544 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
and outcomes, rather than net provider profitability. Writing in the Harvard Business
Review Porter and Lee (2013) write of a values- driven health care model:
We must move away from a supply- driven health care system organized
around what physicians do and toward a patient- centered system organized
around what patients need. We must shift the focus from the volume and
profitability of services provided— physician visits, hospitalizations, proce-
dures, and tests— to the patient outcomes achieved. (p. 50)
Certainly, health networks that choose capitation models of health care delivery
are not the only networks of care that are focused on population health. But in tradi-
tional models of health care delivery that were at the nexus of why we needed health
care reform, it does beg the question “what really is population- based health care and
who is delivering it?”
Essential VIII: Advanced Nursing Practice
The domain of Essential VIII includes:
- Conduct a comprehensive and systematic assessment of health and illness
parameters in complex situations, incorporating diverse and culturally sensi-
tive approaches - Design, implement, and evaluate therapeutic interventions based on nursing
science and other sciences - Develop and sustain therapeutic relationships and partnerships with patients
(individual, family, or group) and other professionals to facilitate optimal care
and patient outcomes - Demonstrate advanced levels of clinical judgment, systems thinking, and ac-
countability in designing, delivering, and evaluating evidence- based care to
improve patient outcomes - Guide, mentor, and support other nurses to achieve excellence in nursing practice
- Educate and guide individuals and groups through complex health and situ-
ational transitions, and - Use conceptual and analytical skills in evaluating the links among practice,
organizational, population, fiscal, and policy issues (AACN, 2006, pp. 16– 17)
Over the past 10 years this has been one of the two essentials (including Essential
III : Clinical Scholarship and Analytical Methods for Evidence- Based Practice) that this author
believes has been underdeveloped. With the BSN- to- DNP student this Essential is robust
in most DNP curricula, as students in entry- level DNP programs have the usual required
clinical content that is still required in master’s advanced nursing practice programs
(which still overwhelmingly predominate). It is in the post- master’s DNP programs
where this content is minimized.
As previously mentioned, the Columbia University DNP (again, formed as a
DrNP initially) probably has the greatest emphasis on Essential VIII than any DNP pro-
gram in the country. I have written about this program and its historical contribution to
doctoral nursing in this text and in Philosophy of Science for Nursing Practice: Concepts and
Applications (Dahnke & Dreher, 2010, 2016). A recent review of their curriculum indicates
their emphasis on comprehensive care across the lifespan is even more explicit. But why
do programs de- emphasize giving DNP students more advanced direct clinical care
skills? Is it a curricular issue, whereas BSN- to- DNP students and post- master’s DNP
graduates need to be at the same eventual endpoint? We do not expect RN/ BSNs (espe-
cially experienced RNs) to be at the same level of practice as generic BSN graduates,