DNP/700 Week 1: Doctoral Expectations and the Roles of Scholar, Practitioner and Leader, sample paper

A Nurse Practitioner Who Already Knows How to Treat Diabetes: What the Practice Doctorate Adds, How It Differs From the PhD and How I Will Grow Into the Scholar, Practitioner and Leader Roles

[Student Name]

University of Phoenix

DNP/700: DNP Expectations Seminar

Week 1 Assignment

[Instructor Name]

[Date]

The author is a composite doctoral student written for a model paper.

For nine years I have practiced as an FNP at a small clinic in northern Arizona, where most of my patients have diabetes, hypertension or both. I know how to adjust insulin, read an A1c trend and talk a farmer into checking his feet. What I do not know how to do is change why half of our patients with diabetes miss their annual eye examination, or how to show our board that a change I make actually worked. Those gaps are why I entered the Doctor of Nursing Practice program. This paper describes what I understand about doctoral expectations, how the DNP differs from the PhD and how I plan to grow into the roles of scholar, practitioner and leader.

Why a Practice Doctorate

The Institute of Medicine (2011) called for nurses to work at the full scope their preparation allows, pursue further degrees through smoother academic pathways, share leadership of health care redesign with physicians and others and be counted with better workforce data. It called for doubling the number of nurses with doctorates by 2020. The practice doctorate responds to the need for nurses who can lead change in the systems where care is delivered, not only deliver care within them.

DNP and PhD

Melnyk (2013) describes continuing confusion, nearly ten years after the national deans' association backed the DNP as the entry degree for advanced practice, about how DNP and PhD curricula should differ and what roles each graduate should fill. She argues that both are essential to improving health care: PhD-prepared nurses generate new knowledge through rigorous research, while DNP-prepared nurses translate evidence into practice, lead quality improvement and evaluate outcomes in real settings. She calls for the two to work together, with the DNP graduate as the bridge between research and practice.

What That Means for Me

I will not design a randomized trial of a new diabetes intervention. I will find the best existing evidence on improving diabetic eye examination rates, adapt it to my clinic, implement it and measure the results. That is a different and equally demanding kind of scholarship.

I came into this program as an expert in treating one patient at a time; the degree asks me to become an expert in changing what happens to all of them.

The DNP Project Is Still Being Defined

Dols et al. (2017) surveyed 90 DNP program directors and found that 87% of faculty were somewhat or very dissatisfied with the DNP project, citing lack of faculty knowledge of evidence-based practice and quality improvement, lack of consensus about the project, limited resources, challenges with clinical sites and students' scholarly writing skills. This tells me that I cannot assume what my project should look like; I need to understand my program's expectations early, work closely with faculty and prepare my writing and site partnerships deliberately.

The Scholar Role

As a scholar, I must search, appraise and synthesize evidence, write with doctoral precision and contribute what I learn to others. My strength is clinical reading: I follow guidelines and read journals. My gap is systematic appraisal. I have never graded a body of evidence or written a formal synthesis. I also have not published. Within twelve months, I plan to complete a structured appraisal of the evidence on diabetic eye screening and submit a short article to a state nurse practitioner newsletter.

The Practitioner Role

As a practitioner at the doctoral level, I am expected to deliver care based on the best evidence and to design care processes, not only follow them. I already practice with skill, but my care is shaped by my own habits and the clinic's routines. I want to move from asking what I should do for this patient to asking what the clinic should do for every patient like this one. Using our electronic health record to see patterns across my panel is a first step; I have requested a report of eye examination completion by patient.

The Leader Role

Leadership at the doctoral level means leading change in organizations and influencing policy. I lead informally: staff ask my opinion, and I precept students. I have not led a formal change project or presented data to our clinic board. I plan to ask our medical director to include me in the next quality committee meeting and to volunteer to present one quality measure each quarter.

Where My Clinical Expertise Helps

Clinical credibility matters when leading change. Staff and physicians in my clinic trust my judgment because they have seen my patient outcomes. That trust is an asset I can use as a leader, as long as I pair it with data rather than relying on reputation alone.

Integration of the Roles

The three roles are not separate jobs. A change in how our clinic handles diabetic eye screening would require me to find and appraise evidence as a scholar, redesign the care process as a practitioner and persuade colleagues, the board and perhaps a local optometrist as a leader. The DNP project will require all three at once.

Expectations I Must Meet

Doctoral study expects independence, disciplined reading and writing, openness to critique and persistence. It also expects me to apply faculty feedback and to revise repeatedly. I am used to being the expert in my clinic; here I will often be the learner. I expect that adjustment to be uncomfortable and necessary.

A Practice Problem Already in View

Our clinic's diabetic eye examination rate, which I estimate at about half of eligible patients, is the kind of problem the practice doctorate is built to address. It has a measurable outcome, a known evidence base and a local cause I can investigate. It also requires collaboration with an outside partner, since we have no eye specialist on site.

Working While Studying

I will continue to work full time. I have reduced my clinic schedule by one half-day a week, blocked two evenings and Saturday mornings for coursework and asked my family for their support. I have also told my medical director about my program, since my project will likely take place in our clinic.

Early Questions for My Faculty

Before the end of this course, I will ask my faculty how my program defines a DNP project, what counts as an acceptable outcome measure and how clinical site agreements are arranged. These questions reflect the uncertainty Dols et al. (2017) describe and should help me start my project planning with realistic expectations.

Conclusion

The practice doctorate equips nurses to move evidence into care and to lead improvement inside health systems, a role distinct from the PhD's generation of new knowledge (Melnyk, 2013). Because the DNP project is still defined differently across programs, I need to learn my program's expectations early. I bring clinical expertise and informal leadership; I must build skills in evidence appraisal, systems thinking, formal leadership and scholarly writing. My plan for each role is specific, and each points toward a practice problem I already see in my clinic.

References

Dols, J. D., Hernández, C., & Miles, H. (2017). The DNP project: Quandaries for nursing scholars. Nursing Outlook, 65(1), 84-93. https://doi.org/10.1016/j.outlook.2016.07.009

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press. https://doi.org/10.17226/12956

Melnyk, B. M. (2013). Distinguishing the preparation and roles of doctor of philosophy and doctor of nursing practice graduates: National implications for academic curricula and health care systems. Journal of Nursing Education, 52(8), 442-448. https://doi.org/10.3928/01484834-20130719-01