Running head: A Self Reflection on the Evolution & Historical Impact of the DNP 1

“A Self Reflection on the Evolution & Historical Impact of the DNP”

LaShelle Melton

Jacksonville State University

NU 707

Instructor: Laura Pruitt Walker, DHEd, MSN, RN, CNE, COI

September 3, 2020
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Why do you want to be a DNP and what do you hope to accomplish through the DNP role

The writer of this paper wants to be a Doctor of Nursing Practice (DNP) to set an

example for her children, to keep a promise she made to her late spouse before his passing, and

last but certainly not least to expound upon previously acquired knowledge from her master's

program. What she hopes to accomplish through the DNP role would be to evolve into an even

better leader who is guided by evidence-based research and practice to compassionate healthcare

back into nursing. She also would love to give back to her community which is a military-based

community service to help veterans reach a better quality of life after their service. She wants to

be the DNP that people ask, "What school did you attend? Because they are producing some

great providers." Evaluating leadership competency growth in Doctor of Nursing Practice (DNP)

students in both academic and organizational settings has been challenging. The purpose of

developing a method of evaluating DNP student leadership focused on a strategy to assess DNP

student growth in the areas of leadership and change. Competencies of leadership that were

evidenced-based and effective in healthcare environments were used as a basis for the leadership

narrative. Descriptive and experiential leadership narrative is an effective method of evaluating

the strategy of fostering DNP student leadership development in the direct patient and system-

focused settings. The leadership narrative is generalizable and transferable in areas where growth

in leadership and competency development is valued. Easily incorporated into the DNP

practicum structure, the leadership narrative is an effective method for both formative and

summative evaluation of DNP student leadership development. It is also consistent with the

accrediting body for DNP education, the leadership narrative can be used to demonstrate

program effectiveness (Nordick, 2019).

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The article entitled, "The DNP degree: are we producing the graduates we intended?"

addresses how recent graduate doctor of nursing practice (DNP) nurses describe their practice,

how their supervisors describe their practice, and whether both parties descriptions of the

practices reflect the American Association of Colleges of Nursing (AACN) DNP Essentials.

Introduced in 2004, the goal of DNP programs was to educate advanced practice RNs for

effective leadership in complex healthcare environments. The value of the DNP degree for

nurses in healthcare systems is evolving. This article speaks about how conventional content

analysis was used to inductively describe how DNP graduates from different schools and their

supervisors described the practice of the recently graduated DNPs. Interviews were reviewed to

assess whether the AACN DNP Essentials were enacted in practice. The overarching theme was

"becoming more: re-envisioning self as an agent of change." Results support the claim that DNP

education prepares advanced practice nurses for leadership across complex healthcare systems.

Evidence of the DNP Essentials is realized when graduates perceive themselves as equal to other

leaders and capable of driving change using evidence and effective collaboration (Bowie,

DeSocio & Swanson, 2019).

What will your contribution be to nursing science through the DNP role

What the writer of this paper envisions her contribution to nursing science to be at this

time would be about service and compassion. She has many ideas of who she would like to be as

a DNP prepared nurse, however she will pray for leadership and guidance on what the will is for

her life. She believes what comes from the heart reaches the heart therefore whatever the role is

she will whole heartily give her best. At the current time, she would like to be of service to the

adolescent and veteran population and start a mentorship program. She is also an educator so she

would also like to continue to grow in that role. The role of the Doctor of Nursing Practice-
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prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely

explored. In her research concerning roles of the DNP, she found an article that surveyed

existing DNP programs to identify the nonacademic settings in which their DNP graduates were

employed and conducted interviews with employers to identify the role and value of the DNP-

prepared nurse in nonacademic settings. Data were collected from January 2016 to August 2016

in an online survey of the DNP programs and qualitative telephone interviews with employers.

An online survey of program directors was conducted from 288 DNP programs across the

United States to capture descriptive information about programs, the types of non-academic

institutions that hire graduates, the percentage of graduates employed by each setting, and

contact information for employers. Questions were asked to employers in different care settings

about the role of the DNP in these settings and how the DNP compares to other nurse leaders and

advanced practice nurses (APRN). Employers were also asked to describe the role of the DNP-

prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators,

and managers. Approximately 130 DNP program directors responded to the online survey and

twenty-three employers participated in telephone interviews. The analysis resulted in four main

themes regarding the role of the DNP nurse in non-academic settings: "DNP-Prepared Nurse

Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and

Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With

Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees. The role of

the DNP-prepared nurse in nonacademic settings is still unclear. These DNP-prepared nurses

typically function as APRNs in clinical care or as health care system leaders. While there is a

low number of DNPs in clinical practice settings, the number is expected to grow as more

graduate and enter practice. Knowledge of the roles, values, and outcomes of the DNP-prepared
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nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting

(Beeber, Palmer, Waldrop, Lynn & Jones, 2019).

