2: EVOLUTION OF PROFESSIONAL ROLES IN NURSING ■ 61practitioner is thus likely to experience ambiguity as he or she tries to “figure this new
role out.” Our view is that the experience of ambiguity is not detrimental, but a sign
of progress. As the new practitioner engages in activities that lead to more secure role
delineation, we think the ambiguity will lessen. Hopefully, patients will respond differ-
ently and positively to the confidence and enhanced skill set of the DNP graduate. Over
time, we predict that health profession colleagues will respond similarly.
A vigorous curricular focus on the concept of role is particularly important for the
student pursuing a DNP degree. However, it is not likely that the expansion and ultimate
role delineation of the DNP graduate will be entirely noncontroversial or always well
received. There will be resistance from current master’s- prepared nurse practitioners,
nurse-midwives, nurse anesthetists, and clinical nurse specialists who will claim your
practice is not different (or better?) than theirs. If their argument prevails, then a given
institution, perhaps, may not compensate the doctoral graduate more highly. Thus, in
supporting doctoral advanced nursing practice, we are unyielding in our plea that the
necessary outcome data must be conducted and disseminated. Nevertheless, there is a
bountiful amount of optimism in the profession about your future and this new degree,
and as one recent graduate has recently written:
Since attaining my doctorate, I find myself better equipped to build upon my
master’s level training. I’m no longer satisfied with doing the “how to,” but
indeed now relish and crave the “why?” and the “why not?” As a doctoral
advanced practice nurse, I am different! (Dreher and Montgomery, 2009,
p. 530)We anticipate that in your new role you will also be different.
■ EMERGENCE OF PROFESSIONAL ROLES IN NURSING: RISING
FROM THE TOIL OF PUBLIC HEALTH NURSES
It is with some incredulity that public health nurses are not more duly recognized for
their role in the evolution of our discipline. Furthermore, while Nightingale’s preemi-
nence still reigns over nursing, her vision for nursing was enacted very differently in the
United States. In many ways, the rise of modern nursing has been accomplished despite
tension from two equally dogmatic nursing subcultures— the conservative traditionalists
and the elite professionalizers (Melosh, 1982; Reverby, 1987). And as quarrelsome as these
two camps have been, progress has indeed been made, and nursing is probably more
advanced here than in any other place on the globe.
THE IMPACT OF NIGHTINGALE
The Nightingale Infl uence
Florence Nightingale wrote about patients and nursing, beginning a revolution of the
roles of nurses, represented up to that point by religious sisters or inmates living in the
almshouses where they served. Her ideas on nursing included a reformed vision of em-
ployment for women, a profession removing the societal attachment to the idea of wom-
anly work and feminine intuition, and replacing the characterization of a nurse with an
educated, highly moral, and stable woman to run the wards. Her nurses required both
theoretical and practical training. In Deloughery’s (1977) book on the nursing profes-
sion, Nightingale changed nursing to “a career and not a last resort” (p. 61) for women