24: ESSENTIALS OF DOCTORAL EDUCATION ■ 529final project is an artificial expectation driven by academia in anticipation that it will
influence practice. Is this a successful approach? Most will agree that it is; not all proj-
ects on the doctoral level reflect practice as much as they reflect satisfaction of academic
expectations. The work product completed in a DNP program reflects an understanding
of the content of the program. As a result, the student hopefully gains a broader under-
standing of concepts and elements that can favorably affect practice outcomes, but this
process does not necessarily reflect an improvement in practice. The onus of responsi-
bility to improve outcomes is on the student as they synthesize knowledge gained and
experiences demonstrated while a student.
Does doctorally prepared advanced practice nursing after graduation rely on the
AACN's Essentials to guide practice? This question requires us to highlight the com-
plexities of practice in an ever- changing delivery system in the context of an evolving
society. When in practice, do DNP- prepared graduates reflect on the essentials after
graduation in order to approach the challenges of patient services? This author believes
that doctorally prepared nurses in practice are prepared to address the complexities of
health care delivery systems and structures that impact patient outcomes. However,
when working through identified challenges the doctorally prepared graduate is mak-
ing decisions in the context of the environment to include the culture, economics, and
personality dynamics of the system. Is the graduate thinking to himself or herself, “I
am making a choice as I consider my clinical scholarship” or asking “How can I assure
that this decision is addressing population health?” or even more specifically, “Is this
decision before me reflective of advanced practice?” These and other essentials of doc-
toral education have been integrated into the thinking processes of the graduate. These
essentials have built a foundation for thought, but are these essentials that spur explora-
tion the basis for current practice? This may seem to be a fine line of distinction yet as an
advanced practice nurse, I suggest that more often than not, practice decisions are made
based on guidelines, system limitations, and human dynamics that mandate a response,
and that the subtleties of the culture and context of the systems being negotiated. Did
The Essentials help to prepare me for these issues? I believe so. Are The Essentials in my
armamentarium to address needed decisions? I do not believe this to be true as prac-
tice is an ever- changing process. With a salute to The Essentials, a well- prepared doctor-
ally educated nursing professional supports practice in order to improve outcomes, but
these same essentials are not the basis for practice. Issues and dynamics outside the
educational process influence practice. Do we owe a debt of gratitude to The Essentials
to help us in this thinking process? I believe that we do, but in the same display of grati-
tude let us acknowledge that practice is not dependent on The Essentials.
■ DO THE ESSENTIALS OF DOCTORAL EDUCATION
TRULY GUIDE PRACTICE?
As discussed earlier, this author believes that practice is guided by multiple dynamics
that must be addressed and maneuvered by the doctorally prepared graduate. Can we
state with confidence that this same educational preparation including the eight essen-
tials truly guides practice? In order to explore this concept, a look at competencies is
needed. A better question to consider is, are the eight essentials competencies of doctor-
ally prepared practice? There are pros and cons to this argument, as the determination
of competencies is an evolving process. Doctorally prepared practice can be grouped in
one or more of the following categories: administration, practice, informatics, and poli-
cy. Absent from these categories of DNP practice is research and education. It is curious