Please explain which nursing philosophy or theory you most identify with and upon which you

base your healthcare practice

The nursing philosophy that the writer of the paper identifies with is Continental

Philosophy which is grounded in the viewpoint that the phenomena of interest are deeply

embedded in the human experience (Butts, 2013). In her experience, she believes this has been

lost in a lot of practice unintentionally. The reason she chose this is for the healthcare she says

given to her grandmother as a child that hinders her grandmother from seeking out much-needed

healthcare because of the treatment she received. Which was a burden on the family because it

was usually an emergency and the ambulance had to be called before she would get the

healthcare that could have been controlled if handled on a routine base. Her grandmother did not

trust her healthcare providers and did not think they cared. Which resulted in her death. As an

adult, she was married to a husband who was overweight, had congestive heart failure and

thrombocytopenia. Her husband had the same mindset as her grandmother which brought back a

lot of bad memories. Her husband verbalized to her many times, "these clinics only want your

money, they don't care about you, they won't even look you in the face, they talk over your head

and I'm not a doctor I don't know what they talking about, they don't listen and the have you in

the waiting room three hours or more to speak to you two minutes". She became a nurse and

made the decision she would be different, one incentive she had was in postpartum and the new

mother reacted her epidural and was paralyzed for 72 hours. This was her first child and she was

a new young mother. The nurse care for all her patients and she would always make this patient

her last one and she would go get the baby and lay the baby against the new mother's chest while
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the nurse feeds the child. The patient cried every time. Upon discharge the patient told the nurse

I don't know why you choose me to care about but I thank you for going above and beyond you

will never know what it means to my baby and I. Her response was, "I only did what I would

have wanted you to do for me if I was laying there and you were my nurse." And that is a prime

example of how she would like to always guide her practice if the roles were reversed how she

would want to be treated as a patient and also as a student.

Although compassion should be integral to nursing, the ongoing reality of this traditional

philosophy has been challenged due to patient reports of care experiences that lack compassion.

Professional guidance reaffirms compassion as an enduring philosophy of contemporary nursing

practice but provides limited insight into what compassion involves. To address the knowledge

gap, a constructivist grounded theory study was undertaken with participants who had

experienced nursing care as patients and exploring what they perceive compassion to involve.

Findings highlighted the importance of cultivating compassion, which involved learning about

compassion, role modeling for compassion, leadership for compassion, resources for

compassion, and systems and processes for compassion. The findings contribute to the ongoing

professional dialogue surrounding compassion, specifically concerning recruitment and

selection, nurse education curricula, compassionate organizational cultures, staffing levels, and

the systems and processes that underpin contemporary ways of working (Straughair, 2019).

Western philosophy in the late twentieth century is, first and foremost, a tale of the

discipline's division into two distinct discourses analytic and Continental philosophy. This article

speaks on the institutional dynamics of American higher education played a decisive role in the

creation of this divide. Through quantitative analysis of the hiring and promotion of

philosophers, it demonstrates how hierarchies and informal academic networks established

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boundaries for mainstream American philosophy that excluded modern European thought. In this

environment, the invidious distinction between the "elite" analytic departments and heterodox

departments at the discipline's periphery was mapped onto the styles of philosophy practiced at

those schools and shaped America's reception of "Continental" European philosophy (Strassfeld,

2020).

What is the difference between the educational requirements for earning a DNP and other

doctoral programs such as the Ph.D., DHEd, DNS, EdD

This was harder than the writer thought it would be answering this question because

programs don't give a lot of information about the different programs unless you are signing up

for their school. One of the major differences between the DNP and Ph.D. in nursing is that the

Ph.D. is more research-oriented while the DNP is geared toward hands-on clinical practice. A

Ph.D. qualifies nurses to participate in research studies and publish scholarly work. The EdD is

designed for those desiring to be experts and lead change in nursing education as they seek

preparation for faculty and/or educator roles. The role is to lead a change in nursing education.

At Teachers College, the EdD in Nursing Education has also included an emphasis on research

and scholarly inquiry. The Doctor of Education in Health Professions (EdD) program at A.T.

