22: REFLECTIVE RESPONSE 2 ■ 503practice (Hlabse, Dowling, Lindell, Underwood, & Barsman, 2016) and identified a
wider range of opportunities to change practice at the system level, rather than on
an individual client basis (Brown & Kaplan, 2016). With an intrinsic drive towards
leadership, vision, and knowledge, along with an persistent extrinsic need for health
care reformation, the APRN- DNP seeks to effect change where clinical practice occurs
through the translation of research into evidence- based practices, enhanced clinical
knowledge, and evaluation of quality outcomes. This approach to improving care and
quality at the point of practice shares a central premise with positive deviance, a pow-
erful strategy that postulates problems within a community are best solved within that
community (Bradley et al., 2009). Positive deviators, such as the those in the emerg-
ing APRN- DNP role, are innovators whose perspectives and behaviors allow them to
obtain better results than others using the same resources within the system (Jaramillo
et al., 2008) The positive deviance approach, which has improved complex health prob-
lems in various public health settings, identifies positive deviants with best practices
and through qualitative study, generates and tests hypotheses to disseminate their
quality strategies (Bradley et al., 2009). This approach supports the necessary collabo-
ration between the researcher (PhD) and the practitioner (APRN- DNP) to bridge the
research– practice gaps that affects quality in health care (Buchholz, Yingling, Jones, &
Tenfelde, 2015). The APRN- DNP’s focus is as an expert in clinical practice, evidence-
based practice, quality improvement, translational research, and in the evaluation of
the outcomes of these applications in clinical settings (Vincent, Johnson, Velasquez, &
Rigney, 2010). Thus, using a positive deviance approach, APRN- DNPs are establish-
ing their roles as vital to link research, practice, and quality outcomes at the point of
care, ultimately impacting overall health system quality.
So, as we continue to actualize the DNP role, consider Dr. Bloch’s cautionary
message “that we must not jeopardize flexibility and creativity of professional nurs-
ing roles,” particularly during this time of unprecedented health care system changes.
As APRNs, it is our vision, our journey, and our responsibility to shape the future of
nursing.
■ REFERENCES
American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in
nursing. Retrieved from http://www.aacn.niche.edu./DNP/pdf/DNP.pdf
American Association of Colleges of Nursing. (2015). The doctor of nursing practice (DNP) fact sheet.
Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/dnp
Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M.
(2009). Research in action: Using positive deviance to improve quality of healthcare.
Implementation Science, 4 (25). Retrieved from http://implementationscience.biomedcentral.com/
articles/10.1186/1748-5908-4-25
Brar, K., Boschma, G., & MeCuaig, F. (2010). The development of the nurse practitioner preparation
beyond the master’s level: What is the debate about? International Journal of Nursing Education
Scholarship, 7 (1), 1–15.
Brown, M. A., & Kaplan, L. (2016). Opening doors: The practice degree that changes practice. The Nurse
Practitioner, 41 (4), 35–42.
Buchholz, S. W., Yingling, C., Jones, K., & Tenfelde, S. (2015). DNP and PhD collaboration: Bringing to-
gether practice and research expertise as predegree and postdegree scholars. Nurse Educator, 40 (4),
203–206.
Graff, J. C., Russell, C. K., & Stegbauer, C. C. (2007). Formative and summative evaluation of a practice
doctorate program. Nurse Educator, 32 (4), 173–177.