60 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
very different place functionally. Society does not yet know exactly what roles they will
play (or be required to fill), and the new domain of this doctoral advanced practice is being
created in real time, even as this text is published.
We, therefore, propose that the functionalist view of the roles of the professional
nurse, where a common socialization of RNs creates stability in the social system, may
not theoretically or properly explain the unfolding role of a new type of advanced prac-
tice nurse. In a discussion of the roles of professionals, a symbolic interactionist view
of DAPNs would indicate that their emerging roles would evolve from an ongoing
examination of their meaning, to a vigorous self- analysis of how satisfying, effective, or
well received the exhibition of the role is. In other words, the critical feedback this new
practitioner receives, processes, interprets, and reinterprets will ultimately reinforce the
role being integrated and assimilated in a new domain of practice. In the study “What
Do People Need Psychiatric and Mental Health Nurses For?,” Jackson and Stevenson
(2000) describe the utility of using this critical feedback from patients (which may not
be explicit) to answer this question. Similarly, Erving Goffman’s (1955) original theory
of “face work,” which is described by Shattell (2004) as the face of the nurse interacting
with the face of the patient in the simplicity or ordinariness of any basic nurse– patient
interaction, is an example of how symbolic interaction theory may be highly useful in
explaining how two different dyadic DAPN roles may evolve.
First, what is the new DAPN/ patient role? Second, what is the new DAPN role
in relation to professional clinicians in other health care disciplinary colleagues? On
an operational level, these questions are: (a) How will the individual patient perceive
Dr. Jane Smith’s role as a nursing primary care provider now using the title “Dr.”?
(b) How will fellow health profession colleagues perceive the new role of the DAPN as
doctoral prepared , not master’s prepared? Will patients have different expectations? Will
colleagues have different expectations? Indeed, Goffman in his classic sociological text
A Presentation of Self in Everyday Life (1959) writes, “When an individual enters the pres-
ence of others, they commonly seek to acquire information about him or to bring into
play information about him already possessed” (p. 1). Will this new type of advanced
practice nurse use the face- to- face feedback to create solutions to any new role conflict
or role strain that may occur? Although role conflict and role strain in the DAPN are
addressed in Chapter 10 by Smith Glasgow, Zoucha, and Johnson, both sociological
concepts are not new to nursing. However, there are likely particular nuances that are
different from the role conflict and role strain of the newly educated, master’s- prepared
advanced practice nurse.
Another important concept in symbolic interaction is that of role- taking. Role-taking
is a key mechanism of interaction that permits us to take another person’s perspective
and to see what our actions might mean to the other actors with whom we interact (Schell
& Kayser- Jones, 1999). One scholar suggests that the outcome of role- taking is not just
the processing of the influence of the interaction on behavior, but requires overt behavioral
change based on the processing of those interactions (Cast, 2004). In other words, in
the DAPN role, the new practitioner is likely to not just think differently, but also to act
differently as new face– work interactions with patient and colleagues are experienced.
We contend that this change in perspective and change in thinking is more likely to
occur as the new practitioner engages in more reflective practice. Johns and Freshwater
(2005) are leading scholars supporting the practice of reflection in advanced nursing
practice and they build and extend the classical work of Schön (1983) who coined the
concepts of “reflection in action” and “reflection on action.” In Chapter 19, Stew writes
about how reflective practice ought to be even more mature and developed in the DNP/
professional doctorate nursing graduate. With deep reflection about this new role and
consideration of what it is or should be (and conversely what it is no longer), the new