24: ESSENTIALS OF DOCTORAL EDUCATION ■ 543doctorally prepared practitioner (or clinician who has similar credentials to medicine and
other advanced health care providers), may provide the necessary leverage to expand
the domains of nursing practice, particularly the domains of doctoral APRN.
Advocacy as a role function has a long history in nursing (Tomajan, 2012). One
author describes the role of advocacy as “seeing a need and finding a way to address it”
(Almidei, 2010, p. 4). However, this author does cringe when he hears nurses indicate
they are the primary advocate for the patient, or the only advocate. The reality is an
individual nurse can be a very good advocate for an individual patient, and can possibly
be the primary advocate. But there are lots of interprofessional members of the health
care team today who take their role of advocacy very seriously and may take offense to
nursing viewing patient advocacy as chiefly in their domain of practice. This is where
interprofessional education (IPE), particularly between NP students and medical stu-
dents and residents (or similar comparative cohorts), may be very helpful. An excellent
study ( N = 306) has been reported in the British Medical Journal of Quality and Safety ,
which included nursing students, pharmacy students, physician assistant students, and
residents focusing on IPE and safety (Brock et al., 2013). The field of “health care safety”
is a very purposeful area where it can be easier to promote expert practice across vari-
ous health care disciplines. This content, particularly in Essentials V and VI remains a
strength since its inclusion in 2006. With the implementation and progress with quality
and safety education for nurses (QSEN), TeamSTEPPS, Just Culture, and other qual-
ity, safety, and continuous improvement processes, there still needs to be an increasing
permeation of this content directly and explicitly into nursing education not just in the
DNP, but across all nursing educational degree levels (Lyle- Edrosolo, & Waxman, 2016;
Penn, 2014; Sweigart et al., 2016).
The final piece to these two essentials (V– VI) and VII are comments on popula-
tion health. Without a doubt, this is a popular buzzword in health care and nursing.
In my own conversations with one of the leading health care executives in New York
City recently, I was informed he thought the word population health was “overused”
and queried “what does it really mean?” If one is talking about a capitated versus fee-
for- service health care system (or network), then easily the capitated model of health
care reimbursement is directly population focused and the most predominant (but
slowly fading) fee- for service is technically, not. Another colleague has said “hasn’t
nursing always been doing population focused health?” Devore and Champion (2011)
in Health Affairs write about accountable care organizations (ACOs) and their centrality
to contemporary health care delivery, especially with the advent of the ACA:
... the goals of an ACO are to empower people to take charge of their health
and engage in shared decision making with providers; eliminate waste and
unnecessary spending while also meeting patients’ preferences for care; in-
crease preventive care and other strategies that could help keep people well;
and increase overall satisfaction with care. (pp. 41– 42)
They also outline how ACOs could provide incentive, reimbursable dollars, when
certain benchmark clinical health outcomes or metrics are made. This is capitated, pop-
ulation health, where a hospital network has control (or let us say accountability) for
“covered lives”— the number of enrollees that any health care network has responsi-
bility for from birth to death. Recently, there has been discussion whether short- term
health promotion will actually save health care dollars (Levine, 2016). It is intuitive that
it does, but when individuals seek costly preventive care (it is not free of course), the
return on investment or savings from the slower progression of chronic or acute ill-
nesses is not quickly seen. Whether the progression from a traditional fee- for- service
model will disappear is unlikely, but market forces are suddenly focused more on value