553chapter TWENTY-FIVE
Today, Tomorrow, and in the Future:
What Roles Are Next for Nurses
Engaged in Doctoral Advanced
Nursing Practice?
H. Michael Dreher and Mary Ellen Smith Glasgow
Despite the plethora of still surging numbers of new Doctor of Nursing Practice (DNP)
programs, the impact these graduates will ultimately have on the U.S. health care sys-
tem remains largely unknown. This is perhaps both disconcerting and opportunistic.
There is need for more data that examine the health outcomes of aggregate popula-
tions from DNP- directed care and administration, if the role of the DNP graduate is to
be supported by the free market and by consumers. Beyond the work of Mundinger
et al. (2000) that supports this degree’s likelihood of having a positive impact on health
outcomes, not initially having substantive pilot data for the DNP degree still presents
a challenge to the profession. It is up to the now decade- long cadre of DNP graduates
and educators to discern the value of this new doctoral degree. We are optimistic that
in time work on evaluating the degree’s worth will be done, and the innovation of
the DNP degree will be affirmed. This concluding chapter takes a summary view of
the three primary doctoral advanced practice roles we have delineated in this text—
practitioner, clinical executive, and educator. We have purposely included the edu-
cator role because probably more DNPs appear to either complete the degree while
in current academic roles, or enter academia postgraduation. There is too much of
an employment trend to pretend that DNPs are completing the degree specifically to
retain or attain an academic position. We have certainly tried to be honest about it in
this text, and confront this trend directly. In this chapter, we reflect on what the DNP
degree is today and what it will likely look like tomorrow, as programs already in exist-
ence are beginning to tweak and modify their curricula after having had many cohorts
of graduates entering the workforce. Finally, we look at the future. We make some cre-
ative projections about where this degree might lead the new graduate. As we move
further into the 21st century and the unfolding first and next decade of health reform
ahead of us, our projections evolve out of Toffler’s (1971) groundbreaking 1970s’ work
Future Shock , Naisbitt’s (1982) Megatrends from the 1980s, and from the 1990s to today,