Still University (ATSU) focuses specifically on developing health professions educators. Unique

in its class, this online program involves practical experience-based teaching rather than

research-based teaching. DNS- Doctoral programs in nursing fall into two categories: practice-

and research-based. The practice-focused track grants the Doctor of Nursing Practice, while the

research-focused program offers the Doctor of Philosophy Degree (Ph.D.) or the Doctor of

Nursing Science degree (DNS). One is not better than the other. Both are terminal degrees that

assume complementary approaches to the highest level of nursing education. Both are
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demanding and rigorous. However, understanding the key differences between the goals and

competencies of each program will guide you along the nursing career path meant for you.

The DNP differs from the traditional Ph.D. in focus and content. The DNP degree is a

practice focused whereas the Ph.D. is research-focused. The DNP is based on the AACN

essentials of the DNP degree. The EdD is designed to prepare nurses to teach at a college level.

The DNS is focused on the development of nursing theory for a practice discipline (Butts, 2013).

The choice in programs depends on the student and their goals, there is a friend who has their

Ph.D. who said she choose to go this route because her focus was education and administration.

She wanted to grow in administration however remains in the same academic setting so she

chooses a Ph.D. versus a clinical advanced practice DNP program. The DNP focuses more on

advanced clinical practice along with research and relies heavily on evidence-based practice.

DNP is required to complete a project on EBP were the Ph.D. is not. There is also background

information provided on the newly constructed PhD-DNP dual doctoral degree, specifically

historical perspectives and existing programs; describe one PhD-DNP program as an exemplar to

illustrate program data challenges and solutions, and discuss the national landscape of the dual

doctoral degree program. PhD-DNP dual doctoral degree programs have existed for 10 years;

there are five known programs nationally. These data include demographic program

characteristics, time to degree, and achievements during and after the program. Challenges about

mentorship, progression to a degree, socialization, and student productivity also are described.

Strategies for moving the dual degree forward nationally depend on a collaborative effort for

data generation and collection from existing PhD-DNP programs. These data can be instrumental

in seeking funding for dual doctoral degree programs. The dual PhD-DNP degree has not yet

gained a foothold nationally. National nursing leaders and organizations can consider developing
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metrics and collecting data that will lend support to future funding initiatives for the dual degree

(Loescher, Love & Badger, 2020).

Why is it important for you to complete the DNP

The writer of this paper needs to complete this program first in foremost for the

accomplishment of a personal goal setting. Then she would like to start a youth program and for

me, the youth must be serviced to understand that they have a living example that you can get

through life's obstacles and still be a productive citizen. The writer has overcome childhood

abuse, neglect, rejection, teen pregnancy, high school dropout, etc. She picked herself up by her

bootstraps and no longer felt sorry or depressed for what she had to go through. She found the

motivation to triumph over tragedy. She started by obtaining her GED and then certification as a

nursing assistant, she worked her way up to DNP and celebrated every win along the way. She

overcame the opinions of others who said she would not and could not. And she not only did it

for her and her family but also to be a living example for the youth in her program. I remember

growing up seeing people come to talk to us at school and she would say they don't have a clue

what I deal with daily. Then I was 18 and involved in a bad MVA where my sister was killed.

Everybody who approached me gave me all the cliché,

"God doesn't make mistakes, Time heals all wounds, you've got to get back to normal;"

just to name a few. But it was until an older gentleman at my church shared with me his story of

pain and his daughter burning. And how he got to a better place one day at a time, he understood

my hurt and it opened my eyes. That is why the completion of this program is important to me. I

need the youth in my community to know I understand and know what they are going through

and it is also important that I show them how to get to a better place.
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Reference

Nordick, C. L. (2019). Evaluating Leadership Competency in DNP Clinical Practice. Journal of

Doctoral Nursing Practice, 12(1), 111-116.

Bowie, B. H., DeSocio, J., & Swanson, K. M. (2019). The DNP degree: are we producing the

graduates we intended? JONA: The Journal of Nursing Administration, 49(5), 280-285.

Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of the

doctor of nursing practice-prepared nurses in practice settings. Nursing Outlook, 67(4),

354-364.

Butts, J. B. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett

Publishers.

Straughair, C. (2019). Cultivating compassion in nursing: A grounded theory study to explore the

perceptions of individuals who have experienced nursing care as patients. Nurse

education in practice, 35, 98-103.

Strassfeld, J. (2020). American divide: the making of "continental" philosophy. Modern

Intellectual History, 17(3), 833-866.

Loescher, L. J., Love, R., & Badger, T. (2020). Breaking new ground? The dual (PhD-DNP)

doctoral degree in Nursing. Journal of Professional Nursing.