25: TODAY, TOMORROW, AND IN THE FUTURE ■ 559thinking (AACN, 2006). The clinical executive track of the DNP degree^4 offers numerous
courses on leadership theories, the process of leadership, and leadership as it pertains
to a health care setting. The practicum experiences for the clinical executive student
provide an opportunity for the student to apply leadership theories in health care set-
tings. The challenge for the DNP clinical executive may be in the attainment of 1,000
practicum hours (post- BSN) that both the Commission on Collegiate Nursing Education
(CCNE) and Council on Graduate Education on Administration in Nursing (CGEAN)
require. The 2015b AACN white paper on the DNP states, “All DNP students, including
those in post- master’s programs, are expected to complete a minimum of 1,000 post-
baccalaureate practice hours” (p. 7). Additionally, Council on Graduation Education for
Administration in Nursing (CGEAN, 2011), while noting that more than 50% of nurses
in leadership- titled positions are estimated to have less than baccalaureate degree prepara-
tion, recommend:
- Nurse managers should be minimally prepared at the baccalaureate or prefera-
bly the master’s in nursing level - Nurse executives are encouraged to seek educational preparation at the doc-
toral level to enhance their roles and contributions to improving health care
outcomes and systems - CGEAN supports the implementation of the DNP as a post- master’s terminal
degree option with an aggregate/ systems/ organizational focus in adminis-
tration, health care policy, informatics, and population- based specialties as
detailed in the DNP Essentials document - CGEAN embraces the role of nurses prepared through PhD programs to ex-
pand knowledge development in relevant leadership and administrative areas
to enhance practice effectiveness and outcomes (p. 3)
In 2012, CGEAN announced that “Until substantial research produces evidence for
a specified number of practice hours, professional doctoral programs that build on
the master’s degree are expected to provide a minimum of 400 practice hours” (p. 2).
Whether CGEAN guidelines are contradictory to total post- BSN hours required by the
AACN/ CCNE would then depend on the individual student’s program of study at the
master’s and doctoral level.
The program of study for the DNP clinical executive should allow students to
further develop their own leadership through introspection, coursework, clinical work,
and mentorship. These types of educational experiences can be elemental, as the clini-
cal executive tries to execute and provide for more quality health care. Furthermore, it
will be critical for the DNP curriculum to have a heavy emphasis on business ethics as
well as clinical ethics. The clinical executive may be one of a few individuals in senior
leadership with a true understanding of the complexity of patient care, nurses’ roles/
responsibilities, and the requisite human and fiscal resources required for positive clin-
ical outcomes. As the voice of nurses in the organization, the clinical executive needs to
have political capital— a good reputation and irreproachable ethics. In order to fulfill
one’s fiduciary responsibilities, the clinical executive must also be knowledgeable and
vigilant with regard to fiscal accountability.
Doctoral level nurse executives will be called upon to bring their respective organ-
izations to a better position than where they found it. Ideally, the doctoral advanced
nursing practice- educated clinical executive will: (a) earn the trust of one’s organization;
(b) be deeply engaged with nursing staff and/ or employees; (c) earn legitimacy and
mobilize one’s own people around a focused agenda; (d) devote considerable efforts
to developing one’s employees and building the organization’s collective leadership
capabilities; and (e) strive for high performance in the organization while delicately