18: DNP-PREPARED NURSE’S ROLE ■ 423nurses. At the federal level, from the Tri- Council and many of the large specialty groups,
there is support for nurse traineeships (Title VIII) and the education of APNs; deans, indi-
vidually and through the AACN, join the research community to lobby for additional funds
for research and evidence- based practice. In the states, issues revolve around licensing
reform and efforts to assure a full scope of practice for nurse practitioners and other APNs.
At the state level, nurses and their organizations engage in power battles with organized
medicine and hospital and nursing home associations over access to care, cost, and quality.
Abood (2007) makes an important contribution when she observes that bedside
nurses know that cost containment and lack of coordination can affect their patients’
quality of care. She also insists that if nurses are to address access, cost, and quality of
care in meaningful ways, they must move out of their comfort zones. Although Abood
is examining policy or practice change at the micro level, she affirms that if nurses are
to bring about changes in policy, they need the access to power, the will to carry their
activities forward, the time, and the energy. Her observations about the level of commit-
ment that policy change requires can be generalized to state and federal policy work.
■ SUMMARY
As has been stated frequently in this chapter, AACN’s Essential V challenges DNP grad-
uates to become engaged in health policy. Their engagement in the world of health
policy at federal and state levels will not create a common voice for nursing in policy
arenas or breakdown the silos that limit interdisciplinary collaboration. However, their
direct engagement in the policy process will bring first- hand observations of patient
care experiences to policy tables. It is well recognized that unidentified problems cannot
be solved. Because APNs work in institutions, primary practices, urgent clinics, and in
communities, they can inform systems thinking, decision making, and innovative, evi-
denced- based practice. In discussing what leadership means for DNP- educated APNs,
Walker and Polancich (2015) posit that contemporary practice requires the application
of specialized knowledge, clinical expertise, and the capacity to discern appropriate
interventions and policy changes that will improve care. Leadership requires a mix of
cognitive, clinical, and interpersonal skills.
Years ago, Hildegarde Peplau said that nurses can win the battle for quality of
care at the bedside but lose it at the policy table. Essential V challenges DNP graduates
to advocate for quality of care, not only at unit and service centers in institutions, but
also in board rooms, in the literature, and in public forums. APNs must speak in the
places where decisions that affect practice and patient care are made.
■ CRITICAL THINKING QUESTIONS
- Discuss the engagement of DNP-prepared APNs in creating health policy changes?
- Be specific about steps that DNP-prepared APNs can take to actualize AACN’s (2006)
Essential V. How can these nurses influence policy change at federal and/or state levels? - How can DNP-prepared APNs provide leadership in improving the quality of community-
based care? - Describe the differences between MSN and DNP-prepared nurses’ engagement in health policy.
- How can a DNP-prepared APN impact the health care policy challenges known as the iron-
triangle: access, cost, and quality? - Describe how a DNP-prepared APN can reduce health care disparities at the population
level?