570chapter TWENTY-FIVE
Refl ective Response 1
Suzanne S. Prevost
This final chapter by Dreher and Smith Glasgow raises several important questions and
challenges for faculty, graduates, and employers of Doctor of Nursing Practice (DNP)-
prepared advanced practice nurses. The rapid expansion of DNP programs, from less
than 10 in 2005 to 269 in 2014 (American Association of Colleges of Nursing, 2015),
demonstrates the broad acceptance of this phenomenon by nursing faculty and admin-
istrators across the United States. Likewise, the exploding volume of DNP student
applications and enrollment provides evidence that this movement is enthusiastically
embraced by students and practicing nurses, as well as those in academe. It is both
intriguing and challenging to observe such a positive response to a nursing innovation,
while there is still minimal evidence to support its effectiveness.
Why are we moving forward with such blind faith? Perhaps this reaction is based on
the widespread acceptance of the inadequacies of our existing health care delivery systems
and the consensus that we need new models of health care delivery and better- prepared
knowledge workers on the front lines. We must, however, instill a sense of urgency among
DNP faculty and students to work cohesively and intentionally to build this body of evi-
dence. The authors suggest that the emergence of new DNP roles will depend on graduates
presenting employers with measurable claims of what they have acquired in their educa-
tion. I would challenge these graduates to go beyond measurable claims to the presenta-
tion of significant results. In this case, significance is not limited to statistical significance
but might be equally compelling in the form of clinical or economic significance.
I applaud Drs. Dreher and Smith Glasgow for their clear delineation of the doc-
toral advanced practice roles of practitioner, clinical executive, and educator in this text.
Although the practitioner and clinical executive roles are becoming widely accepted,
some controversy remains regarding the optimal preparation and roles of DNP-
prepared nurse educators (Florczak, 2010).
The rapid development of doctoral level advanced practitioner programs across
the United States demonstrates the growing national sentiment favoring this level of
preparation for advanced practitioners. However, I concur with the authors that the
variability in DNP program quality, specifically in relation to the level and intensity
of advanced clinical practice experiences, remains a valid concern. Most faculty and
administrators of DNP programs have implemented and documented adherence to
the minimum clinical hour requirements set forth in the 2006 AACN essentials docu-
ment as they prepare their graduates for certification examinations and prepare their