Education for Advanced Nursing Practice.
(American Association of Colleges of Nursing, 2006). The authors’ analysis of the origin
and history of doctorates in the field of nursing is thorough and engaging, beginning
with development of the doctor of education (EdD) degree at the turn of the 20th cen-
tury, and concluding with the current structure of two complementary doctoral level
pathways, the PhD and the DNP. A foundation is laid for understanding the distinc-
tion between, as well as the interface of these two roles as a basis for discussion of the
responsibility for all professional nurses in positions of leadership to engage in health
and public policy development. A particularly important point that the authors make is
that there appears to be variability in level of rigor among DNP programs as developed
by different institutions since the inception of this degree in 2004. Clearly, regulation of
program certification is essential if the DNP role is to be seen as credible, particularly in
the leadership and health policy arena.
While in accordance with all the issues presented by the authors, I particularly
resonate with the concept that the professional nurse in the DNP role is potentially
most powerful in terms of representing patient/ client experiences in the policy arena.
DNPs, given their often intimate and sustained exposure to vulnerable and marginal-
ized populations, are uniquely placed to advocate for policy changes in health care,
with the ultimate aim of assuring access to quality, affordable services. Indeed, it may
be argued that the expertise of a DNP- prepared nurse is invaluable in terms of repre-
senting the realities of underserved populations, those most affected by adverse social
determinants of health (SDOH).
Given, as the authors quoted, that less than 1% of the nursing workforce holds PhD
in nursing or related fields (Robert Wood Johnson Foundation, 2013), how effective are
PhD- prepared nurses functioning alone as advocates for change in health policy that ben-
efit the disenfranchised? Nursing professionals must begin to move beyond differences in
educational preparation, complement the strengths of different educational and experien-
tial preparation, and recall the true advocacy nature of our caring profession if there is to
be movement toward a health policy agenda which addresses more equitable allocation of
resources in our society, the basic premise of the PPACA (2010). Professional nurses at all