1: REFLECTIVE RESPONSE ■ 53as a pseudonym for class, pointing out that in medicine, requiring the prerequisite of
a baccalaureate degree prior to admission to medical school, assured a steady stream
of well- educated (read: “well- bred” as in “invariably well- off enough” to be able to
AFFORD education) young gentlemen, of a certain class. Has anything really changed
here? If anything, this situation has exacerbated. How many bright young individuals,
male or female, interested in a career in health care, are able to sustain the arduous
path of admission to medical school without major support, be it economic, social, or
psychological? Equally, any historical and political analysis cannot afford to ignore
the gender issue in nursing, as tedious as this discussion may be to some. How many
nurses in their 40s and 50s that return for the PhD have spent years raising children,
supporting family, putting their own educational aspirations aside? When it is time
for “them” they choose pursuit of knowledge rather than mere pleasure, perhaps hav-
ing been frustrated in their early youth by economic demands, or perhaps as part of
an ongoing quest toward social status and respect. Ethel Manson Fenwick, organizer
of the British Nurses Association and the editor of the first British journal of nursing
( Nursing Record ), aptly summed up the situation in 1887 when she said, “The Nurse
question is the Women question, pure and simple. We have to run the gauntlet of those
historic rotten eggs” (Fenwick, quoted in Baer, 1997, pp. 256– 257). Has anything really
changed?
When one examines the evolution of the nurse practitioner (NP) role broadly
speaking, within its social context, one gets a sense of the “grass- roots” nature of
its development— a response to a social need for primary care (Dunphy, 2012). NP
programs sprung up willy- nilly; certifications and continuing education programs
abounded for practicing diploma- prepared nurses to become “nurse practitioners.”
In contrast, as broadly observed and described in this chapter, the DNP evolved as a
much more “top- down” movement, springing from ideas of influential nurse lead-
ers and educators (nurse professionalizers ) as actualized in various nursing organiza-
tions like the American Association of Colleges of Nursing (AACN) and the National
Organization of Nurse Practitioner Faculties (NONPF). Against the broader back-
drop of history, and societal need for health care, debates over titling, splitting hairs
over the differentiation of the PhD, DNS, DNSc, and DNP (so well outlined in this
chapter!) will in all likelihood continue. Critical issues face us in terms of the need
for numbers of future nursing faculty and nurse educators. Is nursing knowledge
advancing and contributing to positive change? The unresolved issues of education
and research in DNP education continue to be “clear as mud.” And the speed of
change is only accelerating. How can we best position ourselves as a discipline and
a profession to meet current challenges and anticipate future demands? Medicine
provides a pathway for MD/ PhD education. With a large pool of DNP graduates,
many of who want to teach— or ideally have a mix of practice and teaching and in
some cases research— why not develop DNP– PhD pathways that may enhance both?
Most programs have students who have switched from one to the other once on the
“path” to doctoral education.
Although as an academic I applaud the need for “tight” definition and appreciate
fully the implications in this endeavor in defining knowledge development, curricu-
lum, and the like, some of these issues emerge as “small”— and possibly petty— when
confronted with the magnitude of human need for health care and the subsequent need
for nursing action. Thus, I posit a broader frame for examining these continually impor-
tant and compelling issues in nursing.