500 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
when nurses were not allowed to take blood pressures, and clearly that has changed
over time. To paraphrase the overly quoted Gandhi (b. 1869, d. 1948), we have to “be the
change that you want to see in the world,”^1 or in our case, the change we want to see in
the NP world.
Interestingly, to some extent, the DNP or practice doctorate role has to wait for soci-
ety to catch up with the responsibilities and embrace the role. When Rozella Schlotfeldt
first envisioned the practice doctorate in the 1970s (Schlotfeldt, 1973), society was not
ready for nurses to be educated at a doctoral level and people did not understand the
role. It took many years for people to understand and embrace the role and the con-
cept of a practice doctorate. Dr. Schlotfeldt envisioned that the ND (nursing doctorate)
would affirm nursing’s place as a profession and with recognition within the health care
profession and as an important discipline. She envisioned the practice doctorate as very
different from the PhD or research doctorate.
Whether APRNs entry to practice should be at the master of science in nursing
(MSN) or DNP level is currently highly controversial. However, whether they continue
to be educated at the MSN or DNP level, they will continue to evolve and will con-
tinue to meet the needs within society. We have thousands of APNs who are desirous
of further education and have embraced the DNP with enthusiasm. Additionally, many
schools have found it easier to establish a post- master’s DNP prior to the establishment
of a post- baccalaureate DNP. It remains to be seen if in the future the DNP becomes a
post- baccalaureate program only, as the American Association of Colleges of Nursing
(AACN) has suggested, or if the MSN will continue to be offered for the basic APN edu-
cation and the DNP offered for a more extensive advanced education.
Dr. Bloch rightfully identifies the DNP as a degree and not a role. The role is the
certified nurse practitioners (CNM), certified registered nurse anesthetists (CRNA), NP,
or clinical nurse specialists (CNS) all of which are very different from the basic RN
role. The degree makes the recipient think differently and therefore create innovative
change. To argue for education at the DNP level, all APRNs should learn about culture
and behavior of organizations, the role of policy in the provision of health care, and the
business of health care. It is possible that the APRN in the initial stages must spend so
much time learning about the pathophysiology, diagnosis, and treatment of diseases,
and the pharmacological and non- pharmacological treatment of diseases that they are
not ready to incorporate the organizational systems, the policy issues, and the business
aspects into their practice settings. At this time, the post- MSN DNP is therefore trans-
formational in changing the thinking patterns and enhancing the approach to APRN
practice for those folks who choose to pursue it. The post- MSN DNP students
have: (a) mastered the diagnosis and treatment of the patients they see; (b) are ready to
incorporate research into practice as a way of thinking; (c) to enhance practice through
creating coalitions with other health care providers; and (d) working together to change
the policies that govern the health care environment. The DNP can be a clinician, a
scholar and innovator, and an educator, although the educational role is somewhat
controversial due to the stance of AACN. At this time, a significant number of DNP
graduates are in fact educators, so that stance will likely change over time. As with the
NP degree, it is a constantly changing environment. I agree with Dr. Bloch that we are
embarking on a journey with the practice doctorate, and that we all need to embrace the
journey and see where it takes us.
Dr Bloch provides a very salient and informative table at the end of the chapter
with important points for the DNP student to think about as they embark on their jour-
ney in the DNP world. These points are very well thought out and will be extremely
helpful to the DNP student as they are trying to maneuver this new degree. She rightly
states, what is good for the people, is good for nursing.