542 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
that might improve outcomes, revenues, or both. This DNP leader/ manager must also
be able to speak comfortably to the health care analytics team about how the compila-
tion of big data can point to data trends, and again drive their own or the institution’s
evidence- based decision making.
Essential V: Health Care Policy for Advocacy in Health Care; Essential VI:
Interprofessional Collaboration for Improving Patient and Population Health
Outcomes; and Essential VII: Clinical Prevention and Population Health
for Improving the Nation’s Health
On reflection on the 2006 document, “advocacy” is very difficult to separate from the
advocational communication and activities that promote patient safety and better
health quality. Health care policy and health care politics are more easily differentiated,
and so these two essentials are discussed together. The Essentials document indicates
that, “Political activism and a commitment to policy development are central elements
of professional nursing practice, and the DNP graduate... ” (AACN, 2006, p. 13). The
use of the words “political activism” seem particularly important today if we remember
that the AACN’s development and subsequent proclamations on the DNP all preceded
both the global recession and the implementation of the Affordable Care Act (ACA). It
is interesting, but nonetheless futile, to wonder whether had either of these events taken
place earlier, would the path to the DNP have occurred at all or perhaps evolved dif-
ferently? Nevertheless, “activism” has never been associated with the PhD degree. But
its inclusion in the essentials document is a clear indication that the DNP graduate is
charged to be a bigger leader at the grassroots practice arenas of the profession, not the
traditional academic. This discussion is very similar to the medical profession’s desire to
always be the de facto leader of the modern Medical Home, again marginalizing APRNs
and now doctorally prepared APRNs (i.e., DAPRNs). As part of current health reform,
the Medical Home (first established in 1967 to coordinate complex pediatric care), is
designed to comprehensively emphasize coordinated care, accountable care, preventive
care, and an integrated payment system. A statement on the Joint Principles established
by the American Academy of Pediatrics, American Academy of Family Physicians,
American College of Physicians and American Osteopathic Association includes the
following first three- bullet points:
- Personal physician: Each patient has an ongoing relationship with a personal
physician who is focused on continuous and comprehensive care as part of a
care team. - Physician leadership: Practices are physician- directed and have a team ap-
proach to care delivery. All members of the team, including physician assis-
tants and NPs are critical to the Primary Care Medical Home (PCMH) mission. - Whole person orientation: The PCMH provides for all of the patient’s health-
care needs or takes responsibility for appropriately arranging care with other
specialists, clinicians and professionals (Bertka, 2011, p. 1).
Maybe the DNP student, who has “practice” at the core of their doctoral degree,
should focus on the politics of health care and policy, rather than be educated in very tra-
ditional PhD- oriented health policy courses. Health policy is not the same thing as health
activism, but health activism has to include health policy. Why cannot APRNs be the
primary care provider in a Medical Home? Many of the barriers to comprehensive APRN
practice, particularly of NPs, are multifactorial and not related to acquisition of the DNP
(Hain & Fleck, 2014). However, the DAPRN has an even stronger argument for this role
and for this seat at the table. It is likely the activism of the practitioner, particularly the