58 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
colleagues then and now), but in 2016, 23 states (including the District of Columbia)
allow completely independent nurse practitioner practices (American Association
of Nurse Practitioners, 2016; Ferris, 2001; Pearson, 2010).^5 There is even a very repu-
table blog (its authors have previously won American Journal of Nursing [ AJN ] Book-
of- the- Year awards) that presents a very modern case for why nursing is a profession
(truthaboutnursing.org, 2015). By contemporary standards, at least by Melosh’s defini-
tion, some nurses are indeed autonomous and classically “professional.” Furthermore,
that would mean that the profession of nursing is legitimately partly professional, too.
This chapter, however, focuses on the roles of doctoral- educated advanced practice
nursing professionals that have evolved from the emergence of professional nursing
roles, but the ongoing debate about the nature of the professionalism of nursing con-
tinues. Because the health of our citizenry is so important, the roles of nursing profes-
sionals are particularly critical to both the development of the profession itself and their
impact on society because of the highly skilled work they perform.
Role and Its Meaning for New DNP Graduates
At its most basic level, role can be defined as “a socially expected behavior pattern usually
determined by an individual’s status in a particular society” ( Role, 2010). A more precise
sociological view would characterize role as occurring within systems (or organizations,
or relationships), and therefore a role can be considered a “set of systems states and ac-
tions of a subsystem, of an organization, including its interactions with other systems
of nonsystem elements” (Kuhn, 1974, p. 298). These definitional frameworks lead us to
conceptualize an operational definition of the word role for nursing. It is suggested that
nursing roles are professional, socially constructed, operationalized behaviors that form
the boundaries of what a professional nurse does. It is only through a thorough analysis of
the work of RNs and the roles they play, enact, or fulfill in the course of their professional
work can one ascertain what are advanced (practice) nursing roles.
Finally, what differs or extends the boundaries of advanced practice to doctoral
advanced (practice) nursing roles? In theory, it sounds very simple. In actuality, we believe
that it is more complex. Multiple discussions have ensued in our DNP seminars in the
past 5 years about nursing roles and the nature of advanced practice nursing. For exam-
ple, in the scenario of an overweight or obese patient with accompanying negative health
conditions that need intervention, how does the 20- minute primary care interaction of an
adult nurse practitioner and patient differ operationally from the physician– patient inter-
action (Dreher, 2008b)? This kind of discussion is particularly germane to DAPNs, who
must now identify how their roles and role functions will be different and more advanced
than when they had a master’s degree. Again, the authors contend that if the skill set is
the same, then nursing has a weakened debate calling for a practice nursing doctorate.
Meleis’s work (1975; Meleis & Trangenstein, 1994) on role transitions is still very well
applicable to today’s doctoral advanced practice graduate, especially one who practiced
previously with the master’s degree. In her 2011 book, Meleis suggests, “Role insuffi-
ciency may be manifested in assuming any new roles... ” (p. 2), and further indicates that
there are “some losses and gains in their different roles and support systems” (p. 3). Smith
Glasgow et al. addressed some of the role strain among DNP students in this text’s first
edition and in a replication study in Chapter 10. But we suspect there is more role strain
among DNP graduates than has penetrated the nursing literature. Cusson (Cusson &
Strange, 2008; Cusson & Viggiano, 2002) has written extensively about nurse practitioner
role transitions, especially among neonatal nurse practitioners. The authors are aware that
Dr. Cusson is currently extending her work to role transitions among doctoral advanced
practice graduates and it is precisely this kind of outcome data that the profession needs.